12VAC35-107-80 (E) - ISP requirement - AHCS agrees that staff should be knowledgeable about the contents of the ISPs for individuals and this is achieved through observations during the supervisory and evaluation process. By adding the addition of testing after each training would be an unrealistic expectation that may takeaway from services. Please reconsider this requirement. 

Page 8  Group home or community residential service means a congregate service providing 24-hour direct awake supervision in a community-based home having eight or fewer residents.  Will homes currently approved to provide services to more than eight residents be "grandfathered" in?

vaACCSES Comments -
July 22, 2021
Proposed Licensing Regulations 12VAC35-107 - Residential Services Chapter

12VAC35-107-50 Secondary Screening
Comment: Required when someone is placed on waitlist?  An additional administrative burden when there may be staffing issues already present.

12VAC35-107-70
Comment: Concern with two plans for support (ISPs) - initial and then comprehensive?

12VAC35-107-80 (E) ISP Requirement  

Comment: We agree that staff should be knowledgeable about the contents of the ISPs for the individuals served. Adding the addition of testing after each training is an unreasonable expectation and is an significant administrative burden to providers. Knowledge can be verified through observation during the supervisory and evaluation process. Please delete this requirement. 

12VAC35-107-100 - Progress Notes and Other Documentation
Comment: New requirement that progress notes be entered a minimum of once per shift.--- is this  practical or manageable?  The format of progress notes across all locations of one service is desirable but should be reasonable. The format and timing of notes across various services operated under a single organizational license may need to differ in order to reflect the unique nature of each service and affiliated requirements from pay sources.

12VAC35-107-170 B. 2. & 3.
Comment:  Contradiction - “Menus that must be followed and created in advance” - Yet we are seeking community-based services in which people change their minds when they want to and have access to whatever foods they so choose.

12VAC35-107-290 0. Another added expense?  What is the requirement here attempting to achieve?

12VAC35-107-70
Comment: Concern with two plans for support (ISPs) - initial and then comprehensive?

12VAC35-107-80 (E) ISP Requirement  

Comment: We agree that staff should be knowledgeable about the contents of the ISPs for the individuals served. Adding the addition of testing after each training is an unreasonable expectation and is an significant administrative burden to providers. Knowledge can be verified through observation during the supervisory and evaluation process. Please delete this requirement. 

12VAC35-107-100 - Progress Notes and Other Documentation
Comment: New requirement that progress notes be entered a minimum of once per shift.--- is this  practical or manageable?  The format of progress notes across all locations of one service is desirable but should be reasonable. The format and timing of notes across various services operated under a single organizational license may need to differ in order to reflect the unique nature of each service and affiliated requirements from pay sources.

12VAC35-107-170 B. 2. & 3.
Comment:  Contradiction - “Menus that must be followed and created in advance” - Yet we are seeking community-based services in which people change their minds when they want to and have access to whatever foods they so choose. A number of the people we support do enjoy the process of menu planning/grocery shopping for certain meals they enjoy cooking - but this requirement also contradicts their choices to swap recipes - or go for dinner with their friends at a restaurant instead. 

12VAC35-107-80.A.1 ISP Requirements  Comment: Is the documentation that the individual's needs require a provider operated home and non-center based setting a medical certification?  Is is required for waiver group homes? 

12VAC35-107-80.B.1 Comment: Does the documentation obtained for the Initial ISP that the individual's needs require a provider operated home and no-center based setting satisfy the requirement for the same in the Comprehensive ISP?  Is it required for waiver group homes?

12VAC35-107-80.E Comment: Employees/contractors responsible for implementing the ISP already meet minimum requirements as outlined in job descriptions.  They receive required orientation training and ongoing supervision both of which are documented.  The Developmental Disabilities DSP and Supervisors Competencies Checklist documents proficiency in required competency areas including: Describing outcomes, support activities, and instructions on Plans for Supports for Individuals supported; and Conveys a basic understanding of the health information for the people they support.  It is reasonable that employees/contractors responsible for implementing the ISP are able to demonstrate a working knowledge of the objectives and strategies contained in the individual's current ISP, including detailed health and safety protocols, simply by reviewing the ISP as written.  This working knowledge could be verified by staff signature attached to the working copy of the ISP on site. 

ISPs that are truly person-centered may change frequently in small ways for short periods of time.  Developing and proctoring tests for multiple staff for each change would take away from time available to provide direct services.  Processes are already in place to signal changes to ISP to all staff, such as PCP Change Notes, electronic and direct verbal communication.  Working knowledge of ISP changes could be verified by staff signature attached to the working copy of the ISP on site. 

Documentation of training and supervision is already retained in supervisory notes, staff meeting minutes, and personnel training records.  Retaining documentation in the Personnel file of formal testing of each individual's ISP, including each change, would be cumbersome and require significant coding to protect the individual's confidential information, which should not be part of a Personnel file.  The usefulness of such documentation toward an ultimate goal of ensuring staff working knowledge of ISPs is minimal and would only serve as a personnel intervention, after the fact.  Current processes in place provide more immediate and timely action to ensure staff working knowledge of ISPs.  Please remove this draft regulation for formal testing. 

12VAC35-107-150 Comment:  Guidance is needed as to what "staff requirements" means specifically. 

12VAC35-107-170.A  Comment:  Is this a written protocol for each individual that is updated, or a policy/procedure?

12VAC35-107-170.B.7 Comment: Please clarify that/how the individual's right to make personal dietary choices may supersede the menu being prepared in advance (-170.B.2) and followed (-170.B.3). 

12VAC-107-200.4  Comment:  Please clarify that all actions taken by employees/contractors may be documented in the incident reports, and referenced in the progress notes.       

12VAC35-107-50 Secondary Screening
Comment: Required when someone is placed on waitlist?  An additional administrative burden when there may be staffing issues already present.

12VAC35-107-70
Comment: Concern with two plans for support (ISPs) - initial and then comprehensive?

12VAC35-107-80 (E) ISP Requirement  

Comment: We agree that staff should be knowledgeable about the contents of the ISPs for the individuals served. Adding the addition of testing after each training is an unreasonable expectation and is an significant administrative burden to providers. Knowledge can be verified through observation during the supervisory and evaluation process. Please delete this requirement. 

12VAC35-107-100 - Progress Notes and Other Documentation
Comment: New requirement that progress notes be entered a minimum of once per shift.--- is this  practical or manageable?  The format of progress notes across all locations of one service is desirable but should be reasonable. The format and timing of notes across various services operated under a single organizational license may need to differ in order to reflect the unique nature of each service and affiliated requirements from pay sources.

12VAC35-107-170 B. 2. & 3.
Comment:  Contradiction - “Menus that must be followed and created in advance” - Yet we are seeking community-based services in which people change their minds when they want to and have access to whatever foods they so choose.

12VAC35-107-290 0. Another added expense?  What is the requirement here attempting to achieve?

1. "Group home or community residential service" means a congregate service providing 24-hour direct awake supervision in a community-based home having eight or fewer residents. Services include supervision, supports, counseling, and training in activities of daily living for individuals whose individualized services plan identifies the need for the specific types of services available in this setting. AND Group home services includes 24-hour direct awake supervision in a  community-based home having eight or fewer residents. Services include supervision, supports, counseling, and training in activities of daily living.

Comment: This does not allow for least restrictive environment. Providers have operated for many years with staff that sleep. There are measures in place to ensure the individuals are cared for should the need arise. This doesn’t consider electronic supports that have allowed for greater independence. This will also force smaller group homes to increase the capacity of home to cover the costs of bringing in awake staff. This takes away from services being individualized based on the needs of the people in the home.

2. A. In the event that an individual has been placed on a waitlist prior to receiving services a secondary screening shall be performed prior to admission to the service. The provider shall document:

Comment: According to 12VAC30-122-120, providers cannot have a waitlist as they are expected to be able to serve within 30 calendar days of the referral. Is this regulation contradictory or are we misinterpreting 12VAC30-122-120?

3. 2. After each training, providers shall test the employee’s or contractor’s knowledge, competency or both, and retain documentation of the test of the employee’s or contractor’s knowledge, competency or both within the employee or contractor’s personnel file.

Comment: this places an undue burden on the provider to show competency and is a duplication of effort. This will cause a significant amount of time to create ISP specific tests. We already document our training on ISP’s and ensure understanding of the needs of the person.

4. Reassessments shall be completed at least annually and any time there is a need based on changes in the medical, psychiatric, behavioral, or other status of the individual. Reassessments shall include documented justification that the individual’s needs continue to require a provider operated residential setting.

Comment: Does the provider or the Support Coordinator complete the reassessment? Is this a team effort?

5. Group homes shall meet the following staffing requirements:

Comment: Ratio’s shall be determined based on needs of the people residing in the home rather than a fixed ratio dictated by DBHDS. If everyone in the home sleeps through the night and doesn’t require intervention, it should be at the providers discretion to allow staff to sleep if safety measures are in place should the need arise. Management will continue to evaluate the need for staff changes based on the needs of the individuals.

6. Sponsored residential homes shall meet the following staffing requirements:

Comment: Sponsored residential is an individualized service that serves a max of two people in one home with one sponsor. It is up to the sponsor to have designated staff that are available to provide supports when needed.

7. B. The provider shall have menus. Menus shall:

Comment: Please exclude Sponsored Residential from being required to have menus. Requiring menus in Sponsored takes away from this being a home like environment and makes it institutional. If the person residing in the sponsored home has a specialized diet, the sponsor will follow those dietary guidelines.

8. D. An individual with a communicable disease shall not be admitted unless a licensed physician certifies that: 1. The facility is capable of providing care to the individual without jeopardizing individuals and staff; and 2. The facility is aware of the required treatment for the individual and the procedures to protect individuals and staff.

Comment: Physicians are rarely involved in private provider operations; it is doubtful they would be willing to sign off on these items. This also opens the door to discriminate against someone with a communicable disease. Perhaps a better regulation would be to ensure the provider puts plans in place to serve the person based on their needs while protecting the well-being of others served in the same program or residence.

9. I. The provider shall develop and implement written policies and procedures that include use of standard precautions and address communicable and contagious medical conditions. These policies and procedures shall be approved by a medical professional.

Comment: Would an agency RN count as a medical professional according to this regulation? If not, it would be very challenging to find a medical professional willing to approve other agencies policies and procedures. Please also consider the many providers who do not have any medical professionals on staff.

10. The provider shall secure all cleaning products and other household chemicals by:

Comment: Some program participants have the capacity to manage their own environments and should be permitted to maintain that level of independence. Please allow for a competency assessment to be completed, and if met, household chemicals would not need to be secured.

11. C. The provider shall specify and provide staffing arrangements in all sponsored residential homes, including on-call and substitute care arrangements.

Comment: Please remove “and provide” from this regulation. The sponsored residential contractor is expected to maintain their own staffing arrangements.

12VAC35-107-50 Secondary Screening
Comment: Required when someone is placed on waitlist?  An additional administrative burden when there may be staffing issues already present.

12VAC35-107-70
Comment: Concern with two plans for support (ISPs) - initial and then comprehensive?

12VAC35-107-80 (E) ISP Requirement  

Comment: We agree that staff should be knowledgeable about the contents of the ISPs for the individuals served. Adding the addition of testing after each training is an unreasonable expectation and is an significant administrative burden to providers. Knowledge can be verified through observation during the supervisory and evaluation process. Please delete this requirement. 

12VAC35-107-100 - Progress Notes and Other Documentation
Comment: New requirement that progress notes be entered a minimum of once per shift.--- is this  practical or manageable?  The format of progress notes across all locations of one service is desirable but should be reasonable. The format and timing of notes across various services operated under a single organizational license may need to differ in order to reflect the unique nature of each service and affiliated requirements from pay sources.

12VAC35-107-170 B. 2. & 3.
Comment:  Contradiction - “Menus that must be followed and created in advance” - Yet we are seeking community-based services in which people change their minds when they want to and have access to whatever foods they so choose.

12VAC35-107-290 0. Another added expense?  What is the requirement here attempting to achieve?

vaACCSES Comments -
July 22, 2021
Proposed Licensing Regulations 12VAC35-107 - Residential Services Chapter

12VAC35-107-50 Secondary Screening
Comment: Required when someone is placed on waitlist?  An additional administrative burden when there may be staffing issues already present.

12VAC35-107-70
Comment: Concern with two plans for support (ISPs) - initial and then comprehensive?

12VAC35-107-80 (E) ISP Requirement  

Comment: We agree that staff should be knowledgeable about the contents of the ISPs for the individuals served. Adding the addition of testing after each training is an unreasonable expectation and is an significant administrative burden to providers. Knowledge can be verified through observation during the supervisory and evaluation process. Please delete this requirement. 

12VAC35-107-100 - Progress Notes and Other Documentation
Comment: New requirement that progress notes be entered a minimum of once per shift.--- is this  practical or manageable?  The format of progress notes across all locations of one service is desirable but should be reasonable. The format and timing of notes across various services operated under a single organizational license may need to differ in order to reflect the unique nature of each service and affiliated requirements from pay sources.

12VAC35-107-170 B. 2. & 3.
Comment:  Contradiction - “Menus that must be followed and created in advance” - Yet we are seeking community-based services in which people change their minds when they want to and have access to whatever foods they so choose.

12VAC35-107-290 0. Another added expense?  What is the requirement here attempting to achieve?

12VAC35-107-50 Secondary Screening
Comment: Required when someone is placed on waitlist?  An additional administrative burden when there may be staffing issues already present.

12VAC35-107-70
Comment: Concern with two plans for support (ISPs) - initial and then comprehensive?

12VAC35-107-80 (E) ISP Requirement  

Comment: We agree that staff should be knowledgeable about the contents of the ISPs for the individuals served. Adding the addition of testing after each training is an unreasonable expectation and is an significant administrative burden to providers. Knowledge can be verified through observation during the supervisory and evaluation process. Please delete this requirement. 

12VAC35-107-100 - Progress Notes and Other Documentation
Comment: New requirement that progress notes be entered a minimum of once per shift.--- is this  practical or manageable?  The format of progress notes across all locations of one service is desirable but should be reasonable. The format and timing of notes across various services operated under a single organizational license may need to differ in order to reflect the unique nature of each service and affiliated requirements from pay sources.

12VAC35-107-170 B. 2. & 3.
Comment:  Contradiction - “Menus that must be followed and created in advance” - Yet we are seeking community-based services in which people change their minds when they want to and have access to whatever foods they so choose.

12VAC35-107-290 0. Another added expense?  What is the requirement here attempting to achieve?

12VAC35-107-50 Secondary Screening
Comment: Required when someone is placed on waitlist?  An additional administrative burden when there may be staffing issues already present.

12VAC35-107-70
Comment: Concern with two plans for support (ISPs) - initial and then comprehensive?

12VAC35-107-80 (E) ISP Requirement  

Comment: We agree that staff should be knowledgeable about the contents of the ISPs for the individuals served. Adding the addition of testing after each training is an unreasonable expectation and is an significant administrative burden to providers. Knowledge can be verified through observation during the supervisory and evaluation process. Please delete this requirement. 

12VAC35-107-100 - Progress Notes and Other Documentation
Comment: New requirement that progress notes be entered a minimum of once per shift.--- is this  practical or manageable?  The format of progress notes across all locations of one service is desirable but should be reasonable. The format and timing of notes across various services operated under a single organizational license may need to differ in order to reflect the unique nature of each service and affiliated requirements from pay sources.

12VAC35-107-170 B. 2. & 3.
Comment:  Contradiction - “Menus that must be followed and created in advance” - Yet we are seeking community-based services in which people change their minds when they want to and have access to whatever foods they so choose.

12VAC35-107-290 0. Another added expense?  What is the requirement here attempting to achieve?

12VAC35-107-50 Secondary Screening
Comment: Required when someone is placed on waitlist?  An additional administrative burden when there may be staffing issues already present.

12VAC35-107-70
Comment: Concern with two plans for support (ISPs) - initial and then comprehensive?

12VAC35-107-80 (E) ISP Requirement  

Comment: We agree that staff should be knowledgeable about the contents of the ISPs for the individuals served. Adding the addition of testing after each training is an unreasonable expectation and is an significant administrative burden to providers. Knowledge can be verified through observation during the supervisory and evaluation process. Please delete this requirement. 

12VAC35-107-100 - Progress Notes and Other Documentation
Comment: New requirement that progress notes be entered a minimum of once per shift.--- is this  practical or manageable?  The format of progress notes across all locations of one service is desirable but should be reasonable. The format and timing of notes across various services operated under a single organizational license may need to differ in order to reflect the unique nature of each service and affiliated requirements from pay sources.

12VAC35-107-170 B. 2. & 3.
Comment:  Contradiction - “Menus that must be followed and created in advance” - Yet we are seeking community-based services in which people change their minds when they want to and have access to whatever foods they so choose.

12VAC35-107-290 0. Another added expense?  What is the requirement here attempting to achieve?

12VAC35-107-50 Secondary Screening
Comment: Required when someone is placed on waitlist?  An additional administrative burden when there may be staffing issues already present.

12VAC35-107-70
Comment: Concern with two plans for support (ISPs) - initial and then comprehensive?

12VAC35-107-80 (E) ISP Requirement  

Comment: We agree that staff should be knowledgeable about the contents of the ISPs for the individuals served. Adding the addition of testing after each training is an unreasonable expectation and is an significant administrative burden to providers. Knowledge can be verified through observation during the supervisory and evaluation process. Please delete this requirement. 

12VAC35-107-100 - Progress Notes and Other Documentation
Comment: New requirement that progress notes be entered a minimum of once per shift.--- is this  practical or manageable?  The format of progress notes across all locations of one service is desirable but should be reasonable. The format and timing of notes across various services operated under a single organizational license may need to differ in order to reflect the unique nature of each service and affiliated requirements from pay sources.

12VAC35-107-170 B. 2. & 3.
Comment:  Contradiction - “Menus that must be followed and created in advance” - Yet we are seeking community-based services in which people change their minds when they want to and have access to whatever foods they so choose.

12VAC35-107-290 0. Another added expense?  What is the requirement here attempting to achieve?

12VAC35-107-50 Secondary Screening
Comment: Required when someone is placed on waitlist?  An additional administrative burden when there may be staffing issues already present.

12VAC35-107-70
Comment: Concern with two plans for support (ISPs) - initial and then comprehensive?

12VAC35-107-80 (E) ISP Requirement  

Comment: We agree that staff should be knowledgeable about the contents of the ISPs for the individuals served. Adding the addition of testing after each training is an unreasonable expectation and is an significant administrative burden to providers. Knowledge can be verified through observation during the supervisory and evaluation process. Please delete this requirement. 

12VAC35-107-100 - Progress Notes and Other Documentation
Comment: New requirement that progress notes be entered a minimum of once per shift.--- is this  practical or manageable?  The format of progress notes across all locations of one service is desirable but should be reasonable. The format and timing of notes across various services operated under a single organizational license may need to differ in order to reflect the unique nature of each service and affiliated requirements from pay sources.

12VAC35-107-170 B. 2. & 3.
Comment:  Contradiction - “Menus that must be followed and created in advance” - Yet we are seeking community-based services in which people change their minds when they want to and have access to whatever foods they so choose.

12VAC35-107-290 0. Another added expense?  What is the requirement here attempting to achieve?

July 22, 2021
Proposed Licensing Regulations 12VAC35-107 - Residential Services Chapter

12VAC35-107-50 Secondary Screening
Comment: Required when someone is placed on waitlist?  An additional administrative burden when there may be staffing issues already present.

12VAC35-107-70
Comment: Concern with two plans for support (ISPs) - initial and then comprehensive?

12VAC35-107-80 (E) ISP Requirement  

Comment: We agree that staff should be knowledgeable about the contents of the ISPs for the individuals served. Adding the addition of testing after each training is an unreasonable expectation and is an significant administrative burden to providers. Knowledge can be verified through observation during the supervisory and evaluation process. Please delete this requirement. 

12VAC35-107-100 - Progress Notes and Other Documentation
Comment: New requirement that progress notes be entered a minimum of once per shift.--- is this  practical or manageable?  The format of progress notes across all locations of one service is desirable but should be reasonable. The format and timing of notes across various services operated under a single organizational license may need to differ in order to reflect the unique nature of each service and affiliated requirements from pay sources.

12VAC35-107-170 B. 2. & 3.
Comment:  Contradiction - “Menus that must be followed and created in advance” - Yet we are seeking community-based services in which people change their minds when they want to and have access to whatever foods they so choose.

12VAC35-107-290 0. Another added expense?  What is the requirement here attempting to achieve?

Comments - General Chapter 12VAC35-107

12VAC35-107-10. Definitions

• Please include the definition of Residential Crisis Stabilization Services that matches forthcoming definitions being developed between DMAS and DBHDS. 

12VAC35-107-60.F.2.d Assessments.

Please revise to note the provider shall attempt to obtain BAC or administer a breathalyzer to reflect that individuals have the right to choice.

12VAC35-107-60.G Assessments.

Thank you for recognizing that there are situations where the initial assessment meets the requirements of a comprehensive assessment and that an update is not required.  This increases alignment with DMAS expectations for many services.

12VAC35-107-60.H. Assessments.

Revise to reflect for a minimum of six years after the individual’s discharge, as there are other factors affecting how long records must be retained.

12VAC35-107-80.B.14 ISP requirements.

Change to projected discharge date “or” estimated length of stay, to reflect that some services are anticipated to be the individual’s home for many years.B5 uses the language “defects”; perhaps it’s deficiencies.

12VAC35-107-80.E ISP requirements.

While staff members should be knowledgeable about the contents of ISPs for individuals served, establishing an expectation to train and test all staff members involved with service delivery is an unrealistic expectation that will significantly detract from service delivery.  Observations of competency in and knowledge about providing services is part of the supervisory and evaluation process.  Promoting this is likely to result in providers making fewer updates to ISPs to avoid retraining and testing staff.  For short-term services, a person could potentially be discharged before testing of all staff members (typically three shifts) could occur.  There is no realistic way to document this knowledge and competency without documentation of confidential information about individuals served, which should not be part of a Personnel File.  This also places an undue burden on Human Resources staff members who maintain personnel files.  File sizes would become unmanageable.

12VAC35-107-90.C. Reassessments and ISP reviews.

Remove, as this is not applicable for residential services, which are inherently not medication-only in nature.

12VAC35-107-100.A Progress notes or other documentation.

The intent of this is unclear.  Certainly, the format of progress notes across all locations of one service is desirable. However, the format of notes across the various services operated under a single organizational license may need to differ in order to reflect the unique nature of each service and affiliated requirements from pay sources.  Revise to reflect that the format of progress notes is to be consistent across all locations of the same service type.

12VAC35-107-180.A.3 Community participation.

Specify an exemption for short-term programs that typically do not have individuals leave the milieu, such as substance use treatment programs 30-days or less in duration.