1. State Veterans Homes VA Survey Overview Valarie Delanko JoAnne Parker Office of GEC Operations (10NC4) Winter Conference 2016

2. Discussion Topics SVH Background 2015 Survey Overview SVH Critical Events Falls Collaborative Update 2012 Life Safety Changes Recognition Survey Updates 2

3. SVH Program Census Current SVH Program Structure offering three levels of care: – 152 State Veterans Home Facilities 144 Nursing Home Care programs (25, 317 beds) 55 Domiciliary Care programs (6,176 beds) 3 Adult Day Health Care programs (109 participant slots) 3

4. Number of SVHs 4

5. Surveys Types 5

6. Survey Totals 6 Levels of Care20142015 Number of nursing home care surveys 146153 Number of nursing home care deficiencies 464380 Avg. number of deficiencies per survey 3.182.48 Number of domiciliary surveys 5754 Number of domiciliary deficiencies 5326 Avg. number of deficiencies per survey 1.08.48 Number of adult day health care surveys 24 Number of adult day health care deficiencies 01

7. Top 5 NH standards LineRegulationStandard20142015 2015 % 14751.200 a. The facility must meet the applicable provisions of NFPA 101, Life Safety Code and NFPA 99, Health Care Facilities Code. 1928021% 108 51.120 i. 1-2 Ensure environment remains free of accident hazards as is possible and residents receive adequate supervision and assistance devices to prevent accidents. 403910% 94 51.110 e. 3 Services provided or arranged by facility must meet professional standards of quality and by qualified persons in accordance with the care plan. 33257% 148 51.200 b. 1-4 An emergency electrical power system is provided in accordance with NFPA; on-site emergency standby generator of sufficient size to serve connected load. 24257% 6551.90 b The resident has the right to be free from mental, physical, sexual, and verbal abuse or neglect, corporal punishment, and involuntary seclusion. 11185 7

8. Survey Report Totals 8 Category – Nursing Home20142015 Administration 51.210 510 Fiscal – Part C 15 Resident Rights 51.70 68 Admission, Transfer, Discharge 51.80 01 Resident Behavior and Facility Practice 51.90 2630 Quality of Life 51.100 1021 Resident Assessment 51.110 8165 Quality of Care 51.120 8290

9. Totals 9 Category20142015 Nursing Care 51.130 42 Dietary Services 51.140 1116 Physician 51.150 30 Specialized Rehabilitation Services 51.160 12 Dental 51.170 00 Pharmacy Services 51.180 58 Infection Control 51.190 1215 Physician Environment 51.200 217111

10. Top 5 DOM standards LineGuidelineStandard20142015 2015 % 1814. E Primary Care medical services are provided for domiciliary patients as needed. 2519% 2109. D Each patient’s activity plan is a part of the overall treatment plan 1312% 1652. A The facility has a current State Fire Marshall's certificate or documented evidence of compliance with life safety codes 128% 1672. C There is evidence that reported life safety deficiencies have been or are being corrected. 3228% 1682. D The facility has available an emergency service of electrical power to provide essential service when the normal electrical supply is interrupted 828% 10

11. Totals 11 Category – Domiciliary20142015 1. Governance & Administration 02 2. Safety 416 3. Physical Environment 02 4. Medical Care 46 5. Nursing Service 10 6. Rehabilitation 00 7. Social Services 21 8. Dietetics 11

12. Totals 12 Category – Domiciliary20142015 9. Resident Activities 14 10. Pharmacy 22 11. Medical Records 01 12. Quality Assurance 00 13. Quality of Life 11

13. Survey Deficiency Handout 13

14. Immediate Jeopardy Numbers 14

15. Immediate Jeopardy (IJ) Comparison 15 Reference: : Report to Congressional Requesters - GAO16-33 October 2015 Reference: : The Kaiser Commission on Medicaid and the Uninsured Report August 2015

16. Types of Issues Reported to VACO 16

17. SVH Sentinel Events Reported 17

18. Sentinel Event Reporting State Veterans Homes must report sentinel events to the VA Medical Center of Jurisdiction as outlined in 38 CFR Part 51 and 52. (a)Reporting of Sentinel Events—(1) Definition. A sentinel event is an adverse event that results in the loss of life or limb or permanent loss of function. (2) Examples of sentinel events are as follows: (i) Any resident death, paralysis, coma or other major permanent loss of function associated with a medication error; or (ii) Any suicide of a resident, including suicides following elopement (unauthorized departure) from the facility; or (iii) Any elopement of a resident from the facility resulting in a death or a major permanent loss of function; or (iv) Any procedure or clinical intervention, including restraints, that result in death or a major permanent loss of function; or (v) Assault, homicide or other crime resulting in patient death or major permanent loss of function; or (vi) A patient fall that results in death or major permanent loss of function as a direct result of the injuries sustained in the fall. 18

19. Sentinel Event Reporting (3) The facility management must report sentinel events to the director of VA medical center of jurisdiction within 24 hours of identification. The VA medical center of jurisdiction must report sentinel events by calling VA Network Director (10N 1-23) and Chief Consultant, Office of Geriatrics and Extended Care (114) within 24 hours of notification. (4) The facility management must establish a mechanism to review and analyze a sentinel event resulting in a written report no later than 10 working days following the event. The purpose of the review and analysis of a sentinel event is to prevent injuries to residents, visitors, and personnel, and to manage those injuries that do occur and to minimize the negative consequences to the injured individuals and facility. 19

20. Falls Collaborative 2015 Preventing Falls and Fall Related Injuries for Veterans Collaboration between 30 SVH volunteered homes / the National Center for Patient Safety (NCPS) / and 5 VA long-term care experts to serve as Coaches. Program duration: June 1, 2015 - January 31, 2016. 5 targeted major educational programs. Satisfaction surveys post education for feedback. SVHs provide an initial, monthly and final report to coaches. 20

21. Falls Collaborative Results What did we see? SVHs have a keen grasp of their problem and developed targeted AIM statements. Took immediate action and performed trials before full implementation. Took on several process improvements at one time. Have many SME’s that can share success stories with VA. Reported reduction in repeat falls. 21

22. Falls Collaborative Results What can we do to help? Higher concentration assisting SVHs how to categorize falls using standardization – What is / is not accidental; preventable and un-preventable; Anticipated Physiological and Unanticipated Physiological falls. Work together – include SVH and VA facilities. Share more examples & case studies. Focus on dignity and resident rights versus fall prevention interventions. 22

23. 2012 Life Safety Code Federal Register: Final rule, August 27, 2015 38 CFR Parts 17, 51, 52, and 59 RIN 2900–AO90 - Update to NFPA Standards To ensure the continued safety of veterans in SVHs, VA is continuing to rely upon NFPA codes and standards for VA approval of such facilities. This rulemaking updates our regulations to adhere to more recent NFPA codes and standards. 23

24. 2012 Life Safety Code §51.200 Physical environment. The facility management must be designed, constructed, equipped, and maintained to protect the health and safety of residents, personnel and the public. (a) Life safety from fire. The facility must meet the applicable provisions of NFPA 101, Life Safety Code and NFPA 99, Health Care Facilities Code. Handout of changes provided. 24

25. Recognition Update: Recognition Packages in VA Concurrence Sandusky, OH - 84-bed DOM Reduction (Total DOM beds 216) Pass DOM survey but NH survey is now needed for the 66 NH beds to be moved into the DOM swing space. SVH received new letter with instructions from VACO. Richmond, VA - 40-bed NH Addition (Total NH beds 200) Package in VACO internal concurrence process. Pittsburgh, PA - 236 NH Beds (Reverted 32 DOM beds to NH beds and closed DOM) Survey occurred January 28-29, 2016, waiting on completed package in VACO. Upcoming Recognitions Spring City, PA Increased NH beds by 84 from 184 to 238 Survey occurred February 17-19, 2016, waiting on completed Package in VACO. Hot Spring, SD- New Replacement facility for 52 NH & 48 DOM beds Survey will be in March 2016. Clarksville, TN - New 108 NH Beds Anticipated recognition request Summer 2016. Radcliffe, KY- New 120 NH Beds Anticipated recognition request Summer 2016. 25

26. Contacts Valarie Delanko, RDN, LDN, CPHQ National Program Manager SVH Quality & Survey Oversight 814-860-2201 Jo Anne Parker, MHA National Program Manager SVH Survey Process 202-623-8328 26