Image Area (insert photo of choice) Nursing Homes and Assisted Living Facilites in West Virginia Annual Report October 1, 2013—September 30, 2014 Ofce of Health Facility Licensure & Certfcaton 408 Leon Sullivan Way Charleston, West Virginia 25301 Early Ray Tomblin, Governor Karen L. Bowling, Secretary West Virginia Department of Health and Human Resources Office of Inspector General Office of Health Facility Licensure and Certification Nursing Home and Assisted Living Governor’s Annual Report October 1, 2013 - September 30, 2014 Table of Contents Part Nursing Home Report ……………………………………………………… A Nursing Home Summary Information ………………………………….… B Nursing Home Directory ……..……………………………………………. C Assisted Living Report …………………………………………………….. D Assisted Living Summary Information …………………………………… E Assisted Living Directory ………………………………………………….. F West Virginia Department of Health and Human Resources Office of Inspector General Office of Health Facility Licensure and Certification Nursing Home and Assisted Living Governor’s Annual Report October 1, 2013 – September 30, 2014 Foreword This report and the directories of licensed nursing homes and assisted living residences implement the requirements of Chapter 16, Article 5C, Section 3(q) and Article 5D, Section 3(q) of the West Virginia Code. In the administration of these article, the Director of the Office of Health Facility Licensure and Certification (OHFLAC), through delegated authority, submits an annual report to the Governor, the Legislature and the public. The report describes the licensing and investigatory activities of the department during the year, and the nature and status of other activities of the department, and may include comments on the acts, policies, practices or procedures of any public or private agency that affect the rights, health or welfare of residents of nursing homes or assisted living residences. The annual report includes a list of all nursing homes and assisted living residences in the state. Nursing Home Report Part A Office of Health Facility Licensure and Certification Nursing Home Program The Office of Health Facility Licensure and Certification (OHFLAC) Nursing Home Program is responsible for determining the compliance with state licensure regulations of nursing homes in the State of West Virginia. It also determines facility compliance with standards for participation in the Medicare and Medicaid reimbursement programs. Based on findings of on-site inspections (surveys), the Nursing Home Program licenses all nursing homes per state law. The program also makes recommendations to the US Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) for Medicare (Title XVIII) participation and to the West Virginia Bureau for Medical Services (BMS) for Medicaid (Title XIX) participation. Other responsibilities include complaint investigations, site approval for new construction, and in the case of facility certification, fire safety inspections. Licensure recommendations related to fire safety inspections are the responsibility of the State Fire Marshal’s Office. Nursing Homes and Inspections/Surveys To operate a nursing home in West Virginia, state licensure and/or federal certification inspections or surveys must be completed which demonstrate compliance with regulations. A nursing home license is issued when a facility is in compliance with the Health Care Facility Financial Disclosure law, receive(s) positive recommendations from the State Fire Marshal and the Office of Environmental Health Services and is in compliance with health, environmental and life safety requirements. The average length of time for a survey is determined by the size of the facility, past history of compliance, the number of surveyors, travel time, and the number and types of citations written. The length of time required for the survey/resurvey process, particularly in nursing homes certified for Medicare and/or Medicaid, has been significantly impacted by federally legislated changes under the provisions of the Omnibus Budget Reconciliation Act of 1987 (OBRA ’87). These changes prescribed the methodology and criteria to be used in the long term care survey process. This shift is a direct result of efforts to review and preserve the rights and quality of life of elderly citizens. All certification surveys are unannounced and are, by design, required to be scheduled and completed within a nine (9) to fifteen (15) month time frame, with an average of twelve (12) months for all providers. OHFLAC, however, may conduct a survey or complaint investigation at any time, based on a facility’s past noncompliance and/or allegations of mistreatment, abuse, neglect, misappropriation of property and/or poor care. There are one hundred twenty-nine (129) nursing homes in West Virginia. One hundred ten (110) nursing homes are Medicare and Medicaid certified, seven (7) are Medicare certified only, ten (10) are Medicaid certified only, and two (2) are state licensed only.* During the reporting period of October 1, 2013 to September 30, 2014, OHFLAC performed ninety-four (94) annual surveys and one hundred ninety-five (195) revisits as a result of annual surveys. OHFLAC also completed one (1) initial survey to license one (1) new nursing home.* During the same period, OHFLAC received two hundred (200) complaints resulting in eight hundred thirty-seven (837) allegations regarding nursing homes. One hundred seventy-nine (179) were substantiated and six hundred fifty-eight (658) were unsubstantiated.* Under the Alzheimer’s/Dementia Special Care Units and Programs legislative rule, there are seven (7) licensed special care units within West Virginia nursing homes. West Virginia has five (5) state-owned Medicare and/or Medicaid certified nursing facilities. *See: Nursing Home Summary Information Regulation and Statute Revision On July 1, 2002, the legislative rule, Alzheimer’s/Dementia Special Care Units and Programs (64CSR-85, revised May 1, 2006) went into effect. This legislative rule prescribes specific standards and procedures to provide for the health, safety, and protection of the rights and dignity of individuals served by Alzheimer’s/Dementia special care units and programs. On July 1, 2003, the legislative rule for the Nurse Aide Abuse Registry went into effect (69CSR6, revised July 1, 2012). This rule established standards and procedures for maintaining the Nurse Aide Registry to protect certain rights of West Virginia nursing facility residents and nurse aides that are employed by these facilities. According to the Code of Federal Regulations at 42 CFR 488.331 and 42 CFR 488.431, nursing homes have an opportunity to refute survey findings. The state must offer a facility an informal opportunity, at the facility’s request, to dispute survey findings upon the facility’s receipt of the official statement of deficiencies. This process is known as an informal dispute resolution (IDR). This process can be performed in writing, by telephone or in person. Under West Virginia Code Section 16-5C-12, legislation was passed which made available an independent informal dispute resolution (IIDR) procedure for West Virginia nursing homes. This legislation ensured objectivity regarding the outcome of the IDR decisions by allowing this process to be completed by an independent review organization. A nursing home must make a request for an IDR, including the independent process, in writing during the same ten (10) calendar days they have for submitting a Plan of Correction (POC) for the deficient practices cited as a result of a survey event. If the IIDR process is selected by a facility, the matter will be assigned to one (1) of three (3) independent review organizations accredited by the Utilization Review Accreditation Committee. The facility may be subject to certain costs such as the cost of a face-to-face conference, if one is requested, and the cost charged by the independent review organization, should the facility not be successful in its dispute. For the period of October 1, 2013 to September 30, 2014, OHFLAC received eleven (11) dispute resolution requests involving twenty-five (25) tags. Twenty- four (24) tags were upheld; one (1) was reversed. Four (4) of the upheld tags were slightly modified by the IDR or IIDR committees. Fifteen (15) of these tags were the result of the IIDR process; no tags were reversed and three (3) tags were modified. Further details are shown in the chart below: State Dispute Upheld with Facility Requests Tags Disputed Fully Upheld Reversed Resolutions Modifications IDR 9 19 15 3 1 IIDR 2 6 5 1 0 The CMS further allows facilities to request a federal IIDR prior to imposing civil monetary penalties for cited deficiencies. The process is required to be administered by the state. During the period in this report, one (1) federal IIDR regarding one (1) tag was requested. The tag in question was upheld by the independent review organization. These numbers are not reflected in the chart above. During the 2014 West Virginia legislative session, the state statute regarding nursing homes, specifically related to criminal background checks was updated. This change necessitated changes to be made to the legislative rule which will see legislative action during the 2015 session. The proposed changes in the rule are consistent with the previous change in the statute and are compliant with the Affordable Care Act. Additional updates dealing with common nursing home practices are also addressed in the proposed changes to the rule. Nursing Home Summary Information Part B Nursing Home Program October 1, 2013 - September 30, 2014 Summary Information Total Number of Facilities 110 7 10 2 7 136 Total Number of Beds 9481 111 707 123 211 10633 Survey Activity Initial 0 1 0 0 0 1 Annual Re-licensure 81 5 8 0 0 94 Complaint 177 0 21 2 0 95 Health Revisits 170 6 18 1 0 195 Life Safety Revisits 8 0 1 0 0 9 Total 453 19 54 3 0 529 Complaint Outcomes Total Number of Allegations 761 0 54 22 0 837 Allegation Substantiated 142 0 25 12 0 179 Allegation Unsubstantiated 619 0 29 10 0 658 * Alzheimer's Unit/Program totals represent licensed sub-units within licensed nursing home facilities SNF/NF - Dual Certified SNF - Medicare Only NF - Medicaid Only Licensed Only Alzheimer's Unit/Program* Total Nursing Home Directory Part C