Assisted Living Association of Alabama Spring Conference

1. Assisted Living Association of Alabama Spring Conference March 10, 2010 W.Tom Geary Jr. MD

3. Survey Overview 2009 • Total surveys (1/1/09-12/31/09) 94 • New/Initial SCALF 1 • Follow–up (no score) 13 • Complaint (without score) 2______________________________________ • Surveys with score 78_____________________________________ • Green 16= 20% • Yellow 38= 49% • Red 24= 31%

4. Survey Overview 2009 _______________________________________ Survey result ALF SCALF _____________________________________ Green 12 = 21% 4 = 18% ______________________________________ Yellow 29 = 52% 9 = 41% _______________________________________ Red 15 = 27% 9 = 41% _____________________________________Totals 56 surveys 22 surveys

5. Survey Overview 2009 • Comparison Statistics 2008 2009____________________________________ALF Survey Data GREEN 18% 21% YELLOW 73% 52% RED 9% 27%

6. Survey Overview 2009 • Comparison Statistics 2008 2009 ______________________________________ SCALF Survey Data GREEN 40% 19% YELLOW 32% 41% RED 28% 41%

7. Survey Overview 2009 Five Regular Assisted Living Facilities And Two Specialty Care Assisted Living Facilities Had Zero Deficiencies found during their survey in calendar year 2009

8. Survey Overview 2009 • ENFORCEMENT ACTION 2009 There were 24 facilities with a RED score: Close or change of ownership 12 Probational license 12

9. Survey Overview 2009 Unlicensed Facility Survey Action Report Start date for 2 fulltime surveyors: August 2009_____________________________________ Total number of facility visits: 20 (2.8/month) Number of court cases: 6 (1 to Mental Health) Number closed: 7 Number found NOT to be unlicensed ALF: 6

10. Survey Overview 2009_______________________________ Question:What are the most common regulatory deficiencies that result in a red score on a survey? What are the most serious regulatory deficiencies that will result in enforcement action?

11. Survey Overview 2009 • It is EXTREMELY RARE for any one single deficiency to result in a red survey • There was no facility cited with a red score in 2009 for only one serious deficiency

12. Survey Overview 2009 • As we have reviewed before, in previous presentations, poorly performing facilities almost always demonstrate a failure of leadership: knowing the regulations enforcing complete compliance with the regs provide oversight of the performance of the staff

13. Survey Overview 2009 A. Any deficiency that creates a resident health or safety risk

14. Survey Overview 2009 A. Any deficiency that creates a resident health or safety risk B. Any system-wide failure that puts residents at risk for harm

15. Survey Overview 2009 A. Any deficiency that creates a resident health or safety risk B. Any system-wide failure that puts residents at risk for harm C. Any significant Abuse or Neglect of residents which is not fully investigated, reported to the Bureau, and for which there is no effective corrective action taken

16. Survey Overview 2009 • Health and Safety Risk May be an immediate risk or a pervasive and widespread failure to recognize and respond to the needs of the residents

17. Survey Overview 2009 • Failure to obtain a weight for every resident every month. • Failure to calculate the amount and % weight loss over time: 1 month 3 months 6 months • Failure to notify the doctor and family when a resident has a significant weight loss. • Failure to document something about significant weight loss – a decision and a plan

18. Survey Overview 2009

19. Survey Overview 2009 5. Failure to have a written, individualized plan of care for each resident Must include the physician’s Medical Exam and Plan of Care; the needs and wants of the resident and sponsor/family for personal care and services; and the written communication to the staff of what to do for the resident and when to do it

20. Survey Overview 2009 6. Failure to update the plan of care as the resident gets older or develops new or recurrent medical problems, psycho-social problems, requires hospitalization, or develops other changes in condition; and his or her needs change

21. Survey Overview 2009 7. Failure to identify other significant change in condition, notify, and intervene Most commonly: two or more falls in 30 days or less - Family and doctor not notified Inadequate investigation and assessment and no plan to prevent further falls No written documentation of the care plan changes No written communication of the interventions to the appropriate staff who provide care

23. Survey Overview 2009 8. Failure to identify cognitive or functional problems or decline in a resident – then: initiate and complete the discharge process in a timely manner to ensure that the facility is not providing care beyond that which the facility may lawfully provide 9. Elopement: recurrent episodes not properly addressed

24. Survey Overview 2009 10. Medication issues: Meds must be: Properly maintained and delivered, Taken in accordance with doctor’s orders, Recorded correctly on some type of MAR, and Properly handled at the time of death or discharge. 11. Controlled drugs properly stored with a correct accounting system for all controlled drugs delivered

25. Survey Overview 2009 12. Failure to have the fire prevention and control measures up to date: Failure to have a functional fire alarm system Failure to obtain inspections of the fire alarm and sprinkler systems every 6 months Failure to conduct and document fire drills monthly and for each shift at least once a quarter

26. Survey Overview 2009 B. System wide failure that puts residents at risk for harm 1. Inadequate staffing 2. Lack of Administrator 3. Inadequate food on hand 4. Inadequate staff health screening and training – system wide, both the required subjects for an ALF or SCALF, and Basic CPR

27. Survey Overview 2009 5. Heavy infestation of ants, roaches, rodents – especially with no evidence of pest control efforts 6. Failure to perform appropriate kitchen sanitation and food handling 7. Leaky and unsound structures 8. other fire hazards: gas leaks not addressed, gasoline storage issues

28. Survey Overview 2009 C. Significant Abuse or Neglect of residents which is not fully investigated, reported to the Bureau, and for which there is no effective corrective action taken 1. All allegations of abuse must be taken seriously, investigated and the results reported to the Bureau 2. Accused perpetrators must be immediately removed from duty on a temporary basis to protect other residents

29. Survey Overview 2009 3. Full reports of abuse investigations must be sent to the Bureau promptly after completion 4. Final appropriate action must be taken for substantiated abuse

30. If you have specific questions regarding the survey process or interpretation of the rules, please send an Email to: diane.mann@adph.state.al.us