N ovember 30, 2010

1. November30, 2010

2. Transition and Appointments in Kansas Agencies Interim Secretary of KDHE: Acting Secretary John Mitchell Our Vision – Healthy Kansan’s living in safe sustainable environments.

3. Bureau of Child Care & Health Facilities • Consists of three primary sections with director(s) for each: • Child Care (Corrie Edwards & Rachel Berroth) • Health Occupations & Credentialing (Marla Rhoden) • Health Facilities (Charles Moore) Our Vision – Healthy Kansan’s living in safe sustainable environments.

4. Our Bureau Chief is Joseph Kroll Our Vision – Healthy Kansan’s living in safe sustainable environments.

5. BCCHF Org. Chart Our Vision – Healthy Kansan’s living in safe sustainable environments.

6. We are just one of many Bureaus…. This is us! So you see, we are just one part of a very large system . Our Vision – Healthy Kansan’s living in safe sustainable environments.

7. …and still there is more! Our Vision – Healthy Kansan’s living in safe sustainable environments.

8. Child Care consist of 2 sections : CHILD CARE: The Department administers the licensing law as a preventive program to assure that out-of-home care for children and maternity patients will not be exploitive, unsafe, or unhealthy. Our Vision – Healthy Kansan’s living in safe sustainable environments.

9. (Child Care continued) • The main purpose of the law is to protect the health, safety, and welfare of children receiving care away from their parents and home. It is also a consumer protection law assuring parents that the care they are paying for meets minimum standards of good care. Our Vision – Healthy Kansan’s living in safe sustainable environments.

10. Registration or Licensure(depending on the number of children in care) is required regardless of the motivation for providing care, and whether or not there is advertisement of or payment for services. The essential fact is that a child or children receive care away from their own homes. Our Vision – Healthy Kansan’s living in safe sustainable environments.

11. Foster Care: • The State Department of Health and Environment does not place children in residential care. Children are placed by parents or guardian, by a public agency such as a social and rehabilitation services, or by a private child placing agency licensed to perform a placement service. Our Vision – Healthy Kansan’s living in safe sustainable environments.

12. Various kinds of homes are: Family Foster Home • Twenty-four hour family care for one to four children between the ages of infancy to 16 years of age.

13. Group Boarding Home Twenty-four hour non-secure care for five to ten children between the ages of infancy to 16 years of age.

14. Residential Center Twenty-four hour non-secure care for over ten children between the ages of infancy to 16 years of age. Our Vision – Healthy Kansan’s living in safe sustainable environments.

15. Attendant Care Facility Non-secure care not to exceed 24 hours excluding weekends and holidays for juveniles taken into custody. Our Vision – Healthy Kansan’s living in safe sustainable environments.

16. Detention Center A secure public or private facility which is used for the lawful custody of accused or adjudicated juvenile offenders under 16 years of age pending court disposition. Our Vision – Healthy Kansan’s living in safe sustainable environments.

17. Secure Care Center A secure youth residential facility, other than a juvenile detention facility, used to provide care and treatment for alleged or adjudicated children in need of care pursuant to the Kansas code for the care of children. Our Vision – Healthy Kansan’s living in safe sustainable environments.

18. Secure Residential Treatment Facility A secure facility operated or structured to provide a therapeutic residential care alternative to psychiatric hospitalization for five or more youth with a diagnosis of severe emotional, behavioral, or psychiatric condition."Treatment" means comprehensive, individualized, goal-directed, therapeutic services provided to youth. Our Vision – Healthy Kansan’s living in safe sustainable environments.

19. Special Categories of Service Requiring a License • Child Placing Agency • Maternity Care • Maternity Center or Hospital Our Vision – Healthy Kansan’s living in safe sustainable environments.

20. Health Occupations & Credentialing • Kansas law recognizes over 30 health occupational groups for which licensing, registration, or certification is provided. There are 11 regulatory bodies that issue credentials to those professions. Health Occupations Credentialing (HOC) issues licenses to dietitians, speech-language pathologists, audiologists, and adult care home administrators. Our Vision – Healthy Kansan’s living in safe sustainable environments.

21. Health Occupations & Credentialing (continued) • Certification programs administered by HOC include nurse aides, home health aides, and medication aides. Other related professions or para-professions administered through this section include operators of assisted living facilities or residential care facilities, activities directors, and social service designees for adult care homes (ACH) in Kansas. (ACH’s are regulated by the Kansas Department on Aging) Our Vision – Healthy Kansan’s living in safe sustainable environments.

22. Also administered by HOC and related to the aide certification program is the Kansas Nurse Aide Registry, which is federally mandated to assure that only qualified individuals with no findings of abuse, neglect or exploitation on their records are employed to provide direct care services to residents of adult care facilities. Our Vision – Healthy Kansan’s living in safe sustainable environments.

23. Health Facilities consist of both medical facilities and non-long term care entities. Our Vision – Healthy Kansan’s living in safe sustainable environments.

24. Health Facilities staff: • Our section employs 10 RN’s that work as health facility survey staff that tour the various facilities we regulate to assure they are meeting the licensing and/or certification for Medicare. • We also have one State Survey Manager and an assistant, Risk Management Specialist, 2 Sr. Admin Assistants, & a Certification Specialists Our Vision – Healthy Kansan’s living in safe sustainable environments.

25. The health facilities gang. Our section regulates approximately 850 entities. The list of what we regulate follows…….

26. We regulate/license or certify for Medicare: • Medical Facilities (KSA 65-425): • General Hospitals –State Licensed • Critical Access Hospitals (CAH) –State Licensed • Special Hospitals–State Licensed • Ambulatory Surgery Centers (ASC) –State Licensed

27. We regulate/license or certify for Medicare: Non-Long Term Care Entities: • Home Health Agencies (HHA) –State Licensed • *Hospice *End Stage Renal Dialysis Centers (ESRD) • *Rural Health Clinics (RHC) • *Outpatient Physical Therapy (OPPT) • *Mobile X-Ray • *Comprehensive Outpatient Rehabilitation Facilities (CORF) • * These are Medicare Certified only. There is no state licensing. Our Vision – Healthy Kansan’s living in safe sustainable environments.

28. The web site for Child Care and Health Facilities is: Found at www.kdheks.gov at the Health tab. Our Vision – Healthy Kansan’s living in safe sustainable environments.

29. For Health Occupations: Found at www:.kdheks.gov/hoc Our Vision – Healthy Kansan’s living in safe sustainable environments.

30. What is it?

31. Bedbugs Found in Hospital • A hospital is one of the most recent victims of a bedbug infestation that has hit a nursing home, assisted living care facility and an elementary school, among other facilities, in central Maine. Our Vision – Healthy Kansan’s living in safe sustainable environments.

32. (continued): • A hospital is one of the most recent victims of a bedbug. • Bedbug infestations are on the rise nationally. The tiny insects, which feed on human blood while people are sleeping, are most commonly found in hotels and people's homes, but have also made their way to retail stores, movie theaters and healthcare facilities. • Infestations have nothing to do with cleanliness, and the bugs do not carry or spread diseases. However, they are very difficult and expensive to eradicate once they've established a presence. , assisted living care facility and an elementary school, among other facilities, in central Maine. Our Vision – Healthy Kansan’s living in safe sustainable environments.

33. Emergency Response TimeInformationRef: S&C-07-27July 13, 2007 Our Vision – Healthy Kansan’s living in safe sustainable environments.

34. 42 CFR 485.16(a) of the CAH emergency services Conditions of Participation (CoP) require a CAH to have emergency services available 24 hours a day, while §485.618(d) sets standards for emergency services personnel, including response times for personnel to be available on site. Our Vision – Healthy Kansan’s living in safe sustainable environments.

35. On November 24, 2006 CMS published a final rule (71 FR 68159) amending the CAH CoPs at 42 CFR 485.618(d). The revised final rule allows an RN with training and experience in emergency care to conduct some medical screening examinations (MSE). Our Vision – Healthy Kansan’s living in safe sustainable environments.

36. This is permitted only if:* the RN is on site and immediately available when an individual comes to the CAH’s emergency department and requests examination or treatment;* the RN has training and experience in emergency care; and * the nature of the request for medical care is within the scope of practice of an RN and consistent with applicable State laws and the CAH’s bylaws or rules and regulations. Our Vision – Healthy Kansan’s living in safe sustainable environments.

37. When must the physician be called ?(When does the clock start running – i.e. the 30 minutes or 60 minutes in frontier areas.) • When there is no Qualified Medical Person (QMP) on site to complete the MSE; • when it is beyond the scope and practice of the RN present; or • once the QMP is able to determine the severity/scope of the emergent situation and calls the physician. Our Vision – Healthy Kansan’s living in safe sustainable environments.

38. What are our surveyors looking for in their investigation: • Determine whether or not the CAH uses RN’s to conduct medical screening examinations (MSE’s) of individuals coming to the CAH’s emergency department. • Surveyors are to confirm that the CAH’s bylaws or rules and regulations provide for RN’s to screening examinations within their scope of practice, consistent with State law, and that the RN’s performing such examinations have documented training and experience in emergency care. Our Vision – Healthy Kansan’s living in safe sustainable environments.

39. (continued) • Surveyor must review at least one medical record of an emergency department patient whose screening examination was conducted by an RN, to confirm that the examination was within the scope of practice permitted by an RN, consistent with State law and the CAH’s bylaws or rules and regulations. Our Vision – Healthy Kansan’s living in safe sustainable environments.

40. We can meet your information needs with one stop shopping at…. Our Vision – Healthy Kansan’s living in safe sustainable environments.

41. If there is anything you have questions that you do not believe are being responded to appropriately, please feel free to call Charles Moore. The letter of introduction you should be receiving on each and every survey gives my phone number and e-mail address. Our Vision – Healthy Kansan’s living in safe sustainable environments.

42. Needing more information? Contact: Charles Moore, Director Medical ServicesBureau of Child Care & Health Facilities1000 SW Jackson, Suite 200Topeka, KS 66612e-mail: cmoore@kdhe.state.ks.usDesk Phone: 785-296-0131FAX: 785-291-3419 Our Vision – Healthy Kansan’s living in safe sustainable environments.

43. Other contacts in our Bureau:Anita Hodge RN, State Survey Manager 296-0127Lynn Searles RN, Risk Mgmt Specialist 291-3552Tamara Wilkerson, Licensure & Certi. 296-1263 Lois Wilkins, Sr. Admin Assist-Licensure 296-1258Theresa Carter, Sr. Admin Assist-Cert. 296-1249(all are Area code 785) Our Vision – Healthy Kansan’s living in safe sustainable environments.

44. Web site for Critical Access Hospital (CAH) Federal Regulations and Guidelines Appendix Whttp://www.kdheks.gov/bcchf/index.htmlClick on Bureau of Health Facilities and then forms to get to the above. Our Vision – Healthy Kansan’s living in safe sustainable environments.

45. Thought for the day…“The only real mistake is the one from which we learn nothing” Our Vision – Healthy Kansan’s living in safe sustainable environments.

46. Questions? Our Vision – Healthy Kansan’s living in safe sustainable environments.