THE NEW VA SURVEY PROCESS FOR STATE VETERANS HOMES

1. THE NEW VA SURVEY PROCESS FOR STATE VETERANS HOMES Presentation Date

2. Today’s Presenters Nancy A. Quest Chief, State Veterans Home Program Clinical and Survey Oversight Sheila Scott Project Manager VA Contract Supported Surveys Donna Demaree Contract Surveyor Steve Matune 1st Vice President National Association of State Veterans Homes Fred S. Sganga 2nd Vice President National Association of State Veterans Homes

3. Today’s Session VA Perspective Contractor Perspective State Veterans Home Perspective Answering Your Questions

4. DEPARTMENTOFVETERANS AFFAIRSSURVEY PERSPECTIVE Nancy A. Quest Chief, State Veterans Home Program Clinical and Survey Oversight

5. Why The New Format? Opportunity to Improve VHA was charged with improving the survey process. Extensive consideration of a variety of “in-house” approaches. Decision to contract with expert was selected as the best option.

6. VA Defined Goals Transparency of information and processes Public accountability Increased oversight of facilities that provide care and services to vulnerable populations

7. VA Contractor Selection Process Technical Capability Contractor Experience Qualifications of Personnel Past Performance

8. Vision of the Survey Process Consistency of survey approaches Clear protocol - pre, during and post survey Smaller numbers of experienced surveyors Clear and objective statements of findings Consistency in dealing with findings Timely reporting to State Veterans Homes

9. VA - SVH Survey Phase 1Pilot Program Survey Process Assessment Chelsea, Massachusetts Stony Brook, New York Quincy, Illinois Sandusky, Ohio Chula Vista, California Phoenix, Arizona

10. Review of VA Survey Prep Outline • What to expect… • Initial Tour • First Day • Second Day • Third Day • Required documents… • How to prepare…

11. VA Lessons Learned • The nuances of existing survey process. • Coordination, Coordination, Coordination! • How can we present as one team? • SVH’s expectations & time frames.

12. Review of the Formal Appeal Process 38 CFR Part 51.30(e)(f) states in part: If the VA Medical Center of Jurisdiction Director determines that the State home facility or facility management does not meet the standards… The State must submit the appeal to the Under Secretary for Health in writing, within 30 days of receipt of the notice of the recommendation or decision regarding the failure to meet the standards. The decision of the Under Secretary for Health will constitute a final decision that may be appealed to the Board of Veterans’ Appeals (see 38 U.S.C. 7104 and 7105 and 38 CFR Part 20).

13. Contractor Perspective Sheila Scott Project Manager VA Contract Supported Surveys Donna Demaree Contract Surveyor

14. Corporate Overview Ascellon Corporation provides Management Consulting, Program Management and Information Technology Services. Over 13 Years in Business Serving CMS since 1997 and Conducting Long Term Care Survey for over 6 years ISO 9001:2008 Quality Registration Over 90 Clinical Professionals on Staff Location – Landover, MD with Clinical Professionals in 28 States

15. Recognitions Washington Technology “Fast 50” & Government Computer News (GNC) “50 Fastest Growing Firms” for 3 Years Business Week, Initiative for a Competitive Inner City (ICIC) “Inner City 100”- 2009, Ranked #10, 5th Consecutive Year

16. Core Competencies Quality of Care Evaluation Health Care Quality Management Metrics Development & Performance Monitoring Medical Record Review Data and Statistical Analyses

17. SVH Program Onsite Surveys • Surveys apply VA Standards utilizing CMS Process • 30% of State Home are certified under CMS • Subject to Annual Unannounced Surveys by State Survey Agency • Annual Unannounced VA Survey for Per Diem Payments • For the Remainder of SVH, the VA is Only Oversight Body • Three-Year Contract – Health and Life Safety Code • 137 Annual Surveys • Up to 10 Recognition Surveys • Up to 30 For Cause Surveys

18. Clinical Survey Process Task 1 - Off-site Preparation Task 2 - Entrance Conference Task 3 - Initial Tour Task 4 - Sample Selection Task 5 - Information Gathering Resident Reviews Quality of Life Environment Kitchen Sanitation Medication Pass Abuse Prevention Protocol

19. Clinical Survey Process (cont.) Task 6 - Information Analysis and Deficiency Determination Task 7 - Exit

20. Acceptable Plan of Correction Address how corrective action will be accomplished for those residents found to have been affected by the deficient practice; Address how the facility will identify other residents having the potential to be affected by the same deficient practice; Address what measures will be put into place or systemic changes made to ensure that the deficient practice will not recur; Indicate how the facility plans to monitor its performance to make sure that solutions are sustained. Include dates when corrective action will be completed.  

21. Most Commonly Cited Deficiencies

22. State Veterans Homes Perspective Steve Matune 1st Vice President National Association of State Veterans Homes Fred S. Sganga 2nd Vice President National Association of State Veterans Homes

23. SVH’s Lessons Learned • Preparation is the key! • Understanding the process. • Maintaining a professional tone. • Opportunities to address issues before they become cited deficiencies. • Involving your residents.

24. SVH’s Concerns • Will the new process be fair, balanced & consistent? • Can we maintain the positive tone? • The need for ongoing communications between VA, Ascellon and SVH’s.

25. SVH’s Concerns • Identifying nationwide trends and patterns, so we can continue to improve quality of care and quality of life. • Reports at every NASVH Winter & Summer Conference. • Timeliness of receipt of final written summation.

26. Any Questions??