2013 State Veterans Homes VA Survey Deficiency Overview Valarie Delanko JoAnne Parker Office of GEC Operations (10NC4)

Discussion Topics Deficiencies cited in 2013 Top Deficiencies Discussion – NH & DOM Recognition updates 2

Background Information Current SVH Program Structure offering three levels of care: – 146 State Veterans Home Facilities 137 Nursing Home Care programs (24,898 beds) 54 domiciliary care programs (5,876 beds) 2 adult day health care programs (85 participant slots) 3

Surveys Types

Totals for 2013 Total Number of Nursing Homes Surveyed 151 Total Number of Surveys with Deficiencies 91 (60%) Total State Veteran Home Deficiencies 441 Average Number of Deficiencies Cited per Survey

NH Totals for 2013 Total Number of Nursing Homes Surveyed 97 Total Number of Surveys with Deficiencies 68 (70%) Total State Veteran Home Deficiencies 385 Average Number of Deficiencies Cited per Survey

DOM Totals 2013 Total Number of Domiciliary Surveyed54 Total Number of Surveys with Deficiencies Cited23 (42%) Total Domiciliary Deficiencies Cited56 Average Number of Deficiencies Cited per Survey

IJs for 2013 Total Cited6 Accidents & Supervision: Smoking with Oxygen; burns from hot coffee Falls with Injury Accurate Care Plan Assessments: Failure to follow care plans/supervise residents that smoke 8

Top NH standards 2013 Regulation Number StandardFrequency % of All Tags a. Facility meets applicable provisions of the Life Safety Code of National Fire Protection Association % i. 1-2 Residents environment remains free of accidents, hazards and receives adequate supervision and assistance. 236% d. 2. Comprehensive care plan developed in 7 calendar days after completion of comprehensive assessments, prepared by IDT, and periodically reviewed and revised. 164% b. 1-4 An emergency electrical power system, in accordance with NFPA, on-site emergency standby generator of sufficient size to serve connected load % d.3. Services provided or arranged by facility must meet professional standards of quality or by qualified persons in accordance with the care plan % d.1. Assessments' are conducted with appropriate participation of health professionals, registered nurse and certification of that assessment % b. The resident has the right to be free from mental, physical, sexual, and verbal abuse or neglect, corporal punishment and involuntary seclusion. 61.6% c. Facility management must develop and implement written policies and procedures that prohibit mistreatment, neglect and abuse and misappropriate of property. 61.6% a. b. Facility management must promote care in a manner in an environment that maintains or enhanced dignity, respect, self-determination and participation. 51.3% b. 3. Residents receive proper treatment and assistive devices to maintain vision and hearing abilities. 51.3% 9

Top DOM standards 2013 Regulation Number StandardFrequency % of All Tags 167 C. There is evidence reported that life safety deficiencies have been or are corrected % A. The facility has a current State Fire Marshall certificate or documented evidence of compliance with life safety codes % D. Facility has available an emergency source of electrical power to provide essential service when normal electricity supply is interrupted. 36.4% C. Acceptable practices are employed for maintenance and repair of equipment, buildings and grounds % A.Facility ensures provision of professional medical services for residents.12.13% C.Residents are classified according to domiciliary care required.12.13% D.Resident treatment plan established and maintained for each domiciliary resident.12.13% B.Primary care nursing services are provided for domiciliary residents.12.13% C.Nursing services rendered are documented in the medical record.12.13% G.The nutritional status of each resident is monitored on a regular basis.12.13% A.Residents are treated with dignity and respect.12.13% 10

Functional Deficiencies 2013 Functional Standard Groups Number of Deficiencies Percentage Physical Environment21957% Resident Assessment6016% Quality of Care4311% Quality of Life246% Residents Behavior and Facility Practices164% Resident Rights82% Infection Control62% Dietary Services41% Pharmacy Services31% Nursing Services2.5% Total385100% 11

Physical Environment Tag Regulation Number StandardFY 11FY % change from FY a Life Safety From Fire >100% b1- 4 Emergency Power 10715>100%+ 12

Resident Assessments Tag Regulation Number StandardFY 11FY % change from FY b1 Resident Assessment: Comprehensive Assessments of residents needs 231<66% d1 Resident Assessment: Comprehensive Care Plan 81211<8% d2 Resident Assessment: Comprehensive Care Plan >33% d3Resident Assessment: Periodic Review <13% 13

Quality of Care Tag Regulation Number StandardFY 11FY % change from FY a1-3 Quality of Care: Reporting of Sentinel Events 631<66% d Quality of Care: Pressure Sores 1034>33% i1-2Quality of Care: Accidents <4% 14

Quality of Life Tag Regulation Number StandardFY 11FY122013% change a/b Quality of Life: Dignity 10115<55% g1Quality of Life: Patient Activities 1074<43% 15

Resident Behaviors/Facility Practice Tag Regulation Number StandardFY 11FY122013% change a.Restraints954<20% b.Abuse536 >100% c.Staff treatment of residents 626>100% 16

Recognition Update New State Veterans Homes 5/29/2013Chippewa Fall, WI72-Bed NHC Changes to Existing State Veterans Homes 06/25/2013Hanson, KY156-Bed NHC (36-Bed Addition) 11/01/2013Silver Bay, MN83-Bed NHC (4-Bed Reduction) 11/05/2013Spring City, PA54-Bed DOM Renovation 11/18/2013Union Grove, WI76-Bed DOM and 158-Bed NHC Minneapolis, MN50-Bed DOM (Addition) Recognition Packages in VA Concurrence Kinston, NC100-Bed NHC Ivins, UT108-Bed NHC Payson, UT108-Bed NHC Bennington, VT171-Bed NHC (6-Bed Reduction) 17

Take Away Opportunity to improve in the Physical Environment. Many clinical functions have demonstrated improvement. Relationship between SVHs and VA is key to high quality and safety of Veterans. 18

Contacts Valarie Delanko, RDN, LDN, CPHQ National Program Manager SVH Quality & Survey Oversight Jo Anne Parker, MHA National Program Manager SVH Survey Process 19