5/19/2017 1 May 19, 2017 1 New Administrator Training May 19, 2017 Division of ACF / Assisted Living Surveillance Patricia Hasan May 19, 2017 3 Division of ACF/Assisted Living Surveillance Director Valarie Deetz Central Office Staff Regional Office Staff Western - Noreen Nickason Central - John VanDyke Capital District – Patricia Hasan Metropolitan Area - Bobbi Barrington, John Pinto
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5/19/2017
1
May 19, 2017 1
New AdministratorTraining
May 19, 2017
Division of ACF / Assisted Living Surveillance
Patricia Hasan
May 19, 2017 3
Division of ACF/Assisted Living Surveillance
Director Valarie Deetz
Central Office Staff
Regional Office StaffWestern - Noreen NickasonCentral - John VanDykeCapital District – Patricia HasanMetropolitan Area - Bobbi Barrington, John Pinto
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Regional Offices and Counties Served
Western Regional Office 355 E. Main StreetRochester, NY 14604(585) 423-8185Counties: Allegany, Cattaraugus, Chautauqua, Chemung, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Schuyler, Seneca, Steuben, Wayne, Wyoming, and Yates
Central Field Office 217 South Salina Street4th FloorSyracuse, NY 13202-3592 (315) 477-8472Counties: Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, and Tompkins
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Regional Offices and Counties Served
Capital District Regional Office 875 Central Avenue Albany, NY 12206(518) 408-5287Counties: Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington
Metropolitan Area Office 90 Church Street15th FloorNew York, NY 10007-2919(212) 417-4440Counties: Kings, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster, and Westchester.
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Types of Assisted Living Facilities
Adult Home Enriched Housing Program
Assisted Living ResidenceSpecial Needs Assisted Living ResidenceEnhanced Assisted Living Residence
Assisted Living Program
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Regulations
All ACFs18 NYCRR Codes Rules & Regulations Part 485 18 NYCRR Codes Rules & Regulations Part 486Adult Home18 NYCRR Codes Rules & Regulations Part 487Enriched Housing Program18 NYCRR Codes Rules & Regulations Part 488Assisted Living Residence10 NYCRR Codes Rules and Regulations Part 1000Assisted Living Program18 NYCRR Codes Rules & Regulations Part 49410 NYCRR Codes Rules and Regulations Parts 763 and 766
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Waivers and Equivalencies
Upon request by the operator, the department may waive nonstatutory requirements of this Part. An operator must request and receive written approval prior to instituting any alternative. Applications for approval must be submitted in writing to the appropriate regional office and shall include: (i) the specific regulation for which a waiver is sought; (ii) the reason the waiver is necessary; and (iii) a description of what will be done to achieve or maintain the intended outcome of the regulation and to protect the health, safety and well‐being of the residents. (2) The department may require that the operator make physical plant modifications or adopt special methods or procedures to protect resident health and safety and shall grant written approval only upon determination that the proposed waiver will not adversely affect the health, safety and well‐being of residents.
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Waivers and Equivalencies
Index of Equivalencies in Dear Administrator Letters and on DOH web
Adult Care Facility Waiver Request/Equivalency Notification Form DOH-4235
Why is it necessary and how intent of the regulation will be met
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Waivers and Equivalencies
Water Temperature
Issue: Water Temperature above 110 degrees (43 degrees Celsius).
Conditions for approved equivalency: The water temperature may be raised above 110 degrees Fahrenheit provided that the following conditions are met: 1) The maximum water temperature allowed in resident areas is 120 degrees Fahrenheit. 2) Periodic logs of all water temperature readings must be maintained and immediate action taken should temperatures exceed 120 degrees Fahrenheit . 3) All current residents must receive advance notice and newly admitted residents must receive notice that their water temperature may reach up to 120 degrees Fahrenheit with additional reminders as necessary. 4) The operator must provide assistance with bathing/showering as needed or requested, even if only precautionary due to the higher water temperatures.
Regulations: 487.11 (h) (4) (11) The water temperature at faucets for bathing, showering and handwashing must be capable of attaining a temperature of 95 degrees Fahrenheit and must not attain a temperature in excess of 110 degrees Fahrenheit. 488. 11(e) (9) The water temperature at faucets for bathing, showering, and handwashing must be capable of attaining a temperature of 95 degrees Fahrenheit but must not attain a temperature in excess of 110 degrees Fahrenheit where controllable by the operator.
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Regulation Review
Redefining Adult Care Facilities for the 21st Century
Revise regulations incorporating policy interpretations, waivers and equivalencies; streamline, clarify and reduce duplicity across various sets of regulations.
Members – Residents, Associations, Resident Advocacy Organizations, Administrators, NYS LTC Ombudsman, Independent Living Organization, the Justice Center
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Adult Care Facility (ACF)
Family-type Homes Residence for AdultsShelter for AdultsAdult Homes
Provide temporary or long term residential care and services to adults who, though not requiring continual medical or nursing care as provided by facilities licensed or operated pursuant to article 28 of Public Health Law or articles 19, 23, 29, and 31 of the Mental Hygiene Law, are by reason of physical or other limitations associated with age, physical or mental disabilities or other factors, unable or substantially unable to live independently
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Adult Home (AH)
An adult care facility established and operated for the purpose of providing long-term residential care, room, board, housekeeping, personal care and supervision to 5 or more adults unrelated to the operator
18 NYCRR Part 487
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Enriched Housing Program (EHP)
An adult care facility established and operated for the purpose of providing long-term residential care to 5 or more adults, primarily persons 65 years of age or older, in community-integrated settings resembling independent housing units. Such program shall provide or arrange for the provision of room, and provide board, housekeeping personal care and supervision18 NYCRR Part 488
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Assisted Living Residence (ALR)
Provides or arranges for housing, onsite monitoring, and personal care services and/or home care services in a home-like setting to 5 or more adult residents unrelated to the assisted living provider. An ALR must also provide food, 24 hour on-site monitoring, case management services, and the development of an individualized service plan (ISP).
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Assisted Living Residence (ALR)
A licensed ALR may also be certified as an Enhanced Assisted Living Residence (EALR), and/or Special Needs ALR (SNALR)
EALR Supports aging in placeProvides or arranges nursing care
SNALRServes a those with a special needs, such as cognitive impairment
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Enhanced Assisted Living Residence
Aging in place
Chronically chairfast and unable to transfer
Chronically require the physical assistance of another person to transferwalkclimb/descend stairs
Are dependent on medical equipment and require more than intermittent or occasional assistance from medical personnel
Chronic unmanaged urinary or bowel incontinence
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Special Needs Assisted Living Residence (SNALR)
Provision of Services
Department approved plan
Services provided by appropriately trained individuals
Consistent with Individualized Service Plans
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Special Needs Assisted Living Residence (SNALR)
Disruptive/Aggressive behaviors
Evaluation by the Operator
Determine precipitating factors
Make staff aware of precipitating factors that need to be avoided
Develop a plan to include successful interventions and to promote the highest level of resident function
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Special Needs Assisted Living Residence (SNALR)
Resistance to personal care
ISPs and Case Management documentation including a plan for addressing such services
Staff considerations
Pain
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Assisted Living Program ALP
Adult Home or Enriched House Program and Licensed home care services agency LHCSA orCertified home health agency CHHA orLong term home health care program LTHHCP
If not a CHHA or LTHHCP, must contract with one for nursing and therapy services.
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Assisted Living Program ALP
ALP Regulations Title 18 NYCRR Part 494
Supportive housing and home care to those eligible for placement in a nursing facility
Facility provides or arranges for room, board, personal care, supervision, case management and housekeeping
CHHA, LHCSA or LTHHCP provide nursing and therapy
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Assisted Living Program ALP
Services included in the Medicaid Capitated rate include:
Personal care servicesHome health aide servicesPersonal emergency response servicesNursing ServicesPhysical, Occupational and Speech therapyMedical supplies and equipmentAdult Day Health Care
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Assisted Living Program ALP
Surveillance
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Department Communication
Health Commerce System HCS
Dear Administrator Letter DAL
Statement of Deficiencies SOD, Electronic Plan of Correction
Monthly Association Meetings
BML – Bureau Mail Log (email)
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Health Commerce System
Secure internet based electronic portal used for communications and critical information sharing
DAL # 15-02 March 19, 2015Required and recommended roles
DAL 16-20 September 7, 2016HCS Contact information
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Health Commerce System
Request Accounts
HCS Director and Health Provider Network Coordinator (HPN) Accounts(518)408-1133
Criminal History Record Authorized Person Role 518(402-5549)
Following request ACF Director receives document via email to complete, sign before a notary, and send to the Department’s Commerce Account Management Unit (CAMU)
Populate require HCS Communication Directory Roles
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Health Commerce System
Content – all applications
A – Z index of applications
Choose application, application profile, and green + to add to applications displayed on your home page
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Health Commerce System
HCS Applications
CHRC Criminal History Record CheckEfinds Evacuation of Facilities in Disaster SystemePoc Electronic Plan of Correction HERDS Health Emergency Response in Data SystemUAS_NY Uniform Assessment System for New YorkSecure File Transfer
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Health Commerce System
CHRC Criminal History Record Check
What do you want to doHelp – tutorials, FAQLinks to submit/terminate an employee, schedule fingerprint, manage AP assignments, forms, contact CHRC
L‐Tron Corporation (585)383‐0050, ext 111 for replacement scanner
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Health Commerce System
Epoc Electronic Plan of Correction
DAL 15-03 April 21, 2015DAL 15-09 July 1, 2015 DAL 16-24 November 8, 2016
Administrator role may read, edit, save, submit
POC Editor role may read, edit and save POCs
Operator may read
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Health Commerce System
HERDS Health Emergency Response in Data System
Add to My Applications
Submit reports and requested information to the Department
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Health Commerce System
UAS-NY Uniform Assessment System for New York
Comprehensive assessment used in Medicaid home and community-based long term care programs, including the Assisted Living Program.
Can be used as a basis for plan of care
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Health Commerce System
Secure File Transfer
Transmit sensitive information between HCS users
File remains on the HCS for 14 days
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Health Commerce System
Dear Administrator letters
Primary method of communication from Department to ACFs
Location: Health Commerce System ‐ My Content ‐ Documents by Group ‐ Long Term Care ‐Dear Administrator Letters ‐ (select the year you wish to review) ‐ ACF
Dementia - prn Rx includes signs and symptoms, licensed staff are consulted
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Inspection/Food Service and Nutrition
Staff in charge of the kitchen
Type of service, number of dining rooms, meal and snack times
Diets offered, consistency modifications and fluid restrictions
Posting of menu and substitutions
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Inspection/Food Service and Nutrition
Physician notification of weight changes
Residents not eating well, using adaptive equipment, have swallowing impairment, are receiving room trays, bagged meals, supplements, hospice, or dialysis, physician notification of weight changes
Sanitation NYCRR Part 14
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Inspection/Environment
Name of maintenance director
Staff with HCS access
Smoking policy, designated area, unsafe smoking
Bed bugs
Special services
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Inspection/Environment
Equipment and Systems
Fire Safety – drills, extinguishers, alarm system
Disaster and Emergency Plan
CHRC review
Sanitation NYCRR Part 14
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Inspection/Program
Resident review – preadmission, persistent efforts, post discharge
Local Health Department provides infection control expertise
Staff considerations
A-Z index on HCS as well as DOH web
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Notify the Department
Disaster and emergency procedures. ...... (l) Any time there is a work stoppage, a fire within the building that affects the program, the failure of any of the fire prevention or detection systems, a lack of hot water, interruption or shut off of essential services or any circumstance necessitating the implementation of the disaster and emergency plan, the appropriate regional office of the department will be notified by the next business day.
Other events ……….
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Assessment
May 19, 2017 60
Resident Evaluation
Pre-admission/initial Every 6 months for ALPChange in condition resulting in change in service planAnnual
Ongoing documentation in resident record of resident needs and staff activity undertaken to meet those needs
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Flu and Pneumonia Immunizations
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Termination
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Policies and ProceduresPolicy:A predetermined course of action that is stated clearly and simply
Used to set direction in an organization and assist in guiding decisions
Procedure:Describes step-by-step instructions to accomplish the policy
Identifies the staff person(s) responsible to implement and monitor the procedures
Include sufficient clear detail that end users will easily understand how to comply
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Guidance When Writing a PolicyInformation should be stated in an easy to read format
Language should be clear and easily understood so that it can be retained and used
Avoid lengthy complex information
Remember your objective(s)
Keep language specific to reflect the policy’s intent so there is no misinterpretation
Reference information from a credible source
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Guidance When Writing a Policy cont.Suggested information to be included in each policy:
Agency Name
Title: Clear and concise
Policy Statement/Purpose: Include a purpose which indicates the intent or objective of the policy
Date: Policy date and revision date is clearly indicated
Page Number: Number each page, e.g. 1 of 4 pages
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Guidance When Writing a Policy cont.Information to consider when developing a policy:
Authority: Reference to the guidance which governs the policy, statute or regulation
Application: Who or what the policy applies to is clearly identified (e.g. new employees, food service staff)
Responsible Party: Identify the Title, Position or Department
Terminology: Is defined so that it is easily understood in context of the policy, e.g. authorized person or temporary employee are terms thatmust be defined in the CHRC policy.
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Guidance When Writing a ProcedureDescribe each step by step in the process and actions needed to comply with a policy (while policies guide decisions, procedures show how to complete the task or process)
A well written procedure communicates effectively and should contain the following information: An overview of the procedure Identification of any necessary skills and/or materials needed A logical sequence of steps in the order they occur (steps should be clear, concise and easy to follow) Use illustrations or examples, if appropriate, that may increase the clarify of the steps identified.