ASSISTED LIVING ASSOCIATION OF ALABAMA SPRING CONFERENCE APRIL 4, 2007

1. ASSISTED LIVING ASSOCIATIONOF ALABAMASPRING CONFERENCEAPRIL 4, 2007

2. SURVEY TOPICS MIA SADLER APRIL 4, 2007

3. SURVEY TOPICS • VACANT ALF UNIT SUPERVISOR POSITION • DIANE MANN IS THE ACTING SUPERVISOR FOR ADMINISTRATIVE ISSUES RELATED TO THE ALF UNIT (206-5078) • MIA SADLER IS THE ACTING SUPERVISOR FOR SURVEY AND ENFORCEMENTS ISSUES RELATED TO THE ALF UNIT (206-5216)

4. SURVEY TOPICS • New ALF unit clerical staff: Chrys Foreman (334) 206-5575

5. SURVEY ISSUES • Meetings are being held on a regularly scheduled basis with members of your Association to discuss issues of interest by both the Association and the Department of Public Health.

6. MEMORANDUM TO: Assisted Living Facility Surveyors FROM: Mia Sadler, RN DATE: February 15, 2007 SUBJECT: Annual Medical Exam Requirement The Rules for Assisted Living Facilities and Specialty Care Assisted Living Facilities require that residents receive annual medical exams. The Department of Public Health will consider the visit timely and these requirements as met if the annual medical exam is completed within fourteen calendar days of the date it was due.

7. SURVEY TOPICS • STATEMENTS OF DEFICIENCIES WILL NOW BE WRITTEN USING THE ASPEN SOFTWARE PROGRAM. • DEFICIENCIES WILL BE WRITTEN IN THE LEFT HAND COLUMN • PLANS OF CORRECTION FOR STATEMENTS OF DEFICIENCIES FOR A RED SCORE WILL BE WRITTEN IN THE RIGHT HAND COLUMN

9. SURVEY TOPICS • ADOPTED RULES FOR ALFS AND SCALFS • EFFECTIVE APRIL 25, 2007 WITH THE EXCEPTION OF THE BASIC SANITATION COURSE

10. SURVEY TOPICS • DIETARY TRAINING REQUIREMENTS BECOME EFFECTIVE AUGUST 15, 2007

11. REVISED ALF/SCALF RULES • THE REVISED RULES WILL BE AVAILABLE ON THE ADPH WEBSITE AT THE FOLLOWING LINK • adph.org/providers/Default.asp?id=523

12. REVISED ALF AND SCALF RULES • DEFINES A QUALIFIED DIETICIAN AS ONE WHO IS LICENSED BY THE BOARD OF EXAMINERS FOR DIETETIC/NUTRITION PRACTICE

13. REVISED ALF AND SCALF RULES • EMPLOYEES (PRIOR TO ANY RESIDENT CONTACT) AND RESIDENTS (PRIOR TO ADMISSION) • SHALL BE PROPERLY EVALUATED FOR TUBERCULOSIS. • DELETED REFERENCE TO A NON EXISTENT DOCUMENT, “GUIDELINES OF THE STATE BOARD OF HEALTH FOR MANAGEMENT OF DISEASE AMONG EMPLOYEES AND RESIDENTS OF LONG TERM CARE FACILITIES”

14. REVISED ALF AND SCALF RULES • EMPLOYEE SCREENING • DELETED REFERENCE TO SAME NON EXISTENT DOCUMENT • REQUIRES ALFS IMMUNIZE EMPLOYEES IN ACCORDANCE WITH CURRENT RECOMMENDED CDC GUIDELINES. • INFLUENZA – ANNUALLY

15. REVISED ALF/SCALF RULES • IMMUNIZE RESIDENTS IN ACCORDANCE WITH CDC GUIDELINES (DELETED NON EXISTENT DOCUMENT) • INFLUENZA – ANNUALLY • PNEUMOCOCCAL POLYSACCHARIDE • ONE TIME REVACCINATION WITH PNEUMOCOCCAL POLYSACHARIDE VACCINE AFTER FIVE YEARS FOR: PERSONS WITH CERTAIN HEALTH CONDITIONS AND FOR PERSONS WHO WERE YOUNGER THAN 65 YEARS OLD AND IT HAS BEEN FIVE YEARS OR LONGER SINCE THE TIME OF PRIMARY VACCINATION

16. REVISED ALF/SCALF RULES • There are other immunizations recommended by the CDC. The Department will consult with the ALF Association and the Bureau of Communicable Diseases to discuss the appropriateness of including any other employee vaccinations.

17. CDC WEBSITE ADDRESS • www.cdc.gov/nip/recs/adult-schedule-11x17.pdf

18. REVISED ALF/SCALF RULES • REPORTING REQUIREMENTS • REQUIRES REPORTS BE FAXED TO OUR OFFICE (AS OPPOSED TO JUST CALLED IN) • A FRACTURE OR INJURY RESULTING IN HOSPITALIZATIONS, DEATH, EMS ACTIVATION, OR A VISIT TO THE EMERGENCY ROOM (AS OPPOSED TO JUST HOSPITALIZATIONS) • SEXUAL CONTACT OR A REPORT OF SEXUAL CONTACT BETWEEN A RESIDENT AND A STAFF MEMBER, A RESIDENT AND A VISITOR OR A RESIDENT AND ANOTHER RESIDENT WHEN THE CONTACT IS NOT CONSENSUAL OR WHEN THE RESIDENT IS INCAPABLE OF CONSENTING TO SEXUAL CONTACT.

19. REVISED ALF AND SCALF RULES • A RESIDENT WHO IS SEVERELY COGNITIVELY IMPAIRED WHO IS FOUND TO BE MISSING FROM THE FACILITY WITHOUT STAFF KNOWLEDGE AND IMMEDIATE AND APPROPRIATE STAFF INTERVENTION; • PHYSICAL ABUSE, VERBAL ABUSE, EMOTIONAL ABUSE, OR A REPORT OF SUCH ABUSE DIRECTED AT A RESIDENT BY A STAFF MEMBER OR VISITOR OF THE FACILITY AND INJURY SUCH AS EXTENSIVE BRUISING, PAIN OR INJURY THAT IS NOT CONSISTENT WITH ACTIONS NECESSARY IN PROVIDING DAY TO DAY CARE TO A RESIDENT.

20. REVISED ALF AND SCALF RULES • DELETED FOOD BORNE OUTBREAKS AS A REPORTABLE EVENT • REQUIRES FACILITY TO GIVE A DIRECT PHONE NUMBER • REQUIRES THE NAME OF THE RESIDENT(S), STAFF OR VISITOR INVOLVED IN THE INCIDENT

21. DRAFT REPORTING FORM • Incident Report- SCALF • FAXLINE • REQUIRED NOTIFICATION • (PLEASE WRITE LEGIBLY) • Facility Name: ______________________________________________________________________________________________________________________ • Facility ID #: ________________________________________________________________________________________________________________________ • Facility Direct Telephone Number: _______________________________________________________________________________________________________ • Reporter’s Name and Telephone Number: _________________________________________________________________________________________________ • Time and Date of Report: ______________________________________________________________________________________________________________ • Name of Resident(s), Staff, and/or Visitor Involved: __________________________________________________________________________________________ • When the incident occurred (date & time): _________________________________________________________________________________________________ • Where the incident occurred (ex. Bathroom, bedroom, lawn, etc.): ______________________________________________________________________________ • Circumstances under which the incident occurred: ___________________________________________________________________________________________ • ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ • Injuries to Resident: ___________________________________________________________________________________________________________________ • Immediate Facility Treatment: ___________________________________________________________________________________________________________ • Out of Facility Treatment: ______________________________________________________________________________________________________________ • Action taken by the facility in response to incident:___________________________________________________________________________________________ • _______________________________________________________________________________________ • Incident was witnessed: Yes ________ No _________ If yes, please document name, address, and telephone number of witnesses: ___________________________________________________________________________________________________________________________________ • Staff on duty at time of event: ___________________________________________________________________________________________________________ • _______________________________________________________________________________________ • Administrator/designee signature: _____________________________ Date: _________________ • THE FOLLOWING EVENTS REQUIRE FAXLINE REPORT WITHIN 24 HOURS. • CHECK APPROPRITE BOX(ES) FOR THIS REPORT: • Fracture/Injury resulting in hospitalization, death, EMS activation, or a visit to the emergency room • Elopement • Sexual contact or a report of sexual contact between resident and staff. Sexual contact or report of sexual contact between a resident and a visitor or another resident when the sexual contact is not consensual or the resident is incapable of consenting to sexual contact. • Suspected physical, verbal, or emotional abuse directed at the resident by staff or a visitor; unexplained bruising, pain, or injury • Resident on resident abuse resulting in injury • Fire, earthquake, storm, or other event requiring full or partial evacuation • Intentional self-inflicted injury, suicide, or attempt of suicide by resident • Any unplanned event resulting in media attention • Medication error resulting in hospitalization • Ingestion by resident of any toxic substance requiring medical intervention • Any malfunction of fire alarm, sprinkler system, or a door locking device.

22. REVISED ALF AND SCALF RULES • EXCLUDES COMMUNICABLE DISEASES AS CONDITIONS WHICH THE RESIDENT CAN RECEIVE OR REJECT TREATMENT FOR. • WHENEVER A RESIDENT REQUIRES MEDICAL ATTENTION, NURSING SERVICES, OR CHANGES IN PERSONAL CARE AND ASSISTANCE WITH ACTIVITIES OF DAILY LIVING PROVIDED BY THE FACILITY, THE FACILITY SHALL ARRANGE FOR OR ASSIST THE RESIDENT IN OBTAINING NECESSARY SERVICES.

23. REVISED ALF/SCALF RULES • Participates asked if the facilities would be required to have their current residents resign the receipt of resident rights forms since there was a revision. Ms. Sadler stated no, only residents admitted on or after April 25, 2007.

24. REVISED ALF AND SCALF RULES • DIETARY REQUIREMENTS • BRINGS DIETARY REQUIREMENTS UP TO CURRENT FOOD CODE (2005) • STILL REQUIRES A DIETICIAN (REGISTERED DIETICIAN) FOR CONGREGRATE FACILITIES AND FOR THOSE RESIDENTS WHO REQUIRE A THERAPEUTIC DIET. • NEW RULE REQUIRES THE RESPONSIBILITY FOR THE SUPERVISION OF DIETARY SERVICES TO BE DELEGATED TO A RESPONSIBLE EMPLOYEE WHO IS A GRADUATE OF A DIETARY MANAGERS COURSE OR HAS COMPLETED AN APPROVED COURSE THAT INCLUDES BASIC SANITATION, WHEN A DIETICIAN IS NOT EMPLOYED.

25. REVISED ALF AND SCALF RULES • THE ONLY “APPROVED COURSES” ARE: • THE SERVSAFE “EMPLOYEE GUIDE” (THROUGH THE NATIONAL RESTAURANT ASSOCIATION) • THE APPROVED COURSE OFFERED BY THE ASSISTED LIVING ASSOCIATION OF ALABAMA • WHICHEVER COURSE IS TAKEN PARTICIPATES WILL BE REQUIRED TO SHOW AN ORIGINAL CERTIFICATE DEMONSTRATING COURSE COMPLETION

26. REVISED ALF AND SCALF RULES • SERVSAFE “EMPLOYEE GUIDE” (MINIMUM) • CAN BE OFFERED BY ANY SERVSAFE CERTIFIED INSTRUCTOR • ALABAMA RESTAURANT ASSOCIATION CHARGES $20.00 FOR 3-4 HOUR COURSE • WILL OFFER AT DIFFERENT LOCATIONS AROUND THE STATE BUT REQUIRES A MINIMUM OF 25 PARTICIPATES • BASIC FOOD HANDLING, STORAGE AND MEAL PREPARATION

28. SAMPLE

29. REVISED ALF AND SCALF RULES • “SERVSAFE ESSENTIAL” COURSE-(ABOVE THE MINIMUM REQUIREMENT) • ALLOWS YOU TO BE A SERVSAFE CERTIFIED INSTRUCTOR • A TRAIN THE TRAINER COURSE • NONMEMBERS OF THE ALABAMA RESTAURANT ASSOCIATION COST IS $150.00 • ALL DAY COURSE • HEAVY IN MICROBIOLOGY • MAY BE GOOD FOR ADMINISTRATORS, FACILITIES OWNED BY CORPORATIONS

30. REVISED ALF AND SCALF RULES • ASSISTED LIVING ASSOCIATION OF ALABAMA APPROVED COURSE • $15.00 PER PERSON FOR MEMBERS; $25.00 FOR NON MEMBERS; • TAUGHT BY REGISTERED DIETICIAN FROM US FOODSERVICE • REGIONAL TRAININGS ALREADY SCHEDULED

31. SAMPLE CERTIFICATE OF ATTENDANCE This is to certify that: ______________________________________________ (Name of Participant) Has completed: FOOD SAFETY & SANITATION On:_______________ (Date) CEU Hours: __________________________ ________________________ Pamela M. Polk, RD, LD (#854637) Healthcare Specialist, US Foodservice - Montgomery

32. REVISED ALF/SCALF RULES • DIETARY TRAINING REQUIREMENTS BECOME EFFECTIVE AUGUST 15, 2007

33. REVISED ALF/SCALF RULES • Participates at the conference asked if the Food Safe courses taught through the County Health Departments would be accepted by the Department. Ms. Sadler informed the group that she would need to assess if the course was comparable to the two already approved before answering. Ms. Sadler told the participates that she evaluate those couses.

34. REVISED ALF RULES • PLAN OF CARE – A LISTING OF THE RESIDENT’S NEEDS OR PROBLEMS THAT REQUIRE INTERVENTION BY THE FACILITY, SUCH AS BEHAVIORAL SYMPTOMS, WEIGHT LOSS, FALLS AND THERAPEUTIC DIETS. • ADDED • The facility shall assess the appropriateness of interventions required by each resident monthly. • Weigh and record weight of each resident monthly.

35. REVISED ALF RULES • PLANS OF CARE • Residents assessed on a monthly basis and more often when necessary to identify significant changes in health status or behavior to include medication awareness. • Significant change is defined as two or more falls in 30 days or less, a significant weight loss, unmanageable or combative or potentially harmful behaviors, any adverse drug interaction or over sedation or any elopement. • Defines significant weight loss and unplanned weight loss

36. REVISED ALF RULES • ANY SIGNIFICANT CHANGE REQUIRES IMMEDIATE INTERVENTIONS AND DOCUMENTATION OF INTERVENTIONS OR REASSESSMENT OF EXISTING INTERVENTIONS.

37. REVISED ALF RULES • CLARIFIES WHAT THE DEPARTMENT EXPECTS REGARDING THE DESCRIPTION OF ADL ASSISTANCE REQUIRED BY THE RESIDENT. • BATHING, DRESSING, TOILETING, GROOMING (AS OPPOSED TO BODILY HYGIENE) • AMBULATION • FEEDING (AS OPPOSED TO JUST DIET) • MEDICATION ASSISTANCE • RISK TO PERSONAL SAFETY

38. REVISED ALF RULES • ADDS REQUIREMENT THAT THE RESIDENT SHALL HAVE THE OPPORTUNITY TO DEMONSTRATE HIS OR HER ABILITY TO CORRECTLY UTILIZE THE UNIT DOSE PACKAGE SYSTEM AT EVERY OPPORTUNITY FOR MEDICATION USE.

39. UNCHANGED ALF RULE • A RESIDENT WHO IS NOT AWARE OF HIS OR HER MEDICATION IS DEEMED TO BE SEVERELY COGNITIVELY IMPAIRED, WHICH IS DEFINED AS: A RESIDENT INCAPABLE OF RECOGNIZING HIS OR HER NAME, DOES NOT UNDERSTAND AND CANNOT BE TRAINED TO UNDERSTAND THE UNIT DOSE SYSTEM OR THE RESIDENT LIKELY CANNOT PROTECT HIMSELF OR HERSELF FROM MEDICATION ERRORS BY FACILITY STAFF.

40. REVISED ALF RULES • ADDS LANGUAGE THAT RESIDENTS WITH A CHRONIC CONDITION THAT CAUSES HIM OR HER TO BE SEVERELY COGNITIVELY IMPAIRED SHALL BE APPROPRIATELY DISCHARGED.

41. REVISED SCALF RULES • THE PSMS AND BEHAVIOR SCREENING FORM SHALL BE COMPLETED WHEN THERE IS A SIGNIFICANT CHANGE IN THE RESIDENT (IN ADDITION TO: PRIOR TO ADMISSION AND ANNUALLY).

42. SURVEY COMPLIANCE ISSUES • SIX ASSISTED LIVING FACILITIES AND TWO SPECIALTY CARE ASSISTED LIVING FACILITIES HAVE HAD THEIR LICENSES DOWNGRADED TO PROBATIONAL AND ENTERED INTO CONSENT AGREEMENTS WITH THE DEPARTMENT. • AS OF MARCH 20, 2007-THREE ADDITIONAL ALFS AND TWO ADDITIONAL SCALFS HAVE ENFORCEMENT ACTIONS PENDING.

43. SURVEY COMPLIANCE ISSUES ONE EMERGENCY LICENSE SUSPENSION

44. SURVEY COMPLIANCE ISSUES • INELIGIBLE RESIDENTS • UNLICENSED STAFF ADMINISTERING MEDICATIONS • PERSONNEL AND TRAINING REQUIREMENTS • NOT IDENTIFYING SIGNIFICANT CHANGES AND IMPLEMENTING WRITTEN INTERVENTIONS TO ADDRESS THE CHANGES. • NOT FOLLOWING PHYSICIAN ORDERS • WITHHOLDING INFORMATION AND TELLING UNTRUTHS

45. “THE BIG FIVE” Weight loss Behaviors Elopements Pressure Sores Falls