Total Care Exceptions and Hospice Care

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

Community Care Licensing - Key Indicators

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

CCL Response to Budget Crisis

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.

Fee Increase from Community Care Licensing

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?