DD Licensing and Certification Tools

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Rule applications

Comprehensive 24-Hour Residential Services for Children & Adults with Developmental Disabilities

• 411-325-0100 Inspections & Investigations
• 411-325-0110 Variances
• 411-325-0120 Health: Medical
• 411-325-0130 Food & Nutrition
• 411-325-0140 Health: Physical Environment
• 411-325-0150 Safety: General
• 411-325-0160 Program Management & Personnel Practices
• 411-325-0170 Safety: Staffing Requirements
• 411-325-0180: Individual Summary Sheets
• 411-325-0190 Incident Reports And Emergency Notifications
• 411-325-0200 Safety: Transportation
• 411-325-0280 Fire Safety Requirements
• 411-325-0300 Rights: General
• 411-325-0350 Rights: Physical Intervention
• 411-325-0360 Psychotropic Medications And Medications For Behavior
• 411-325-0380 Money Management
• 411-325-0390 Exits, Entry And Transfer
• 411-325-0430 Individual Support Plan
• Housing/Structure/Safety
• Miscellaneous

411-325-0100 INSPECTIONS AND INVESTIGATIONS:

(8) Abuse Investigation and Protective Services Report.

• Licensing specialists are to follow up on PSI’s, either during on-site visits or by contacting the County to determine if the program has implemented the recommendations and corrected the issues.
• Licensing specialists are to use professional judgment to determine if the program action/inaction warrants a mid-cycle review.

411-325-0110 VARIANCES:

(1) Criteria for a variance.

Variances are required when a program plans to implement the following:

• A practice, policy or procedure that either cannot be addressed through the ISP process or is not in compliance with the OAR’s (sill height, window size, prn psychotropic meds, mechanical restraints, etc.); or
• When an individual objects to a restriction put in place due to another individual’s issue (locked kitchen, locked personal hygiene supplies, etc).
• The variance must be submitted to the CDDP for their recommendation, and then submitted to SPD for final approval or denial.

411-325-0120 HEALTH - MEDICAL:

411-325-0120 Expectations when there is a “Missed Medication” protocol.

• The documentation on the MAR needs to reflect the time the medication was actually administered. If the time is not accurately stated on the MAR then OAR Medication Administration 411-325-0120 (5) (d) is cited.
• If the missed medication protocol was not followed then OAR Implement a Physician’s Orders 411-325-0120 (2) (e) is cited. If the time of the medication administration is not documented on the MAR then cite OAR Medication Administration 411-325-0120 (5) (d). If the reason for the irregularity is not documented on the back of the MAR then cite OAR 411-325-0120 (5)(i). Missed medications and treatments that result in harm, or have risks of potential harm should be turned in as a potential PSI.

411-325-0120 (2)(d) Physician’s Orders

• When a physician’s order says one 50mg tablet and the pharmacy sends two 25mg tablets. It is okay to dispense the two 25mg tablets.  There is no citation for the label and order not matching because it is the same dose.
• If the physician writes an order for OT and PT interventions so the services will be paid for by insurance and it is evident the physician wants the provider to follow their recommendations, no new physician order would be required.
• Electronic signatures will be accepted as long as the agency has the documentation stating that the signature has been “electronically verified” or “electronic signature”.

411-325-0120 (2)(d) Physician’s Orders & 411-325-0300 (2) (n) Rights: General (Individual Choice)

• The program must have a physician’s order to administer medications mixed in food or juice, with the intent to disguise the medication so that the individual will take it. This issue should be addressed where applicable, e.g., the PFW, BSP, Safety Plan and/or Nursing Care Plan.

411-325-0120 (2)(d)(B) over the counter (OTC) topical medications

• Use of OTC topical medications without a physician’s order needs to be followed per provider’s policy. Check the provider’s policy and procedures to see how they want this to work. The provider’s medication management policy shall describe how OTC topical medications are to be utilized without a physician’s order. OTC topical medications defined by Dr. Kitchin as: applications in the eyes, ears, nose and on the skin. (This can become a problem for EMP & ATE providers, as they need an order for OTC topical medications, or a variance for this practice.)

411-325-0120 (4)(b) Medication Procurement and storage (Medication Labels)

• When there has been a medication order change, and the pharmacy will not dispense the new medication until the existing medication is used up, it is acceptable to attach to the medication container directions that refer the reader to the MAR and the new physician’s order. (Specifically prn’s, creams, etc. Call one of the Licensing nurses if you have questions.)
• For OTC medications, as long as the medication’s intended usage is the same as the manufacturer’s label, no pharmacy label is needed.

411-325-0120 (8) PRN Psychotropic Medications

• Use of PRN sleep aids requires a variance (prn psychotropic) unless it is for a medical condition diagnosed by the prescribing practitioner, e.g., insomnia, restless leg syndrome, or as directed by Hospice.
• 2/27/06: Clarification on “medical condition” needed from Tina Kitchin.

411-325-0120 (11) Nursing Services

• Nursing Orders can be part of the nursing services being provided. Nursing orders by the Board of Nursing definition are: “Prescriptions for specific nursing interventions initiated by the RN which are intended to produce the desired outcome or objective, be it short term or long term, as defined in the plan of care.”  Nursing Orders may include:
  • Measures to maintain comfort (Holding bowel medications when a person has diarrhea. Holding a person’s regular meal and ordering clear liquids or a bland meal due to illness. Cool sponge baths for fever. In response to an injury, ordering ibuprofen be administered every 8 hours for the next 24 hours when an existing prn order is in place.)
  • Measures to support human functions and responses
  • Maintaining an environment conductive to well being
  • Health teaching and counseling (self administration of inject able medications)
  • Advocacy on behalf of an individual (suggesting medical referral be pursued)
• These orders can be documented in the Nursing Care Plan, progress notes or on NCR forms utilized for physician telephone orders, and the document should reflect that it is a “nursing order” and be signed by the nurse.
• Nursing Orders should be linked back to a Nursing Care Plan, acute or long term, which is based on a documented assessment of the individual’s health status.
• When a Licensing Specialist has questions about a nursing order, ask to see the nurse’s assessment from which the order is based. If questions still exist, contact one of the RN Licensing Specialists for assistance. (Focus on coordination of care.)

411-325-0130 FOOD & NUTRITION:

411-325-0130 (2)(a) Modified or special diets.

• Menus & Going Out To Eat
  • Menus need to reflect what was available for the meal for individuals on physician ordered diets. There should be instructions/directions for staff on how to meet dietary requirements for individuals that eat out, and there should be documentation reflecting items consumed. If there is no documentation of food consumed, then cite OAR 411-325-0120(2)(d)(D) for not following physician ordered diet. (See exception below dated 2/27/06.) Carefully look at times when everyone in the home ate a meal out together for potential provider convenience. Individuals who frequently eat out could be of concern based on what the ISP/Financial Plan directs and their financial situation.
  • 2/27/06 – If an individual refuses to follow a prescribed diet, the ISP needs to clearly document the conflict. As long as it is the individual’s choice to not follow his/her diet order, there will be NO citation.

411-325-0130 (2) Modified or Special Diets (Dietitian)

• If the physician referred the individual to a dietitian and stated to follow their recommendation then no new-signed physician order would be needed for the diet recommended.
• 5/23/06 Portion control requires a physician’s order.

411-325-0130 (2) & (2) (a) (b) Diet Orders, Menus & Instructions

• Diet Order (special diets or modified food texture)– When menus do not reflect the necessary modifications (e.g., no dairy, no caffeine), there must be a system in place noting how the modifications be made to meet the individuals needs or food preferences.
• Instructions for staff need to be in place regarding the preparation and serving of modified and special diets.

411-325-0140 HEALTH - PHYSICAL ENVIRONMENT:

411-325-0140 (13) State & Local Codes (Repairs/Renovations/Permits) (Per SPD, Community Housing Section, 4/19/05)

• Any repairs or modifications that involve electrical or plumbing generally require at least a repair permit. An example for plumbing would be replacing a water heater. A permit is required to replace a water heater so as to assure that the earthquake straps are in place. Any modifications that involve moving, building or replacing a wall would need a construction permit. Non-structure repairs or modifications would not normally require a permit.
• SPD, Community Housing Section has copies of Building Code books that licensing staff can look at for information, but they are not easy to decipher.
• Individual city or county zoning codes can usually be accessed on line.
• If a provider wants to increase their capacity from five beds to six or more beds then city zoning may be an issue. A conditional use-permit is needed unless the home exists in a multi-family-use zone. There are also additional fire codes to meet when capacity exceeds five beds.

411-325-0150 SAFETY - GENERAL:

411-325-0150 (9) First-aid kit and manual/

• Unlocked first-aid kits can contain only band-aids, tape, and bandages.
• First-aid kits that contain OTC topical medications, scissors, tweezers and gloves, etc. must be locked.
• 2/27/06: A variance may be submitted to keep the first-aid kit unlocked.The variance must document that there is no one in the home with PICA issues or issues with sharps. It does not need to be reflected on the Safety Plan.
• 2/27/06: First-aid kits in vehicles do not need to be locked.

411-325-0160 PROGRAM MANAGEMENT & PERSONNEL PRACTICES:

• Licensing Specialists will review personnel records for the items required by the OARs.  If the required documentation is not available at the home, or cannot be brought to the home, the licensing specialist will go to the agency’s main office to review the personnel records.

411-325-0160 (4) Core Competencies/Re-mediation

• When reviewing an agency’s core competency training plan, as long as the training plan addresses what the steps are to retrain or “re-mediate” a staff in the areas that the staff needs retraining, the agency does not need to use the actual word “re-mediation”.

411-325-0160 (4) & (7)(f) Core Competency

• Core Competency Training applies to 24-Hour residential services and only those staff hired after 4/1/99.
• Look for a statement, policy, or employee agreement. If there is not a written statement, the program will receive a citation.
• Documentation must reflect staff met basic qualifications in the agency’s competency based training plan which includes: health, safety, values and personal regard, and the service provider’s mission as appropriate to their job description. These should have been developed based on core competencies developed in conjunction with SPD. Licensing Specialist will refer back to the agency’s statement or policy and review what formats are used that document staff are meeting core competencies. Be sure to include in the review records of any staff whose core competencies has been waived, or re-mediated.
• Written documentation should be found that the staff has demonstrated competencies identified in the agency’s training plan and is appropriate to their job description.

411-325-0160 (8) Personnel Files (Computerized):

• If the computerized records are listings of training dates, the Licensing Specialist will need to see the corresponding training records/documents. This may require going to the main office to review the actual training records/documents in the personnel file.
• Staff who have previously worked for an agency and left their employment and then been rehired by the agency need to have a criminal history check, and core competency training upon their rehire. CHC rules are available online, refer to it for specific requirement.
• If the program indicates a CHC has been sent but yet to receive an approval, verify this information with the Authorized Designee or call the CHC office to verify.

411-325-0160 (8)(f) 12-Hours of Job Related Annual In-service Training

• Find out what system the agency uses (e.g., hire date to hire date or calendar year). If the staff person has been there more than one year, count back one year.
• If there is a question that a staff person is not “literate” and “capable of understanding written and oral orders”, and “able to communicate with individuals, physicians, services coordinators, etc.; or “able to respond in an emergency situation”, make sure that the Executive Director of the agency is aware of the concern.
• 5/23/06 Nurses do NOT need additional certification in CPR/1st Aid.

411-325-0160 (9) Program Documentation Requirements

• 411-325-0160 (9)(b)(d) Documentation Requirements (Incident Reports): When a program re-writes an incident report, they must attach the original incident report to the re-written IR. This is to assure no falsification occurred.
• 411-325-0160 (9)(c) Signatures on a signature key should be one of the following:
  • First initial and last name
  • First and last name
  • First, middle & last name
  • First name, middle initial, & last name
  • First and middle initial and last name.

411-325-0170 SAFETY - STAFFING REQUIREMENTS:  

411-325-0170 (2) (a-e) Exceptions to Minimum Staffing Requirements (HOME ALONE-ADULTS ONLY)

• Anytime when an individual is home alone, the issue must be reflected on both the RTR and Safety Plan. The OAR requirements regarding home alone must be followed.
• In apartment settings, if there is a staff available in one of the apartments, it is not considered home alone, unless there is a 1:1 staffing requirement for an individual at the site.
• If more than one individual is home alone, verify if more than two individuals are home alone at one time. Make sure no individual’s home alone time goes over 5 hours in a 24-hour time period. (Remember no home alone time allowed between 11:00 PM and 6:00 AM.)

411-325-0180: Individual Summary Sheets:

• 2/27/06: All citations around missing information on the summary sheets will be cited at the severity level ‘A’, even if there are errors on more than one summary sheet.
• 2/27/06: Currently, the employment rule still requires documenting the SSN on the summary sheet. The residential rule does not. Employment programs can get a variance to not have the SSN on the summary sheets. The variance does not have to be individual specific, but should be site/county specific. If employment programs do not have a SSN listed on the summary sheet and do not have a variance, it will be cited at a severity level ‘A’.

411-325-0190 INCIDENT REPORTS AND EMERGENCY NOTIFICATIONS:

411-325-0190 (1)(d) Incident Report Administrative Review

• When the administrator writes an incident report, the Licensing Specialist needs to look at the intent of the IR, verifying whether it is a quality assurance review by the administrator that resulted in an IR being written. The concern is that administrators involved in an incident must have another administrative staff review their actions.
• When computerized incident reports are being utilized, the Licensing Specialist needs to: 1) Determine the system doesn’t allow for others to change information that someone else has entered, 2) Look for documentation of the incidents/behaviors for which an IR should have been written, and locate the corresponding IR in the computer system, 3) Ensure documentation includes all required elements as a “paper” IR would.
• 2/27/06: If there is an incident report that the agency fills out that does not fall under the OAR definitions for requirement of an incident report (i.e., physical aggression, injury or unusual incident), the agency is not required to complete all the elements of the IR (e.g., follow-up taken to prevent a recurrence of the incident). It is best practice to complete all sections; however, it will not be cited.
• When a program re-writes an incident report, they must attach the original incident report to the re-written IR. This is to assure no falsification occurred. Cite 411-325-0160 (9)(b)(d) Documentation Requirements

411-325-0190 (1) & 411-325-0020(41) Definition of Injury:

• 2/27/06: At this time, the rule does not define injury, so a variance is required if the agency wants to limit what is defined as an injury for incident reports.

411-325-0200 SAFETY - TRANSPORTATION:

411-325-0200 (3) Drivers
Review personnel records and look for evidence that staff that are driving have current driver’s license. Check who are drivers and ask how the program assures the driver’s licenses are current. Also check the following:

• A copy of the current drivers license (not expired); or
• A document from the provider’s insurance carrier or from a DMV report that indicates the license expiration dates.

411-325-0200 Fire Extinguishers in Automobiles
This is no longer a requirement. If one is carried in a vehicle, any size is acceptable. (Best to be secured to prevent being a projectile during sudden stops.)

411-325-0280 FIRE SAFETY REQUIREMENTS:

Overnight Visitors in a Licensed Home

There is no simple answer when trying to meet the desires of individuals to have friends stay over. It would be expected that:

• There has been an ISP team discussion.
• The numbers of the individuals in the home, including the visitors, do not exceed the maximum capacity on the license. If the visitors are receiving DD services, the ISP team considers the visitors’ care needs and/or abilities to care for themselves.
• No violation of the safety and health requirements of the OAR.

411-325-0300 RIGHTS - GENERAL:

411-325-0300 Substantiated Protective Service Investigation (PSI’s)

• When a program has substantiated PSI's that involve significant injuries, repetitive occurrences or pervasive patterns, OAR 411-325-0300 (1) should be cited.

411-325-0300 (2)(f) Privacy

• Active intercoms need to be addressed in either the BSP or Safety Plan.
• For married couples, each person must have an individual file. Confidentiality of information is expected and usually is part of the provider’s policies and procedures.

411-325-0300 Abuse Prohibited for Adults and Children (Mandatory Abuse Reporting)

• When you call in a potential abuse, cite 411-325-0300 Rights (2)(g) and 411-325-0190 Immediate notification (3).
• The provider must implement the actions within the deadlines to prevent further abuse as stated in the PSI report. 2/27/06: If this has not occurred then cite 411-325-0100(8).

411-325-0300 (2)(g) Mechanical Restraints

• Use of mechanical restraints, including those ordered for a medical condition, requires a variance and the ISP team discussion. For example, a helmet is used to prevent injury due to SIB and the person is unable to remove the helmet. The use of the helmet (for SIB) must be addressed on the Behavior Support Plan, and there must be directions on when and how to use the helmet.
• Transportrelated safety devices used in vehicles will not be considered as mechanical restraints, thus no variance is needed. This includes plexi-glass, vest restraints, and seat belt guards. The issues must, however, be related to an identified risk and be addressed on the Safety Plan.

411-325-0350 RIGHTS - PHYSICAL INTERVENTION:

411-325-0350 (1) OIS Physical Intervention Technique(s)

• An OIS Level IF (Individual Focus) certification is required for staff working with individuals with Behavior Plans that require the use of physical interventions, e.g., release, deflection, shirt-belt hold, 1 person 1-arm or 2-arm support, etc.
• 3/27/06 If OIS certificates are not available a copy of the roster that indicated the individual passed is acceptable in lieu of the certificate.
• 3/27/06 Prone Restraints – Need to see documented ISP team discussion regarding the risk vs benefits of using a prone restraint. Must have OIS Steering Committee approval. If you see any emergency prone restraints, inform Jim Ransom.

411-325- 0350 (1)(c) Medical Restraints

• Physical interventions used routinely for a medical procedure require documentation that staff have been trained on the technique. It is expected a written procedure will be developed if the restraint is to be used on an ongoing basis.
• 2/27/06: OIS is working on procedures for medical restraints, but nothing official is out yet. It has not yet been determined if OIS IF certification will be required once this is in place.

411-325-0350 (2) Staff Training-OIS Certificates

• Look for current OIS level “IF” or “C” certificates in personnel records if one individual’s Behavior Support Plan contains physical restraint components. Call Jim Ransom for questions regarding “C” level certificates.

411-325-0350 (5) Incident Reports

• Incident reports must be written for each time a physical restraint is used, including medical restraints. The program may consider a variance to reduce writing an IR. For example, if staff uses an arm holding/restraint to prevent a SIB, and although the frequency is high but the severity of the event does not put individuals at risk, and there is a tracking mechanism in place, a variance may be considered.

411-325-0360 PSYCHOTROPIC MEDICATIONS AND MEDICATIONS FOR BEHAVIOR:

Psychotropic Medications and ISP

• Psychotropic medications no longer are listed on the ISP. The RTR directs an ISP team discussion to identify if this is a risk and determine the support needs.

411-325-0360 (2) Balancing Test

• It needs to be done annually either on the DHS Balancing Test Form or include the mandated language from the Form onto the provider’s balancing test form. It should be evident what was provided to the prescribing practitioner for determining risks vs. benefits. If not then ask staff what was provided.
• A balancing test needs to be done when a new medication is started or when a new physician prescribes psychotropic medications. Look at dates on balancing test and start date of a psychotropic medication. 
• A balancing test is not needed for a decrease or increase in psychotropic medications. However, there needs to be documentation or evidence of the reason for the decrease or increase in the psychotropic medication, as well as monitoring of desired responses and adverse consequences. [411-325-0360 (1)(b)].

411-325-0380 MONEY MANAGEMENT:

411-325-0380 (1) TV Cable

• The cost of basic cable is considered part of the room and board fee collected from the individual.  Individuals can agree to pay cable costs above the basic rate for extra cable service in the common living area or in their own bedroom, which must be documented in their Financial Plan.

411-325-0380 (1)(b) Safeguarding the Individuals Funds:

• 2/27/06: The individual’s Financial Plan must address a spending limit before ISP team approval is required (i.e. over $100 per item). Documented ISP team approval is needed for these purchases as well as purchases made by the individual that the agency is required to purchase. For example, if the individual wants to buy a king sized bed or special bedding, it is ok as long as there is team discussion and approval. The program must also monitor the individual’s bank accounts to ensure that the accounts don’t exceed $2000, which may cause the individual to lose funding. Spending money to keep accounts under $2000 must meet the criteria documented in the individual Financial Plans.
• 3/27/06 ISP team decision-making regarding use of funds for special excursions/trips. Regarding payment of staff fares and costs for such trips.  It should be noted that these answers are based on the following assumptions:
  • the event is not local and is usually like a trip to Disneyland, or something special the individual wants.
  • It is assumed the agency is paying the staff salary. 
  • The request is for payment of staff entry fees, fares, meals. 
  • If salary is part of the request we do not believe that this would be approvable as there would be both BOLI issues as to employer at the time of the trip and Medicaid issues. 
• The ISP team review should include the following:
  • Is the trip something that is desired by the person?
  • Has the Team, considered or attempted alternative methods for paying for these types of things through fund raising or family gifts?
  • Is the total cost for the person (including extra fares and fees) equal to or less that purchasing something like this through agencies like TRIPS.  Does this make financial sense for the person?
  • If the event is being prorated across several individuals are the costs assigned to each person equitable and fair?  Are there individual budgets assigned.  (One individual cannot be charged more just because they have more money than the rest of the group.)
  • Are procedures in place to ensure individualized accounting of expenditures for the trip and the level of detail of receipts required?
  • Does family/guardian support?
  • If there are any dissenting team members there must be a thorough discussion of the reasons for dissent and a concerted effort to address the concern.
  • If a case manager or any team member believes that the plan would result in a financial exploitation of the person and the team cannot agree then it must be elevated to the DD manager and possibly to SPD/OIT for evaluation.  At that point the case manager would be unable to authorize that element of the plan until the issue is resolved. 
• 7/28/06 Gift Cards/Pre-Paid Visa Cards: These cards cannot be used to bank money, but can be used for on-line purchases or purchases that require a credit card (i.e. holding reservations).

411-325-0380 (3) Reimbursement

• Programs can be cited for reimbursements that occurred outside the 2-year licensing period, if we hadn’t reviewed the the individual in the last licensing period.

411-325-0390 EXITS, ENTRY AND TRANSFER:

411-325-0390 (6) Exit

• An individual changing service elements, i.e., Supported Living or S.I.L.P., it is an exit from the 24-Hour Residential Service element and an entry into Supported Living or S.I.L.P.
• An individual moving from one county to another county, but within the same agency is also an exit from the original county and an entry to the new county.

411-325-0430 INDIVIDUAL SUPPORT PLAN

411-325-0430 (1) Blended Plan
An ISP that does not have evidence of cooperation between the 24-Hour Residential and the Employment providers so that there is a blended plan needs to be communicated to Sue Stoner.

7/28/06 If an individual has a new vocational program, but same residential program, the team needs to review the RTR, ISP and protocols. The team can document that the current plan is accepted as written. There needs to be an Action Plan to address the new employment situation. The team needs to do a 60 day ISP, but do not have to do the entire process (PFW’s, RTR, etc).

411-325-0430 (2) Annual ISP Date
An ISP meeting held in the same month as the previous year’s ISP is in compliance with the OAR.  It does not need to be the exact same date. Remember there must be a valid ISP covering between the meeting date and the date the new ISP is to be implemented. Keep this in mind when an ISP is held at the end of one month but not implemented until the next month.

411-325-0430 (3)(b)(c) the Risk Tracking Record and Court Orders:
If an individual receiving services has court orders that restricts their rights, this would need to be addressed through the ISP process. Read court orders and PSRB restrictions carefully, a BSP may still need to be in place.

411-325-0430 (3)(b)(c) Locked items (food, hygiene supplies, gates, etc.)

• For the individual for whom locking of items is needed, the issue needs to be identified on their RTR and Safety Plan. No variance is needed even if the person objects. This should be addressed through a discussion if it affects what's most important to the person.
• For all others in the home: If they do not mind the restriction, no documentation is expected, (other than on the agenda to see that the issue has been addressed.)  If they do object, this should be reflected in the ISP or supporting documents and a variance will be needed for the person objecting.

411-325-0430 (3)(d) Nursing Care Plans:
Nursing care plans must be shared with the team and the ISP team needs to sign off acknowledging that they have reviewed and know what is in the plan.  If the team has concerns about the contents of the NCP, there should be an agenda item regarding the NCP. The PFW is also a good place to record any issues with the Nursing Care Plan (in the ISP team’s additions/changes section of the PFW). There may be an Action Plan to address any issues with the Nursing Care Plan by the team

411-325-0430 (4)(f) Service Supports

• 3/27/05 Independence, Integration and Productivity – If Independence, Integration or Productivity is not reflected in the ISP cite 411-325-430 (4)(f).

Guardianship

• Duration of guardianship depends on probate court of the county of origin. The county where it was issued can be called to see if it is current.
• If no guardianship papers are in the record then we need to act as if there was no guardian.
• Need to cite even when ISP is sent to the guardian but have not been returned. (CDDP suppose to “blow the whistle” if they are not fulfilling their role. Provider can discuss with CDDP challenge guardianship if they are not responsive.) Remember there can be alternative ways to get approval.
• If policy sign off’s or ISP meeting notices are sent via certified mail, the green card is proof of notification and there is no citation.

411-325-0430 (4)(g) Signature Sheets

• There are two signature sheets. Per the new ISP process there is an ISP signature sheet and there is the Document of Supports Signature Sheet.
• If the individual, or the individual's guardian does not sign the ISP, and the ISP has not been explained to the individual, cite OAR 411-325-0300 (2).
• If the Case Manager or their designee does not sign the ISP, licensing should notify Sue Stoner, Marilee Bell, the Regional Coordinator, and Laurie Lindberg.

HOUSING/STRUCTURE/SAFETY:

• 3/13/06 Deadbolts on exterior doors are o.k. if they are single action (unlatches automatically when one turns the knob or lever). Deadbolts that require a key are not allowed (per Housing Dept.).
• 3/13/06 Wood paneling in homes are acceptable (per Housing Dept.).
• 3/27/06 Bathroom Fans (Per Information Memorandum Transmittal (SPD-IM-06-001) dated 1/3/06)
  • Bathroom fans should be inspected monthly.
  • Fans that are exceptionally noisy should be replaced. If the fan sounds abnormal, find out why.
  • Dirty fans should be cleaned. Make sure the fan blades are not covered with lint or dust.
  • Avoid unnecessary continuous operation. Extended operation of a bathroom fan may cause it to over heat, resulting in a fire.
  • Most bathroom fans should be able to exhaust the bathroom in 15-30 minutes time.
  • Replace questionable fans (noisy or mal-functioning fans). RECOMMENDATION
  • Make sure replacement fan is the correct size for the bathroom. Multiply the length times the width times 1.1. This will give you the approximate cubic feet per minute (CFM) required for the size of the room. RECOMMENDATION
  • Replace fan switch with a timer type switch that will automatically shut off. I would recommend the 60-minute type that sell for less than $20.00. RECOMMENDATION

MISCELLANEOUS:

Agency QA:
If the program completed a self-assessment, identified deficiencies and corrected them (with documentation to verify), licensing will not cite the issue.

3/27/06 Medicaid Modernization Act (MMA):

• If an individual refuses to pay or cannot pay for pharmacy bills, bring the information back to Laurie and Barb. Also refer the program to their Service Coordinator. DO NOT CITE.
• Financial Plans need to be updated to reflect pharmacy bills. DO NOT CITE YET.
• DO NOT question Plan choices by ISP teams.