In overall review of the documents up for comment in this it is continually noting punitive tactics as opposed to DBHDS working alongside the provider community for the betterment of services to those that are supported by these groups. We are supposed to be partners in this to ensure quality person-centered services are being provided.
This document focuses heavily on progressive citations that can have a large impact on an already stressed system and still not promote/foster quality services for those in the state of Virginia. This guidance may have a more negative impact as the provider community will now fear the offices of DBHDS and may refrain from reporting for fear of repercussions. I can recall a time not long ago when working with Licensure was a pleasure and used as a learning experience. We freely reported and received feedback to better our systems. Even when Licensing Reports became a way of educating providers there was still a level of respect and support offered. This document changes that focus and continually reiterates how the provider agency will continue to receive citations, and even when we make attempts to do something right, if we fail to get it correct as noted within the guidance of this document then we will get yet another citation.
Timely reporting is critical and the provider community respects that. However, to assume that a provider agency with over 1000 DSP's has to meet the same criteria as a provider agency with 10 DSP's does not seem to be set as a level playing field.
In addition, to expect within 48 hours to have an update to a Serious Incident, is unrealistic as often testing is not completed in that time frame or results have not been determined. Provider agencies should not be held to this time frame. It is recognized that the Incident Management unit has time lines to close their cases but that should not impact the provider agency time line as the provider agency is working directly for the individual and also managing the care during that time. This should not impose a citation due to late follow up.
As with the other guidance documents, to think that any provider agency can PREVENT things from happening is unrealistic. We can only work to mitigate as stated in the DBHDS regulation regarding reporting. In addition, it should not be assumed that every concern that arises is systemic. We should not burden the system to expect a full policy revision, or training for all DSP's when it is not something that has impacted the whole provider agency.
With regards to progressive citations related to the same regulation, it is unrealistic to assume that a large provider agency may not have certain things reported related to the same regulation that may be very different in nature. That does not constitute a systemic concern or something that should be addressed with a progressive citation. It would need to be re-evaluated to determine what method gets to the criteria necessary for progressive citations but takes into account all the different areas and citations that could fall under one regulation. In addition, the size of the provider agency and the amount of programs run within that agency would also need to be taken into account.
This document should be re-worked with input from the provider community and withdrawn until a time when that can be completed.