Initial Comments:
A focused fundamental survey visit was completed on January 22 and 23, 2024. The purpose of this visit was to evaluate compliance with the Requirements of 42 CFR, Part 483, Subpart I Regulations for Intermediate Care Facilities for Individuals with Intellectual Disabilities. The census at the time of the visit was nine, and the sample consisted of six individuals.
Plan of Correction:
483.410(d)(3) STANDARD
SERVICES PROVIDED WITH OUTSIDE SOURCES
Name - Component - 00
The facility must assure that outside services meet the needs of each client.
Observations:
Based on observation and interview with day program staff, day program administrative staff, facility nurse and the qualified intellectual disabilities professional (QIDP), the facility failed to ensure that outside services meet the needs of each individual for one of one sample individual who utilizes a specialized communication device. This practice is specific to Individual #2.
Findings include:
1. Observations of the green room at the day program site was completed on 01/22/2024 between 1:45 and 2:15 PM. During this time period, Individual #2 was observed sitting at a table with the staff person sitting next to him. Subsequent interviews with both the day program staff person and the Director of the day program who was also present in this area, was completed between 1:50 and 2:05 PM. When the interviewees were asked what trainng plans are in place for Individual #2, the Director of the day program indicated that
Individual #2. has a training plan to develop communicaton skills using a communication device - a GoTalk 20. This device is an electronic tablet like device with 20-25 individual pictures on the face of the device. These pictures include photos of staff and family,as well as pictures of other everyday objects or situations.. When an operator presses a picture, the device will respond and identify the picture for the user
When the survey staff asked if Individual #2 has the device with him today, the day program staff person stated no but the director stated the device was in located in Individual #2's backpack. This interviewee then obtained the device from the backpack and brought it to the table where Individual #2 was seated. When asked if Individual #2 can use the device, the day program staff person stated that Individual #2 is able use the device, but often chooses not to use it. Upon request by the survey staff member to observe Individual #2 use the device, the day program staff person handed the communication device to Individual #2, and asked him to point to the picture of his mother. Individual #2 pressed his mother's picture but there was no response from the device. The day program staff person asked him to do it again and Individual #2 again pressed the picture of his mother with the same result.
At that point, the staff person flipped over the device and turned it on. The staff person again asked Individual #2 to point to the picture of his mother. Individual #2 again pointed to his mother's picture but the device again produced no sound. The staff person then cued Individual #2 to point to his father's picture which he did without prompting; at that time, a garbled sound was produced by the device. This process of pointing to a picture with either no sound or garbled sound occurred for approximately 2 more attempts before the director stated that the device was not working and needed to be fixed.
In response to a request by the survey staff to review doucmentation associated with the communication training plan, both the day progam staff and the Day program director were unable to locate documentation relative to the use of the electronic GoTalk 20 device.
2. Interview with the qualified intellectual disabilities professional (QIDP) on 01/23/2024 at
9:55 AM revealed that doucmentation for the use of the GoTalk 20 device while at day program was available at the residence. This interviewee also indicated that the device should be utilized on a daily basis. A review of this data collection for the time period from 01/02/2024 to 01/22/2024 was completed on 01/23/2024 at approximately 9: 58 AM.
This review indicated that there were only six (6) instances of data collection completed by day program staff during that time period with results noted as follows:
01/02/2024Not applicable
01/04/2024Resident not available
01/092024Not applicable
01/11/2024Not applicable
01/16/2024Resident not available
01/22/2024No data available on day of observation at day program by the surveyor
Interview with the qualified intellectual disabilities professional (QIDP) on 01/23/2024 at approximately 10:00AM, revealed the communication device should be with Individual #2 at all times and used at all naturally occurring times. The QIDP was unable to define what "not applicable" meant in the documentation noted above.
3. A review of the record of Individual #2 was completed on 01/23/2024 from approximately 8:30-10:45 AM. This review noted that Individual#2 has an annual program plan dated 08/25/2023. Under the section identified Prioritized Needs list the first need identified on this list is the need for increased communication skills. It states that
Individual #2 will communicate his needs using his Go Talk 20 device. In a review of the communication assesment protion of this annual program plan, it is noted that
"[Individual #2] is non-verbal and can make some of his needs and wants known to staff. [Individual #2] will follow 1 step directions with physical prompting by staff...[Individual ##2 points or gestures toward desired food or items with verbal prompting...[Individual #2] uses a Go Talk 20 Communication device to help him communicate his needs with staff and family."
Further review of the record revealed that Individual #2 is currently involved in a communication training plan, revised on 10/9/2023. He met criteria for identifying the picture of a truck with 2 verbal prompts for 10 out of 12 sessions on 11/30/2023. Individual #2 is currently working on identifying the picture of a person having a headache with mixed sessions of prompting and number of prompts.
4. Interview with the QIDP on 01/23/2024 at approximately 10:10 AM, confirmed Individual #2 does have a communication device and the device needs to be in arms reach at all times, and not be used only for Individual #2's training plan, but at all times to increase his communication skills. The QIDP added the device should be assessed daily for batteries by residence staff to assure its operability. This interviewee was unable to indicate why the day program staff were not aware of the training program or operation of the Go Talk 20 device.
Plan of Correction:The Qualified Intellectual Professional (QIDP) will meet with the Interdisciplinary Team (IDT), which includes Day Program Services on 2/9/2024 to review Individuals #2 Individual Program Plan (IPP) training plans which includes a specialized communication device. The team will ensure the specialized communication device is available, operative and documentation to be completed is accurate with objectives and methodology of the current training program. If the training program needs to be modified through team agreement, the QIDP will ensure the team has a projected date of revision. While the program is being revised, a communication substitute program will be implemented (picture system to flow with the training program with no sound). All other training programs will also be reviewed with the IDT for Individuals #2 and revisions will be made according to team agreement to ensure outside services are meeting the needs of Individual #2. Completion Date: 2/9/2024
All staff working with Individual #2 will be trained on the current training programs of the IPP which includes the specialized communication device and substitute program. All training sheets will be forwarded to the QIDP, and documents will be kept in the IPP referenced book in the facility as well as the Training Department to record the hours for training purposes. Completion Date: 2/23/2024
The QIDP will meet with the IDT, which includes Day Program Services on 2/9/2024 to review all the other Individuals that reside at the facility; to review IPP training plans which may or may not include a specialized communication device. The team will ensure all training plans are available, material present and documentation to be completed is accurate with objectives and methodology of the current training program. If the training program needs to be modified through team agreement, the QIDP will ensure the team has a projected date of revision to ensure outside services are meeting the needs of Individual's that reside at the facility. Completion Date: 3/15/2024
All staff working with all other Individuals that reside at the facility will be trained on the current training programs of the IPP which may or may not include specialized communication devices. All training sheets will be forwarded to the QIDP, and documents will be kept in the IPP referenced book in the facility as well as the Training Department to record the hours for training purposes. Completion Date: 3/31/2024
The QIDP will visit the day services and complete an observation 2 times per month for 3 consecutive months and then monthly thereafter. The Observation will include, Activity offered, lunch served, adaptive equipment recommended during program and lunch time, any behavioral concerns noted, speaking with day services staff for the individual and any feedback from the day services and any safety programming/material concerns will be noted. The audit will be signed by the Director of the Day Services for each visit. The Audits will be reviewed by the Program Director monthly and any concerns, non-compliance will be noted and addressed by the Program Director through individual team meetings. The Audits will be forwarded to the Administrator for review and recommendations. Completion Date: 2 times per month for 3 months and Monthly thereafter.
Responsible: QIDP, Program Director, Day Program, Program Specialist, Day Services Director, and Administrator
Administrator will oversee and ensure compliance
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