Evaluations www.careandcompliance.com/eval We deeply value your feedback, and will utilize it in the ongoing development of our courses and services. Regulation Update and Review Introduction 1. New laws 2. Other Bills of Interest 3. Medication Management 4. Admission and Retention 5. Hospice Care 6. Total Care Exceptions 7. First Aid, CPR, DNRs 8. Staff Training Requirements NEW LAWS 2014 New Laws Assembly Bill 261 – Billing Clarification Amendment to H & S Section 1569.884; addition to Section 1569.652 • Prohibits advance notice for terminating an admission agreement due to death of the resident New Laws Assembly Bill 261 – Billing Clarification • Fees must stop accruing once all personal property is removed • Can’t impede removal of property during reasonable hours • Licensee must refund fees paid in advance covering the time after the property has been removed. • Refund issued to whoever is contractually responsible for the fees, or resident’s estate New Laws Assembly Bill 261 – Billing Clarification • If fees are assessed while personal property remains in the apartment after death, the licensee must inform resident’s responsible person • Policy must be disclosed in the admission agreement New Laws Assembly Bill 261 – Billing Clarification • Applications to Assisted Living • Documentation • Penalties New Laws Assembly Bill 581 – Retaliation Prohibition Amendments to H & S Sections 1539, 1568.07 and 1569.37 Prohibits licensee and staff from discriminating or retaliating against a resident or employee for complaining to CCLD or LTC Ombudsman New Laws Assembly Bill 581 – Retaliation Prohibition Current law states: “No licensee shall discriminate against resident or employee” New law adds officer or employee of the licensee New Laws Assembly Bill 581 – Retaliation Prohibition Current law states: No licensee shall discriminate or retaliate “for initiating or participating in CCLD inspection” New law includes filing complaint or grievance with CCLD and adds complaint, grievance or request for investigation by ombudsman New Laws Assembly Bill 581 – Retaliation Prohibition • Applications to Assisted Living • Penalties and Citations New Laws Assembly Bill 633 - CPR Additions to Section 1799.103 to H & S Code Prohibits any employer from having a policy that prevents an employee from voluntarily performing CPR New Laws Assembly Bill 633 - CPR Exceptions: DNR and Trained Staff Liability protections: Employer – no duty to train Employee – Good Samaritan New Laws Assembly Bill 663 – LGBT Training Amendment to Sections 1562.3 and 1569.616 of the H & S Code Adds cultural competency and sensitivity in LGVT issues to required 40-hour administrator certification course New Laws Assembly Bill 663 – LGBT Training Applies to RCFE’s and ARF’s Also requires training for LTC ombudsman New Laws Assembly Bill 620 – Missing Resident Notification Plan Addition to Sections 1279.8, 1507.15, 1569.317 and 1584 of the H & S Code New Laws Assembly Bill 620 – Missing Resident Notification Plan Every RCFE (and other licensees) shall, for the purpose of addressing issues that arise when a resident is missing from the facility, develop and comply with an absentee notification plan as part of the written record of care the resident will receive. New Laws Assembly Bill 620 – Missing Resident Notification Plan The plan shall include and be limited to the following: a requirement that an administrator, or his or her designee, inform the resident’s authorized representative when that resident is missing and circumstances under which law enforcement shall be notified. Other Bills Assembly Bill 10 – Minimum Wage Increase Assembly Bill 241 – Domestic Worker Bill of Rights Assembly Bill 1217 – Home Care Licensure NEW LAWS 2015 Effective January 1, 2015 New Laws 2015 Assembly Bill 1572 – Changes RCFE Resident and Family Council Requirements. Requires every licensed residential care facility for the elderly, at the request of residents, to assist them in establishing and maintaining a single resident council. Authorizes specified persons or others to participate in resident council to make recommendations to administrators to improve the quality of daily living and care in the facility and to promote residents' rights. Requires facilities to respond to any written concerns or recommendations submitted by resident council within 14 days. New Laws 2015 Assembly Bill 1572 – Changes RCFE Resident and Family Council Requirements. (Cont.) Requires the facility to appoint a designated staff member to assist the council under certain conditions. Bans interference with the formation, maintenance, or promotion of a resident council. Click here to read the full bill. New Laws 2015 Assembly Bill 1899 – Prohibition on Licensure for RCFE Abandonment. Amends the State Residential Care Facilities for the Elderly Act that provides for the licensure and regulation of residential care facilities for the elderly. Excludes a licensee who abandons the facility and the residents resulting in an immediate and substantial threat to the health and safety of those residents, from licensure in facilities licensed without the right to petition for reinstatement, and licensees who failed to take all reasonable steps to transfer affected residents to minimize trauma. Click here to read the full bill. New Laws 2015 Assembly Bill 2044 – CPR and Emergency Training and Staffing Relates to residential care facilities for the elderly. Requires that at least one administrator, facility manager, or designated substitute who has adequate qualifications be on the premises of a facility 24 hours per day. Requires a facility to employ, and an administrator to schedule, a sufficient number of staff members. Requires certain training to include building and fire safety and the appropriate response to emergencies. Click here to read the full bill. New Laws 2015 Assembly Bill 2717– Codifies Resident Rights Establishes rights for residents of privately operated residential care facilities for the elderly, including to receive a specified amount of notice before involuntary transfer, discharge, or eviction, to be accorded dignity in relationships with staff, to be granted a reasonable level of privacy, and records confidentiality. Requires a facility staff person to advise a resident and the resident's representative of these and other rights. Click here to read the full bill. New Laws 2015 Assembly Bill 2632 – Requires Investigation of Arrests Before Granting Criminal Background Clearance. Prohibits the State Department of Social Services, with regard to community care facilities, residential care facilities, foster family home or certified family home, residential care facilities and child day cares, from issuing a criminal records clearance to a person who has been arrested for specified crimes or for any crime for which the person is granted a criminal record exemption prior to completion of an employment investigation. New Laws 2015 Assembly Bill 2632 – Requires Investigation of Arrests Before Granting Criminal Background Clearance. (Cont.) Requires a check to see if a person has been convicted of certain crimes for which an exemption cannot be granted. Click here to read the full bill. New Laws 2015 Assembly Bill 1153 – Ban on RCFE Admissions. Permits the California Department of Social Services (DSS) to suspend admissions to a RCFE if the facility has violated the law, been cited for repeated violations, or has failed to pay a civil penalty. The bill would authorize a licensee to appeal the suspension and would require the department to adopt regulations that specify the appeal procedure. Click here to read the full bill. New Laws 2015 Assembly Bill 1382 – Increases Initial and Annual RCFE Licensing Fees This bill increases the initial and annual licensing fees for RCFEs for every sized facility. After initial licensure, a fee shall be charged by the department annually on each anniversary of the effective date of the license. Click here to read the full bill. New Laws 2015 SSP/SSI Rates: The Non-Medical Out of Home Care (NMOHC) Payment Standard will be as follows: Supplemental Security Income (SSI): $733 State Supplementary Payment (SSP): $412 Total NMOHC Payment Standard: $1145 Amounts are double for SSI/SSP couples. New Laws 2015 SSP/SSI Rates (Cont.): The NMOHC Payment Standard includes the following components: Room and board: $492 Care and supervision: $522 maximum Amount payable for basic services: $1014 Personal and incidental needs allowance (must be provided to the recipient): $131 NEW LAWS 2015 Effective July 1, 2015 New Laws 2015 Assembly Bill 1523 – Liability Insurance Requirement All residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. Click here to read full bill. New Laws 2015 Assembly Bill 2236 – New Civil Penalty Structure Raises the fine for violations that result in death to $15,000; and violations that result in serious bodily injury or constitute physical abuse to $10,000. It establishes a four-step appeal process that includes review by an administrative law judge. Lesser violations, including the statutorily defined “serious violations” and repeat violations, remain at $150. This bill also increases civil penalties for death, serious bodily injury, and physical abuse in all CCLD licensees as well. Click here to read full bill. NEW LAWS 2016 Effective January 1, 2016 New Laws 2016 Assembly Bill 1570 – Increases Caregiver Training and Administrator Exam This bill would require the certification program for an applicant for licensure to consist of 80 hours of coursework and a state-administered examination of no less than 100 questions. The bill would require the examination to reflect the uniform core of knowledge required and would require the department, no later than July 1, 2016, and every other year thereafter, to review and revise the examination in order to ensure the rigor and quality of the examination. New Laws 2016 Assembly Bill 1570 – Increases Caregiver Training and Administrator Exam (Cont.) This bill would require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive 20 hours of training before working independently with residents, an additional 20 hours within the first 4 weeks of employment, and an additional 20 hours annually, as prescribed. The bill would also apply the training requirements specific to dementia care to all residential care facilities for the elderly. Click here to read full bill. New Laws 2016 SB 911– Increases Administrator Certification Requirements, Medication Requirements and Caregiver Training This bill prohibits retaliation for calling 911. It also significantly increases administrator certification training hours and updates the content of the class. The bill also increases the training hours for staff who assist with medications and adds a new caregiver training topic to the initial training as described in AB 1570. Click here to read full bill. Regulation Review: Medication Management Medications: Assist vs. Administer Medications F.A.Q.’s: 1. When can staff assist with eye drops to residents? Ear drops? Nose drops? 2. Are trained staff allowed to measure medications with an oral syringe? 3. Can unlicensed staff apply a patch or topical medication for a resident who cannot reach the area? 4. Can liquid narcotics be centrally stored? 5. Is an exception required for medications to be crushed? Medications F.A.Q.’s: 6. Is it necessary to contact the physician before each does when assisting a resident with PRN morphine? 7. Can a family member administer medication to a resident NOT on hospice? 8. If a medication label only has a month and year listed for the expiration date, does it expire on the first day of the month listed, or the last day? Medications F.A.Q.’s: 9. Are medications purchased from Canada and Mexico safe and/or legal? 10. Does CCL allow electronic physician signatures for medication orders and prescriptions? Regulation Review: Admission and Retention Admission & Retention • Allowable Conditions • Restricted Conditions • Prohibited Conditions Regulation Review: Hospice Care End of Life Hospice Care • Waivers • Care Plans • Training End of Life Hospice Care Plan • Agency contact info • Description of services to be provided by the agency • Primary contacts • Licensee responsibilities • Services by other persons • Training needs End of Life Hospice Training Needs • Dying process • Psychosocial support • Care of bedridden residents • Pain management End of Life Total Care: • What it means for staff/residents • Exceptions and waivers Regulation Review: Total Care BACKGROUND WHAT IS TOTAL CARE? • Total care is defined as a condition where residents depend on others to perform all of their activities of daily living. • A prohibited condition, per regulation 87615. BACKGROUND • • An exception must be obtained to retain a resident who requires total care in an RCFE Old process: Obtain hospice waiver Accept/retain resident on hospice Resident becomes “total care” Request total care exception New CCL Total Care Policy NEW CCL TOTAL CARE POLICY • • • CCL has updated their total care policy to streamline and expedite the process. Update is in section 87632 of the RCFE Evaluator Manual. Available at www.ccld.ca.gov As written it only applies to “total care” residents who are receiving hospice services. NEW CCL TOTAL CARE POLICY • New policy in a “nutshell:” Submit 2 (of 3) required exception components in advance as part of your hospice waiver (Total Care Plan) NEW CCL TOTAL CARE POLICY • All exception requests must include (87616): 1. Documentation of the resident's current health condition including updated medical reports, other documentation of the current health, prognosis, and expected duration of condition. 2. The licensee's plan for ensuring that the resident's health related needs can be met by the facility. 3. Plan for minimizing the impact on other residents. NEW CCL TOTAL CARE POLICY • New Total Care Policy SUBMIT ADVANCE AS 1. Documentation of the resident's currentINhealth condition PART OFdocumentation HOSPICE including updated medical reports, other WAIVERduration of of the current health, prognosis, and expected condition. 2. The licensee's plan for ensuring that the resident's health related needs can be met by the facility. 3. Plan for minimizing the impact on other residents. NEW CCL TOTAL CARE POLICY • New Total Care Policy 1. Documentation of the resident's current health condition including updated medical reports, other documentation of the current health, prognosis, and expected duration of condition. 2. The licensee's plan for ensuring that the resident's health related needs can be met by the facility. 3. Plan for minimizing the impact on other residents. MET VIA RESIDENT”S HOSPICE CARE (RETAIN ON FILE) NEW CCL TOTAL CARE POLICY Obtain Total Care Plan Approval Request total care exception request when notifying CCL of the initiation of hospice services Propose hospice care plan as variance to 87616(1) NEW CCL TOTAL CARE POLICY What if I already have a hospice waiver? Submit an addendum to the existing hospice care waiver plan that includes the total care component. If the Department approves this addendum, the licensee may then use the option of requesting the total care exception under the simplified methods noted above. The Total Care Plan TOTAL CARE PLAN • • Submit in advance as part of hospice waiver. Must include: • The licensee’s plan for ensuring that current total care residents’ health related needs can be met, or provisions made for them to be met by the licensee. • How it will minimize this impact on the other residents. TOTAL CARE PLAN PLAN FOR ENSURING HEALTH RELATED NEEDS CAN BE MET: • Staff training • Additional support from hospice care staff • Family/volunteers • How will you manage medications? • Bedridden? TOTAL CARE PLAN MINIMIZING IMPACT ON OTHER RESIDENTS: • Private rooms • Ensuring “sufficient” staff • Adjustments to staff schedules • Backup staff Regulation Review: First Aid, CPR, and DNRs EFFECTIVENESS OF CPR • CPR is not like you see in movies and television. EFFECTIVENESS OF CPR 5-10% of people who undergo CPR will survive EFFECTIVENESS OF CPR 15-24% of people who undergo CPR in the hospital will survive to discharge EFFECTIVENESS OF CPR 0-5% of frail nursing home residents survive CPR EFFECTIVENESS OF CPR 3x persons with advanced dementia have survival rates 3x lower than those without dementia First Aid and CPR Requirements FIRST AID AND CPR REQUIREMENTS • • • 87411 Personnel requirements “Staff providing care shall receive appropriate training in first aid…” FIRST AID AND CPR REQUIREMENTS • • • • • New Bill 2044 This bill requires that there be a designated “in charge” staff person when the administrator is not present. This person must have training necessary to respond to emergencies and provide necessary care and supervision. The bill also requires that there be at least one CPR-trained staff person on duty at all times. Several other provisions are already required by regulation. FIRST AID AND CPR REQUIREMENTS • • • First aid kits Advanced directives AED Advanced Directives ADVANCED DIRECTIVES Health and Safety Code § 1569.156: • Not condition the provision of care or otherwise discriminate based on whether or not an individual has executed an advance directive, consistent with applicable laws and regulations. ADVANCED DIRECTIVES Health and Safety Code § 1569.156: • Provide education to staff on issues concerning advance directives. • Provide written information, upon admission, about the right to make decisions concerning medical care, including the right to accept or refuse medical or surgical treatment and the right, under state law, to formulate advance directives. • Provide written information about policies of the facility regarding the implementation of the rights described ADVANCED DIRECTIVES • • • Must give to all residents PUB 325 www.ccld.ca.gov ADVANCED DIRECTIVES • • • POLST Standardized advanced directive format www.capolst.org ADVANCED DIRECTIVES ADVANCED DIRECTIVES ADVANCED DIRECTIVES ADVANCED DIRECTIVES HONORING A DNR • • • 87469 If a resident who has a DNR on file experiences a medical emergency, facility staff shall do one of the following: Immediately telephone 9-1-1, and present the DNR to the responding emergency medical personnel HONORING A DNR • • • 87469 If a resident who has a DNR on file experiences a medical emergency, facility staff shall do one of the following: Immediately give the DNR to a physician, RN, or LVN, if in the resident's presence at the time of the emergency and assumes responsibility HONORING A DNR • • H&S Code Section 1569.73 “A facility that has obtained a hospice waiver from the department pursuant to this section need not call emergency response services at the time of a life-threatening emergency if the hospice agency is notified instead…” AEDs AED • • 87607 RCFEs are permitted to maintain and operate automated external defibrillators (AED) AED • • • • Must notify CCL in writing Staff who will operate must have a valid “operator’s certificate” Must document quarterly proficiency demonstrations Must maintain an AED supply kit Common Questions COMMON QUESTIONS What should our policy be? • No simple answer • Depends on your organization and your staff • Options: • • • • No CPR, call 9-1-1 Caregivers no CPR, nurses can do CPR, call 9-1-1 Train everyone in CPR Train at least one person in CPR COMMON QUESTIONS What do I tell my staff? • Tell them to call 9-1-1 • Nurses can initiate CPR based on their clinical judgment and comfort level COMMON QUESTIONS What do I tell my residents? • Make sure they are aware of your CPR policies • Talk to them about end of life wishes Staff Training Requirements Staff Training Dementia Training Requirements Initial training for: • Caregivers - Section 87707 of the Title 22 requires caregivers to receive 6 hours of initial training within 4 weeks of employment. • Administrator – receives training as part of the initial certification process • All staff – “All personnel shall be given on the job training or have related experience in the job assigned them.” Staff Training Dementia Training Requirements Annual training for: • Caregivers - Section 87707 of the Title 22 requires caregivers to receive 8 hours of annual training on Dementia related topics. • Administrator – 8 of the 40 hours required to recertify must be on Dementia related topics • All staff - “All personnel shall be given on the job training or have related experience in the job assigned them.” Staff Training Dementia Training Requirements •Documentation and Record keeping Staff Training Medication Training Requirements – Review For staff assisting with medications (OSHA 1569.69): Initial - In Communities with 15 or fewer residents, staff must complete 6 hours of initial training (2 hours of “shadow” training) within 2 weeks of hire and prior to assistance with self-administration of medications. Annual – Staff must complete 4 hours of in-service training on medication related topics in each succeeding 12-month period. Staff Training Medication Training Requirements – Review For staff assisting with medications (OSHA 1569.69): Initial - In Communities with 16 or more residents, staff must complete 16 hours of initial training (8 hours of “shadow” training) within 2 weeks of hire and prior to assistance with self-administration of medications. Annual – Staff must complete 4 hours of in-service training on medication related topics in each succeeding 12-month period. Staff Training Medication Training Requirements – Review Who is allowed to train? Who is allowed to shadow? Staff Training Medication Training Requirements – Review Who is allowed to train? Shadow? Any of the following practical experience or licensure requirements: • Two years of full-time experience, within the last four years, as a consultant with expertise in medication management • Two years of full-time experience, or the equivalent, within the last four years, as an administrator for a RCFE • Two years of full-time experience, or the equivalent, within the last four years, as a direct care provider assisting with the self-administration of medications • Possession of a license as a medical professional Staff Training Medication Training Requirements – Review Documentation and record keeping Staff Training Initial/Orientation Training – Review • Personal Rights • Abuse and Neglect • Other required topics Staff Training Initial/Orientation training – Review • Direct Care Staff must receive 10 hours of training within the first four (4) weeks of hire. Required topics include First Aid, Aging process, Personal care services (ADL’s), Resident Rights, Policies and Procedures, Psychosocial needs and Dementia. • Direct Care Staff must receive four (4) hours of annual training on topics related to direct resident care. Staff Training Initial/Orientation training – Review To receive an RCFE administrators license, you must complete 40 hours of initial, in-class training from an approved vendor, pass the state exam (within 60 days of the final day of that class), and send in $100 to licensing for your initial certificate. Training Solutions Training Solutions Online Staff and Administrator Training: For Staff • 10-hour orientation • Annual training • Medication: Initial and Annual • Dementia: Initial and annual Training Solutions Online Staff and Administrator Training: For Administrator • 20 hours Continuing Education • Webinars Training Solutions Online Staff and Administrator Training: • Cost • Documentation/Certificates Training Solutions In House Training Training Solutions In House Training • Training Kits and Materials • Pre-made forms, documents and exams • Reusable • Stay up to date • Cost Training Solutions In House Training • Create your own training curriculum Outsource Training • Approvals required • Instructor Credentials • Cost • Convenience Training Solutions Live Classroom Training Questions? Review Questions Review Questions 1.One of the new laws implemented for 2014 had to do with CPR. This new law prohibits what? Review Questions 1.One of the new laws implemented for 2014 had to do with CPR. This new law prohibits what? It prohibits any employer from having a policy that prevents an employee from voluntarily performing CPR Review Questions 2. True/False: A new RCFE caregiver must receive 10 hours of initial training within 1 week of employment. Review Questions 2. True/False: A new RCFE caregiver must receive 10 hours of initial training within 1 week of employment. False. They must receive 10 hours of training with 4 weeks of employment. Review Questions 3. For any staff assisting with self-administration of medications, it is required that they receive __________of continuing education annually on medication related topics. Review Questions 3. For any staff assisting with self-administration of medications, it is required that they receive 4 hours of continuing education annually on medication related topics. Review Questions 4. DNR stands for what? A. B. C. D. Daily and Nightly Report Do Not Resuscitate Diagnosed Non-Responsive Drug and Narcotic Report Review Questions 4. DNR stands for what? A. B. C. D. Daily and Nightly Report Do Not Resuscitate Diagnosed Non-Responsive Drug and Narcotic Report Review Questions 5. Assembly Bill 261 addresses new Billing Clarifications for 2014. According to this new bill, fees must stop accruing once this has been completed. Review Questions 5. Assembly Bill 261 addresses new Billing Clarifications for 2014. According to this new bill, fees must stop accruing once this has been completed. Fees must stop accruing once all personal property has been removed from the room/living quarters. Review Questions 6. True/False: There will be a minimum wage increase in California in 2014. Review Questions 6. True/False: There will be a minimum wage increase in California in 2014. True. The California minimum wage will increase in 2014 and again in 2016. Review Questions 7. Medication training includes 2 components which must be completed before assisting residents with self-administration. What are they? Review Questions 7. Medication training includes 2 components which must be completed before assisting residents with self-administration. What are they? The initial training and the shadow training. Review Questions 8. True/False. Dementia training: If your Community cares for dementia residents, caregivers must receive 6 hours of initial training within 4 weeks of hire date. Review Questions 8. True/False. Dementia training: If your Community cares for dementia residents, caregivers must receive 6 hours of initial training within 4 weeks of hire date. True. It’s time for……. COMMUNITY FEUD! COMMUNITY FEUD! There are some new laws that went into effect in 2014. What are the FIVE (5) topics discussed in this course that were changed or amended. (Example: Minimum Wage Increase) 1 2 3 4 5 COMMUNITY FEUD! We surveyed 100 administrators about the RCFE initial certification process. What are some of the steps you need to take to get your initial license? What were the 5 most mentioned steps? 1 2 3 4 5 COMMUNITY FEUD! What are 4 training solution options for you or your staff that are mentioned in this Course? 1 2 3 4 COMMUNITY FEUD! Each direct care staff member must complete 10 hours of orientation training within 4 weeks of being hired. What are the seven (7) required topics that must be included as part of this training? 1 2 3 4 5 6 7 COMMUNITY FEUD! According to the OSHA Health and Safety Code, who is allowed to do the “shadowing” portion of the required medication training? 1 2 3 4 5 COMMUNITY FEUD! We surveyed 100 RCFE and ARF administrators regarding online staff and administrator training. They were asked “What are the benefits of online training?” The top five (5) answers are on the board. 1 2 3 4 5 Evaluation www.careandcompliance.com/eval If you have not completed your evaluation please take time to complete when time permits, your feedback is greatly appreciated.