HEALTHCARE FACILITY REGULATION

1. HEALTHCARE FACILITY REGULATION Presented by: Elaine Wright Director, Personal Care Home Program

2. Regulations for Personal Care Homes/Assisted Living FacilitiesCommunity Living Arrangements and Adult Day Centers Fire Safety Symposium June 21, 2016

3. DCH Mission RESPONSIBLE HEALTHY ACCESS Access to affordable, quality health care in our communities Responsible health planning and use of health care resources Healthy behaviors and improved health outcomes

4. AGENDA Introduction Licensure Requirements Residents – Admission/Retention Criteria Waiver or Variance Requirements Fire Safety Inspections and Reports Complaints Questions

5. Definition PCH/ALC – residence that provides Housing Meals and one or more: Personal services, i.e. assistance with eating, bathing, grooming, dressing, toileting, or supervision of medications To two or more adults unrelated to owner by blood or marriage

6. Definition-2 • Community Living Arrangement (CLA) – same but for DBHDD population • Service differences • Admission differences • DBHDD verifies the residence will exclusively serve DBHDD residentially-funded consumers • Usually 2-4 consumers only

7. Definition - 3 ●Adult Day Care Social Model ●Adult Day Health Care Medical Model ●Effective January, 2015 ●Services to 3 or more participants, requires licensure If serving exclusively the developmentally disabled- exempt

8. Licensure Requirements Permit is required when Housing, food service and personal services are provided to two or more residents Exemptions - boarding homes, host homes, care of family members or one resident, shelters - Referral to local inspectors, i.e. planning, zoning, business license, etc. - Referral to fire department • 3 or more day care participants • Investigate unlicensed personal care homes

9. Application requirements Application Electrical Inspection Fire Safety Inspection CRC for owner/administrator Proof of possession of property ID affidavit Local zoning approval Floor plan HFRD on-site Inspection

10. Fire Safety Inspection ● Inspection, required of each PCH, regardless of size with occupancy load ● From fire department having jurisdiction ● 7+ Residents - Fire Safety Inspection from State Fire Safety Inspector (or local fire authority) ● 2-6 Residents – possible Private Fire Safety

11. Residents Personal Care Home should admit and retain only residents who Are 18 years of age or older Do not require restraints, isolation, confinement Are not bed bound Do not require continuous nursing care and services Do not require more care than the PCH can provide

12. Residents-2 • PCH residents must be • Ambulatory • Resident has ability to self-preserve with minimal assistance, i.e. staff assist in transferring and respond to verbal directions to self-propel to exit • Resident has ability to move from place to place by propelling wheelchair or using walker

13. Residents ● Must meet admissions criteria ● Retention criteria is same as admissions criteria

14. Variences and Waivers • Definition • Waiver • Variance • Waiver regulations provide for exceptions to rule • Provisions of rules can be waived • Provisions of law cannot be waived

15. Waiver/Varience Process • Policy • Forms • Provider identifies rule(s) to be waived • Submits to HFR • Place the request on the Rules Waiver Register maintained by SoS for 15 days • Open for public comment

16. Process-2 • Request is on website for 15 days • Meet internally to review • Review facility’s compliance history • Review facility’s waiver history • Review specific documentation sent • To include Fire Safety Approval Form

17. Process -3 • For waiver of HFRD admission criteria, info includes • 1. Date of admission of resident • 2. Current physical exam • 3. Floor plan - indicate resident’s room, exits/ramps and escape routes identified • 4. Current staffing schedule/sitter schedule • 5. Copy of the last 3 fire drills • 6. Hospice Plan of Care, if applicable • 7. A statement from the appropriate fire official

18. Process-4 • Written statement from fire authority • Levels of care • Not an evaluation of the resident • Not a recommendation re waiver • Asking for a FS evaluation, given information regarding resident population/location etc. • Asking for feedback

19. Fire Safety Approval Form

20. Process -5 • Review and make recommendation • Have sufficient information? • Physician report match HFR assessment? • HFR evaluates based on compliance with rules

21. Process -6 • Make waiver/variance decision • Establish conditions • Changes in resident status • Care and services • Fire safety • Admissions • Staffing • Other services • Changes in Ownership

22. Process-7 • Follow-up on subsequent surveys • Is facility meeting conditions of waiver? • Are there care issues? • Additional residents who do not meet the admission/retention criteria • Review fire drills

23. Rule Requirements • HFR may require repeat fire safety inspection of any PCH • If physical plant undergoes substantial repair, renovations, additions • If HFR believes residents may be at risk • If there is a substantial increase in the amount of personal assistance offered to residents • Keyed Locks

24. HFR Surveyos • Are NOT fire inspectors • Rely on fire safety inspections • Conduct initial inspections • Review policies and procedures • Review disaster preparedness plans • Review fire safety inspection • Survey for HFR rules • Facility should have no residents

25. HFR Surveyors-2 • Conduct annual inspections • Review changes in policies and procedures • Review changes in disaster preparedness plan • Survey for ORS rules • Review fire drill reports • Observe / interview residents • Determine resident needs • Review staffing schedules

26. HFR Surveyors-3 • Conduct complaint investigations • Focused inspections based on allegations • Complaints regarding inappropriate residents • Result in violations being cited • Facility must submit plan of correction • Follow-up visit must confirm compliance • Negative outcome for resident or failure to achieve or maintain compliance may result in adverse actions

27. HFR Surveyors -4 • Primary role re Fire Safety • Identify potential problems/issues • Make appropriate referrals as needed

28. Referral to Fire Safey • When obvious fire safety violations • Keyed locks/Blocked egress etc • When there are questions about FS compliance • e.g. drills do not show complete evacuation • When four or more inappropriate residents • When evacuation times exceed 13 minutes • When we’re considering waiver request re admission/retention

29. Fire Drills • Review fire drills on survey • If questions, may suggest fire drill monitored by local fire department • If questions, may request to be notified of time of next fire drill • Excessive evacuation time will result in violations cited and POC by facility

30. Referral to HFR • Allegations that facility is operating without a permit • Questions regarding facility’s staffing • Questions regarding abuse, neglect or exploitation • Issues regarding care and services • If residents are improperly placed • If evacuation times cannot be met

31. QUESTIONS???

32. Contact information Main number 404-657-5850 • Applications/Waivers Director: • Yolanda Smith yfsmith@dch.ga.gov • 404-657-1511 • Complaint number • 1-800-878-6442 or 404-657-5726

33. Contact Information PCH program Elaine Wright, Director ehwright@dch.ga.gov 404-657-5856 Managers Roxanne Cade: rcade1@dch.ga.gov 404-657-4074 Shirley Rodrigues: serodrigues@dch.ga.gov 404-657-4302 Karen Brown: klbrown1@dch.ga.gov 404-657-3817