MALA Annual Conference Lansing Center Lansing, MI Wednesday May 17, 2017, 10:30 a.m. Licensing Update from AFC & Camps Licensing Division Grant Sutton, AFC Consultant, Grand Rapids Jay Calewarts, Director, AFC & Camps Licensing Division

LARA/Bureau Overview Shelly Edgerton, LARA Director Larry Horvath, Bureau Director Currently there are 4 Divisions: AFC and Camps Division (includes AFC, HFA and camps) Child Care Licensing Division Federal Survey and Certification Division Health Facilities Licensing, Permits & Support Division

Bureau of Community and Health Systems (BCHS) Org Chart

AFC & Camps Org Chart 27 new consultants in last 2 years!

HFA Inspection Cycle MCL333.20155. (1) …the department shall make at least 1 visit to each licensed health facility or agency every 3 years for survey and evaluation for the purpose of licensure. Reduces regulatory burden on providers More time for staff to focus on initial applications and complaints Changed in October of 2015 License renewal still required annually Policy is to inspect every other year unless get manager approval to go earlier or extend.

HFA TB screening Requirement for screening of residents and staff at an HFA changing New testing/screening requirements based on CDC guidelines and risk assessment Anticipated that new requirements will be approved in upcoming months (JCAR currently reviewing) Working on similar language for AFC See link for proposed HFA rule revisions http://w3.lara.state.mi.us/orr/Rules.aspx?type=Number&id=R 325.1901

Inspection Model Move from Interview and Observation to full inspection model for renewals Because of increasing complaints/serious violations June or July of 2017 Still have interview and observation as part of inspection Hope to catch issues early and get it corrected before someone is seriously hurt

AFC Council Rule Review MCL 400.710(5) The rules shall be reviewed by the council not less than once every 5 years. Have begun to review rules as required by law Currently reviewing special certification rules Hope to have draft AFC rule changes for special certification ready for public comment before end of summer Once complete with special certification will move to other AFC rule sets Any proposed rule changes you may have, please send to me at calewartsj@michigan.gov

Referrals to APS Have heard comments about increased APS visits Likely because of a 2015 and 2016 audit by OAG where they found AFC Licensing was not referring all instances as required to APS As a result of the audit, LARA is now referring everything that may be considered abuse, neglect or exploitation upon receiving complaint Continue to work with APS to try and decrease unnecessary referrals to APS

Environmental Inspections Policy revised environmental inspections by local health department on June 1, 2016 Will request local health departments to inspect AFC’s with private well or private sewage disposal system initially and upon renewal (including Family Homes) Could be requested in other instances as needed

Assessment Plan and Individual Plan of Service Make sure that you and your staff know the assessment plan and individual plan of service Review resident history and ask the placing agency questions if things are missing from plan of service You as a licensee are responsible to ensure that the resident is safe and free from harm If not in the placing agencies plan, it is not a free pass

AFC Definition Definition of foster care (Act 218)… “The provision of supervision, personal care and protection in addition to room and board for 24 hours a day, 5 or more days a week and for 2 or more consecutive weeks for compensation.” Definition of adult foster care facility “a governmental or nongovernmental establishment that provides foster care to adults.”…

Is a License Required? (AFC) Provision of supervision Provision of personal care Provision of protection Provision of room and board Twenty-four hours a day Five or more days a week Two or more consecutive weeks for compensation

HFA Definition Definition of Home for the Aged per MCL 333.20106 (3) “A supervised personal care facility…that provides room, board, and supervised personal care to 21 or more unrelated nontransient, individuals 60 years of age or older.” Note that it goes on to say that it can be less than 20 individuals if in a distinct part of a nursing home.

Is a License Required? Investigating unlicensed providers is complaint driven 195 unlicensed investigations in 2016, 56 in 2017 however some are still ongoing 9 substantiated unlicensed providers to date in 2017; 49 in 2016, 36 in 2015 and 41 in 2014 Work with unlicensed provider to achieve compliance

Is a License Required? Workgroup was formed over a year ago to discuss LARA’s interpretation of the law Members include a representative from MALA, Leading Age, MCAL, The Arc Michigan, MPAS, AFC Advisory Council, State LTC Ombudsman and LARA. Discussions originally focused on AFC but were not able to come to a consensus. HFA became focus as we felt that we could come to a consensus

SB 378 HFA Amendments Senator Knollenberg is expected to introduce a bill to revise the Public Health Code for Homes for the Aged. It is believed that this bill would include: Board and Care model for Fire Safety review for existing facilities More clearly defines “supervised personal care” Attestation that room and care parties are unrelated 55 years old or older Cap background checks Add a claw back clause that the department can revoke an exemption for systematic care issues that cause serious injury, death or mental anguish

Fire Separation-Group Home Rule 511. (1) If the heating plant is located in the basement of a small group home, standard building material may be used for the floor separation. Floor separation shall also include at least 1 3/4-inch solid core wood door or equivalent to create a floor separation between the basement and the first floor.

Fire Separation-Group Home Rule 511. (2) Heating plants and other flame-producing equipment located on the same level as the residents shall be enclosed in a room that is constructed of material which has a 1-hour-fire-resistance rating, and the door shall be made of 1 3/4-inch solid core wood. The door shall be hung in a fully stopped wood or steel frame and shall be equipped with an automatic self-closing device and positive-latching hardware.

Fire Separation-Group Home Rule 40. (6) Heat-producing equipment located in a basement shall be separated from the remainder of the home by means of a floor separation. Standard building material shall be sufficient for the floor separation …

Questions & Answers Email: calewartsj@michigan.gov BCHS-Help@michigan.gov Lansing Office Address: 611 W. Ottawa Street Ottawa Building, 1st Floor PO Box 30664 Lansing MI, 48909