106-60

The requirement to have records within an hour for an onsite visit is not feasible. As a county agency, many of our personnel records are stored with county human resources department. In addition, it can take time to set up a guest account, etc. in order to get the records. While we strive to get records as soon as possible, this short of a turnaround time does not leave room for staff who may be assisting with individuals and are unable to make the hour requirement.   With location of service sites, it may take more than an hour to transport the files to the location.

106-80

Not all modifications should require the same modification form information and attachments.  Please provide clarity on what is required for specific changes.   

The requirement to have service modifications to the department at least 45 business days prior to the change slows down providers’ ability to ensure service delivery and individuals’ choice of providers. This requires over 2 months of notice, based on business days.  This is not practical in many instances.  Additionally, the department’s timeframe for response is not defined. We request shorter timeframes to meet individuals’ changing needs and defined timeframes for departmental response.   

D. There may be situations where this is not possible to provide 45 business days notice, i.e. sudden illness or death of sole ownership organizations.  There must be an emergency exception for this requirement to ensure services. If the services provided are not changing with the new owner, why does a service description have to be submitted?

E.6. This is concerning.  What is considered significant?  Is this meant for each individual as in if a provider can’t provide services to an individual for a month as they are traveling?  Unreasonable.

G. Again, what is the department timeline for returning or responding to the information?  What is to happen in the interim; if there is a sudden change in ownership, do people have to move out of group homes ASAP?  This is a concern for person-centered system.

106-120

We support the following language to section E. The department shall review the plan and notify the provider within 10 business days if the corrective action plan is approved or not approved.  If not approved, the department shall provide a written notification of the non-approving of the CAP, which at minimum includes the (1) reason the plan is not approved.  (2) a summary of the information that is missing or needs revision for the plan be approved; and, (3) specific concerns with the proposed plan.  The provider has 10 business days from the receipt of the non-approval notification to revise and resubmit the corrective action plan.

It is unreasonable to be required to use DBHDS’ issued corrective action plan.

F. Seems the commissioner should have the final say, not the director of licensing.

106-180

This is concerning for the requirement of a governing body as this will prevent growth in the system; only organizations and not single owners can open services?

106-250 & 260

The requirement for driver’s to have a Virginia driver’s license is unreasonable. Many providers have employees from surrounding states (e.g., WV, D.C., TN, MD) and additionally this is discrimination against military personnel and spouses who by law are allowed to keep a driver’s license from their “home” state. 

106-300

The requirement for the trainings as listed to be done within seven days is unrealistic and unfeasible. Those providers that are within the constructs of another agency (i.e., local government jurisdiction) are often bound by their onboarding training requirements. Additionally, medication administration training is a multiple day training that requires specific credentials for trainers. Many providers do not provide this onsite. Same is true for CPR/first aid. This requirement as written is an impediment to adequate service delivery and service choice to get staff trained within this short timeframes. The requirement for supervision prior to training is not defined and doesn’t allow for shadowing of seasoned peers.

The medication administration should only be applicable if the position will be administering medications.  The medication administration class is a 32-40 hour class.  It cannot be done during this timeframe.  The staff must have medication administration training prior to administering medications.

Section B.2.e. What does “utilizing community support services” mean?

Section B. 3. This section repeats some of the information from above in section 2.

106-310

As written, this will delay making changes based on own internal Quality Assurance and Risk Management evaluations.  Suggest indicating the provider is responsible for ensuring policies are maintained that are in compliance with this chapter.  Policies must be available for review by the department on request.  This hurts providers from changing to respond to needs of agency or as other regulations change if the policy includes items from this chapter.  Current way written is impractical and excessive.

106-320

In section B. “certified as tuberculosis free” is confusing; suggest changing to using language from A  “shall obtain a statement of certification by a qualified licensed practitioner indicating the absence of tuberculosis in a communicable form…”

106-340

What is the orientation period referenced in the regulation? 

106-410

Is the posting reference meaning posting online or on the wall?  Posting on a wall is not practical as this could be pages and pages long.  Posting information indicating a full fee schedule is available upon request is practical, posting a full fee schedule is not. 

106-430

It is not always possible to provide 30 business days advanced notice to end services.  30 business days is a long time period.

106-510

Is the posting reference meaning posting online or on the wall?  Posting on a wall is not practical as this could be pages and pages long.  Posting information indicating a service description is available upon request is practical.

106-550

Clarification needed on prohibition on staff visitors. As written, it contradicts the statement above allowing open houses. We value privacy and confidentiality; however, is impractical. As written, it prohibits ANYONE (e.g., food delivery, job applicants, other government department leaders) from coming on to the premises of ANY licensed building.   This is unreasonable.

106-570

We agree with the importance of reviewing all serious incident levels on a quarterly basis; however, concerns with requirement for documentation of steps to mitigate potential future incidents. While we strive to provide robust, person-centered services; the amount of incidents in a particular area does not always mean an issue. Individuals should have the dignity of risk with their choices. 

Concern that providers are required to submit information to licensing via CHRIS within 24 hours and are only provided 24-48 following to provide updates; yet are provided 30 days to conduct a root cause analysis.

The requirement for Level 2 incidents to be reported within 24 hours in the CHRIS system creates an unreasonable administrative burden to report incidents on weekends and holidays.  Requiring Level 3 incidents to be reported within 24 hours makes is reasonable based on the seriousness of the incidents.  Having till the next business day to report Level 2 incidents into the CHRIS system is reasonable.  Licensing and Human Rights are not responding to the events on holidays or weekends.  This has created issuing violations for reporting incidents reported 30 hours late, when the provider provided the individual the appropriate care and treatment.  This is creating a citation program and not providing quality assurance and oversight for service delivery.