Overall in review of the guidance documents and compliance updates to regulations, it is evident that the department is attempting to enforce standards that focus on data collection and follow up accountability that continues to increase and not account for the reality of service delivery, leading agencies away from the direct care and oversight that is necessary in truly maintaining the person centered quality community services that every individual within the state deserves. The increased punitive approach by the department does not allow for a supportive and truly partnering relationship among the Provider community and staff offices under DBHDS. The true intention of corrective action plans as well as reporting requirements center on the basis of safety protection for individuals which all providers from across the state want to ensure; however this stance from DBHDS does not truly address this but rather creates data that can be utilized versus remediation support and training that could truly help services as a whole.

The following is an outline of the areas of concern that have been pulled from the most recent final regulation document.

12VAC35-105;

160; Additional requirements outlined for a more detailed route cause analysis shall be simply noted as “a more detailed root cause analysis shall occur as determined by the agency and incident that occurs” The outlined minimum policy standards should be what is included within the routine incident reviewing process that occurs for all serious incidents as part of the risk management plan. It is recommended that the language reflected in the requirement outlined within the previous stage.

170; If a corrective action plan was implemented according to the noted action steps and deadline; however, did not prevent a recurrence then regulations suggest that this CAP be continued. Again, this does not account for an evaluation as to what may have occurred within each circumstance but rather indicates that if a CAP was implemented and actions steps were taken then another CAP would be issued if there were further issues that surfaced that warranted such a need. Regulation and guidance that does fully account for areas of service delivery to include location, service site, services, etc. This may be seen more in larger agencies than small agencies; however, all provider agencies must be viewed in the evaluation of ensuring that regulations are applicable across settings.  

320; It is appreciated that this section was updated to no apply to sponsored residential home services due to the nature of these types of service settings; however adding additional requirements to include monthly fire and evaluation drills within section 550 does not appear to be appropriate for all individuals within services. Having routine drills is important; however we also want to ensure that individuals are able to be prepared for emergencies that arise and not done so repetitively that individuals may become desensitized to responding appropriately thinking that it may be simply another drill that they are encouraged to participate in. This requirement should be based upon several factors to include services, settings, staffing, etc.

Thank you for your time and consideration of all comments that are noted within this town hall forum as the feedback and input from the whole provider community is imperative in order to move forward in a direction and focus that truly centers around the services and needs of the individuals across the state of Virginia.