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RALF Newsletter September 2019Page 1 Title By: Author Residential Assisted Living Facility Program Newsletter September 2019 Inside This Issue 1 Gold Awards 1 Silver Awards 2 Important Rule Information 2 As-Worked Schedules Note 3 As –Worked Schedules 4 FLS Oxygen Regulations 5 Featured FAQ 6 Food Code Training Videos 7 Rule Refresher: Refrigerated Medications 8 2019 Training Update 8 Final Thought Gold Awards Facility Administrator Date Serenity Place Residential Care Joy Cook 5/16/19 Silver Awards Facility Administrator Date Streamside Assisted Living Angela Madsen 5/2/19 Park Place Assisted Living Community, Inc. Jennifer Hagen 5/9/19 Pocatello Assisted Living Center Brenda Buck 5/15/19 Morningstar of Idaho Falls Glenda Stoddard 6/19/19 Desano Place Suites Theresa Pendleton 7/23/19 Edited and Compiled By: Ashley Henscheid Page 2 Title By: Author Important Rule Information By: Ashley Henscheid The rules for assisted living facilities in Idaho (IDAPA 16.03.22) are in the process of re-approval, involving many revisions to the chapter. The primary intent of the proposed edits is to streamline the rule set by removing duplicate or conflicting requirements, clarifying vague terminology, etc. A summary of the proposed rule changes, as well as the current draft of the proposed rules themselves, can be found on our website (www.assistedliving.dhw.idaho.gov). Some public comments have already been made to and addressed by the Department - this information is also available on the website; titled “Negotiated Rule Making Comments.” Additional written recommendations and comments can be made until September 25th using the contact information below: Mail to: Idaho Department of Health & Welfare Division of Licensing and Certification Attn: Tamara Prisock P.O. Box 83720 Boise, ID 83720-0036 Hand deliver to: 3232 Elder Street Boise, ID 83705 Attn: Tamara Prisock E-mail to: DHWRules@dhw.idaho.gov The information on the next page is re-published from 2017. For those of you who have not seen it before, the page was designed to be printed and kept somewhere for easy reference. For everyone else, we hope you find the reminder helpful! As-Worked Schedules Note Page 3 Title By: Author As-Worked Schedules By: Tom Moss 16.03.22.730 Facility Administrative Records for Personnel and Staffing - The administrator must assure that the facility’s personnel and staffing records are maintained as described in Subsections 730.01 through 730.03. 730.02 Work Records - Work records must be maintained in writing for the previous three (3) years which reflect: a. Personnel on duty, at any given time; and b. The first and last names, of each employee, and their position. *** There are no specific rules addressing staffing timecards or schedules*** Timecards Schedules Timecard: A card used to record an employee's starting and quitting times, usually stamped by a time clock. Why is a timecard important to you? For more accurate paychecks, increased fairness and improved job satisfaction Timecards do not count for as-worked schedules because they document when an employee was at work – not where they were working. Schedule: Often called a roster, is a list of employees and associated work information (e.g. location, work times, responsibilities for a given time period, etc.) Why is a schedule important to you? To ensure there are enough caregivers and other professionals to meet the needs of the residents. Schedules do not count for as-worked schedules because they document who was supposed to be there – not who was actually there. Administrative Records As-Worked Schedule: Documentation which captures who was working at any given time in a building. It includes the first and last names, as well as the positions, of all facility personnel (i.e. nurse(s), administrator, caregivers, medication technicians, management staff – EVERYBODY). Why is an as-worked schedule important to you? When a concern, such as an abuse allegation, arises in your facility, you can very quickly determine who you need to talk to for a given time period. As-Worked Schedules Page 4 Title By: Author FLS Oxygen Regulations By: Nate Elkins The tanks to the right (sizes in chart) are pressurized medical (inert) gas oxygen cylinders and are required to be secured by rack or chain. When attached to the filling station, that would be considered “secured.” The security requirement also applies when a resident has a tank on their walker, wheelchair, etc. and it is considered “in use.” The tank still needs to be secured in a holder; at no time can a tank be carried around loosely in a resident’s hands. The tanks pictured to the left contain liquid oxygen and they are specifically used to transfer liquid oxygen from this reservoir to portable hand- held canisters to be used by the person requiring oxygen. This transfer process is referred to as “transfilling” and is highly regulated. The liquid oxygen reservoirs are constantly venting gaseous oxygen into the room where they are stored. Above its critical temperature of -118°F, liquid oxygen will only exist as a gas. When oxygen expands from a liquid to a gas, it occupies 860 times more volume. Liquid oxygen by itself is not flammable, but an oxygen-enriched atmosphere makes all other materials much more combustible. The reason liquid oxygen is so dangerous is if it were to be spilled, then any combustible material it comes into contact with will immediately ignite. Liquid oxygen boils at -297°F (at standard atmospheric pressure) and it brings the ignition temperature of anything it comes into contact with down to the point where the material will ignite at room temperature. That is why the transfer of liquid oxygen is not permitted on a surface that has combustible materials, such as carpet, vinyl tile and even asphalt. It can only be transferred on concrete or ceramic surfaces. (Continued on next page) Page 5 Title By: Author FLS Oxygen Regulations By: Nate Elkins (Continued from previous page) The requirements to follow for the transferring of liquid oxygen (transfilling) from one container to another are: • Transfilling must be accomplished at a specifically designated location. • The location must be separated from patient care and treatment areas by 1-hour fire rated construction. • The location must be mechanically-ventilated. • The location must be sprinklered. • The location must have ceramic flooring or concrete flooring. • The location must be posted with signs identifying transfilling is occurring. • The location must be posted with signs that say “No Smoking.” The following pamphlets are recommended for purchase, if you have not already done so, from the CGA: P-2.6 (https:// portal.cganet.com/Publication/Details.aspx?id=P-2.6) and P-2.7 (https://portal.cganet.com/Publication/Details.aspx?id=P-2.7). If you are currently not complying with any of the above listed requirements, this office strongly recommends that you stop the transfilling process until you can correct what is non-compliant; it is that dangerous. Question: Is a person who needs a two-person assist with transfers appropriate for admission to a RALF? (Continued on next page) Featured FAQ Page 6 Title By: Author Featured FAQ Food Code Training Videos By: Polly Watt-Geier (Continued from previous page) Answer: They can be, but the facility would have to have at least two staff on around the clock to provide the assistance. The reason for this is to ensure the facility is prepared to meet each resident’s needs at all times. When the resident that requires two staff needs assistance during non-business hours to use the restroom, in the event of an injury, should they need a shower, etc. it is necessary to have those staff available, and more, to ensure assistance and supervision can still be provided to additional residents of the facility. In the past, the RALF team has received requests to offer food code training to front-line staff. Recently, the Department collaborated with the Idaho Health Care Association (IHCA), Sue Linja from S & S Nutrition and Amanda Warren from Sysco. Sue and Amanda graciously offered to present a one-day training that could be filmed. From this one-day training, seven videos were created for front-line staff to access. The videos are available on our website: www.assistedliving.dhw.idaho.gov Look on the far right-side of the website under Resources Links, then expand the section “Food Safety/Nutrition” (by clicking on the section title or the plus sign next to it). The videos are listed with any corresponding handouts below them. The six different videos are titled: Basic Food Safety, Menus & Recipes, Customer Service, Memory Care, Tips & Tricks and Potluck. The videos do not have training certificates attached to them, so make sure to document the hours of training for your staff in your facility’s continuing education tracking system. We hope you and your staff learn new information and enjoy these videos. Page 7 Title By: Author Rule Refresher: Refrigerated Medications By: Stacey Saenz One of the basic needs of residents in residential assisted living facilities is assistance with medications. It is the facility’s obligation to store these medications in a safe manner. Many medications require storage in a refrigerator, such as certain injectable medications and suppositories. According to IDAPA 16.03.22.310.01.c, the facility must: • Ensure that the medications are kept in a locked unit, including those in a refrigerator. • Monitor refrigerators containing medication for appropriate temperatures (38° - 45°F). • Log/document these temperatures on a daily basis. If the refrigerator temperature falls outside of this range, best practice would be for the facility to have a policy in place to address this issue and to implement the policy when there is a temperature issue. The policy should include: • A method for staff to report these abnormal temperatures. • The specific steps to be taken to ensure that the medications, which were stored in a refrigerator with temperatures out of range, remain safe and effective. One method would be to contact the pharmacy(s) that distributed these medications to discuss the temperature change and verify the efficacy of these medications. • How to properly dispose of refrigerated medications if they are determined to be no longer effective due to the temperature change. Most medications that require refrigeration are critical to residents’ health and many are very expensive. A refrigerator that does not hold temperatures at the acceptable range can result in thousands of dollars in lost medications. Therefore, it is vitally important for the facility to properly store these medications. Let’s keep the residents, and their medications, safe! Page 8 Title By: Author 2019 Training Update Mental Health Awareness in Assisted Living: The Department of Health and Welfare (DHW) and Bonneville County law enforcement have teamed up to provide this training on September 17th in Idaho Falls. Those who attend will be taught to identify common signs and symptoms of persistent mental illness and be introduced to helpful de -escalation strategies. More details on this training and registration can be found in FLARES; attendees will receive three CEUs. Here is an update for the 2019 free (“bootcamp”) trainings being provided by the RALF Program: Basic Administrator Training: There will be one more Basic Administrator course, held in Boise at the RALF Program office. The remaining two-day training is scheduled for November 5th & 6th. Professional RCA Training: The remaining 2019 schedule includes: courses in Pocatello on October 10th with focus topics of Infection Control and Drug Diversion, a course in Boise on October 23rd with a focus topic of Disaster Preparedness and a course in Boise on October 30th on the topic of Drug Diversion. Nurse Training: There are two more Nurse Training courses, as follows: Pocatello on October 8th & 9th and Boise on October 29th & 30th. Invitations and registration forms for the remaining courses will be uploaded to FLARES as the courses open. Course registration documents and additional details related to the trainings will also be available on the RALF website (www.assistedliving.dhw.idaho.gov) as each training gets closer. To each assisted living administrator, resident, surveyor - every reader, we leave you with this final thought to consider in your daily interactions and choices: “We are just two people. Not that much separates us.” Kathryn Stockett, The Help Final Thought RALF Program Contact Information • Phone: (208) 364-1962 • Email: RALF@dhw.idaho.gov • Websites: www.assistedliving.dhw. idaho.gov www.flareslive.com/ portal/ ProviderLogin.aspx Images from Pexels and Pixabay