In Home and Co Communit ity- Base sed Long Term rm Se Serv - PowerPoint PPT Presentation

In Home and Co Communit ity- Base sed Long Term rm Se Serv rvic ices es and Su Support rts s Pro rogra rams ms

 An allegatio egation n or or an actual al oc occurrenc rrence e of of an inciden ident t that adve versel rsely impa pacts cts or has the potentia ential to adve verse rsely impact pact the health, alth, welfare fare or safet ety y of a p parti ticip cipant ant. Eve very ryone one that works ks with h long g term services vices and supp pports orts progr grams ms must st report. port.

 Compla omplain ints ts are e also so to to be be reported orted th throu ough gh th the Re Repor ortable table Eve vent nt mo modul ule. .  Ma Main in ty types of of com omplaints laints to to report ort: a) qual ality ity of f car are – worker sleeps on duty b) se serv rvic ice e is issu sue – wheelchair repair not done

 No Not all ll co compla laints ints need to b be re report rted. d. Lis isten n careful ully ly & & use dis iscretion ion. . E.G. Pers rson n co compla lain ins s that ch chic icken is is serv rved d 7 days a w week, every week. Turns out that chic icken n is is se served d twic ice a w week & & cli lient has optio ions. ns. A A compla laint int that nothin ing g but hotdogs gs are served ed should ld be reported. d.

 Reviews views REs s fr from m Suppo ports rts Pla lanners, ers, Pro rovide viders, rs, Par articipa cipants, nts, Fam amily, y, or other er inter erested ested par arties es. . ~ Purp rpose ose of f re revi view ew is help p ensure re problems roblems ar are re reso solved, lved, to id identify ntify tre rends nds with h typ ypes of f incidences, idences, to pro ropose pose qual ality ty imp mprove rovemen ment, t, an and to me meet fe federal ral re requirements. irements.

 Is s di dire rectly tly re resp sponsibl nsible e to the he fed eder eral l Cent nters rs for r Medi dicare re and nd Medi dicaid aid Services rvices (CMS) S) for r the he ope pera ratio tion n of the he Community mmunity Op Optio ions ns Waiv iver, er, Commu mmunit nity Fir irst st Cho hoic ice e and nd the he Medi dicaid id Pers rsona nal l Care re Pro rogra ram. m.  Al All l of the hese se pr progra rams ms us use or w r wil ill l us use the he Me Medi dicaid id Rep eport rtabl able e Ev Even ents s sy syst stem em.

 CMS S provi vides des Maryl ylan and d wi with a cer ertain ain % % of matching hing funds ds for operatin rating g appro roved ved program grams s  CMS requires that State’s ensure that certain federal eral Assuran urances es wi will be met  A A system tem of rep eporting rting ev even ents ts hel elps ps us to meet the CMS Assuran urance e of ensuring uring the health, lth, we welfare re and safety ty of parti ticipants ipants serv erved ed in our programs. grams.

 We mu must t provid ovide CMS MS wi with th evi vide dence nce th that t we we ha have ve a sy syste tem m to to com ommunica municate te issue ues s inv nvol olving ving partici rticipants pants in n a ti time mely ly ma mann nner and nd th the me e means ns to to res espond ond to to the the issues. ues.

 We We use data from RE progr gram am to show w CMS that t we we have ve evi vidence nce that people e are res esponding ponding time mely to issues, ues, priorit itizi izing ng issues sues and looking ng for wa ways to prevent vent problems blems from re-occurr curring. ng. Quality ty imp mprov rovem ement ent is ex expec ected ted wh when en we we see ee problem blematic atic data trend nds. s.

 Imm mmediate ediate Jeopardy ardy (IJ) ) is is defined fined as as an an al alleged ged or r ac actual al incident ident that at pre resents sents an an imm mmediate diate & se seri rious ous thre reat at of f in inju jury, ry, har arm m or r deat ath h of f an an individual. dividual.  A t A tele leph phone one cal all l mu must st be ma made to the ap appropriate ropriate off ffices ices or au r author horities ities within thin 24 hours rs. .

 This is includes: ludes:  Law enforceme ement nt  Chil ild or a adult lt protectiv ive e servic ices es  Th The e Divi vision on of Qualit ity y and Comp mpliance ance Revi view  Other er protocol ol your r employer yer may require uire

If f the informati rmation on you rece ceive ive is insuffi ficient cient for you to know whether er the situatio tion n is under r co control, rol, you will need to make an onsite te visit t within n 24 24 hours rs to mak ake e sure e the e saf afet ety y of the e par artici cipan pant t is being g ensured. If f the situatio tion n is under co control rol and the cl client t is known wn to be safe, you will need to go onsite e within in (2) 2) business ness days.

 The SP’s report must be made thru the tracking cking syst stem em wi within (5) calend ndar ar days s of the eve vent. t.  This s report rt made wi within (7) calend ndar ar days s of the origi ginal nal eve vent must contain in the interven ervention, on, and follow w up action plan.  The incident ent must be resolve ved d by the SP P wi within n (45 45) calen endar dar days s of the e ev even ent. t.

 Min inor r in inci cidents nts do no not have to be be re report rted. d.  The standa dard d is is to re report any in injury y that re requires ires tre reatment ent beyond nd Fir irst Aid id.  You should ld stil ill l report min inor in incid idents nts if if they y happen en re repeatedly. edly.  e.g. g. Partic icip ipant ant fall lls but does not in injure herself; elf; however er, , 3 fa fall lls occur in in (2 (2) weeks

 Wh When the same type of in inci cident ent happens ens repeatedly edly wit ith a n narrow range ge of tim ime, such h as ~ ~ Fall lls ~ D Dis isorie ient ntat ation ion ~ R Refusing sing to ke keep medic ical al appoin intmen tments Revie iew the cir ircumstanc tances es around d these inci in cidents ents to de determ rmine ine if if somethi hing ng ca can be done to re reduce the frequen uency. y.

e.g. g. A pa part rtic icip ipant ant has fall llen n (3) 3) tim imes in in two weeks. s. You revie iew where fall lls are happeni ening ng and look at the participant’s environment. Is it wet flo loors in in th the bathroom? om? throw rug in g in the bedroom? m? objects ts la layin ing g all ll ov over the house? se? Can the envir ironment nment be modif ifie ied d to he help lp prevent ent the fall lls? s?

 Comp mplete lete all sec ections ons of the e rep eport rt wi with useful eful detail il  The Medicaid aid revi viewer wer should ld read d the report ort and have ve a clea ear unders erstan anding ding of wh what happ ppen ened, ed, wh what wa was done & wh what remains ns to be done  Dates es are e ve very imp mportant! tant!  Attachm chmen ents ts can be uploaded aded but the report rt must st still be complete te in all areas! as!

 Th The e SP SP wi will rev eview ew all information mation and docum umen ent findings ings  Action n steps ps must be identi tifi fied ed ~ lo ~ locate e a new ew assist isted ed livi ving g home me ~ reques uest increase ease in hours rs of personal sonal assist istan ance ~ ob ~ obtain n a PE PERS RS ~ continue nue wi with curren ent plan of servic vice, e, no change ges s needed ded at this time

 Th The Re Report rtabl ble e Ev Events s sect ctio ion of th the trackin ing g system em has a p pla lace for progr gress s notes  Once ce you have co comple leted ed a se sect ctio ion of th the report, you cannot go go b back and amend nd it it  The purpose se of the progr gress ss note is is to all llow you to up update te in informati ation n or m modif ify y it it as needed. ed. For ex examp mple le, , you may need to note that the date of the event t was in inco corr rrect ct or r pro rovid ide e more re in inform rmation tion about the event.

 Progr gress ss notes are als lso used d to d document ent foll llow-up. up. The Medic icaid id revie iewer ers s need to kn know that there e was appropria iate te foll llow-up up so the case can be clo losed at the St State le level. l. e.g. g. A participant’s physician refers him to a ca cardio iolo logi gist st for foll llow-up up post hospi pita taliza lization tion for r ch chest pain in. DHM HMH H revie iewer wers s wil ill l lo look fo for a p progr gress s note stating ing that a ca cardio iolo logy gy appt was sch chedul eduled ed or r even better, r, attended ded.