12VAC35-105-20. Definitions.
“Direct care position” means any position that includes responsibility for: (i) treatment, case management, health, safety, development, or well-being of an individual receiving services or (ii) immediately supervising a person in a position with this responsibility.
Comment: The Case management role being defined as a component of the definition of Direct Care Position seems to contradict the CMS definition of Case Management. It is unclear how this new definition will be applied to service provision, and credential and training requirements across all disabilities.
CMS definition of case management
"Level II serious incident"
5. A hospital admission;
9. Ingestion of any hazardous material.
Comment: Need additional clarification/ definition of Hospital admission – i.e. medical admission. And additional clarification of what constitutes a hazardous material i.e. ingestion of a material that warrants a call to poison control.
12VAC35-105-160. Reviews by the department; requests for information; required reporting
E. A root cause analysis of each serious incident shall be conducted by the provider within 30 days of discovery to include at least the following information: (i) a detailed description of what happened; (ii) an analysis of why it happened, including identification of all identifiable underlying causes of the incident that were under the control of the provider; and (iii) identified solutions to mitigate its reoccurrence.
Comment: This seems excessive, particularly for Serious Incident Level 1 if it is apparent staff followed agency’s policy and procedures. We do not have a designated position whose primary duties are Risk Management Activities and currently do not have anyone with a strong skill set for such activities. We would need and welcome well defined expectations and root cause analysis training from the department before this requirement goes into effect.
12VAC35-105-320. Fire inspections.
The provider shall ensure adequate staff to safely evacuate all individuals during an emergency
Comment: Supervised Residential sites may not be able to plan for and adequately staff a site for a fire event that may occur at night when most residents would be asleep. This is type of an event is out of the ordinary and cannot be planned for in advance.
12VAC35-105-400. Criminal registry background checks and registry searches.
B. Prior to hiring an applicant, the provider shall obtain the employee's written consent and personal information necessary to obtain a search of the registry of founded complaints of child abuse and neglect maintained by the Virginia Department of Social Services.
E. The provider shall review the criminal history background check and registry search results prior to hiring the applicant and shall maintain the following documentation:
Comment: The statements for pre-hire activities to obtain applicant written consent and personal information as well as the criminal check being completed prior to hire will place a burden on the agency’s ability to hire and retain the necessary man power to provide coverage for needed services to the individuals we serve. It is understandable and warranted for the protection of those we serve that new hires do not provide direct service prior to receiving results of the criminal background and registry checks. The time between hire and receipt of results is generally used by our agency to provide the necessary required trainings to the new hires.
12VAC35-105-660. Individualized services plan (ISP).
C. This ISP shall be developed based on the initial assessment with the full participation and informed choice of the individual receiving services. To ensure the individual’s participation and informed choice, the provider shall explain to the individual or his authorized representative, as applicable, in a reasonable and comprehensible manner, the proposed services to be delivered, alternative service or services that might be advantageous for the individual, and accompanying risks or benefits. The provider shall clearly document that this information was explained to the individual or his authorized representative and the reasons the individual or his authorized representative chose the option included in the ISP.
Comment: If the ISP is a person centered plan, completed with the individual/AR/Legal guardian then documenting the reason why an option is chosen in an ISP seems to be redundant documentation.
12VAC35-105-675. Reassessments and ISP reviews.
D. The provider shall review the ISP at least every three months from the date of the implementation of the ISP or whenever there is a revised assessment based upon the individual's changing needs or goals.
2. These reviews shall document evidence of progression towards or achievement of a specific targeted outcome for each goal and objective.
Comment: Reassessment and ISP reviews do not always result in progress. This line indicates there is always progress. It should end with an or … this would lead into the next line of what to do if there is no progress.
3. For goals and objectives that were not accomplished by the identified target date, the team shall meet to review the reasons for lack of progress and provide the individual an opportunity to make an informed choice of how to proceed.
Comment: the line that states teams shall meet implies a face to face meeting with all parties working with the individual at every review / reassessment. This is not always possible for all cases and across all disabilities. Documenting care coordination on an ongoing basis and on an as needed basis should be sufficient.