Common Rule Violations

1
Common Rule Violations

• Personal Care Home Program Training

2
Agenda

• Common Violations
• Potential Solutions
• Questions
• Update

3
Common Rule Violations 2001

• For ALL PCHs
• .06(4) Administration
• .14(2) Personnel
• .17(2) Resident Files
• .06(1) Administration
• .14(6) Personnel

• .16(1) Admission Agreement
• .10(13) Physical Plant Health Safety Standards
• .15(3) Admission
• .14(10) Personnel
• .14(8) Personnel

4
Common Rule Violations 2002

• For ALL PCHs
• .17(2) Resident Files
• .14(2) Personnel
• .14(6) Personnel
• .06(4) Administration
• .16(1) Admission Agreement

• .15(3) Admission
• .14(8) Personnel
• .10(13) Physical Plant Health Safety Standards
• .14(4) Personnel
• .20(8) Nutrition

5
Common Rule Violations 2003

• For All Facilities
• .17(2) Resident Files
• .14(2) Personnel
• .14(6) Personnel
• .15(3) Admission
• .16(1) Admission Agreement

• .06(4) Administration
• .14(8) Personnel
• .10(13) Physical Plant Health and Safety
  Standards
• .10(1) Physical Plant Health and Safety Standards
• .14(4) Personnel

6
Common Rule Violations 2004

• .10(13) Physical Plant Health Safety Standards
• .12(1) Services
• .16(1) Admission Agreement
• .06(4) Administration
• .14(10) Personnel

• For All Facilities
• .17(2) Resident Files
• .14(6) Personnel
• .14(2) Personnel
• .15(3) Admission
• .14(8) Personnel

7
Common Rule Violations 2005

• For ALL PCHs
• .17(2) Resident Files
• .14(2) Personnel
• .14(6) Personnel
• .15(3) Admission
• .10(13) Physical Plant Health Safety Standards

• .14(8) Personnel
• .06(4) Administration
• .16(1) Admission Agreement
• .12(1) Services
• .10(1) Physical Plant Health Safety Standards

8
Common Rule Violations 2006

• For ALL PCHs
• .14(6) Personnel
• .14(2) Personnel
• .17(2) Resident Files
• .15(3) Admission
• .14(8) Personnel

• .10(13) Physical Plant Health Safety
• .14(10) Personnel
• .16(1) Admission Agreement
• .06(4) Administration
• .10(2) Physical Plant Health Safety Standards

9
Common Rule Violations 2007

• For ALL PCHs
• .14(6) Personnel
• .17(2) Resident Files
• .15(3) Admission
• .14(2) Personnel
• .10(13) Physical Plant Health Safety

• .14(8) Personnel
• .12(1) Services
• .10(1) Physical Plant Health Safety Standards
• .15(2) Admission
• .06(4) Administration

10
1. Personnel .14(6)

• . 14(6) all staff must have
• A physical exam by a licensed MD and
• TB screening
• Within 12 months prior to employment
• Follow-up exams after significant illness or
  injury re readiness to return to work

11
Personnel Solution

• Have good system or procedures to follow in
  hiring staff
• Be sure administrator/on-site manager knows
  system
• Ensure PE is signed by Georgia licensed physician
• Use checklist
• Review files periodically

12
.14(6) History

• 2001
• 605
• 2002
• 515
• 2003
• 413
• 2004
• 407
• 2005
• 434
• 2006
• 374
• 2007
• 388

13
2. Resident Files .17(2)

• .17(2) Resident files must include a variety of
  information
• Identifying info, next of kin, guardian, etc.
• Admission / Discharge
• Medical info, health appraisals, meds, MD
  instructions
• Personal items inventory, resident rights
• Admission agreement, insulin certification, etc.

14
Resident Files continued

• No data available on citation frequency of
  specific requirements
• With rule revisions, will have frequency of
  specific requirements

15
Resident Files Solution

• Know regulations / requirements for resident
  files
• Use ORS checklist or develop own to ensure
  compliance
• Review files periodically
• Include in admissions policies and procedures a
  system to obtain required information

16
.17(2) History

• 2001
• 794
• 2002
• 707
• 2003
• 561
• 2004
• 411
• 2005
• 451
• 2006
• 332
• 2007
• 313

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3. Admission .15(3)

• .15(3) Administrator must interview potential
  resident to ensure home can meet residents needs
• PCH must obtain a physical exam within 30 days
  prior to admission

18
Admission 2

• PCH must obtain TB screening within 12 months
  prior to admission
• Physical exam requires specific information

19
Admission Solution

• Ensure facility has excellent policies and
  procedures regarding admission
• Ensure policy addresses interview with resident,
  physical exam, TB screening, etc.
• Advise families/residents of requirements prior
  to admission

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Admission Solution 2

• Ensure staff knows requirements
• Do NOT admit until information is obtained

21
.15(3) History

• 2001
• 489
• 2002
• 369
• 2003
• 344
• 2004
• 260
• 2005
• 295
• 2006
• 323
• 2007
• 284

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4. Personnel .14(2)

• .14(2) All staff must have required training
  within 60 days of employment
• CPR
• First Aid
• Emergency Evacuation Procedures
• Resident Population
• Resident Rights
• Long-term Care Resident Abuse Reporting Act

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Personnel Solution

• Have good policies and procedures that describe
  how training, including current certification,
  will be achieved
• Have good documentation system
• Train administrator/on-site manager on system
• Be creative with training
• Check competencies

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.14(2) History

• 2001
• 798
• 2002
• 601
• 2003
• 523
• 2004
• 378
• 2005
• 448
• 2006
• 347
• 2007
• 277

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5. Physical Plant .10(13)

• .10(13) The PCH should have sufficient hot water
  for residents use
• AND hot water should not exceed 110 degrees F.

26
Physical Plant Solution

• Know hot water temperature at point of use by
  residents
• Invest in a thermometer
• Know residents needs for assistance with bathing
• Provide assistance needed
• Install safety devices as needed

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Physical Plant - Solution

• Waiver request prior to 2/08
• Rule change effective 2/08

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.10(13) History

• 2001
• 563
• 2002
• 331
• 2003
• 242
• 2004
• 209
• 2005
• 283
• 2006
• 199
• 2007
• 212

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6. Personnel .14(8)

• .14(8) All staff must obtain a satisfactory
  criminal records check determination
• 2002 CRC changes
• Obtain CRC through local law enforcement
• Must be GCIC check

30
Personnel Solution

• Facility must have procedure regarding how they
  will obtain the CRC
• CRCs can now be obtained from local law
  enforcement
• Ensure adequate documentation of the local law
  enforcement agency

31
Personnel Solution 2

• Facility must have good filing system to ensure
  that information is available and is kept
  confidential
• Conduct periodic review of staff files
• NOTE New CRC changes per 2/08 rule revisions

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.14(8) History

• 2001
• 378
• 2002
• 354
• 2003
• 294
• 2004
• 215
• 2005
• 257
• 2006
• 212
• 2007
• 196

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7. Services .12(1)

• PCH must provide
• Room, meals and personal services commensurate
  with resident needs
• 24-hour responsibility
• Protective care and watchful oversight
• Assistance with ADLs and supervision of residents
  medications

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Services 2

• Services must be provided by appropriately
  qualified staff

35
Services Solution

• Know needs of residents
• Have good policies and procedures on how PCH will
  handle
• Medications, admissions, changes in condition,
  etc.
• Follow-up with MD and other health care visits

36
Services Solution 2

• Know how to relate to outside services
• Document, document, document

37
.12(1) History

• 2001
• 236
• 2002
• 207
• 2003
• 134
• 2004
• 199
• 2005
• 212
• 2006
• 149
• 2007
• 190

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8. Physical Plant 10(1)

• Each home must be in compliance with applicable
  fire safety rules
• Includes bi-monthly fire drills with two fire
  drills conducted at night
• Maintain documentation of fire drills

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.10(1) Solution

• Must have procedures regarding fire drills
• Train all staff
• Conduct bimonthly with two when residents are
  sleeping
• Have good documentation system

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.10(1) History

• 2001
• 116
• 2002
• 169
• 2003
• 205
• 2004
• 117
• 2005
• 176
• 2006
• 149
• 2007
• 158

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9. Admission .15(2)

• Home shall not admit or retain a resident who
  requires more than the facility is permitted to
  provide
• Residents requiring continuous medical or nursing
  services shall not be retained

42
Admission Solution

• Know limitations of rule
• Know limitations of facility physical plant,
  staff, staff qualifications
• Establish admission/retention criteria within the
  rule parameters

43
Admission Solution 2

• Have system to identify individuals who require
  more care
• Marketing? Are residents led to believe they can
  always stay?
• Communication with family?
• Issue 30 day notice unless discharge meets
  emergency criteria

44
.15(2) History

• 2001
• 110
• 2002
• 85
• 2003
• 79
• 2004
• 47
• 2005
• 2006
• 68
• 2007
• 143

45
10. Administration .06(4)

• Each facility must have a written Disaster
  Preparedness Plan (DPP)
• DPP must be regularly rehearsed
• Evacuation drill plans must be rehearsed at least
  semi-annually
• Maintain documentation

46
Administration Solution

• Follow simple/same format
• Include each potential disaster
• Do NOT repeat the rules
• BP advise local emergency management agency
• Maintain documentation
• BP ensure all staff is able to conduct each
  drill
• New rule requirements

47
.06(4) History

• 2001
• 855
• 2002
• 447
• 2003
• 294
• 2004
• 163
• 2005
• 238
• 2006
• 181
• 2007
• 135

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Summary

• 1. Personnel
• 2. Resident Files
• 3. Admission
• 4. Personnel
• 5. Physical Plant Health and Safety Standards

• 6. Personnel
• 7. Services
• 8. Physical Plant Health and Safety Standards l
• 9. Admission
• 10. Administration

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Update

• Adult Day Care Rules
• Rule Changes effective 2/13/08
• Definitions added
• Personnel requirements revised
• Reporting requirements added
• PCH Rating System