DOEA & AHCA Assisted Living Facility & Adult Family Care Home Provider Training Alberta G. Granger,...
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Transcript of DOEA & AHCA Assisted Living Facility & Adult Family Care Home Provider Training Alberta G. Granger,...
DOEA & AHCAAssisted Living Facility & Adult Family Care Home
Provider Training
Alberta G. Granger, Assisted Living Unit Manager
Field Office Management Agency for Health Care Administration
April 2005
Total ALF Beds as of 12/31/03 and 12/31/04
60663 60144
74835 74278
14172 14134
0
10000
20000
30000
40000
50000
60000
70000
80000
2003 2004
Total BedsPrivate OSS
ECCsLNSLMH
16,031 beds
19,501
333 ECC
681 LNS
760 LMH
Total Number of Specialty Assisted Living Facilities2,279 Assisted Living Facilities
Total Number of Assisted Living Facilities In Florida 12/31/04
ALFs by CAPACITYDecember 31, 2004
Capacity #Facilities Percent Total Beds
6 & under 895 39.27 5,294
7-10 187 8.21 1,619
11-25 430 18.87 6,787
26-50 270 11.85 10,268
51-75 198 8.69 12,592
76-100 109 4.78 9,923
101-150 137 6.01 16,423
151 & up 53 2.32 11,372
Total 2,279 100 74,278
ALF License Types
Standard License
Extended Congregate Care (ECC)
Limited Nursing Services (LNS)
Limited Mental Health (LMH)
468 AFCHs
2,065 Beds
Adult Family Care Homes (AFCHs)
The Survey Tasks
• Pre-Survey
• Entrance Conference
• Tour of the Facility
• Review of Policies and Procedures
• Resident Sample Selection
• Observation/Interview/
Record Review
• Medication Review and Observations
• Dining Area and Dietary Observation
• Staff Resident Ratio/Staff Interviews/Personnel Records
• Physical Environment and Related Issues
Top Ten ALF Deficiencies In FloridaJanuary 1, 2004 through December 31, 2004
0
50
100
150
200
250
300
350
400
SA0614SA1101SA1103SA0209SA0416SA1104SA0513SA0514SA0525SA0309
397 1 1 1
Personnel records must contain verification of freedom from communicable disease including tuberculosis
323 2 2 2
Freedom from tuberculosis must be documented on an annual basis
245 3 3 4
244 4 4 3All licensed facilities must have an annual fire inspection conducted by the local fire marshal/authority having jurisdiction
208 5 10 6The medical examination report shall address certain items
Facility must maintain a daily up-to-date record for residents who receive assistance with self-administration of medication
SA0614
SA1101
SA1103
SA0209
SA0416
Count 2004
Rank 2004
Rank 2003
Rank 2002Tag Description
Top Ten Assisted Living Facility Cites
197 7 N/A N/A
Direct care staff must have a minimum of 1 hour of emergency procedures/major incident training within 30 days of employment
SA0513
Direct care staff without CORE training must have 1 hour of resident rights and identification of abuse/neglect training within 30 days of employment 217 8 N/A N/A
SA0514
At least one staff person with First Aid and CPR training shall be in facility at all times
191 9 8 N/A
SA0525
190 10 6 7The resident’s record must include a copy of the contract
SA0309
All facility employees must complete a continuing education course on HIV and AIDS biennially
SA1104
203 6 7 N/A
Count 2004
Rank 2004
Rank 2003
Rank 2002Tag Description
Top Ten Assisted Living Facility Cites
110 1 2 2
Physical Plant 61 2 6 4
Untrained/Unqualified Staff 54 3 10 8
53 4 7 7Administrative
40 8 9 9
Resident Care
Medication Problems/Errors554
560
581
542
Count 2004
Rank 2004
Rank 2003
Rank 2002
Alleg Code Description
544
558
Medical Records 52 5 N/A N/A
578
549
Resident Abuse/Neglect
Dietary
44
51
7
6
1
4
1
3
557
562
Resident Rights
Lack of Supervision
37
29
9
10
3
N/A
5
NA
Top Ten ALF Confirmed Complaints
Beds in 11 ALFs Without InsuranceAs of 12/31/04
0
5
10
15
20
25
1 2 3 4 5 6 7 8 9 10 11
Total Beds 76
Private 59
OSS 17
AREA OFFICE
Top Ten AFCH Deficiencies In FloridaJanuary 1, 2004 through December 31, 2004
0
20
40
60
80
100
120
140
160
SF0401SF0203SF0606SF0610SF0404SF0213SF0704SF1200SF0303SF0204
152 1 1 1
Resident records must contain the health assessment form 65 2 5 5
AFCH personnel must have valid First Aid and CPR certification 64 3 2 2
63 4 6 8
AFCH personnel must meet Level 1 background screening requirements
55 5 4 4
AFCH personnel records must include documentation of First Aid and CPR training
AFCH personnel records must include verification of freedom from communicable disease
SF0401
SF0203
SF0606
SF0610
SF0404
Count 2004
Rank 2004
Rank 2003
Rank 2002Tag Description
Top Ten Adult Family Care Home Cites
47 7 7 10Facility must maintain a list of all prescribed medications for all residents
SF0704
Facility must have proof of satisfactory fire safety inspection 45 8 N/A 9SF1200
Facility must have proof of satisfactory county health department inspection 44 9 10 N/A
SF0303
40 10 8 6The resident’s record must include a copy of the residency agreement
SF0204
Resident records shall contain the resident’s monthly weight record
SF021350 6 3 3
Count 2004
Rank 2004
Rank 2003
Rank 2002Tag Description
Top Ten Adult Family Care Home Cites
8 1 1 3Inappropriate Residents 6 2 4 4
Administrative 2 3 3 41 4 2 4Medication Problems/Errors
1 4 N/A 6Dietary
Unlicensed Facility582548
542554
Count 2004
Rank 2004
Rank 2003
Rank 2002
Alleg Code Description
544
535
Medical Records 1 4 4 3
549545
Nursing Service
Billing/Refunds11
44
54
64
552
557
Sanitation
Resident Rights
1
1
4
4
5
3
6
5
558 Resident Abuse/Neglect 1 4
560 Physical Plant 1 4
4
3
6
4567 Staffing 1 4 4 6
577 Operating Outside Scope of License 1 4 5 N/A581 Untrained Staff 1 4 5 2551 Over Capacity 1 4 4 4
Top AFCH Confirmed Complaints
Risk Management & Adverse Incidents
• June 30, 2004 Report to the Legislature
• Assisted Living Facilities’ Adverse Incident Reports Were Incomplete
•Narratives Did Not Clearly State What Happened to the Resident
•Narratives Did Not Clearly Describe the Actions Taken to Enhance Residents’ Safety and Prevent Recurrence of Similar Incidents
Adverse Incidents
• Adverse Incident Review and Reporting are Required for Assisted Living Facilities, but Beneficial for Any Program
• ALF Statute Reference: 400.423, F.S.
• ALF Administrative Rule Reference: 58A-5.0241 F.A.C.
• ALF Policy Guidance, September 3, 2004 (Handout)
• Online Submission of Adverse Incidents (Handout)
Determining An Adverse IncidentQuestions & Answers
Did an incident occur in which a resident was injured or a specific situation existed?
AND
Is the incident in which one or more of the statutorily defined injuries/situations occurred?
AND
Is the incident an event that is associated completely or partly with the facility staff’s intervention or lack of intervention?
DETERMING AN ADVERSE INCIDENT
(CONTINUED)
Incidents Which Are Automatically Defined as Adverse:
• Abuse, neglect or exploitation as defined in s. 415.102, F.S., (Vulnerable Adult)
• Resident elopement (based on the facility’s definition of elopement)
• An event that is reported to law enforcement. (Does not include notification for Baker Act transport or required notification of a death determined to be from natural causes.)
Completion Of ALF Adverse Incident Forms
Contact Information Resident Information Risk Manager Information (If Applicable) Incident Information/Outcomes/Circumstances Resident’s Representative Information Additional Outcome Information (15-Day Report)
Personnel/ Witnesses/Analysis/Corrective Action Signature and Printed Name of Person Reporting
Most Frequently Asked Questions
Q:Do deaths of natural causes or expected deaths of residents who are hospice patients need to be reported?
A: Although the circumstances of every death must be reviewed individually, unless the death is related to staff intervention or lack of intervention, it is not reportable. Not all deaths are adverse incidents.
Most Frequently Asked Questions
Q:Do all transfers to an acute care facility for diagnosis and/or treatment need to be reported? What about pre-existing medical problems that get worse?
A: As with deaths, every circumstance that results in transfer to an acute care facility must be reviewed individually. Unless the condition requiring transfer is related to staff intervention or lack of intervention, it probably is not reportable. Not all transfers to a higher level of care are adverse incidents.
Most Frequently Asked Questions
Q:Do I need to report resident-to-resident altercations?
A: If there is no injury and the police are not called, it probably does not need to be reported. If law enforcement is called to investigate an assault, it must be reported. If the act is willful or threatened, resulting in substantial mental, emotional, or physical impairment, it must be reported as abuse (if a resident was transferred to the hospital for treatment the “transfer” outcome box would also be checked). If an unsafe environment existed at the time of the altercation based on insufficient staff monitoring or intervention, it must be reported as staff neglect.
ALF ADVERSE INCIDENTS REPORTED BY MONTH
January 2004 - December 2004
0100200300400500600700800900
1000110012001300
1-Day Reports Rcvd. 532 517 621 555 495 504 494 572 506 479 524 546
15-Day Reports Rcvd. 461 470 552 696 456 310 423 562 431 638 493 454
Totals 993 987 1173 1251 951 814 917 1134 937 1117 1017 1000
Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04
Grand Totals1-Day: 634515-Day: 5946
Both: 12291
0
1
2
3
4
5
6
7
8
*Based on AHCA MLC Form **This data may change due to late reporting by facilities
# Claims 6 8 1 2 2 6 2 7 3 3 1 4 2 0 4 1 3 1 0 0 4 0 2 0
12/02 1/03 2/03 3/03 4/03 5/03 6/03 7/03 8/03 9/03 10/03 11/03 12/03 1/04 2/04 3/04 4/04 5/04 6/04 7/04 8/04 9/04 10/04 11/04
Grand Total: 62 NOIs
ALF NOTICES OF INTENT TO LITIGATE REPORTED BY MONTH
December 2002 -November 2004