WACS REVIEW FOR MINIMIZING CITATIONS - Tamra Stimach, Tacoma AFH Provider 4/18/2020 Copyright material for education - Adult Family Home ...

WACS REVIEW FOR
       MINIMIZING
       CITATIONS
   Tamra Stimach, Tacoma AFH Provider
4/18/2020 Copyright material for education

YOUR BUSINESS
DEPENDS ON YOUR
KNOWLEDGE OF
THE LAWS
Why is it important?
•   Insurance companies review yearly
    inspections
•   Less citations result in a decrease in
    liability insurance
•   Caregiver education and
    implementation of safer practices
    can help to reduce citations

RCS WROTE OVER
  9,887 CITATIONS
  FOR AFHS IN 2019
➢ How do we decrease these?
     •   Read and understand the laws and what
         they are asking from you as the provider

➢ Implementing a system with policies will
   decrease your workload and prevent
   citations
     •   How do you organize employee files?
     •   How do you train and plan for fire drills?
     •   What is your policy on changing the
         batteries in fire alarms?
     •   Do you do a review of your AFH before
         your yearly inspection is due?

WAC 388-76- 10025 LICENSE ANNUAL FEE
▪ In 2019, DSHS wrote 431 citations regarding this one law

▪ DSHS sends your renewal out in the mail two months ahead of time

▪ A common reason for citations is that providers may not have paid the fee on
 time
▪ Being solvent as a business owner is your responsibility

▪ Only an IDR (Informal Dispute Resolution) can take this citation off if you have
 all the checks cleared beforehand and if the Office of Financial Management
 did not post it properly

LICENSE LAW

WAC 388-76-10025                                                  SUGGESTIONS
▪ License annual fee.                                             ▪ Make a budget plan
▪ (1) The adult family home must pay the license fee
  that is established in the state's operating budget,              ▪ i.e. put even money away monthly so
  as described in RCW 70.128.060.                                     when the annual fee is due there’s
▪ (2) Each year, the home's annual license fee is due                 enough money to pay it
  during the same month in which the home was
  initially licensed
                                                                  ▪ The fee depends on the number of AFH beds
   ▪ For example, if the home was licensed in June 2010, then
      the annual licensing fee will be due in June of each year
                                                                  ▪ Current rate is $225.00 per bed
▪ (3) The home must ensure that the department
  receives the annual license fee when it is due
▪ (4) If the home does not pay the fee when it is
  due, the department will impose remedies

2019 CITATIONS
TOTALS

    2652   3030

    2267   1938

INFECTION CONTROL LAWS

 WAC 388-75-10255                                                    WAC 388-76-10260
▪ The adult family home must develop and implement an
   infection control system that:                                    ▪ If AFH suspects anyone working or
▪ (1) Uses nationally recognized infection control standards;         living in the home has or may have a
▪ (2) Emphasizes frequent hand washing and other means of
                                                                      communicable disease, the home
   limiting the spread of infection;                                  must implement nationally
▪ (3) Follows the requirements of chapter 49.17 RCW,
   Washington Industrial Safety and Health Act to protect the
                                                                      recognized infection control
   health and safety of each resident and employees; and              measures
▪ (4) Directs all staff to:

▪ (a) Dispose of razor blades, syringes, and other sharp items in
   a manner that will not risk the health and safety of residents,
   staff, other persons residing in the home or the public; and

▪ (b) Use all disposable and single-service supplies and
   equipment only one time as specified by the manufacturer.

WAC 388-76-10255 /10260
▪ 44 citations regarding above WACs in 2019
▪ With the Covid-19 epidemic in 2020, this will most likely be one of the top citations going forward
▪ Create and utilize an infection control manual for each AFH
▪ Have the following on board: hand sanitizer, PPE (gloves, gowns, face masks, eye protection), EPA
  registered disinfectant, soap and paper towels
▪ Good practice:
  ▪ use handless soap dispensers
  ▪ extra trash cans
  ▪ wall units for sanitizer
  ▪ additional equipment to check vital signs in case a patient is isolated in their room
  ▪ 14 days worth of supplies is suggested for 6 residents and all staff in case of an epidemic (exact required
     quantities have not been recommended by officials at this time)

SAFETY AND MAINTENANCE LAW

WAC 388-76-10750
 ▪   The adult family home must:
 ▪  (1) Keep the home both internally and externally in good repair and
 condition with a safe, comfortable, sanitary, homelike environment that is
 free of hazards;
 ▪   (2) Ensure that there is existing outdoor space that is safe and usable
 for residents;
 ▪  (3) Provide clean, functioning, safe, adequate household items and
 furnishings to meet the needs of each resident;
 ▪   (4) Provide safe and functioning systems for:
 ▪   (i) Laundry;
 ▪  (j) Artificial and natural light;ure that there is existing outdoor space
 that is safe and usable for residents;

SAFETY AND MAINTENANCE LAW
▪ (k) Ventilation; and
▪ (l) Any other feature of the home.
▪ (5) Ensure water temperature does not exceed one hundred twenty degrees Fahrenheit at all
  fixtures used by or accessible to residents, such as:
▪ (a) Tubs;
▪ (b) Showers; and
▪ (c) Sinks.
▪ (6) Provide storage for toxic substances, poisons, and other hazardous materials that is only
  accessible to residents under direct supervision, unless the resident is assessed for and the
  negotiated care plan indicates it is safe for the resident to use the materials unsupervised;
▪ (7) Provide rapid access for all staff to any bedroom, toilet room, shower room, closet, other
  room occupied by each resident;

SAFETY AND MAINTENANCE LAW
▪ (8) Keep all firearms locked and accessible only to authorized persons; and

▪ (9) Keep the home free from:

▪ (a) Rodents;

▪ (b) Flies;

▪ (c) Cockroaches, and

▪ (d) Other vermin.

HERE'S ANOTHER EXAMPLE:

HERS’S AN EXAMPLE:

WHERE DO YOU FIND THE TABLES AND CHARTS?
▪ DSHS website– look under Tables and charts and you will be able to see all the
 citations written for both AFH and AL
  ▪ Citations in regards to regulations are posted quarterly

▪ To be proactive, study these citations, learn the laws and keep up with what’s
 happening in our industry
  ▪ Common citation trends can be identified

▪ Having policies and procedures in your AFH will minimize citations

RSC TABLES AND CHARTS 2019

WHAT PROVIDERS DO ON A REGULAR BASIS?
▪ Upon being asked a question by the licensor, avoid stating “I did know that
 law”
▪ Good practice: review and educate staff on AFH regulations regularly
  ▪ i.e. print 1-2 laws out weekly and have the staff read it followed by a discussion

▪ Create your own WAC book with tabs in order to have a hard copy to
 reference
  ▪ Ensure that you consistently keep it updated

GOOD PRACTICE SUGGESTIONS
▪ Computer-based systems may help decrease citations
  ▪ i.e. RMS and Syncwise

▪ Thorough in-home reviews may be performed by a consultant
  ▪ They will give you guidance, tools and resources on what needs to be fixed in order to avoid citations, thus
    resulting in keeping insurance lower

▪ Attending WAC related classes and/or chapter meetings will help provider gain further
  knowledge
▪ Consult AFHC via phone or e-mail regarding questions and clarifications as they are very
  knowledgeable on AFH regulations and good practices
  ▪ In addition, may also work with qualified mentor in the industry

  ▪ Social media sites are not always accurate

GOOD PRACTICE SUGGESTIONS CONT’D
▪ Post citation plan of correction should be typed up and submitted
  ▪ Post this next to your license and inspection reports so families are aware that you
    rectified the issues

▪ Keeping citations at a minimum will ensure that your AFH is presentable to
 prospective resident families/POAs
  ▪ Citations are publicly posted online and very accessible on the DSHS website

ENDING COMMENTS
▪ If the providers study the laws and educate AFH staff, it’s a win-win
▪ Knowledge is power!
▪ The goal of this teaching was to help gain insight on how to look up common
  citations in the AFH industry
  ▪ Try your best to learn the 239 WAC 388-76 laws

▪ This is your business and you’re in control of making it successful
▪ Contact READY MEDS Pharmacy for a complimentary medication review on site done
  by a Pharmacist that includes:
  ▪ Review of medications to ensure in stock, in date and proper storage
  ▪ Check MARs for completeness, accuracy and proper documentation
  ▪ Review all WACS related to medication distribution system to prepare for inspection

ANY COMMENTS OR QUESTIONS
▪ Thank you to Ready Meds Pharmacy and the AFHC for giving us the
 opportunity to learn through webinars, so we stay informed and keep
 learning. Both teams ROCK!