Assisted Living and Residential Care

SB 74 - News for Regional Center programs

2012-02-01T15:23:00.000-08:00

From a position paper by ResCoalition:

CONCERN

The Department of Developmental Services testified this new audit process was in response to the BSA audit, yet, the BSA audit was of Regional Centers, not vendors and there was no recommendation that vendors get audited. Yet, SB 74 is targeted at the providers/vendors. The way SB 74 was written requires that small entities providing direct service through multiple Regional Center contracts be required to obtain audits at their own expense, a daunting budgetary concern in this economy, especially as the majority of providers have received a 4.25% rate cut passed in the past couple of budget years. Under SB 74 requirements, entities providing residential services to as few as five individuals will fall under this requirement despite the fact that they hold five separate contracts for approximately $60,000/year, one contract per individual they serve. This has created an unfunded mandate with a cost range of six to twelve thousand dollars per year.

ResCoalition is concerned that this sweeping legislation negates the purpose of accountability and transparency both recommended by the BSA and directed by the Governor. Firstly, it is unlikely that the Regional Centers will have the ability to review audits from all the providers/vendors which will prove this requirement to be inadequate and an unnecessary financial burden. In this time of budget crisis it is important for funds to be focused on direct service to the population, this audit requirement as written, will only take money away from this effort.

Fiscal audits won’t address service issues related to improving quality of services to individuals with developmental disabilities. A fiscal audit only ensures there are adequate fiscal process to track dollars, it does not address if those dollars were spent on the correct services.

This audit requirement does, however, make sense for larger contracts/purchase of services as outlined in the BSA audit recommendations. Therefore, specifying the contract/purchase of service amounts of over $250,000 and $500,000 will be required to obtain an independent audit which will be submitted to and reviewed by the Regional Center allows for manageable loads for the Regional Center in addition to narrowing the most likely concerns for financial mismanagement of public funds as outlined in the BSA audit recommendations. This also meets the mandate for accountability and transparency of public funds which is the concern within this system.

INTENT
ResCoalition believes that the true intent of the BSA audit findings/recommendations and the Governor’s directive was to address the issues pertaining to RC contracts/purchase of service that exceed certain financial thresholds. Unfortunately, this bill currently dilutes the ability for the system to locate large pockets of misused or misappropriated public funds while creating an expensive unfunded mandate for the community.

RECOMMENDATIONS

ResCoalition recommends adding the clarification that these audits will be necessary for individual contracts or purchase of service that meet the fiscal threshold outlined in the legislation:

(A) When the contract/purchase of service amount received from the regional center or regional centers during the entity’s fiscal year is more than or equal to two hundred fifty thousand dollars ($250,000) but less than five hundred thousand dollars ($500,000), the entity shall obtain an independent audit or independent review report of its financial statements for the period. Consistent with Subchapter 21 (commencing with Section 58800) of Title 17 of the California Code of Regulations, this subdivision shall also apply to work activity program providers receiving less than two hundred fifty thousand dollars ($250,000).

(B) When the contract/purchase of service amount received from the regional center or regional centers during the entity’s fiscal year is equal to or more than five hundred thousand dollars ($500,000), the entity shall obtain an independent audit of its financial statements for the period.

QUESTIONS TO CONSIDER
As we consider the implications of this change, there are some issues that might arise. One concern that was presented was the manpower it would take to identify those contract/POS agreements over the identified thresholds. With the transition to electronic data systems including billing, it is anticipated this will actually be minimal. A second concern and legitimate question is to whether this provides adequate oversight. When one reviews the BSA audit, the problem contracts identified, would all still qualify under this modification.

Paraprosdokians

2011-09-05T20:08:00.000-07:00

This made me chuckle:

A paraprosdokian is a figure of speech in which the latter part of a sentence or phrase is surprising or unexpected in a way that causes the reader or listener to re-frame or reinterpret the first part. It is frequently used for humorous or dramatic effect, sometimes producing an anticlimax. For this reason, it is extremely popular among comedians and satirists.

"Where there's a will, I want to be in it," is a type of paraprosdokian.

I asked God for a bike, but I know God doesn't work that way, so I stole a bike and asked for forgiveness.

Do not argue with an idiot. He will drag you down to his level and beat you with experience.

Going to church doesn't make you a Christian any more than standing in a garage makes you a car.

The last thing I want to do is hurt you, but it's still on the list.

Light travels faster than sound. This is why some people appear bright until you hear them speak.

If I agreed with you, we'd both be wrong. (I have to remember this one)

We never really grow up, we only learn how to act in public.

War does not determine who is right - only who is left.

Knowledge is knowing a tomato is a fruit; Wisdom is not putting it in a fruit salad.

The early bird might get the worm, but the second mouse gets the cheese.

Evening news is where they begin with 'Good evening', and then proceed to tell you why it isn't.

To steal ideas from one person is plagiarism; To steal from many is research.

A bus station is where a bus stops. A train station is where a train stops. On my desk, I have a work station.

How is it one careless match can start a forest fire, but it takes a whole box to start a campfire?

Some people are like Slinkies ... Not really good for anything, but you can't help smiling when you see one tumble down the stairs.

Dolphins are so smart that within a few weeks of captivity, they can train people to stand on the very edge of the pool and throw them fish.

I thought I wanted a career, turns out I just wanted pay checks.

A bank is a place that will lend you money, if you can prove that you don't need it.

Whenever I fill out an application, in the part that says "If an emergency, notify:" I put "DOCTOR".

I didn't say it was your fault, I said I was blaming you.

I saw a woman wearing a sweat shirt with "Guess" on it...so I said "Implants?"

Why does someone believe you when you say there are four billion stars, but check when you say the paint is wet?

Women will never be equal to men until they can walk down the street with a bald head and a beer gut, and still think they are sexy.

Why do Americans choose from just two people to run for president and 50 for Miss America?

Behind every successful man is his woman; behind the fall of a successful man is usually another woman.

A clear conscience is usually the sign of a bad memory.

You do not need a parachute to skydive. You only need a parachute to skydive twice.

The voices in my head may not be real, but they have some good ideas!

Always borrow money from a pessimist. He won't expect it back.

A diplomat is someone who can tell you to go to hell in such a way that you will look forward to the trip.

Hospitality: making your guests feel like they're at home, even if you wish they were.

Money can't buy happiness, but it sure makes misery easier to live with.

I discovered I scream the same way whether I'm about to be devoured by a great white shark or if a piece of seaweed touches my foot.

Some cause happiness wherever they go. Others whenever they go.

There's a fine line between cuddling and holding someone down so they can't get away.

I used to be indecisive. Now I'm not sure.

When tempted to fight fire with fire, remember that the Fire Department usually uses water.

You're never too old to learn something stupid.

To be sure of hitting the target, shoot first and call whatever you hit “the target”.

Nostalgia isn't what it used to be.

Some people hear voices. Some see invisible people. Others have no imagination whatsoever.

A bus is a vehicle that runs twice as fast when you are after it as when you are in it.

Change is inevitable, except from a vending machine.

Regional Centers and audits

2011-08-23T14:38:00.001-07:00

From ResCoalition:

In March of this year, the legislature passed SB74. This bill was intended to find additional savings in an effort to reduce the budget deficit. Within this bill there five (5) trailer bills in addition to specific savings. One trailer bill was titled Regional Center Audits. Within this trailer bill were provisions that mandate vendors to also get audits in some cases. Since this trailer bill has created a great deal of confusion and frustration amongst the vendor community this is being written to clarify what the new requirements are. First, you are only required to get a financial audit IF you receive more than $500,000.00 in payments from one or more regional centers a year. This means total gross income from one or more regional centers, not just more than 500,000.00 per vendorized program. It is important to remember that it is regional center payments NOT room and board payments. This means that if the regional center is payee, you don’t include the SSA/SSI payments in calculating your threshold. You also exclude any money paid by the RC for P&I.

If you have gross revenues from one or more regional centers you must get a financial audit from an independent CPA, and must be done in accordance with the American Institute of Certified Public Accountants. This means they’ll look at your accounting practices and methods, and your procedures for recoding, classifying, and summarizing transactions and accumulating information. If yours is a nonprofit you should already be doing annual independent financial audits. As a result, you wouldn’t be required to do another. You can turn in that one.

If you have gross revenues from one or more regional centers between 250,000 and 500,000 (remember excluding room and board payments and no P&I), you are not required to do a financial audit. Instead you are required to get a financial review. This is a less cumbersome (and cheaper) process.

Now there is an interesting issue surrounding this mandate. There is no legal requirement for when the audits must be completed. By this we mean there are no timelines for completion. This means that a Regional Center cannot cite you for failing to get an audit done on time – there is no time requirement. We appreciate this will be a contentious issue because RC’s will attempt to give us deadlines. However, these deadlines are not enforceable and they cannot penalize us for failing to comply.

If you have any thoughts or questions please don't hesitate to throw them back. If you have a question, I'd bet at least 30 other people are thinking the same thing so get back to us.

Since we're talking about XB/SB74 trailer bill language, there is a section that now requires negotiated rate programs (if you are funded under the ARM rate structure, you are not negotiated rate) to spend at least 85% of funding on direct service expenditures. If more information on this is of interest to you, please let us know.

Boyd Bradshaw

President ResCoalition

Total Care Exceptions and Hospice Care

2011-08-02T14:18:00.000-07:00

Here's the policy:

Health and Safety Code Section 1569.73 requires facilities to obtain a Hospice Care
Waiver from the California Department of Social Services if they wish to retain clients
receiving hospice care services. Residents receiving hospice care services may
eventually require “total care,” which is a prohibited health condition as outlined in
California Code of Regulation (CCR), Title 22, Section 87615(a)(5).

Total care isdefined as a condition where residents depend on others to perform all of their activities of daily living, see (CCR) Title 22, Section 87459 Functional Capabilities.
A licensee must request a total care exception to allow a resident to be retained in the
Residential Care Facility for the Elderly (RCFE) if the resident’s condition requires total
care. The requirements for requesting this total care exception are found in California
Code of Regulation (CCR), Title 22, Section 87616.

To see the new and improved procedure, to to
http://ccld.ca.gov/res/pdf/10rcfe04.pdf

CA Budget passed

2011-07-05T14:44:00.000-07:00

CDCAN Information:

LEGISLATURE PASSES BUDGET BY MAJORITY VOTE - HEADS TO GOVERNOR

SACRAMENTO, CALIF (CDCAN) [Last updated 06/28/2011 09:19 PM] - The California Legislature passed, on a majority vote, the main budget bill for 2011-2012, SB 87 that did not rely on any votes from Republicans.

The Assembly voted to pass the main budget bill after brief debate by a vote of 51 to 25 just after 6:30 PM.. The State Senate followed but had alittle more difficulty in rounding up the needed 21 votes among Democrats to pass it. The first roll call taken at around 7:25 PM, failed to win the necessary 21 votes to pass, but subsequently passed at 9:19 PM by a vote of 21 to 19.

SB 87 was sent immediately to the Governor for his approval, which he is expected to sign either this evening or tomorrow morning.

Both houses also approved 6 of the 7 budget trailer bills. As of 09:19 PM both houses are waiting for the one remaining budget trailer bill dealing with education finance that the State Senate has still not received from the Legislative Counsel for members to review and vote on. That trailer bill is expected to be delivered to the Senate at around 9:45 :PM and both houses are expected to take up the bill and pass shortly after that, wrapping up their work on all the budget bills. .

State Employees Getting Raises?

2011-06-07T14:35:00.000-07:00

In response to information that Psych Techs will get a raise this year, while most other services take cuts, this information is adapted from a bulletin board. Raises some pretty interesting questions, doesn't it?

How can the state afford to increase pay to state employees while so many state funded health and human service programs in our communities are in danger of collapse?

I have talked about the DDS budget with many consumers and family members and there is one statistic that concerns them more than any other. How can it be that the average cost per individual served at the State Developmental Centers has been allowed to reach $346,000 per person per year? It’s true that as population declines, the cost per person rises, but at some point it becomes ridiculous, and we are long past that point.

And it never stops. Of all the destructive things included in the Governor’s 2011-2012 budget, there is one item that few people have noticed. In August, 2010, the Legislature approved a new contract for the California Association of Psychiatric Technicians (CAPT). That contract raises the TOP of the wage scale for Psych Techs at the Developmental Centers by 5% - effective January 1, 2012. This means that the direct service staff in the Developmental Centers, who are already at their highest level of earnings, will get an even bigger share of the funds available for the developmental disabilities system. Meanwhile, community-based services are starving.

Consider this: The average annual cost to serve an individual at a State Developmental Center in 2011-12 will be approximately $346,000. The best estimate I've heard of the average annual cost to serve individuals in the community who have moved out of a Developmental Center is $110,000. Just a few years ago the average cost at the DCs was about $249,000. If the DCs were required to limit their average annual cost per consumer to $249,000, a savings of $97,000 per individual would be realized. Since there are approximately 1800 individuals currently residing in California's DCs, the annual savings to the State would be $174 million. That is the exact amount the legislature is requiring to be saved from community services in the coming year.

When asked how direct service staff in DCs could possibly be getting raises at this particular moment, we are told that these raises make up for other concessions they’ve made. Concessions with an incredible benefit package, which so many community services are simply not able to provide.

Your thoughts?

Community Care Licensing - Key Indicators

2011-05-07T12:04:00.000-07:00

Due to the ongoing fiscal crisis in California, CCLD has lost 30 percent of the staffing resources necessary to complete mandated inspections. To increase health-and-safety protections for those in care, CCLD is implementing a program to increase the current frequency of inspections and implement Key Indicators Compliance Reviews. The key indicators are a shortened version of the larger set of regulations. They are "key" in that they measure and predict compliance with the full set of regulations. This does not eliminate the licensee's responsibility to be compliant with all regulations. Nor does it mean that a facility will not be cited for noncompliance with regulations not listed as key indicators.

Check out the key indicators:

http://www.myccl.ca.gov/res/docs/ARF-kit.pdf
http://www.myccl.ca.gov/res/docs/RCFE-kit.pdf
http://www.myccl.ca.gov/res/docs/GH-kit.pdf

And how can you stay in compliance?
Community Training Connection's Regulatory Update Subscription AND
Compliance Connection - regulatory compliance and best practices - with people with over 100 total years of industry experience.

http://www.communitytrainingonline.com

Budget thoughts - Regional Centers

2011-04-23T12:54:00.000-07:00

I have been writing to the Governor, legislators, and talking to anyone who will listen (and many who didn't want to listen at all) about this situation - which I hear about almost weekly from clients.

Just got off the phone with the administrator of a regional center-funded residential facility that has 4 clients, 4 service coordinators, 1 quality assurance staff, and a case management liaison. Each of those regional center staff visit this facility at least 4 times a year (and the service coordinator sees each client quarterly if they are on different visit cycles based on their birthday month), bringing the grand total of regional center visits to at least 12 times per year, plus at least 1 CCL visit. And most of the residents/consumers/clients in these facilities attend a day program, so there are additional people who might notice changes that would require follow up (if you accept the assumption that the monitors are assuring people's health and safety in facilities). In sharp contrast to RCFEs, who can go up to 5 years without seeing a monitoring person. I understand that the CCL part has to do with Medicaid Waiver and an agreement with Department of Health Services, but really??????? Is it just me?

My letters to legislators address the massive inefficiencies in our systems. Assigning one person to each facility still means quarterly visits which can be done at a fraction of the current cost to the operations budget. And might begin to address the disparity between expenditures for regional center operations and purchase of services. Residential providers are expected to provide routine transportation without additional compensation to their current rates. The rates were set when gasoline was somewhere around $1.25 (according to CA Energy Commission). RC staff have had been reimbursed at progressively higher rates since the residential rates were set. And whose rates of pay have been decreased by over 4%? And who will have to pay back funds from July 2010? Hmmm.......

I know people read these posts. I know why no one responds in writing. I wish you would, though.

Argh…..

Soles 4 Souls at Sports Chalet

2011-04-05T22:54:00.000-07:00

In response to the devastating earthquake and tsunami that hit Japan, Soles4Souls has once again reached out to Sport Chalet to ask for help collecting gently worn shoes.

During our last Soles4Souls shoe drive, you collected and brought in over 1.3 million pairs of shoes to help those in need in Haiti.

Your help is needed again.

Sport Chalet Locations will be accepting gently worn men's, women's, and kids' shoes through Sunday, April 10th.

All shoes collected will be sent directly to Soles4Souls for distribution in Japan and other areas of need.

So take a look in your closet, under your bed, and out in the garage...

Go next door and ask your neighbor if they have shoes they'd like to donate too.

Then just stop by your local Sport Chalet and drop them in the box.

We thank you so much!

=========

If you are attending classes on April 9 in Torrance or April 10 in Granada Hills, bring shoes. We will drop them off at Sport Chalet by the April 10th deadline. It's all good.

Trailer Bill Language

2011-04-05T22:52:00.000-07:00

This information is from ResCoalition, an organization representing residential service providers who serve people with developmental disabilities.

The governor signed into law SB74 which finalized the DDS budget. What this means to residential service providers is the following:

In addition to the trailer bill language listed below, there was a provision of SB74 that mandates that DDS create and present best practices to the legislature by May 15th. These best practices replace the Purchase of Services Standards that was previously required. It is expected however that they will generally be the same.

4620.3. (a) To provide more uniformity and consistency in
the administrative practices and services of regional centers
throughout the state, promote appropriateness of services,
maximize efficiency of funding, address the state budget deficit,
ensure consistency with Lanterman Act values, maintain the
entitlement to services, and improve cost-effectiveness, the
department, in collaboration with stakeholders, shall develop best
practices for the administrative management of regional centers
and for regional centers to use when purchasing services for
consumers and families. Developing regional center administrative management
best practices, the department shall consider the establishment of
policies and procedures to ensure prudent fiscal and program
management by regional centers; effective and efficient use of
public resources; consistent practices to maximize the use of federal
funds; detection and prevention of fraud, waste, and abuse; and
proper contracting protocols.

There are NO PROVISIONS FOR FUNDING TO BE CUT FURTHER. The outstanding $174 million dollars is attached to DDS's best practices/purchase of service (POS) standards. There is NO provision to cut funding further if adequate savings is not achieved through the best practices/POS standards process.

Trailer bills were passed as part of this bill to "save 191 million dollars". These trailer bills impact us in the following ways . . .

4629.7. (a) Notwithstanding any other provision of law, all
regional center contracts or agreements with service providers in
which rates are determined through negotiations between the
regional center and the service provider shall expressly require
that not more than 15 percent of regional center funds be spent on
administrative costs. For purposes of this subdivision, direct service
expenditures are those costs immediately associated with the
services to consumers being offered by the provider. Funds spent
on direct services shall not include any administrative costs.
Administrative costs include, but are not limited to, any of the
following:
(1) Salaries, wages, and employee benefits for managerial
personnel whose primary purpose is the administrative management
of the entity, including, but not limited to, directors and chief
executive officers.
(2) Salaries, wages, and benefits of employees who perform
administrative functions, including, but not limited to, payroll
management, personnel functions, accounting, budgeting, and
facility management.
(3) Facility and occupancy costs, directly associated with
administrative functions.
(4) Maintenance and repair.
(5) Data processing and computer support services.
(6) Contract and procurement activities, except those provided
by a direct service employee.
(7) Training directly associated with administrative functions.
(8) Travel directly associated with administrative functions.
(9) Licenses directly associated with administrative functions.
(10) Taxes.
(11) Interest.
(12) Property insurance.
(13) Personal liability insurance directly associated with
administrative functions.
(14) Depreciation.
(15) General expenses, including, but not limited to,
communication costs and supplies directly associated with

This bill would make certain persons or entities that have been
convicted of prescribed crimes or have been found liable for fraud
or abuse in any civil proceeding, or that have entered into a
settlement in lieu of conviction for fraud or abuse in any
government program, within the previous 10 years, ineligible to
be regional center vendors, and would require the department to
adopt related emergency and nonemergency regulations. The bill
would require the State Department of Social Services and the
State Department of Public Health to notify the department of any
administrative action, as defined, initiated against a licensee serving
consumers with developmental disabilities

4640.6. (a) In approving regional center contracts, the
department shall ensure that regional center staffing patterns
demonstrate that direct service coordination are the highest priority.
(b) Contracts between the department and regional centers shall
require that regional centers implement an emergency response
system that ensures that a regional center staff person will respond
to a consumer, or individual acting on behalf of a consumer, within
two hours of the time an emergency call is placed. This emergency
response system shall be operational 24 hours per day, 365 days
per year.

4648.12. (a) The Legislature finds and declares that under
federal and state law, certain individuals and entities are ineligible
to provide Medicaid services.
(b) An individual, partnership, group association, corporation,
institution, or entity, and the officers, directors, owners, managing
employees, or agents thereof, that has been convicted of any felony
or misdemeanor involving fraud or abuse in any government
program, or related to neglect or abuse of an elder or dependent
adult or child, or in connection with the interference with, or
obstruction of, any investigation into health care related fraud or
abuse, or that has been found liable for fraud or abuse in any civil
proceeding, or that has entered into a settlement in lieu of
conviction for fraud or abuse in any government program, within
the previous 10 years, shall be ineligible to be a regional center
vendor. The regional center shall not deny vendorization to an
otherwise qualified applicant whose felony or misdemeanor charges
did not result in a conviction solely on the basis of the prior
charges

4648.14. Notwithstanding any other provision of law, the State
Department of Social Services and the State Department of Public
Health shall notify the State Department of Developmental Services
of any administrative action initiated against a licensee serving
consumers with developmental disabilities. For the purposes of
this section “administrative action” includes, but is not limited to,
all of the following:
(a) The issuance of a citation requiring corrective action for a
health and safety violation.
(b) The temporary or other suspension or revocation of a license.
(c) The issuance of a temporary restraining order.
(d) The appointment of a temporary receiver pursuant to Section

4652.5. (a) (1) An entity receiving payments from one or
more regional centers shall contract with an independent accounting
firm for an audit or review of its financial statements subject to all
of the following:
(A) When the amount received from the regional center or
regional centers during the entity’s fiscal year is more than or equal
to two hundred fifty thousand dollars ($250,000) but less than five
hundred thousand dollars ($500,000), the entity shall obtain an
independent audit or independent review report of its financial
statements for the period. Consistent with Subchapter 21
(commencing with Section 58800) of Title 17 of the California
Code of Regulations, this subdivision shall also apply to work
activity program providers receiving less than two hundred fifty
thousand dollars ($250,000).
(B) When the amount received from the regional center or
regional centers during the entity’s fiscal year is equal to or more
than five hundred thousand dollars ($500,000), the entity shall
obtain an independent audit of its financial statements for the
period.

Existing law requires regional centers, in order to implement
changes in the level of funding for regional center purchase of
services, to reduce certain payments for services delivered by
4.25% from July 1, 2010, to June 30, 2011, except as specified,
and authorizes the temporary modification of personnel
requirements, functions, or qualifications, or staff training
requirements, and suspends prescribed annual review and reporting
requirements for affected providers, until June 30, 2011.
This bill would continue those provisions until June 30, 2012.

Support AB 862

2011-02-21T15:56:00.000-08:00

ASSEMBLYMAN SILVA INTRODUCES

REGIONAL CENTER RECORDS ACT

February 17, 2011

SACRAMENTO – Today, Assemblyman Jim Silva (R - Huntington Beach) introduced

AB 862, the Regional Center Records Act. This measure will bring transparency to a major taxpayer-funded program in California. “Taxpayers have a right to know how their money is being spent. Parents, vendors and the centers themselves will benefit from increased transparency,” Silva said.

Since the passage of the Lanterman Act in 1969, the 21 Regional Centers have been the conduit to provide services to the developmentally disabled. While they have done great things in accomplishing this mission, recent investigative reports have given cause for concern. A report by the California State Auditor has raised serious questions about how the regional centers choose and pay vendors for the services they provide as well as capital projects and administrative services. The state auditor has suggested that a more uniform, transparent process would improve the cost effectiveness of this program.

“We are proud to be the sponsor of this Act. Regional centers are vital to the community but they need to be more forthcoming with their information,” said Boyd Bradshaw, president of the ResCoalition, a coalition of residential care providers.

California appropriated over $4 billion in last year’s budget to provide for the developmentally disabled. AB 862 will require the 21 Regional Centers to make several important points of data available to the public to include fiscal and administrative information. It can be heard in its first committee as soon as 30 days from introduction.

Assemblyman Jim Silva represents the 67^th Assembly District, which includes the communities of Anaheim, Cypress, Garden Grove, Huntington Beach, La Palma, Los Alamitos, Rossmoor, Seal Beach, Stanton, Sunset Beach and Westminster.

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Valentine's Day

2011-02-09T15:33:00.000-08:00

The month of February and Valentines Day brings a celebration of love and stirs couples to rekindle feelings of romance and devotion. Not so different from young couples are aging seniors, celebrating memories of sweethearts and romance in days gone by. Sit a while with a senior couple and they will soon be telling you their romance story or listen to a widow or widower as they sing their favorite love song from their youth.

Dementia and Alzheimer’s can rob senior minds of many of these treasured memories, changing their personality and life style. Because of these and other illnesses, many seniors end up in nursing homes or care facilities where only their basic physical needs are cared for by the facility staff. To these seniors, Valentines Day becomes no different from every other day. They often find it difficult to relive memories of the past. In one care facility a sign placed lovingly over a patient’s bed reads, “I Am Somebody’s Sweetheart,” as if to say I once dreamed, lived and loved, please treat me kindly.

To see the rest of the article, go to http://www.longtermcarelink.net/article-2011-02-7.htm

Vendor Cuts - Lawsuit Update

2010-11-13T23:26:00.000-08:00

Information from ResCoalition:

The state budget recently passed included an additional 1.25% cut to regional center vendors, retroactive to July 1, 2010.

There are now 12 plaintiff groups participating in a lawsuit against all regional centers and DDS, making this a broad based lawsuit representing most vendor types in the state. The suit addresses the retroactive cut - one which would be devastating to providers.

A second hearing is scheduled for November 23rd to make a decision. This is an extremely important case because NO PRECEDENT exists in CA for retroactive returns of money. This means there is nothing that says the state can or can't take money back after paying it. With a projected 6 years of additional deficits in CA AND the $25 billion coming up next year this could be a significant issue for years to come.

Stay tuned for updates.

CCL Response to Budget Crisis

2010-10-07T07:39:00.000-07:00

This information came to us in several forms last week. We've had some information that the policy would change, but nothing posted on ccld.ca.gov as yet.

Applications
With very limited exceptions, application processing will cease immediately. Application specialists are being reassigned to other duties. CCL is reviewing pending applications to see if any can be processed quickly. On a case by case basis, CCL will make exceptions for immediate health and safety such as an unlicensed operator and situations involving communities where residents are already in care (change of management company, change of owner).

Appeals
Appeal processing has been put on hold, although licensees should continue to submit them. Health condition relocations will be the only exception. LPAs are being instructed to call their manager before citing a licensee if there is any doubt about a regulatory requirement in order to avoid the need for an appeal in the first place.

Orientations
No orientations will take place after October 1, 2010. Those already conducted will not expire while this suspension is in place.

Other
CCL is also suspending all internal training, limiting staff involvement in community events and meetings, and reducing phone coverage for the public. Public phone coverage is limited to 10am to 3pm. Licensee “Officer of the Day” phone time will not be reduced.

What Will CCL be Doing?
CCL's top priority is complaint investigations. Depending on the staffing level of the individual office, 5-year inspections and 30% random sample inspections will take place if staffing allows. CCL also intends to continue processing waivers and exceptions.

Audit of regional centers....

2010-08-25T14:51:00.000-07:00

.....finds nepotism, fear of retaliation (from California Watch Blog)

A nonprofit executive awarded state funds to her sister even though the service was available at a lower cost. A chief executive breached a confidential police tipline. And workers spent $900,000 on transportation - purposely spiking the budget to ensure more money the next year.

Those were some of the findings in a Bureau of State Audits report about state oversight of regional centers, nonprofit organizations that spend about $3.4 billion annually to serve 240,000 Californians with developmental disabilities.........

.........The Assembly Committee on Accountability and Administrative Review called for the probe of the Department of Developmental Services. Committee chairman Hector De La Torre, D-South Gate, said the audit backed up what he heard in a prior hearing about "favoritism in contracting, a lack of information about how regional centers spend billions of public dollars per year, and the pervasive fear of retaliation among regional center staff and service providers."

For the full story, click on:

http://californiawatch.org/watchblog/audit-of-regional-centers-finds-nepotism-fear-of-retaliation-4256

Comments following the article also interesting.....

Smoking in Residential Care Facilities

2010-05-05T22:35:00.000-07:00

One of our Adult Residential students got a copy of a ruling about smoking from a regional center employee that stated that smoking was not permitted anywhere on the grounds of the facility. It was delivered with a warning that the facility would be fined if anyone was smoking. They were having people walk to the edge of the property to smoke, fearing a citation if smokers were discovered in the previously known "designated area."

It seemed impossible to enforce. And it is - because it didn't apply to Adult Residential Facilities. The sections quoted on the ruling are for children's facilities.

As if this work isn't difficult enough having to balance the interests - often changing - of two enforcement organizations......

Please let me know if you also received this information.

2010-05-04T06:30:00.000-07:00

Please support AB 2220

Currently, there is no policy to evaluate the governance of the monies filtered through the regional center system. The Department of Developmental Services is not equipped to monitor the individual financial aspects that may assist in ensuring the funding is being utilized effectively, efficiently, and in the best interest of those with disabilities.

Regional Centers hide under their non-profit status when asked for information that would typically be covered under the California Public Records Act and the Legislative Open Records Act, among other statutes It is the intent of AB 2220 to require the Regional Centers, private non-profit community agencies that utilize public funds to provide state mandated services to persons with disabilities, to disclose information to the public under the California Public Records Act (PRA).

Send letters of support to hcdd@pacbell.net

"Building Partnerships, Supporting Choices"

2009-09-21T11:18:00.000-07:00

That's the tag line on DDS letterhead - has that filtered down to the regional centers?

Supporting choices?

Like for the woman recently moved from her home of 15 years with 2 hours notice?

Building partnerships?

Your partner is interesting.... you take all of the financial risk and your partner is in complete control.

What do you think?

Regional Center Update

2009-09-21T11:07:00.000-07:00

Here's the uniform closure schedule. I'd love to hear from those of you who will have to staff at times you haven't had to in the past. I'm trying to figure out the real impact of the budget - which is significantly more than the 3% "discount" for residential.

For me, the issue that keeps getting swept under the rug is that there is only one place in the developmental services system that didn't take a cut (4 budget areas - DDS headquarters, State Developmental Centers, Regional Center Operations, and Purchase services). I'll give you a hint - DDS HQ and State DCs are staffed by state employees who have to take furlough days. So what's wrong with this picture? The "stakeholder" meetings where information was gathered about how to best approach budget cuts didn't seem to take the information from all of the "stakeholders." The question I kept posing to legislators was to consider the importance of specific services to the people with developmental disabilities - Choice: roof over head or case manager? Choice: Early intervention services or 21 accounting departments? I may have oversimplified the choices here, but I think the message is clear.

Please let me know what your thoughts are. You can send messages on this blog and no one has to know who you are - for those who fear retaliation should you have an opinion that is counter to those who sign the payment authorization forms and make referrals.

Uniform closure schedule:

1. January 1

2. The third Monday in January

3. The third Monday in February

4. March 31

5. The last Monday in May

6. July 4

7. The first Monday in September

8. November 11

9. Thanksgiving Day

10. The day after Thanksgiving Day

11. December 24

12. December 25

13. December 26 (for 2009 this Holiday is observed on Monday, December 28, 2009)

14. For 2010 ONLY, April 5, 2010

15. Effective 2010 and on, the second Monday in October (due to the 60 day notice requirement this is NOT a FY 2009-10 Holiday)

Regional Center Update

2009-09-11T12:18:00.000-07:00

I've taken about 8 calls in the last month that give me a sense that regional centers have increased their expectations of providers. Long term clients are being moved with little or no notice, providers are being required to do renovations to their property, and there has been a lot of pressure to meet the training requirements (not that I'm complaining about that, of course).

I am a major supporter, as those who know me will attest, of great programs that are respectful of clients, but it seems that increasing expectations right now is just bad timing. All of you have given the regional center services at a 3% "discount" and it's still unclear what the impact of the day program universal closure days will be. It seems like the regional centers might be looking at how to better value the services provided in residential care.

And then there's training...... Our company is a training company, so you won't hear me telling people not to get training. We've tried to keep our catalog reasonably priced. We've increased our online offerings, to save you travel costs and time. And yet, I hear about regional centers that don't accept online training to meet the Title 17 requirements, and those that are requiring people to get training to meet plans of correction. My favorite was a request to train people on how to cook chicken. As my teenage daughter might say, "whatever...."

And to that training requirement..... Third Thursday at Sam's Cafe at New Horizons in North Hills. Reasonably priced at $20 for 3 CEUs; 4th staff person may attend at no cost. Call us or check website www.CommunityTrainingOnline.com for more information.

Fee Increase from Community Care Licensing

2009-09-11T12:09:00.000-07:00

Today I sent an email newsletter with the good news and the bad news from Community Care Licensing. Annual fees are increasing by almost 10%. Since most of our client facilities are experiencing, in some cases, unprecedented open beds, this is really bad news. For those funded by regional centers, this is a major slap in the face. First a 3% "discount" on your billing; new days for day program closure where you'll staff when you haven't in the past; now an increase in rates.

Here's the full fee schedule, effective 7/28/09:

http://ccld.ca.gov/res/pdf/Fees.pdf

It's a good thing that most of you love the work you do and that the residents/clients/consumers come first for you. It's hard to imagine that those making these decisions have considered the impact on the people you serve. Maybe I've been around this continuous state budget crisis too long.

What do you think?

Date Changes

2009-06-12T16:58:00.000-07:00

We have moved our 3 hour training in the San Fernando Valley to the Third Thursdays, starting in August. Mostly we like the way it sounds......Third Thursday. Much easier to remember than any other schedule, isn't it? Information on these classes will be posted on our website within the week.

Regional Center Funding June 2009

2009-06-12T16:51:00.000-07:00

What follows is an invitation from Boyd Bradshaw, the president of ResCoalition to give your thoughts on changes that could be made to Title 17 that wouldn't affect consumer health or safety. There is a growing sense in Sacramento that not ALL stakeholders have been represented in the discussions about how to find millions of dollars in the budget. Most of you know that the current proposals for cuts ALL come from the provider budget. Here is your chance to say what's on your mind. In every class, one of you has wondered aloud about why the bureaucracy doesn't take the same level of cuts as the providers.

ResCoalition is the reason that Level 2 and 3 providers had an increase to accomodate changes in the minimum wage; ResCoalition is the reason that you had money returned to you shortly after the 3% "discount" was applied (SSI funds were not supposed to be discounted); ResCoalition is fighting for regional center oversight and transparency. In short, this group is a major voice for residential providers. I hope you'll send your thoughts.

- - - - - - - - - - - - - -
06/12/09

I met with DDS yesterday and they've asked us to try and identify anything that can be modified or changed within title 17 constraints to save money. Even though we're primarily residential service providers, they're interested in any and ALL ideas relating to Title 17 - lets give them some.

Please gather ideas and get them back ASAP to hcdd@pacbell.net. Don't worry about collecting everything and sending them once, feel free to blast as you come up with them.

If you have any questions or concerns please drop me an email or call me at 714 637-0200

Training for Regional Center Vendors

2009-06-09T11:35:00.000-07:00

This has been a tough year, hasn’t it? Real estate values are down. Cuts from the Regional Center with more on the way, it seems. Retirement accounts – who knows? Because we truly feel your pain, Community Training Connection, Inc. has added a cost efficient training program that gets you administrator CEUs (to meet Community Care Licensing and Regional Center requirements), as well as getting those CEUs required for the caregivers by Regional Centers.

The training will be offered on the Second Wednesday of every month from 10 AM to 1 PM at New Horizons at 15725 Parthenia in North Hills. There is plenty of parking in the back of the building. The fee for the classes is $20, which includes refreshments, handouts and a certificate for 3 CEUs. The classes are scheduled to be most convenient for staff who work around consumers’ day program schedules. If you send more than 3 staff members, one staff can attend at no fee.

Please mark your calendar with the following dates:

July 8, 2009

August 12, 2009

September 9, 2009

October 14, 2009

November 11, 2009

December 9, 2009

Taking these classes, and 20 hours online gets you the 40 required for Licensing. For Level 2 staff, three classes meets the regional center requirement. For Level 3 and 4, only four classes and the requirement is met. We’re doing our best to make life easier for you.

We do need to take reservations so that we can be sure to bring enough handouts. Please call Janet Tran in our office to reserve space. For your convenience, we accept all major charges, as well as checks. Walk ins are welcome, if space permits. You can also register online at http://www.communitytrainingonline.com.

As always, informative, lively and fun!

Regional Center Budget Cut Proposals

2009-05-01T16:00:00.000-07:00

I have been very vocal - and pro-active - about my concern that budget cuts should be made furthest from the people who need services. That, for me, means cutting at the bureaucracy - cutting out the parts of the system that are irrelevant to people with developmental disabilities and their families. There's so little talk about cutting at other levels, it seems like the elephant in the living room. By requiring the cuts to be at the purchase of service part of California's Developmental Services budget, I have seen vendors turn against vendor - not the most productive way to operate.

Here is a summary of the proposals - thanks Marty Omoto:

Transportation:

This reduction would be achieved by maximizing “cost effective” transportation services that reduces costs to specialized or contract transportation services.

Day Program and Work Activity Uniform Closure Dates:

Reduction is achieved by implementing a 14 day Uniform Holiday Schedule for day programs, look-alike day programs, and work activity programs.

Day Program and Work Activity for Older Adults:

Reduction would be achieved by creating a new service for seniors at a reduced rate and with a corresponding increase in the staffing ratio.

Increased Volunteerism and Employment:

Reduction would be achieved by creating the “Custom Endeavors Option” (CEO) which would will offer the opportunity to develop a customized employment or volunteer option with support from existing providers for 5% of current population.

Supported Living and IHSS

This reduction would be achieved by prohibiting regional centers from purchasing personal care services for consumers who are Medi-Cal beneficiaries. All Supported Living Service (SLS) Agencies will be required to assist a consumer to apply for IHSS within five days of moving into a Supported Living arrangement. All Supported Living Service (SLS) Agencies will be required to assist a consumer to apply for IHSS within five days of moving into a Supported Living arrangement.

Quality Assurance Review

This reduction would be achieved by eliminating Regional Center funding and requirement for conducting a Triennial Quality Assurance Review of vendored Community Care Facilities.

Just a few - so.....what do you think?

How many of you have contacted your state assembly or senate representative? Invite them to your facility? Ask them what suggestions they have for cutting anything further from your budget.

Disaster Planning for RCFEs in California

2009-05-01T15:46:00.000-07:00

Have you looked at your disaster plan lately? Will it be complete enough to meet the requirements of the new legislation? Do you have a back up plan for electricity? For some, it will mean having a back up generator. Have you thought about - really thought through - how you could stay in your facility for three days without electricity, gas or water? Are you absolutely certain that your staff would stick around until relief staff arrives?

Inquiring minds want to know.......

Swine Flu Information for Residential Care

2009-05-01T15:42:00.000-07:00

May 1, 2009

From Time Magazine (excerpt)

Top 5 Swine Flu Don'ts

By Bryan Walsh

The global rise in swine flu has showed few signs of slowing. Now in 11 countries, the H1N1 flu virus was confirmed on Thursday in the Netherlands and Switzerland; in Canada, cases rose to 27 and in the U.S., the caseload increased to 109 in 11 states, with hundreds of school closures that sent some 160,000 students home. Meanwhile, the World Health Organization (WHO) has said that a new flu pandemic is imminent, yet some pharmacies (in New York City at least) are temporarily running short of the antiviral Tamiflu. So, no one would blame you for feeling scared about getting sick.

Here are five things not to do in dealing with the swine flu frenzy.

1. Don't Rush to the ER

With the cable news networks reporting nonstop on swine flu, it feels like the disease is lurking everywhere, and that your slightest sniffle is a sign that you've contracted the virus. That would explain why people with no outward symptoms of illness are flooding emergency rooms in swine flu–affected states, afraid that they might be sick. That's a really bad idea.

First of all, having to examine people who aren't really sick only stresses the already strained resources of hospitals that are trying to prepare for a pandemic. Plus, going to an emergency room unnecessarily may even pose a slight risk to you. In past outbreaks, including SARS in 2003, hospitals were actually loci of infections — all those sick people in close proximity — and the same could be true of swine flu.

If you actually have flu-like symptoms — a fever above 100° F, headache, sore throat, body aches, chills or fatigue — and you live in an area where there have been confirmed swine flu cases, by all means report to your doctor. Otherwise, leave the hospital to the sick people.

2. Don't Be Afraid to Eat Pork

On April 29, the CDC announced that swine flu would no longer be referred to as swine flu, but as the "2009 H1N1 flu." It's less catchy, but more accurate. For one thing, there is no evidence that this virus makes pigs really sick. And the H1N1 virus actually contains genes from swine, avian and human flus. The virus also cannot be spread through pork products — you can't contract swine flu by eating bacon, hot dogs or anything else that was once a pig. Nor will culling pigs, as authorities did in Egypt, do anything to stem the spread of the disease. H1N1 has jumped to humans and is passing easily from person to person, so it's now a human flu that needs to be controlled in us, not the pigs.

3. Don't Hoard Antivirals

The H1N1 virus has so far proven vulnerable to the antiviral drugs Tamiflu and Relenza, which is good news. A cornerstone of the government's pandemic preparations was the stockpiling of 50 million doses of those drugs over the past few years, enough to ensure that doctors would be able to respond sufficiently to new outbreaks. But that capacity could be compromised if people begin stockpiling antivirals for their own use. Already there are reports of pharmacies running short of Tamiflu, and many hospitals in the U.S. have begun restricting the power to prescribe antivirals to just a few doctors. Also, the misuse or overuse of Tamiflu or Relenza by patients can promote resistance in the flu virus — effectively removing the only bullets from our gun.

4. Don't Leave Home If You Feel Sick

In the absence of a vaccine, the only defenses we have against the spread of H1N1 are simple ones. Cover your mouth when you sneeze or cough (with your arm, not your hands, to avoid spreading the virus through handshakes) and wash your hands frequently. Buy a pocket-sized bottle of hand sanitizer and use it — it's the easiest way to avoid getting sick.

But when it comes to slowing the overall spread of a pandemic flu, the best thing we can do is keep sick people away from everyone else. It's called "social distancing," and studies of the deadly 1918 Spanish flu showed that cities that instituted distancing measures quickly suffered lower death tolls than cities that did nothing or reacted slowly. So if you're feeling sick, don't go to work until you feel better — even though that may not be the most welcome advice for the nearly 50% of private-sector workers in the U.S. who don't get paid sick days.

5. Don't Panic

TV anchors can't stop asking the question: "When is it time to start panicking?" How about never? Panic can only lead to stupid actions — on a personal and national level — that would likely make a pandemic worse.

As worrying as the epidemic has been, keep in mind that only one person so far has died of swine flu outside Mexico. Many scientists are beginning to think that even if we do have a full-fledged pandemic on our hands, it may likely be a mild one. A computer model by researchers at Northwestern University estimated that even if nothing were done to slow the spread of the disease from now on, by the end of May the U.S. would have only about 1,700 cases. The good news is that H1N1 is hitting North America at the tail end of its flu season. It's possible that the virus may peter out and re-appear next autumn, but that gives us months to prepare.

As WHO and CDC officials keep reiterating, influenza is an enigma, and H1N1 will keep evolving, keep changing — so we can't predict how the epidemic will progress. But one thing is certain: Panicking will only make the situation worse. "This is a cause for deep concern, but not panic," said President Barack Obama in his April 29 news conference. In the midst of all this anxiety, that's the best advice there is.

Marketing for Small Homes

2009-03-27T12:22:00.001-07:00

It may just be a flook, but the small homes that have all of their beds filled also happen to be the highest price homes. How many of you have lowered your price just to get the bed filled? That may not necessarily be the best thing for you in the long run. We have a few providers who are charging a daily rate for residential care, which is an interesting option. How many of you have thought about that?

Adult Residential Facilities

2008-07-30T20:14:00.000-07:00

How are the Regional Center funded programs doing in the face of this year's budget crisis? We hear that one regional center will not vendor new homes unless they commit to providing transportation to day programs. That service was generally funded under another vendor code when gasoline was $2.00 a gallon. Now that we're over $4.25 in most places, it seems to be pushing vendors over the edge. It's not like there was much of a profit to begin with. Who is meeting with legislators? Who has a better way to spend that gets more money closer to the client/consumer/individual/person?

Medication Training for RCFEs

2008-07-30T20:09:00.000-07:00

It seems as if most communities and board and care homes have figured out the training requirement, but we keep getting calls from homes where licensing is citing for reasons not clear in the legislation. What does a new facility do to assist with medication with a new residents, if the administrator does not have a person to shadow on the day of admission?

How are you destroying medication? We've had some interesting stories in our classes about how medication is getting destroyed.