ANNUAL REPORT FY15 - Rappahannock-Rapidan Community Services · RAPPAHANNOCK RAPIDAN COMMUNITY...

ANNUAL REPORT — FY15 July 1, 2014 — June 30, 2015

Our History In 1972, the local governments of Planning District 9 (Culpeper, Fauquier, Madison, Orange,

and Rappahannock) formed the Rappahannock-Rapidan Community Services Board. This

action was prompted by a variety of factors facing local government at that time. First,

Chapter 10 of Virginia Code §37.1 called for local accountability in the provision of publicly

funded behavioral health, intellectual disability, and substance use disorder services to local

citizens in the community and those in state operated facilities. Minimal local funding

standards were also established along with baseline criteria for board membership and

service delivery. At this same time, the Planning District Commission was completing a study

to address the best method for delivering services to the elderly within the region.

Ultimately, its recommendation was for the newly formed Rappahannock-Rapidan

Community Services Board to also provide services under Title III of the Older Americans Act.

These events formed the foundation of a combined area agency on aging and community

services board, a unique organization at its inception, and it continues to be the only such

combined agency in Virginia. Its combined statutory mission rests with its Area Plan for

Aging Services (Federal Older Americans Act), and Virginia Code §37.1 through its

Performance Contract with the Virginia State Department of Behavioral Health and Disability

Services. The Rappahannock-Rapidan Community Services Board and Area Agency on Aging

(RRCSB-AAA) is defined in Code as an Operating Community Services Board.

In 2011, we changed our name to Rappahannock Rapidan Community Services (RRCS).

Our Mission The mission of RRCS is to improve the quality of life of the citizens of Planning District 9 by

providing comprehensive behavioral health, intellectual disability, substance use disorder,

and aging services.

Our Vision RRCS strives to accomplish its mission by offering a comprehensive array of services in our

local communities.

TABLE OF CONTENTS From the Executive Director ........................................................................................................... 2

Fiscal Year 2015 Annual Report Highlights ..................................................................................... 2

Priorities and Challenges for FY16 and Beyond .............................................................................. 3

DIVISION OF AGING AND TRANSPORTATION ................................................................................. 4

Division Program Summary......................................................................................................... 4

Highlights and Achievements from FY15 .................................................................................... 4

Area Agency on Aging Service Outcomes by County ................................................................ 17

CLINICAL DIVISION ........................................................................................................................ 18

Division Program Summary....................................................................................................... 18

Highlights and Achievements from FY15 .................................................................................. 18

COMMUNITY SUPPORT DIVISION ................................................................................................. 24



FINANCE AND ADMINISTRATIVE SERVICES DIVISION ................................................................... 28



QUALITY ASSURANCE DIVISION .................................................................................................... 33



Significant Events: Data and Summary ..................................................................................... 34

Annual Report of Human Rights and Privacy Activities ............................................................ 35

Organizational Compliance Annual Report............................................................................... 42

APPENDICES .................................................................................................................................. 45

Consolidated Financial Data ..................................................................................................... 46

Community Services Board Service Outcomes by County........................................................ 48

Board of Directors and Senior Staff .......................................................................................... 53

LWohlford

Rectangle

RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES Annual Report – FY15 (July 1, 2014 – June 30, 2015)

Page 2

From the Executive Director

During Fiscal 2015, the organization faced a number of challenges and opportunities that shaped the services described in this report. We are proud of the services we provide and the importance of these services to the individuals and communities we serve.

Brian Duncan, Executive Director

Fiscal Year 2015 Annual Report Highlights

• RRCS received funding from the Fauquier Hospital Foundation to develop a strategic plan to provide publicly funded outpatient mental health services in Fauquier and Rappahannock counties.

• RRCS successfully completed fundraising for the renovation of the Culpeper Senior Center. RRCS anticipates a grand opening during the summer of 2016.

• Two staff in the Aging and Transportation Division completed the Care Transition Intervention (CTI) certification training. Additionally, RRCS completed its CTI readiness assessment. RRCS is now ready to actively participate in this evidence-based program to assist patients successfully transition from hospital care back to their home. The goal of the program is to reduce hospital readmission rates.

• RRCS received a designation from the National Health Services Corp. (part of the US Department of Health and Human Services) that allows eligible employees to receive funds for student loan repayment in exchange for working at RRCS.

• Under the Clinical Division, RRCS began a Youth and Young Adult Coordinated Care (YACC) program to address the needs of teens and young adults facing a first episode psychosis.

• In collaboration with local law enforcement, notably Chief Louis Battle of Warrenton, RRCS established the Crisis Intervention Team (CIT) program. This program provides training to law enforcement officers in the appropriate strategies for communicating with individuals in crisis and with mental health issues.

• Two new group homes were added in the Community Support Division. One new group home is in Fauquier and the other is in Culpeper.

• RRCS launched a quarterly employee recognition program: PWC – People Who Care.

• A banking request for proposal was completed and the contract awarded to Union Bank and Trust.

• An audit request for proposal was completed and the contract awarded to Snead, Williams & Mayhew, PLLC.

• RRCS successfully transitioned from Medicaid to Magellan for mental health services invoicing.

• Through its myriad programs, RRCS served 5,700 clients in FY15.


Page 3

Priorities and Challenges for FY16 and Beyond

Priorities for the Community Services Board

• Realignment of adult outpatient and psychiatric services

• Transition to rapid access care model

• Opiate use, addiction, and local solutions

• Increased use of telemedicine

• Care for individuals in community settings with more intense needs

• Young Adult Coordinated Care (YACC)

• Crisis Intervention Team (CIT)

Challenges for the Community Services Board

• Amplified expectations for the care of individuals with increasingly complex, long-term needs

• Timely access to services

• Funding

Priorities for the Area Agency on Aging

• Maintaining senior centers as the local focal point for services

• Care Transitions Initiatives (CTI)

• Responsive one-call information center for transportation needs

Challenges for the Area Agency on Aging

• Funding

• Transition of services to increased focus on caregivers, care transitions, and collaborations with healthcare providers

DIVISION OF AGING AND TRANSPORTATION (Area Agency on Aging)

Ray Parks, Director

Division Program Summary

The Division of Aging and Transportation Services functions as one of Virginia’s 25 Area Agencies on Aging (AAA). In this capacity, RRCS provides a comprehensive array of services and supports for aging individuals and their families. Included within multiple program sites are: care coordination; information and referral; nutrition and health promotion services delivered through five senior centers; home delivered meals; door-to-door as well as non-emergency medical transportation; mobility management; volunteer coordination; respite personal care; adult day care; insurance counseling; long-term care ombudsman services; and more. Collaborating with regional Aging and Disability Resource Connections, including the Aging Together partnership, our AAA promotes strategies for aging in place with dignity, choice, and access to needed services.

Highlights and Achievements from FY15

Aging Services

• We exceeded annual projections for Care Coordination Services, Socialization/Recreation, Emergency Supports, and Volunteer Programs.

• Two staff completed Care Transitions Intervention (CTI) certification training in June 2015. Additionally, RRCS completed its CTI readiness assessment and has entered into agreements with local and regional healthcare systems.

• RRCS support coordinators assisted approximately 800 people with Medicare/Medicaid related issues and enrollment.

• RRCS provided over 200 homebound individuals with home delivered meals or liquid nutritional supplements.

• The annual satisfaction survey results indicated that 97% of respondents would recommend RRCS senior centers and home delivered meals/liquid nutritional supplements to family and friends.

Transit

• Care-A-Van volunteer drivers provided 410 round trips, including 62 veteran transports, using RRCS wheelchair accessible minivans.


Page 5

• The transit department provided 79,249 one-way trips for 774 agency program participants.

• Over 325 volunteers provided 44,848 documented hours of service.

• Volunteer drivers provided 120 round trips with their own vehicles for senior healthcare visits. Volunteers provided 2,951 hours of service assisting seniors in our service area with transportation to their healthcare visits (this includes Care-A-Van transports).

Fund Raising

• Voluntary contributions (e.g. program income) from both congregate (senior center) and home delivered meals totaled $29,510. As no fees are charged for these services, these voluntary contributions are essential for continued service provision.

• Bowl for Seniors: On June 20, 2015, our eighth annual Bowl for Seniors event brought in $10,000 for RRCS aging services in our region. Aging Services Specialist Judy Seale once again chaired the event bringing together multiple sponsors, staff, volunteers, and community team participants. The Mountain Run Bowling Center in Culpeper has been a great venue for this annual fundraiser.

• The five county senior centers continued to engage in multiple fund raising initiatives raising an annual total of $83,870.

• CK Catering proceeds, which help to offset nutrition program expenses, exceeded $10,000 for FY15.

Bowl for Seniors 2015

Aging Services Advisory Council members,

volunteers, and staff provided assistance

throughout the day to make this fundraiser so

successful!


Page 6

Aging Advisory Council

The RRCS Aging Services Advisory Council grew stronger and more active with additional members and increased oversight of services.

RRCS Aging Services Advisory Council

Standing L to R: Ray Parks, Jenny Biché, Bonnie Vermillion, David Pollok, Richard Fletcher, Anita Richards Seated L to R: Erika Bays, Eileen Peet, Chris Miller, and Lola Walker

Not pictured: Judy Shulick, Jim Livingston, Nancy Babb, and Jackie Dare

Care Transitions Intervention

The Care Transitions Intervention (CTI) model of hospital care transitions is evidence based and headed for statewide expansion as facilities seek to reduce hospital readmission rates. Patients with complex care needs and family caregivers work with trained RRCS staff to learn skills that will ensure their needs are met during the transition from hospital to home. This is a low-cost, low-intensity, evidence-based intervention. Having two trained staff on board, in addition to completing our readiness assessment to provide the service, puts RRCS in a good position to enter into agreements with local/regional healthcare systems. RRCS participates in the Central Virginia Care Transitions Collaborative, based in Charlottesville, as well as the Virginia Partners for Care Transitions, a statewide group facilitated by the Quality Improvement Organization.

Central Kitchen/CK Catering

The central kitchen prepares nutritious meals for the five senior centers operated by RRCS. They also prepare a daily staff lunch (for sale) and store and distribute home delivered meals.


Page 7

CK Catering continues to thrive under the management of our new Central Kitchen Supervisor, Deborah Roark. Following the retirement of Marian Taliaferro, who developed CK Catering, the operation has maintained a positive reputation for great food and service. CK Catering offers a wide variety of reasonably priced menu selections. Proceeds help to offset nutrition program expenses.

Emergency Medical Alert Program

The Emergency Medical Assistance Program (EMAP) installs personal medical alerts, free of charge, for adults over 60 years of age or disabled persons living alone, who are alone during the day, or in danger of falling. This system works through a telephone landline and includes a pendant worn around the neck that will call 911 at the push of a button. There is no monthly fee. EMAP began with a small program in Madison in 2013 and has expanded significantly to all five counties. Through donations, grants, and fundraisers, we have raised $31,619 under the leadership of Senior Support Coordinator, Toni Browning. Staff have installed 274 units, to date, in our five counties. The program is donation based.

Fan Care

Fan Care provides free fans to elderly Virginians within the Dominion Virginia Power service area who are age 60 or older and meet income guidelines defined by the Area Agencies on Aging. Fan Care is a public-private partnership administered by the Department of Aging and Rehabilitative Services and Dominion Virginia Power. We administer Fan Care by screening applicants and distributing fans. A small number of window air conditioners are also available. This program is open from June through September.

In FY15, our agency was allotted $3,000 to purchase fans. Regretfully, this program did not receive funding until the end of June. Since the hot weather began early in the season, we found other outlets to distribute fans. We talked to several non-profit agencies regarding the program and distributed fans to Madison Emergency Services Association in Madison and the Orange County Free Clinic. We also gave fans to our seniors at the senior center and any home delivered meal clients who requested them.

Home Delivered Meals/Nutritional Services

Five nutritious frozen meals per week are available to persons 60 years of age or older who are homebound and have no one to prepare meals for them. Liquid nutritional supplements are also available with a prescription from a doctor. A support coordinator must make a home visit and assessment before delivery starts.


Page 8

This program is funded through voluntary contributions. Contributions for both congregate (senior center based) and home delivered meals totaled $29,510 in FY15. No fees are charged for these services; therefore, local contributions are essential for continued service provision.

In FY15, we received and evaluated three responses to our request for proposal to continue providing home delivered frozen and shelf stable meals. The result was a renewed contract with GA Food Service beginning April 2015.

RRCS provided over 200 homebound individuals with either Sun Meadow Total Meal System products (through our contract with GA Food Service) or liquid nutritional supplements (primarily Ensure). In addition, shelf-stable meal boxes were distributed to cover inclement weather, missed deliveries, etc.

Home Delivered Meals – 2015 Satisfaction Survey Results

1) The response rate decreased again from the previous year. The figures below represent responses in the “good” or “excellent” range:

2015 2014 2013 2012

Delivery Time 100% 98% 100% 100%

Courtesy 100% 98% 100% 100%

Variety 88% 69% 85% 85%

Ability to eat 82% 81% 95% 85%

Preparation 82% 75% 85% 85%

Frozen meal quality 75% 63% 80% 70%

2) Significant changes (greater than 5%) from last year’s data include:

• A 19% increase in satisfaction with the variety of meals

• A 7% increase in positive responses regarding the ability to prepare these meals

• A 12% increase in satisfaction with meal quality

3) 97% of respondents (all but one) indicated they would recommend our home delivered meals program to family or friends.

4) Historical averages for Home Delivered Meals responses in the “Good/Excellent” range:

2015 2014 2013 2012 2011 2010 2009 2008 2007

88% 81% 91% 88% 79% 84% 81% 78% 80%


Page 9

57% of the individuals enrolled in the Home Delivered Meal program are receiving liquid nutritional supplements rather than frozen meals, so the survey sample size for frozen meals has continued to decrease.

5) Three individuals indicated a preference for completing the survey on line in the future.

6) 94% of respondents indicated that they understood the pledge system of contributing to the cost of the meals.

Housing Programs

The division welcomed Ginger McAlister as Housing Program Manager in August 2014. Ginger oversees Leaflin Lane, our 23-unit apartment complex for low-income seniors. She also manages our voucher program with the assistance of Rental Assistance Agent, John Lawson.

Housing Choice Voucher Program

The housing choice voucher program is the federal government's major program for assisting very low-income families, the elderly, and the disabled afford decent, safe, and sanitary housing in the private market. Since housing assistance is provided on behalf of the family or individual, participants are able to find their own housing - including single-family homes, townhouses, and apartments. The Virginia Housing Development Authority (VHDA) has contracted RRCS to administer the Housing Choice Voucher Program for our area.

The Housing Choice Voucher Program at RRCS was exceptionally busy this fiscal year. After a couple of years of not being able to pull from our waiting list - which caused the total number of vouchers issued to fall below our baseline - we were able to pull 91 applicants. Of that number, 44 families were able to receive assistance with their housing expenses. Currently, our HUD baseline number of vouchers is set at 257, an increase of 22.

Housing for the Disabled (Project Rental Assistance Contract 811 Program)

The Project Rental Assistance Contract (PRAC) 811 program allows persons with disabilities to live as independently as possible in the community by increasing the supply of rental housing with the availability of supportive services. The program also provides project rental assistance, which covers the difference between the HUD-approved operating cost of the project and the tenants’ contribution toward rent. RRCS currently operates five 811 properties.


Page 10

Elder Housing - Leaflin Lane Apartments (Project Rental Assistance Contract 202 Program)

Leaflin Lane Apartments is a HUD PRAC 202 property. This program helps expand the supply of housing for the elderly. It provides very-low-income elderly with options that allow them to live independently.

Leaflin Lane Apartments has 23 one-bedroom units. Tenants must meet the very-low-income guidelines established by HUD and the head of household or spouse must be 62-years or older in order to qualify. Rents are based on income and tenants are responsible for paying 30% of their adjusted household annual income for rent. Water, sewer, and trash collection are included in the rent and tenants are responsible for their own electricity bill.

There is a waiting list for these apartments; the waiting list is closed for additional names at this time.

During this reporting period, RRCS completed Real Estate Assessment Center inspections on several PRAC 811 and PRAC 202 properties. RRCS received high scores on each evaluation.

In-Home Services/Respite Care

Respite care services provides up to 40-hours per month of care by an in-home aide to families and caregivers who live with and care for an elderly adult 24-hours a day. This provides a needed break to caregivers. A sliding scale fee applies.

The in-home services/respite care program was significantly downsized due to budget constraints. Our participation in the state funded Respite Care Initiative continued to provide vital personal care services on a sliding scale fee basis for several families.

Ombudsman

The long-term care ombudsman investigates and assists in resolving complaints made by, or on behalf of, residents of nursing homes, board and care homes, and similar adult homes. The ombudsman provides information about licensed long-term care facilities in the state or local area, usually including descriptive information.

Protective Money Management Program

The Protective Money Management Program (PMMP) promotes independent living for seniors who are having difficulty managing their financial affairs. The program recruits, trains, and supervises volunteers who help their clients by establishing budgets, paying bills, and ensuring financial stability. The service is offered free of charge to low-income seniors living in our service area.


Page 11

PMMP, formerly managed on a volunteer basis by its benefactor Doug Schiffman, became a program responsibility for Volunteer and Aging Services Manager, Lola Walker during fiscal year 2015. Lola currently provides support and coordination for 36 volunteer representative payees assisting 48 clients under Social Security Administration regulations and RRCS volunteer and accounting policy guidelines.

Senior Centers

As a focal point for nutrition, education, socialization, and disease prevention, the five senior centers hosted multiple service providers and volunteers from the community to provide high quality programs. The senior centers are open to people 60 years of age and over and offer a wide variety of programs, both informative and entertaining. An enrollment process is completed once the participant visits the center three times. Suggested donations are collected to help cover the costs of the meals. This year, thanks to some state supplemental nutrition funding, all congregate meal participants also received a box with components for five shelf-stable meals to take home with them each month.

The senior centers also conduct fundraising activities throughout the year to generate revenue for a wide variety of socialization and recreational activities, including trips.

Each center participated in the Library of Congress - Culpeper featured movie days, Older Americans’ Month service projects, games, exercise, music, disease prevention programs, and regional holiday luncheons. Extraordinary volunteer and community support, plus the hard work and dedication of the senior center supervisors, make all of this possible.

Culpeper

The Culpeper Senior Center renovation/expansion project has progressed to the bidding stage thanks to the faithful efforts of the fund raising committee, the generosity of the community (local governments as well as individuals), and the tireless efforts of Gladys Williams, Senior Center Supervisor. Plans are complete, the building permit has been acquired, and a temporary program relocation site has been secured. We hope to have the project completed by the end of summer 2016 and look forward to inviting the Culpeper community to a grand opening celebration.


Page 12

Pictured left to right: Judy Shulick – Campaign Chair, Dr. Linda Daniel, Joe Daniel, Brian Duncan – Executive Director of RRCS, and Gladys Williams – Culpeper Senior Center Supervisor

Dr. Linda and Joe Daniel made a generous challenge to the Culpeper community as part of the renovation fundraising effort. The Daniels offered to match $2.00 for every $1.00 raised for the Capital Campaign to expand and renovate the Culpeper Senior Center.

Fauquier

The 10th Annual Blues and Barbecue event was held at the Fauquier Senior Center with great food and live music to entertain guests from all five counties.

Madison (Nest Egg)

The Madison Senior Center had a strong presence at the County Fair featuring a King and Queen who were in the parade, award-winning exhibits, and $2,000 in sponsorship donated from a special Friday meal benefit.

Orange

Senior safety was in focus at the Orange Senior Center with program presentations by Services to Abused Families (SAFE), TRIAD, Senior Medicare patrol, and the County Sheriff.

Rappahannock

The Rappahannock Senior Center was always on the go with multiple trips and outings including a garden tour of the State Arboretum, a train ride from Cumberland to Frostburg, MD, a tour of the Aquatic Center in Warrenton, an historic driving tour of Little Washington, fishing trips, and much more.


Page 13

Senior Medicare Patrol

Senior Medicare Patrol makes community presentations to raise awareness of beneficiaries and/or their caregivers about waste, fraud, and abuse in the Medicare and Medicaid programs.

Support Coordination

Recognizing that seniors may need special assistance in solving a wide range of problems, RRCS provides support, through support coordinators, in solving a wide range of problems. Support coordinators are available in each county to meet with elderly adults and offer assistance through services provided by RRCS or referrals to appropriate agencies in the community. Support coordinators also assist older adults with enrollment in public benefit programs. The goal is to assist frail older adults remain in their homes as long as possible.

Transit Services

Transit services functions as a primary source of transportation for the majority of RRCS clients to their various day support and treatment programs. On any given day, transit moves approximately 200 clients. Transit services also delivers the home delivered meals to service area clients.

RRCS is a Medicaid Transportation Provider. Agency-wide, transit services is responsible for maintaining 77 vehicles.

During this reporting period, RRCS entered into a contractual arrangement for leased vehicles, agency fleet maintenance management, and vehicle disposal with Enterprise Fleet Management. The result has been a major, affordable upgrade in the quality of the RRCS motor pool and fleet maintenance operations.

For the first time in many years, RRCS transit operators participated in the Community Transportation Association of Virginia Roadeo in Harrisonburg where drivers’ skills are tested against other drivers from agencies all over the state. This being our first year of competition, the drivers did very well with one individual earning the highest score in the written test. This test covered subjects such as safety, pre-trip inspections, and braking distances.

Transit services is also increasing the visibility of the agency in our community by participating in the Culpeper and Brandy Station Fireman’s parades. There was good crowd attendance at both events and our patriotic entries received a great response.


Page 14

Under its contract with the Rappahannock Rapidan Regional Commission’s Mobility Management Program (funded by a Federal Transportation Administration New Freedom Grant), RRCS employs transportation solutions specialists to carry out the following responsibilities:

• Staffing the one-call center at 540-829-5300

• Providing hands-on mobility management services

• Promoting the Foothills Express bus service to Charlottesville

• Collecting data to demonstrate outcomes

• Participating in the Foothills Area Mobility Systems (FAMS) steering committee

Care-A-Van

Care-A-Van is a service providing door-to-door transit for healthcare appointments. It is open to those who are:

• Disabled,

• A client of RRCS, or

• Anyone over the age of sixty.

The program uses volunteer drivers for RRCS supplied wheelchair accessible vans. There is no charge for this service, however, donations are accepted.

Foothills Area Mobility Systems

Foothill Area Mobility System (FAMS) is a regional partnership whose purpose is to increase mobility options for residents of Culpeper, Fauquier, Madison, Orange, and Rappahannock counties and promote efficiency of transportation services through coordination and innovation. RRCS, through the services of the Mobility Specialist, works directly with elderly and disabled persons who need assistance in arranging appropriate transportation. The Mobility Specialist is familiar with the needs of older adults and persons with various types of disabilities, and has knowledge of available services and eligibility requirements. RRCS also provides travel training for targeted consumers.


Page 15

One Call/One Click Center

The one call/one click center is designed to provide information on all travel modes and directly assist with travel arrangements and training. This service is a collaborative effort of Virginia Regional Transit and RRCS. Free information and referrals on all available public, private, and volunteer transportation serving our area is provided from a centralized location and by calling one phone number.

Virginia Insurance Counseling & Assistance Program

The mission of the Virginia Insurance Counseling and Assistance Program (VICAP) is to educate, counsel, and assist older consumers on medical benefit programs, long-term care insurance, and problems or questions with Medicare and Medicaid. VICAP also assists people who are new to Medicare by explaining supplemental insurance, sometimes called Medigap, and helping them navigate the myriad providers so they can make an informed choice of polices. VICAP counseling helps people enroll in Medicare Part D insurance; assists clients who need help applying for Medicaid, food stamps, and other government programs along with Medicare savings programs; and assists clients to apply for Extra Help, a program that helps individuals with premiums and co-pays for the Medicare D program.

In FY15, RRCS Aging Division support coordinators assisted approximately 800 people with Medicare/Medicaid related issues and enrollment. A new feature this year has the enrollment of Medicaid/Medicare dually eligible individuals into Commonwealth Coordinated Care — a pilot that is being evaluated in selected locations of Virginia leading up to a more comprehensive managed care system.

Volunteer and Aging Services

The Retired and Senior Volunteer Program (RSVP), a federally funded grant program providing support and recognition for multiple non-profit agencies throughout our service area, ended in March 2015. However, various volunteer services continued within RRCS under the coordination of our Volunteer and Aging Services Manager, Lola Walker. This program provides a supportive volunteer clearinghouse for persons of any age. Benefits include liability insurance, volunteer recognition, and copies of the Voice of Experience newsletter.

Service Project: Our annual “Five for Supplies” service project in honor of Martin Luther King Jr.’s Day of Service resulted in the collection and distribution of 10,000 school supply items. Collections included items that are regularly posted on supply lists given to students at the beginning of the school year. Once again, the local schools were most grateful for the assistance.


Page 16

Warrenton Adult Day Health Center

Warrenton Adult Day Health Care offers a safe, nurturing environment for adults who need daily help with health and personal activities. The center offers participants stimulating programs and social contact and, at the same time, provides a break for caregivers. Services at this center are open to eligible individuals who need daytime support, regardless of where they live in our service area. Services are paid by Medicaid for those eligible; private pay services are also available on a sliding scale.

The center hosted its final “Grandma’s Homemade Favorites” fundraising project this year with great success - selling an assortment of cookies, candy, and other homemade goods.

Voice of Experience Newsletter

The Voice of Experience is a quarterly aging services newsletter for active older adults and their families in our service area.


Page 17

Service Outcomes by County Division of Aging and Transportation

(AREA AGENCY ON AGING)

SERVICE TYPE

SENIORS SERVED

CULPEPER FAUQUIER MADISON ORANGE RAPPAHANNOCK

Provision of nutritious meals, health education, socialization, recreational, fundraising, and volunteerism for local seniors in local Senior Centers.

86 69 71 63 50

Aging and disability resource connection for all information needed by seniors and caregivers needing services and supports in our area. A principle of “No Wrong Door” is used, meaning, one call should enable someone to obtain the information they need and to start a process for support and referrals. Support Coordinators also provide insurance counseling, emergency supports, options counseling, and care coordination services.

171 125 103 167 45

An adult day healthcare program is provided to seniors for meaningful activity and a break for caregivers.

1 7 0 0 1

Respite personal care allows seniors to remain in their homes and provides family caregiver support to promote aging-in-place.

12 0 4 4 0

With the assistance of local volunteers, home delivered meals and nutritional supplements are distributed to seniors for improved health and quality of life.

80 33 19 32 12

Human Services Transportation (CSB and AAA) provides access to needed services using a combination of professional drivers, trained volunteers, and transportation specialists for improved mobility.

175 83 49 99 30

CLINICAL DIVISION (Community Services Board)

Ryan Banks, LPC, Director


FY15 represented significant transition for the Clinical Services Division. Ryan Banks, LPC, was hired as the new Director. Ms. Banks set forth to thoroughly review the division and moved to determine the best ways to address community needs and expectations for behavioral health and substance abuse services from RRCS. Long wait times for nonemergency care continued to be a challenge in the overall system. County funded projects in Culpeper and Fauquier are assisting with certain aspects of this challenge. Clinical staff training was provided in collaborative documentation to better integrate the use of electronic health records into the day-to-day work of outpatient staff.

The Clinical Division reached 2,100 clients in all programs in FY15.


Division-wide

• RRCS received a designation from the National Health Services Corp. allowing eligible employees to receive funds for student loan repayment in exchange for work at the agency.

• RRCS located mental health staff at the University of Virginia Culpeper County Hospital emergency room to address individuals with mental health, instead of medical, issues.

Children and Family Services

• Prevention Services formed a new coalition in Madison County.

• Lynne Blythe was named the new Coordinator for Children’s Services.

Other Services

• The division began the Youth and Young Adult Coordinated Care (YACC) program and hired Ashley Clark, Ph.D., as program manager.

• RRCS completed the initial set-up of the Crisis Intervention Team (CIT) program and began the recruitment process for a coordinator.


Page 19

• Clinical services began planning a transition to a rapid access model to reduce wait times between initial contact and treatment.

• The behavioral health offices implemented centralized scheduling.

• Boxwood Recovery Center opened six beds for medically managed detoxification services.

• In cooperation with the Fauquier Free Clinic, the division set up an intern program and developed plans to expand the program into the Culpeper and Orange Free Clinics.

• In collaboration with Commonwealth Autism, the division provided training about the Autism Diagnostic Observation Scale-2 and the Autism Diagnostic Interview to more than 20 attendees. This training was funded primarily through a regional grant and with the generous support of the Fauquier Mental Health Association.


Page 20

Children and Family Services

Behavioral Health Support Coordination

Support coordinators evaluate, link, monitor, and advocate for services to meet the needs of children (18 years old and younger).

Infant and Toddler Connection Program

Infant & Toddler Connection provides early intervention services to families and their babies and toddlers (birth to 36 months) with developmental delays, atypical development, and/or disabilities. Early intervention services are delivered in the child's natural environment (typically the home), and focus on supporting the family in helping their child learn during everyday routines and activities. For more information, please visit: www.infantva.org.

Intensive Care Coordination

Intensive Care Coordination provides services to a youth and his/her family for the specific purpose of maintaining the youth in, or transitioning the youth to: home; a family-like setting; or other community based setting. Intensive Care Coordination services focuses on preventing the child or youth from having to move out of the community setting due to complex, challenging behavioral health issues.

Prevention Services

Prevention Services promotes healthy behaviors and lifestyles for youth development. The program addresses protective factors and major risk factors, such as dangers of substance abuse or teen suicide and other mental health concerns. Programs include mental health first aid, suicide prevention gatekeeper, resilience, substance abuse, and mental health trainings.

Over the past year, Alan Rasmussen, Clinician - Prevention, has presented programs at 12 local schools reaching over 3,600 students. He is also supporting various local foundations and is active in various county coalitions that address prevention issues.

In FY15, prevention services continued to work with community coalitions to address key community issues. A new coalition formed in Madison County called the Madison Strong Community Coalition. This group works with RRCS to offer suicide prevention gatekeeper training as well as mental health first aid training for community partners

www.infantva.org


Page 21

and residents. This coalition is currently developing educational presentations addressing key community issues.

Crisis Services

RRCS Crisis Services operates to provide immediate access and evaluation for individuals experiencing mental health emergencies in the RRCS five county area.

In FY15, Crisis Services provided on average 163 face-to-face evaluations per month with 22 resulting in involuntary hospitalizations per month.

Crisis Intervention Team (CIT)

Crisis Intervention Team (CIT) program is an intensive 40-hour training session to teach law enforcement officers and other first responders methods for coping with tough situations involving individuals in crisis. The training is designed to provide the strategies and abilities needed to communicate with individuals in crisis and with mental health issues. RRCS, in conjunction with regional law enforcement, was instrumental in setting up the program and facilitates the region-wide training by providing a CIT Coordinator.

Outpatient Mental Health Services

Outpatient Mental Health Services consist of an array of center-based services designed to evaluate and treat the effects of mental health disorders that impair a person’s ability to function. Services include individual and group therapy, psychiatric services, and evaluations.

In FY15, over 2,100 clients were provided services at the three outpatient offices located in Culpeper, Fauquier, and Orange counties. (Pictured: Culpeper Behavioral Health Clinic)


Page 22

Culpeper Jail and Probation Project

Staff are assigned to the Culpeper jail to assess needs and provide supports for individuals brought into the criminal justice system and recent parolees.

In the first three quarters of FY15, the RRCS clinician conducted 93 intake assessments.

Substance Abuse Services

Substance Abuse Outpatient Services

Outpatient services include motivational enhancement therapy, individual psychotherapy, education groups, group therapy, the Women’s Alternatives (an intensive outpatient program for chemically dependent women), drug screening, acupuncture, and case management services.

Boxwood Residential Treatment Center and Detox Facility

Boxwood Residential Treatment Center is a 28-day residential alcohol and drug treatment program. Treatment at Boxwood involves educational films, lectures, relapse prevention, and counseling for individuals, families, and groups.

Boxwood Detox is a 7-day medically monitored program for withdrawal from substances.

Approximately 550 clients received substance abuse services in FY15.

Young Adult Coordinated Care

Young Adult Coordinated Care (YACC) is an evidenced based program centered on the coordinated specialty care model of service for adolescents and young adults (age 15 – 25) who are experiencing psychosis for the first time. Individuals in the program will receive support from a team of professionals. The support will not only focus on reduction of symptoms, but also community integration.

In FY15, YACC program staff has:

• completed evidence-based training on coordinated specialty care and begun accepting new referrals,


Page 23

• presented the vision of the program and the specifics of the coordinated specialty care model at the Virginia Association of Community Service Boards conference in Williamsburg, and

• developed a website and began providing community members with routine newsletters to provide information on the development of the program and education on issues of psychosis.

COMMUNITY SUPPORT DIVISION (Community Services Board)

Paula Stone, LPC, Director


The Community Support Division provides a range of programs for adults with both behavioral health and intellectual disabilities. The goal is to offer the necessary supports needed for these individuals to live in the community. The services include case management; 24 hour supervised housing and group homes; supported apartment living; employment support; and day rehabilitation services.


Division-wide

• The Virginia Department of Behavioral Health and Disability Services raised the rates for services provided in Rappahannock and Culpeper counties to match those in other Northern Virginia counties.

• The division implemented conflict-free case management, including updating all relevant employee policies.

• The division implemented on-call positions to back-fill vacancies, staff on vacation, etc. reducing the need for additional overtime costs.

Intellectual Disability (ID) Services

• ID services began conversion of group home staffing to 24-hour awake staff. All homes will convert to a 24-hour awake staffing pattern in FY16.

• The division began analysis of the impact of the Virginia Intellectually – Developmentally Disabled Waiver Redesign (scheduled to begin in 2016) on RRCS programs.

• RRCS added two new group homes – one in Warrenton and one in Culpeper - for individuals with complex needs coming back to the community from state facilities.

• RRCS continued work on the consolidation of Bridges programs (Fauquier and Orange).

• The division began adjusting programs for clients with intellectual disabilities to conform to the funding and regulatory changes scheduled to begin in FY16.


Page 25

Mental Health Support Coordination Services

Mental Health Support Coordination Services evaluates, links, monitors, and advocates for services to meet the needs of our clients with a serious mental illness. Mental Health Support Coordination Services is an entry point for all RRCS residential and day support programs.

Approximately 600 clients received support coordination services in FY15.

Mental Health Case Management

Mental Health Case Management implements the Governor’s Access Program (GAP) that allows more individuals diagnosed with a serious mental illness to be eligible for Medicaid. This increased access to much needed services for individuals who do not have insurance. Since January 2015, we have had 111 referrals. We are currently serving 40, with six more to be opened and/or in pending status.

Hospital Liaison

The Hospital Liaison program assists patients making the transition from a state training center into the community with appropriate supports and resources to achieve and maintain recovery and pursue life goals.

Psychosocial Program (Visions)

Visions offers a structured day program for psychosocial rehabilitation services. The program includes a work-ordered day, educational opportunities, community integration, vocational support, and individualized staff services. Visions Clubhouse members are given opportunities to volunteer in all aspects of the program.

In FY15, 82 members received services at Visions.

Mental Health Skill-Building

Mental health skill-building provides individualized training to enable individuals with a serious mental illness achieve and maintain community stability and independence in the most appropriate, least restrictive environment. The hours and types of support provided are based on the individual’s assessed needs.


Page 26

Transitional Housing

RRCS operates two transitional homes for adults with mental illnesses. Guinn Lane has staff available on-site 24-hours per day and Orange Apartments have staff on-site to support individuals as needed. Individuals work on independent living skills and developing emotional stability to transition into a less restrictive setting.

Section 8 rental assistance was pursued for residents in the Orange apartments. Many continue to be on the Section 8 wait list, but three residents have been approved. This will support rent expectations comparable to the surrounding area without creating a hardship for residents. Also, the transferrable nature of these vouchers support the philosophy of mental health skill-building, which is to promote a recovery model, where individuals increase their ability to live in less restrictive environments as they learn and grow, becoming more confident in themselves, their ability, and progress in recovery.

Intellectual Disability Services

Intellectual Disability Support Coordination (Children and Adults)

Support coordination includes evaluation, links, monitoring, and advocacy for services to meet the needs of our clients. Intellectual disability case management is an entry point for all RRCS residential and day support programs.

Approximately 550 clients received support coordination services in FY15.

Bridges/Pre-Vocational Services

Sites in Fauquier and Orange counties offer day-support and pre-vocational services for adults with intellectual and developmental disabilities. Bridges utilizes individual supports and provides consumers with meaningful activities in the community.

In FY15, plans were finalized to consolidate these two locations into a state-of-the-art facility near Brandy Station. Construction plans and specifications are complete and RRCS anticipates the new facility will open in 2016.

The Bridges program served 113 clients in FY15.

Group Homes

The staff in our 11 group homes work with individuals diagnosed with intellectual disabilities to promote independent living and meet functional behavior goals in home and community settings. An individualized treatment plan is designed to address


Page 27

identified issues in skill-building areas. Some examples include social behaviors, independent living skills, hygiene, medication management, household skills, peer support, and others. The homes are staffed 24-hours a day, providing support and skill-building services. (Pictured: Locust Grove Group Home)

In FY15, we accepted the last client into the Millfield and Aster group homes. The complex needs of the individuals in these homes have provided our staff an opportunity to grow and expand their knowledge, skills, and abilities. RRCS is proud to be able to provide a community residence to individuals who, because of their level of care, would likely have remained in a more restrictive environment.

The process of moving an individual from a state-run training center into the community is long and tedious and is accomplished with a tremendous amount of oversight, monitoring, and scrutiny from external reviewers and various levels of compliance agents. RRCS is happy to say that it successfully met all of the requirements.

We successfully added Skilled Nursing License to our provider menu for all group homes, allowing delivery and reimbursement of this level of service in each of our homes.

At the end of FY15, we had 49 clients in our group homes.

FINANCE AND ADMINISTRATIVE SERVICES DIVISION (Supports both the Area Agency on Aging & Community Services Board)

Anna McFalls, Director


The Finance and Administrative Services division is responsible for all of the administrative operations of RRCS. These responsibilities include accounting, administrative services, clinical operations, human resources, information technology, procurement, and reimbursement. This division supports both the Area Agency on Aging and Community Services Board.


Accounting

• A banking request for proposal was completed and the contract awarded to Union Bank and Trust.

• The audit of FY14 financial records was completed successfully and an unmodified opinion received from Robinson Farmer Cox Associates.

• An audit request for proposal was completed and the contract awarded to Snead, Williams & Mayhew, PLLC.

• All six HUD group homes were setup on QuickBooks accounting software to more efficiently gather and report financial data and to allow for electronically printing of checks and 1099s.

• The new, consolidated Representative Payee program became operational and collective bank accounts fully in use for client payments. Client funds are tracked through QuickBooks accounting software and appropriately reported to Social Security.

• The accounting department has had many staff transitions in FY15: Sara Hinsley became the new Accounting Manager; Tammy Taylor became the new payee specialist for the Representative Payee program; Crystal Aylor become the new Payroll Specialist; Charlsa Phillips became the new Accounts Payable Specialist; and Michelle Curry became the new Accounting Specialist.


Page 29

Administrative Services

• The Executive Assistant position transitioned from the Executive Director’s office to Finance & Administrative Services division with expanded responsibilities.

• In March, the Finance & Administrative Services division attended their annual Retreat. The entire day was planned and facilitated by staff with a focus on recognition and appreciation.

Clinical Operations

• Clinical Operations implemented client portal capability that is being used for all of the physician’s clients.

• Clinical Operations set-up automated appointment reminders to be sent by e-mail, text, or both, per the client’s choice.

Human Resources

• Human Resources conducted a position classification study by reviewing all agency position classification duties and revising all agency classification descriptions. New evaluation templates were created based on the new descriptions.

• Human Resources centralized the training records for all programs and staff.

Information Technology

• Information technology replaced the BlackBerry Server and devices with iPhones to use the existing Lotus Notes e-mail software.

Reimbursement

• The Infant & Toddler Connection (ITC) program was implemented in Credible (the electronic health records system).

• RRCS successfully transitioned from Medicaid to Magellan billing for mental health services.

• Final reimbursement conversion from BTI software on the AS400 to Credible was completed.


Page 30

Workforce Development Team

The Workforce Development Team is a workgroup comprised of staff selected from across all departments within RRCS. This workgroup meets periodically to review agency-wide procedures, suggest efficiencies, and develop programs and events to enhance employee morale.

• During FY15, the workforce development team implemented several initiatives. One was a wellness initiative called Track to Wellness. The first program in this series was Water for Wellness. The second program was Working Towards Wellness. The third program was Walking for Wellness. Moreover, free and confidential health screenings were offered to all staff members in October 2014 and in May 2015.

• Another initiative was to revise the Employee Service Award Program. The existing schedule for the program was adjusted to better accommodate the luncheon allowing employees to enjoy their half day off. Personalized anniversary cards signed by the Executive Director and including an invitation to the luncheon are now mailed to the employee’s home address. Gifts are based on tenure.

• An Employee Recognition Program called PWC – People Who Care was another accomplishment of the Workforce Development Team. The purpose of the program is to recognize employees who help strengthen the agency and the success of individuals we serve and our programs. Quarterly winners receive a $100 bonus and all of the quarterly winners are entered for the Employee of the Year.

• The Workforce Development Team coordinated another successful agency picnic. The picnic drew over 50% of all staff and included opportunities for teambuilding and socializing outside of the work environment.

Accounting

The accounting department staff record, report, and analyze the financial data of the agency. Some of their duties include preparation of financial statements, preparation and oversight of the annual audit by an independent CPA firm, generating the annual budget for the agency, processing payroll and employee benefit deductions, processing vendor payments, completing financial reports, managing all client representative payee funds, and providing support to senior management and other departments regarding budgeting, revenue sources, and expenses.

Administrative Services

The administrative services staff provides support to many entities within the agency. Staff provides administrative support for the Board of Directors (and their various committees), the Local Human Rights Committee, the Executive Director, Director of Finance and Administration, as well as other division departments. Additionally, they administer all contracts, credential and contract for licensed clinical staff, process cash


Page 31

receipts, issues stakeholder and staff newsletters, and facilitate the agency’s liability, malpractice, property, and auto insurance.

Human Resources

The Human Resources department manages and oversees the practices and policies that affect RRCS’s employees. This includes recruitment and staffing, performance management, legal compliance, classification and compensation, training, benefits administration, and policy development.

In FY15, Human Resources advertised 134 open positions, which averages to 11 hires per month. The hiring cost for each new employee averages to a little over $100 per candidate, before training costs.

The major recruitment challenge faced during FY15 was attracting qualified candidates for full-time & on-call Access/Emergency Services Clinician positions and Community Living Support Specialist positions. There is also on-going recruitment for full-time & on-call Residential Counselor positions used to build a waiting list of appropriate candidates.

Information Technology

The information technology department provides RRCS with four major functions:

1) Infrastructure and maintenance

2) Applications and system administration

3) End user support and system troubleshooting

4) Project management

RRCS has 16 servers (nine physical servers and six virtual servers) and supports 284 computers – including 124 laptops.

Procurement

Following the Code of Virginia Procurement Act, procurement staff purchase a wide variety of basic to complex goods, services, and professional services. For more complex procurements, they use a team approach to develop documents and verify goods or services being purchased.


Page 32

Reimbursement

The reimbursement staff are responsible for the accounts receivable for RRCS. This includes manual and electronic billing to Medicare, Medicaid, commercial insurance companies, contract agencies, and direct client payee for all agency programs that generate fees. They also support and train program staff in the use of Credible (for electronic health records), determine fee eligibility for clients, and verify insurance and personal income for clients receiving services from RRCS.

QUALITY ASSURANCE DIVISION (Supports both the Area Agency on Aging & Community Services Board)


Quality Assurance (QA) staff work in concert with administration and program staff for all aspects of incident reporting, human rights, privacy, complaint handling, records management, and overall risk management. This division supports both the Area Agency on Aging and Community Services Board.


The RRCS significant event reporting policies serve as a way to monitor and evaluate critical health and safety indicators throughout the agency – within programs, facilities, and among individuals served. Aside from basic regulatory compliance, the overarching goal of health and safety initiatives is one of a broad health, safety, and quality improvement vision. The initiatives include learning about root-causes (how and why did it happen?), developing sound methods of prevention, as well as increasing competency in identifying and responding to situations that pose potential risk of harm.


Page 34

Significant Events: Data and Summary

During FY15, there were 627 incidents reported to Quality Assurance (QA). The charts below are a representation of these incidents in the following areas and categories during FY15 as compared to the reports received during the previous fiscal year (366 incidents in FY14).

Injury/Illness Reports: by General Location

Location FY14 FY15 Community Support Residential 129 240

Client's Home 79 102 Bridges 57 100 Visions 11 22

Senior Day Program 11 20 Transit 4 19

Boxwood 24 15 Clinic/ Other RRCS Site 7 10

Other Community Setting 0 6

TOTAL # INJURY OR ILLNESS 322 534

TOTAL # INCIDENTS 366 627

Client Deaths: (‘service area’ data unavailable for FY14

deaths) Client Deaths FY14 FY15

TOTAL # DEATHS 17 19 TOTAL # INCIDENTS 366 627

Incidents Reported to Licensing: by Type

Incident Type FY14 FY15 Injury/Illness 19 142

Client Death 17 19

TOTAL REPORTS TO LICENSING 36 161 TOTAL # INCIDENTS 366 627

RRCS experienced various changes involving significant event reporting during the middle of FY14 through the end of FY15. Some of these changes were internal and some changes were brought upon by the Virginia Department of Behavioral Health and Disability Services (DBHDS) enhancements to regulatory reporting requirements. Toward the end of FY14, DBHDS increased incident reporting expectations and at that time QA began the process of carrying those instructions out to front-line staff and establishing new reporting procedures – a process that continued through FY15. The QA department also expanded from a two-analyst department into a four-analyst department, partly in an effort to provide an increased level of ongoing support to staff regarding some of these enhanced regulatory expectations.


Page 35

Annual Report of Human Rights and Privacy Activities

Overview

The four principle human rights activities were training staff, handling complaints, investigating allegations of abuse or neglect, and handling privacy issues such as subpoenas. Those activities are summarized in the following sections.

State Incident Reporting Tool

The Virginia Department of Behavioral Health and Developmental Services (DBHDS) has continued the use of its statewide electronic reporting system, Comprehensive Human Rights Information System (CHRIS), for significant incidents. The goal is to improve the timeliness and accuracy of critical incident reporting in licensed programs and create a database of information that would be easier to analyze. During FY15, we have been able to extract reports from the CHRIS database for the Local Human Rights Committee. DBHDS has continued to implement changes in the system that affected incident investigations and required more interaction with clients and authorized representatives during an investigation. There has been some indication there will be further changes in CHRIS during FY16.

Training

Since most of our human rights training events are the monthly new employee orientation and the on-line Human Rights update training for all staff, we do not report the specific number of events and participants. Staff are trained in Human Rights at orientation with annual follow up training on-line.

QA staff coordinated with Visions program staff to provide training to members of the program concerning their human rights and the complaint process. This was initiated due to numerous complaints from Vision program members about changes within the program, many of which involved events and rules, not actual human rights violations.

QA staff attended a human rights complaint investigation training with Fidura and Associates, which has led to some alterations in the investigation response and reporting process. Clients, authorized representatives/guardians, and staff are now notified of investigation findings in writing rather than verbally.


Page 36

Complaint Handling

FY 2015 Annual Summary of Complaint Handling By Program

Program Informal Handling Founded Visions 5 Outpatient 8 1 Orange Apartments 1 1 Boxwood 3 1 Emergency Services 1 Locust Grove Group Home 1 Aster Group Home 2 1 Total 21 4

Only programs with documented complaints are listed.

FY 2015 Annual Summary of Complaint Handling By Type

Type of Complaint Informal Handling Founded Treatment with Dignity 19 3 Sound Therapeutic Practice Provider Choice Least Restrictive Treatment Breach of Confidentiality 2 1 Access to Service Total 21 4

Under the current Human Rights Regulations, complaints are not categorized as formal or informal. Complaints, however, may be handled formally or informally depending on the preference of the individual served. We have five days to resolve a complaint informally before the complaint automatically becomes formal. The Regulations encourage the use of the informal complaint handling process. All complaints are reported to the Regional Advocate and to the Local Human Rights Committee. Additionally, a quarterly report of human rights complaints is brought to the agency Senior Management Team for review.

Our goal is to handle complaints informally whenever possible. We believe the informal process is usually quicker and more satisfactory to consumers. This year we had an increase in the number of complaints compared to previous years:

FY15 FY14 FY13 FY12 FY11 FY10 21 16 15 14 9 10


Page 37

All 21 complaints were handled informally which, according to the Human Rights Regulations, is the preferred handling method. Unlike previous years, there appears to be an unusual pattern in this year’s data, with an increase in complaints from the Visions and Outpatient programs. Part of the increase in the Visions program came about because of some program changes, which a small group of members were unhappy about and resulted in multiple unfounded complaints. The cause of increased complaints from Outpatient is unclear; however, only one of these complaints (privacy - an unintentional mix up in mail) was founded. There is no indication of a pattern that would suggest any particular problem areas. While the number of complaints remains within the range of the last six years, it is worth noting that the number of complaints has increased in the last four years. This is worth monitoring to see if it indicates a trend or is just normal year-to-year fluctuation. The number of categories from year-to-year has remained similar until this year:

FY15 FY14 FY13 FY12 2 6 5 5

This could be a result of the limitations of categories in electronic CHRIS reporting and having to interpret where complaints should be reported.

Abuse & Neglect Allegations

FY 2015 Annual Summary of Allegations of Abuse or Neglect

Program Total #

Alleged Perpetrator Disposition

Staff Other Med Errors Found Unfound

Med Errors

Found Unfound

Visions 2 2 2

Boxwood 2 1 1 2

Orange Bridges 11 11 11

Fauquier Bridges 22 22 22

Airlie GH 2 2 2

Aster GH 7 1 6 1 2 4

Canterbury GH 5 5 5

Foxcroft GH 6 1 3 2 2 2 1 1

Liberty GH 3 2 1 3

Millfield GH 1 1 1

Remington GH 4 3 1 3 1

Total 65 5 50 10 3 52 4 6


Page 38

FY 2015 Annual Summary of Allegations of Abuse or Neglect by Category

Program Total # Category of Abuse/Neglect

Peer/Peer Staff Physical Staff Neglect Med Error

Boxwood 2 1 1

Orange Bridges 11 11

Fauquier Bridges 22 22

Visions 2 2

ID Residential Tot. 28 14 4 10

Airlie GH 2 2

Aster GH 7 1 6

Canterbury GH 5 5

Foxcroft GH 6 3 1 2

Liberty GH 3 1 2

Millfield GH 1 1

Remington GH 4 3 1

GRAND TOTAL 65 50 1 4 10 Only programs with documented allegations are listed.

Figures in italics are data for specific group homes. This data is totaled in the line labeled “ID Residential Total”

RRCS is aggressive in reporting allegations of abuse or neglect. Our practice is to report allegations and subsequently investigate, rather than investigate first and only report those that we feel are credible. As a result, any errors should be on the side of over-, not under-reporting.

FY15 saw a significant increase in abuse/neglect allegations over FY14

FY15 FY14 FY13 FY12 FY11 FY10 65 50 29 23 28 30

One possible reason for this increase could be the continued improvement in reporting since the change in procedure for reporting significant events to the QA staff. Program staff are now instructed to send an e-mail to their supervisor and QA staff to notify of a significant event, referencing the note in the electronic health record for more information. Staff are then to follow-up with the written significant event report to QA. This process has made it easier for the programs to report incidents quickly, and for QA to make reports to DBHDS within the 24-hour time frame.


Page 39

As in the past, most of our allegations of abuse and neglect are peer-to-peer incidents in which one individual served strikes or threatens another individual served. As expected, these incidents are concentrated in our larger congregate settings and in particular our Bridges programs. Our Bridges programs serve individuals with intellectual disabilities and have a higher consumer to staff ratio than the group homes. Several of these individuals have significant behavioral issues that result in minor incidents of aggression against peers. In peer-to-peer cases, the key human rights issues are whether or not staff could have reasonably prevented the incident from happening and whether staff responded appropriately after the incident to protect the individuals involved. Just because an individual has been aggressive to another individual does not constitute a founded case. A peer-to-peer incident is founded only if staff actions or staff failure to act contributed to a preventable peer-to-peer incident. Peer to peer incidents are typically handled with therapeutic interventions for the consumer(s) involved. As with previous years, we have a very low incidence of founded abuse or neglect allegations. The three founded neglect incidents within the group homes seemed to be a result of staff failure to follow established procedures and protocols. Supervision has addressed this issue with staff and provided some corrective training.

There is an increased focus within the intellectually disabled (ID) programs to provide assessments by a behavioral specialist for individuals frequently involved in behavioral incidents and develop therapeutic behavioral contracts and individual service plans. In FY16, DBHDS will be revising the Human Rights Regulations and significantly changing the role of the Local Human Rights Committees (LHRC). Part of this change will be the requirement for a Behavioral Management Committee to review all behavioral plans before they are presented to the LHRC. QA and ID staff have begun exploring requirements and procedures for this committee.

Another change in reporting, which has increased the number of neglect incidents, is the implementation of reporting medication errors as significant events. Some medication errors are reported to DBHDS as staff neglect, and as this process continues to be defined and implemented, the numbers in this incident category will likely see a marked increase. Many of the medication errors seem to stem from staff members not following the proper procedure/protocol for medication administration. QA staff are developing a written procedure to assist residential and day program staff with the administration and documentation of medications, which is expected to lead to an eventual decrease in medication errors.

Privacy Activities

Privacy Officer activities include the review of subpoenas and consultation with the RRCS attorney regarding each subpoena for protected health information. The Privacy Officer also regularly consults with staff regarding both specific and general questions about disclosing information. All privacy activity data reflect the full fiscal year.


Page 40

FY 2015 Annual Summary of Subpoena Handling

Total # Sent Record # Motion to Quash Filed

Other Outcomes

Subpoenas for Records 7 5 0 2

RRCS had 20 subpoenas in FY15, which is significantly lower than it has been the past five years. The number of subpoenas for records was lower than the last three fiscal years, as was the number of subpoenas for witness.

FY15 FY14 FY13 FY12 FY11 FY10

Records 7 13 11 23 7 17 Witness 13 19 19 22 18 13 Total 20 32 30 45 25 27

FY2015 Subpoenas for Witness by Type of Staff Subpoenaed

Type of Staff Therapist Support Coordinator Total

# of Court Appearances 4 9 13 # Quashed, Released, other 0 0 0 Total 4 9 13

FY15 continued the increasing trend of support coordinators being subpoenaed to court. Prior to FY11, the only staff usually subpoenaed to court was direct service staff. In FY15 (as in FY14), we had no court appearances for doctors.

FY15 External Requests for Protected Health Information

Direct service staff continue to handle many routine disclosures of information with written authorization from individuals receiving services. The Privacy Officer handles requests that come to Bradford Road offices by either forwarding the request to direct service staff or responding directly to the requester. The trend of high numbers of records requests being handled by the Privacy Officer continues:

FY15 FY14 FY13 FY12

130 86 67 63 In FY15, there were 42 requests where the Privacy Officer copied records and responded directly to the requester.


Page 41

FY 2015 Disability Requests

FY15 saw a significant increase in the number of requests by Disability Determination Services for records and assessments. Disability requests represent a significant expenditure of staff time and resources. A typical request requires that direct service staff make a copy of the individual’s record and complete an assessment of the degree to which the individual is disabled. Additionally, some individuals are seeking our services for the sole purpose of supporting a disability claim and not primarily for therapeutic benefit. The only compensation we receive for a disability request is a maximum of $15 for copying the record. This fee typically falls far short of the cost to RRCS for the time and expenses of handling these requests. Disability requests either are sent directly to a provider at one of our clinics or are sent to our administrative office. When they are sent to our administrative office, the Privacy Officer logs the request and forwards it to the primary staff of the individual seeking the disability claim, or in some cases, copies and mails records directly (FY15=25; FY14=14). Disability workers regularly make follow-up requests to check on our progress in processing the request. The Privacy Officer logs these calls as well and forwards the follow-up request to the direct service staff. This activity consumes considerable time for therapists, physicians, psychiatric assessment and support staff, support coordinators, and the Privacy Officer.

The following numbers reflect requests that have come to our administrative offices. Additional requests come directly to providers at our clinics

Disability Request FY10-FY15

FY15 FY14 FY13 FY12 FY11 FY10 # of Requests 106 74 67 97 52 49 # of Follow up calls 61 59 49 83 65 96


Page 42

Organizational Compliance Annual Report

Introduction

In FY15, the Quality Assurance (QA) department became a four-member team with the addition of another Quality Analyst and a Quality Assurance/RN. With a full staff, there was a redistribution of work tasks with a QA lead contact and a team approach for support and backup. Although much of the focus again this year has been the continued development and proper utilization of the electronic health records (EHR), centralized record reviews have again been scheduled and implemented as part of this process. There continues to be a major focus of QA staff time to the development of the Meaningful Use Reports and Attestation Process related to the EHR.

There have been two other areas of major focus for the QA team during FY15. One was the opening of two new ID group homes under the US Department of Justice settlement and Bridge funding program, requiring a substantial amount of time and attention from the QA/RN, to ensure clients’ needs are being met and adequate supporting documentation entered into the chart. The other is the implementation of a new procedure and training program for the E-Mar/medication administration process within the group homes and day programs, aimed at reducing the number of medication errors in these programs. QA staff work with the Human Resources office to provide monthly training for new employees, as well as annual follow-up training for all staff, including Human Rights; Privacy and Confidentiality; Waste, Fraud, and Abuse; and Whistle Blower policies/procedures. QA staff have also been focusing on reviewing and updating quality assurance and human rights policies, a project that will continue into FY16. QA staff have started developing guidelines for an intern position to join the team in FY16.

Records Review Activities

Implementation of the EHR has changed the focus and record review process for QA staff. Record reviews this year have focused on the efficient use of the EHR to meet and maintain compliance with licensing and Medicaid requirements, especially with the recent manual changes. There is a continued focus on the implementation and utilization of proper forms and processes to meet program and manual changes, to reduce the number of incomplete services, and to process required data corrections.

Records reviews take place at two levels. Each program conducts internal audits of program records to assess compliance with agency policy and external regulations. Programs have various ways of reporting these findings to their staff and correcting errors found. QA staff have collaborated with program managers and supervisors to develop effective tools for providing this oversight and monitoring with the EHR system.


Page 43

In addition to program level record reviews, QA staff conduct extensive reviews of records, one program at a time. Medicaid reimbursed cases are an important focus of these reviews because these records are the ones which are subject to the Federal requirements for an Organizational Compliance Program and because the records represent the greatest risk exposure for the agency if there are errors in the records. We also review non-Medicaid reimbursed services, such as the Boxwood Treatment program and the Boxwood Detox program.

Programs for review by QA staff are selected based on the following criteria:

• How long has it been since our previous review?

• What is the assessed risk in the particular program?

Because of limited review resources the last two years, the focus of the QA team has been on programs in which we have assessed a greater risk to the agency. For example, if previous reviews indicated record keeping problems in a particular program, then QA conducts more frequent reviews of those programs to ensure that planned corrections are implemented and sustained. The review schedule has recently been revised to allow review of all programs yearly, beginning with programs undergoing recent changes in Medicaid or Licensing regulations, or structural and/or supervisory changes. Limited focus reviews are also completed whenever there is a medication error or human rights complaint review.

Quality Assurance Review Process

The implementation of EHR has greatly changed the record review process. In the early months of the EHR, record reviews were a little more complicated, as part of the records were still in paper charts located at the program sites and part was entered into the EHR and available via computer. With the EHR in place for two years now, this situation is improved, with most of the information being scanned or entered into the computer. The QA record reviewer will no longer need to go to the program site to review the paper charts. With the implementation of the EHR, QA staff made a decision to change the review schedule and process. A schedule has been put in place to review fewer charts for each program, allowing for a quicker reporting time to the program manager, and a shorter delay in program changes being made. This will also allow for more frequent reviews of each program to ensure that the appropriate changes and corrections have been made in documentation and reporting.

Once a program has been selected and a review completed, the QA records reviewer meets with the program manager or supervisor to review the findings. The manager is given both detailed case-by-case review findings and aggregated data that indicate the accuracy percentage for each record element reviewed. The manager also receives a narrative summary of findings that identifies patterns or problem areas that need to be addressed. The manager is responsible for taking these findings and working with his or her staff to correct all correctable issues and put a process in place to prevent these


Page 44

issues from occurring in the future. The program manager will confer with the QA record reviewer about any unresolved issues that have financial implications for the agency. The QA reviewer then reports these findings to the Senior Management Team.

Programs Reviewed by QA Staff in FY15

The following programs, records, and services were reviewed and monitored by Quality Assurance staff during FY15:

• ID Group Homes

• Guinn Lane MHSS

• Community Consumer Submission (DBHDS) Compliance and Completion of Data

• Incomplete Services Reviews (monthly)

• Unapproved Services Reviews

• Bridge Funding documentation/process for Millfield and Aster Group Homes

General Internal Findings

The EHR has proven to be an effective tool for ensuring a higher level of compliance with critical documentation standards. However, despite improvements, we continue to have problems in many of our programs with quarterly reviews completed late or not at all and with progress notes not being completed the day of service as required with the implementation of the EHR. There is also some concern over the lack of detail being included in the progress notes in some of the programs. The EHR is providing an effective means for supervisors and QA staff to monitor these issues and provide more immediate feedback to staff.

APPENDICES


Page 46

Consolidated Financial Data 1

Revenue Sources

Source Amount Comments

State of Virginia $5,717,120 Increase of $781K over prior year

All Local Sources 2,051,914 Increase of $464K over prior year

Fees for Services 9,247,169 Increase of $1.5M over prior year

Federal Funds 2,110,388 Increase of $105K over prior year

Other Sources 900,460 Small increase of $1K over prior year

Other Transfers 3,826,109 Decrease of $229K over prior year

Grand Total $23,853,160

1 Unaudited - Report consolidates information from both State and Federal fiscal years.


Page 47

Expenditures

Source Amount Comments

Personnel $14,562,591 Increase of $768K over prior year

Staff Development 87,768 Slight increase of $3K over prior year

Facility Expense 937,824 Decrease of $116K over prior year

Equipment / Supplies 1,829,242 Decrease of $39K over prior year

Travel / Transportation 736,378 Decrease of $47K over prior year

Professional Services 972,244 Decrease of $398K over prior year

Other 632,571 Decrease of $13K over prior year

Sub-Total $19,758,618 Overall increase of $158K over prior year

Admin + Food Service 2,463,031 Decrease of $231K over prior year

Transportation 490,056 Decrease of $36K over prior year

Aging Services 373,582 Increase of $64K over prior year

Sub-Total: Transfers $3,326,669 Overall decrease of $203K over prior year

Grand Total Expenses $23,085,287

Grand Total Revenues $23,853,160

Grand Total Expenditures $23,085,287

Revenues – Expenditures $767,873


Page 48

SERVICE OUTCOMES BY COUNTY

Culpeper County Total Impact: 1,989 Citizens

RRCS Board Appointees:

Mr. Edward Alan Anstine Ms. Elizabeth Davis

Ms. Christina Kearney

Service Outcomes – Culpeper County

COMMUNITY SERVICES BOARD Behavioral

Health

Intellectual

Disability Substance

abuse

Provision of individual and group counseling for children and adults, psychiatry services, evaluations and treatment of moderate to severe mental illness in outpatient community centers.

633 0 182

Urgent care and crisis intervention services provided to children and adults in multiple community settings experiencing mental health crisis.

527 In other 150

Service coordination and linking to community services for children and adults with disabilities to reinforce quality of life and success in community living and work.

227 215 In other

Stable housing for adults and residential care and support in community-based housing provided up to 24 hours a day in local community.

27 28 0

Families supported with early intervention services for their infants and toddlers age birth to 3 N/A 90 N/A

Meaningful day activities and work for adults with disabilities for rehabilitation, recovery, and training. 44 46 N/A

Inpatient detox, rehabilitation, and recovery services for adults seeking recovery from addiction disorders. N/A N/A 56


Page 49


Fauquier County Total Impact: 1,745 Citizens


Ms. Pat Balasco-Barr Ms. Beth Darrough, Ph.D.

Mr. Robert Weigel

Service Outcomes – Fauquier County


Health

Intellectual


abuse


792 0 222


436 In other 143


156 153 In other


2 24 0





Page 50


Madison County Total Impact: 559 Citizens


Ms. Bonita Burr Ms. Clare Lillard

Mr. Robert Legge

Service Outcomes – Madison County


Health

Intellectual


abuse


132 0 26


88 In other 23


40 41 In other


1 0 0





Page 51


Orange County Total Impact: 1,480 Citizens


Ms. Sarah Altman Ms. Marcia Brose

Ms. Mary Lou McFarland

Service Outcomes – Orange County COMMUNITY SERVICES BOARD

Behavioral Health

Intellectual Disability

Substance abuse


410 0 114


305 In other 72


159 132 In other


18 14 0





Page 52


Rappahannock County Total Impact: 302 Citizens


Ms. Elizabeth Blubaugh Ms. Demaris Miller

Mr. Doug Schiffman

Service Outcomes – Rappahannock County


Health

Intellectual


abuse


94 0 24


60 In other 9


33 13 In other


0 0 0





Page 53

RAPPAHANNOCK RAPIDAN COMMUNITY SERVICES

Board of Directors and Senior Staff

2015 OFFICERS OF THE BOARD

Ms. Marcia Brose, Chair (Orange) Mr. Edward Alan Anstine, Vice-Chair (Culpeper) Mr. Doug Schiffman, Secretary (Rappahannock)

BOARD MEMBERS BY COUNTY REPRESENTED

Culpeper County Mr. Edward Alan Anstine

Ms. Elizabeth Davis Ms. Christina Kearney

Fauquier County Ms. Pat Balasco-Barr

Ms. Beth Darrough, Ph.D. Mr. Robert Weigel

Madison County

Ms. Bonita Burr Mr. Robert Legge Ms. Clare Lillard

Orange County Ms. Sarah Altman Ms. Marcia Brose

Ms. Mary Lou McFarland

Rappahannock County Ms. Elizabeth Blubaugh

Ms. Demaris Miller, Ph.D. Mr. Doug Schiffman

SENIOR STAFF Executive Director

Brian D. Duncan

Aging & Transportation Division Director

Ray Parks

Clinical Division Director Ryan Banks, LPC

Community Service Division Director Paula Stone, LPC

Finance & Administrative Services Division Director

Anna McFalls

CONTACT INFORMATION

Administrative Offices: 540-825-3100

Emergency Services (after hours): 540-825-5656

One Call Center (Transportation Services): 540-829-5300

RRCS Volunteer Program: 540-825-3100, extension 3358

Intake for Behavioral Health Services:

Culpeper Clinic: 540-825-5656

Fauquier Clinic: 540-347-7620

RRCS does not discriminate on the basis of race, color, national origin, sex, religion, age, disability, or any other characteristic protected by law, in employment matters and in its programs and services. For additional information on RRCS’s nondiscrimination policies and procedures, or to file a complaint, please visit the website at www.rrcsb.org or contact the Human Resources Manager, 15361 Bradford Road, P. O. Box 1568, Culpeper, VA 22701. Telephone: (540) 825-3100.

15361 Bradford Road PO Box 1568 (Mailing Address) Culpeper, VA 22701 540-825-3100 www.rrcsb.org [email protected]

http://www.rrcsb.org

http://www.rrcsb.org/

mailto:[email protected]?subject=Annual%20Report

ANNUAL REPORT FY15 - Rappahannock-Rapidan Community Services · RAPPAHANNOCK RAPIDAN COMMUNITY...

Documents

Transcript of ANNUAL REPORT FY15 - Rappahannock-Rapidan Community Services · RAPPAHANNOCK RAPIDAN COMMUNITY...