Posts Tagged ‘assisted living’

Regulatory Reform in the Home-Stretch

June 21st, 2013

Our Licensing & Rulemaking teams have spent the better part of 18 months working with hundreds of folks from numerous associations and licensed facilities as part of our regulatory reform initiative.  We’ve been overhauling 18 Articles of regulations for Healthcare Institutions and Behavioral Health Service Agencies including hospitals, skilled nursing facilities, outpatient surgery and treatment centers, recovery care, adult therapeutic foster homes, assisted living, home health agencies, hospice facilities, DUI services; residential treatment centers and midwives.  It’s been a long road- and we’re in the final-stretch now. 

Our teams are busy going through some final revisions to the 600 pages of new Rules, which we’ll be filing next week.  We’ll have an October 1 implementation date on each of the packages.  That’ll give our licensees a chance to learn the new rules before they’re expected to comply with them; it’ll give our surveyors time to learn the new rules so we can survey to them properly; and it’ll give AHCCCS the time that they need to figure out some reimbursement issues. 

As an added bonus- the state budget that was signed by the Governor on Monday gives us extended “exempt” rulemaking authority through April of 2014…  meaning that we’ll be able to make additional revisions as we implement the new regulations and find areas that can use tweaking.

Evidence-Based Decision-Making: A Key Regulatory Benchmark

November 19th, 2012

The role of a surveyor can be a difficult one. Our team of licensing surveyors need to maintain neutrality as regulators and be able to apply the Arizona Administrative Code (otherwise known as “the rules”) to a wide variety of facilities within the healthcare system.  Part of our surveillance includes investigating complaints- which can be generated from an array of internal and external sources.  When the complaints come because of TV or other media coverage- it can pose unique challenges for our team.  But…  no matter where the complaint comes from, our job is to use facts and evidence to drive our investigation, decision-making, and interventions. 

There are 3 forms of evidence that we use to substantiate an allegation made in a complaint: 1) observation; 2) documentation; and 3) interviews. Two of these forms of evidence need to be present before we find that a complaint is “substantiated”.  By using these tried and true evidence-based tools we put ourselves in the best position to identify real health and safety problems without jumping to conclusions.

Focusing on facts and evidence (and not allowing one’s self to be driven by media coverage) is a good start…  but there are a few things that both surveyors and healthcare professionals can do to keep focus on providing a healthy and safe environment. Keep good records, document, sign and store up to date data, maintain consistent supervision for those that require it, follow your agency’s policies and procedures without fail, report what’s required, be proactive (not reactive), and seek out ongoing education in your field.  Don’t cut corners when it comes to care… and don’t be afraid to admit a mistake or that you do not have all the answers. 

So, if you happen to hear or see a TV story about a facility, keep in perspective that the story might focus on anecdotes and what the reporter thinks they know or even just their opinion- not necessarily what the evidence demonstrates.  In a time when information is disseminated second by second rather than day by day, let’s remember that we all share the same goal, to promote Health and Wellness for all Arizonans, which includes providing surveyors, community, clients and staff accurate and factual information.

Curious about the real scoop on how all of our licensed facilities are doing?  Check out our AZ Care Check website which has the details about our evidence-based investigations and surveys.

Our New Strategic Plan

October 17th, 2012

The vision of the Department is to ideally achieve a state of Health and Wellness for all Arizonans and our mission is to promote, protect, and improve the health and wellness of individuals and communities in Arizona. The updated mission and vision statements are helping us build public health value in-house as well as in the community.  The format was modernized and ADHS is making an effort to educate our partners and reinvigorate staff on our goals.

We’re among the largest and most complex of state agencies. With over 1,600 employees and an annual budget of more than $1.8B, we provide a wide variety of services and a diversity of programs housed within its five divisions: behavioral health; licensing; planning and operations; public health prevention; and public health preparedness. The two-fold mission of public health services includes prevention and preparedness for the state. The public behavioral health system oversees services for 150,000 enrolled clients and the state’s only public psychiatric hospital, the Arizona State Hospital. The division for licensing is charged with certification of nursing homes, assisted living and child care centers, hospitals and other health care facilities. The division for planning and operations oversees the budget, procurement, audit and special investigations, information technology, workforce development, rule-making, human resources, policy, continuous quality improvement, and accreditation.

Our strategic priorities are the pathways we use to achieve targeted improvements in public health outcomes. We’re committed to moving along with our partners in local health departments toward voluntary public health accreditation. The work towards accreditation will require the agency to look at the statewide public health system as a whole, collaborate with stakeholders, and provide evidence that our work meets the ten essential public health services. The ten essential services were set as a national standard in 1994 by a steering committee consisting of all US Public Health Service agencies and representatives from other major public health organizations. Accreditation focuses on quality, transparency, and partnerships. Through the accreditation process, our leadership will identify strengths, weaknesses, and opportunities for continuing to build public health infrastructure in a way that will best align our resources with key priorities.

Our new updated Strategic Plan lays out the framework for how we’ll use quality improvement, lean methodologies, best practices, and strategic alignment to achieve our vision of “Health and Wellness for All Arizonans

Sonoran Public Health Department & ADHS Snag the Paul Fannin Award

June 11th, 2012

 The Secretario de Salud Publica & the ADHS jointly received the Arizona Mexico Commission’s Paul Fannin award for our public health collaborations last Friday night.  This is a top award for the Commission- with the award going to “… an organization that has demonstrated acts of goodwill and support toward the development of the Arizona-Sonora relationship.”  It’s named after the AMC’s founder, Governor Paul Fannin.  This is the first Fannin award that has gone to binational recipients.  ASU and UA got a joint award as did ADOT and the Yuma Port Authority a few years ago…  but this is the first one with binational recipients. 


We were jointly recognized for our awesome collaboration on things like valley fever surveillance and interventions, real-time infections bi-national disease reporting, TB case and treatment coordination, collaboration during the H1N1 pandemic, laboratory science teamwork, teen pregnancy and substance abuse prevention, collaboration on assisted living standards, and much more.  Thanks to all of you who have made our relationship with Salud Sonora a success!


Interim AD for Licensing

May 10th, 2012

 Colby Bower will serve as our Interim Assistant Director for Licensing while we recruit and hire a permanent Assistant Director.  Colby has been serving as our Legislative Affairs chief for the last couple of years.

Colby fills several of the criteria that we needed for the interim post: 1) He’s a good risk manager and has a good understanding of the importance of Stakeholder relations; 2) He understands the matrix of our statutes and rules- and knows that we need to exercise our authority through the prism of public health; 3) He’s good with people; and 4) Now that the legislative session is over- he’ll have the time needed to invest in the program.  Our Operations folks are busy doing all of the IT, finance and legal things to get Colby the authority and tools he’ll need in his post.

We’ve already announced our recruitment for a permanent Assistant Director.  I blogged about the recruitment yesterday, including a hot link to the job announcement on ADOA’s website.  Our goal is to complete the recruitment process and hire a permanent AD this summer.


Join me in welcoming and thanking Colby for his willing to fill this important post while we go through the full recruiting process!

ADHS Looking for a Forward-thinking Assistant Director

May 8th, 2012

Promoting Health and Wellness for all Arizonans” is the motto of the Arizona Department of Health Services.  We promote and protect the health of Arizona’s children and adults and set the standard for personal and community health through direct care, science, public policy and leadership.  Want a piece of the action? 

We’re looking for an experienced and proactive leader to become our new Assistant Director for Licensing Services. This key position reports directly to me and manages six different state and federal licensing units including Long Term Care, Medical Facilities, Child Care, Assisted Living, Behavioral Health, and Special Licensing.  The job oversees about 200 employees and a budget of $17M.  But- what makes the job exciting is that you’ll have a unique opportunity to lead a dynamic team and use your talents and skills to make Arizona a healthier place- “Promoting Health and Wellness for All Arizonans”.

Arizona Mexico Commission Progress

February 10th, 2012

I’m writing this from my hotel room in Rocky Point- after a long day (and night) of the inter Plenary Session.  The 2 day conference started Thursday and goes through tonight.  We meet twice a year- it’s basically an opportunity for us to form partnerships across the border and to develop regional approaches to things like valley fever surveillance, burn patient infrastructure, substance abuse, TB, border first aid, farmworker health, and Sonora’s efforts to provide licensing and quality assurance services for assisted living in Sonora (and how we can partner with them as they set up their program). 

During last summer’s Session we signed a bi-national Declaration to develop regional surveillance for valley fever.  We’ve made a lot of progress in the last 6 months, and tomorrow we’ll be following up on that initiative at Sonora’s public health laboratory, checking out the lab instruments and equipment that we were able buy (with federal funds) and indefinitely post in Hermosillo in their lab. We’ll also be setting up some joint training sessions. There are lots of other examples of what we do through the Commission on health- this is just an example. 

The Arizona Mexico Commission was started by then Arizona Governor Paul Fannin in 1959 to improve partnering between Arizona and Sonora in a wide range of areas.  It’s evolved over the years to become a premiere and unique cross-border nonprofit organization whose mission is to improve the well-being and quality of life for residents of Arizona by promoting a strong, cooperative relationship with Mexico and Latin America through advocacy, trade, networking and information.  The Commission has 14 bi-national committees that act as industry and community advocates in partnership with the Commission Sonora-Arizona (from Sonora, Mexico) to facilitate cross-border trade, business and community networking and bi-national information sharing.  Our link is through the Health Services Committee.

Click here to see some of the public health facilities and an ambulance they use on the beach.

Doing the Right Thing

February 1st, 2012

Our Assisted Living Licensing shop received a complaint about physical and verbal abuse of vulnerable adults in an assisted living facility in Casa Grande a couple of weeks ago.  Surveyors Matthew Deise and Doris Laidlaw responded to the facility and interviewed several residents and caregivers at the home, who confirmed that some employees treat the residents disrespectfully.  Some of the residents appeared fearful and unwilling to talk, which can also be a warning sign of abuse- and a signal to dig deeper.  

Although the investigation is still ongoing, our team notified AHCCCS, Adult Protective Services, and the Ombudsman’s office of these concerns to coordinate needed services for the residents and ensure that their safety is protected.  Right after our call- AHCCCS placed 24-hour supervisory staff in the home and another home owned by the same person.  Our team called the owner and manager of both facilities for a meeting the next morning to ensure that they were aware of their responsibility to protect not only the health and safety of the residents, but also the resident’s rights, including the right to be treated with dignity and respect and to express grievances without constraint or fear of retaliation. 

Our team is still working through the details of this case- but it shows how important our licensing work is…  our team is on the front lines of not only keeping people safe- but making sure that they’re treated with dignity and respect.

AZ Carecheck

November 14th, 2011

It’s been a while since I mentioned to you that our Division of Licensing has a really good web site called AZ Care Check.  Our website provides a 3 year history of survey results, complaint investigation results and if any of our licensed facilities (nursing homes, assisted living, hospital and other medical facilities, childcare or behavioral healthcare services) including any enforcement actions in the last 3 years. 

AZ Care Check also provides the user with facility names, addresses, city, phone number and other useful pieces of information. In fact, once you select a facility to review, you can even be linked right to MapQuest to get directions. Of course, the main value of this website is to provide the user with up to date information about our licensed facilities so a good decision can be made when services/care are needed.  I encourage you to visit the website and to pass it along to someone you know who may find this website useful.

Assisted Living Team Makes a Difference

July 26th, 2011

A survey team from our assisted living office went into an Assisted Living Center in Mesa in response to multiple complaints and concerns from family, residents and from the Arizona Long Term Care System (ALTCS) providers last December.   As a result of the four day inspection, the facility was put on a provisional license pending correction of deficiencies, including many health and safety violations.  The facility houses many residents who are at the supervisory level of care and able to direct their own self-care. There are also residents who have ambulation issues such as using wheelchairs, walkers, other mobility aids or are bedbound.

The most important health and safety violations were problems with fire safety, including smoke detectors being disabled and residents smoking in their rooms.  The facility was also deficient in conducting fire drills for residents and employees.   Our team of surveyors monitored and encouraged the facility’s efforts to comply with facility rules and provided technical assistance to staff.  Over the past 6 months the Department has worked with this facility and the new manager to correct the deficiencies; in particular, to ensure that fire drills were conducted and the smoke detectors and alarms were frequently monitored. 

 Last week those efforts paid off when a resident (on oxygen) lit a cigarette and set his bed on fire (against facility regulations.  He had been under notice to relocate because he continued to smoke in his room.  The smoke detector and the fire alarm went off, the sprinklers engaged and the fire department was called.  The manager and the staff reported to the room and emptied four fire extinguishers, knocking down the flames before the fire department arrived. The resident, who was able to reach the ground floor in his wheelchair, was taken to a hospital for treatment.  Because of the recent fire drills, the staff and residents of the facility knew what to do, and did it. As a result there have been no permanent injuries to the remaining residents.

 We want to thank all of our surveyors who have assisted this facility for the past few months, and those who made visits over the weekend: Christy Neal, Pat Greenquist, Margaret Wheeler, Doris Laidlaw, Rosey Diaz, Sherry Daniely, Nicole Morong, Reina Manso, Lori Schrock, and Amber Harris, to regain compliance and to avoid what could have been a major tragedy, and to protect the residents’ health and safety.