Developmental Services Topics

January 2011. Governor Jerry Brown released a state budget that will cut state spending by $12 billion, including an 8-10% cut for state employees not covered under a bargaining agreement. In June 2011 voters will be asked to continue, for the next five years, the current level of personal income and sales taxes. The proposed budget will attempt to consolidate or slash many state functions. Some of the cuts in state spending will directly effect Medi-Cal and the Department of Developmental Services. As expected, there will be a 4.25% reduction to regional centers and to service provider payments that will continue until June next year. Brown’s budget calls for cuts to the SSI/SSP reimbursement rates, and reduction in the tax credit for dependents from $300 to $99 and 0.5-percentage-point increase in the vehicle license fee, a 1-cent increase in the state sales tax rate.
RCFE and ARF resident’s health and safety was put at risk when the Legislature reduced inspections from annual to every five years. CCL’s attempt to return to annual inspections requires money. but CCLD’s proposal for more money was rejected by the Legislature.
CCLD had to prioritize its workload as money remains at issue because of the worsening budget crisis.The workload priorities have three items at the bottom of the drawer; new applications, orientations, and appeals.
Brace-up care providers as more cuts and more fees are coming your way.

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2 Responses to Developmental Services Topics

  1. admin says:

    CHOCKING: Prevention and Intervention
    Unfortunately, there have been several choking incidents in residential facilities that have resulted in the death of a consumer. Please carefully read the following article and share with all your staff.

    We need our lungs to work: We need oxygen to live. The oxygen in the air needs to get down the air passages of the nose, back of the throat (called the pharynx) into the trachea and bronchioles in the lung to air sacs where the oxygen is absorbed and carbon dioxide exchanged so that we can maintain life. If the airways are blocked or if damaged or fluid stops the air sacs working then airways are blocked or if damaged or fluid stops the air sacs working then we are without oxygen, as a result we become sick and can die. Things like asthma, bronchitis, and pneumonia can cause problems getting enough oxygen, but this article is mainly to look at the problem of choking.

    What is choking? Choking happens when an object or piece of food gets stuck on the pharynx (back of throat or airway and blocks the air getting into the lungs. If the object cannot be removed by the person coughing, then the oxygen does not get to the person’s bloodstream through their lungs and they can die.

    How do we cut and swallow without choking? When we are eating we chew the food in our mouth. Then we organize it to swallow it down into the esophagus (the tube that leads down from the lower part of the throat (pharynx) to the stomach). In the pharynx, just below the back of the tongue, is the entrance to the airway to the lungs. It is covered by a flap called the epiglottis. This flap is open for us to breath, but when we swallow it closes the airway, so that food does not get in the airway to the lungs. When a person chokes, something like a piece of food or anything from the mouth (e.g.. toy a child is sucking on) gets stuck across the airway in the pharynx or in the airway at the esophagus or below it.

    What does choking look like! This is a terrifying experience and the person cannot breath, they cannot talk, and often cannot swallow. They will be agitated, will grab their throat or wave their arms. They will try to cough but their cough may be weak and they may be wheezing and perhaps drooling. We need to act immediately to help them.

    What do we do if a parson chokes? The way to help is to use the first aid abdominal thrust (Heimlich maneuver). From behind the person, place the thumb side of your fist against the middle of their abdomen just above the navel. Grasp your fist with the other hand and give quick upward thrusts. Have someone also call 911. Sometimes we cannot manage with this procedure and need to care for the person if they become unconscious. If you do not know this way to help or have not practiced it recently, please ask your health team to train you. We never know when we may need to use it; at work with consumers, at home at mealtimes, out at a restaurant, or with a child choking on a toy part. (Please be ready!)

    How can we reduce the threat of choking? The most common cause for choking is pieces of food. Our consumers are often at risk because they cannot munch and chew or swallow in an organized way. Any consumer who gags or coughs during meals needs to be checked by your nutrition management/ team. If we make the food into smaller pieces or even pureed we may help swallowing be safer. Often we have to slow the person’s eating pattern down to be safe and certainly watch for stuffing or over- ‘ stuffing food into the mouth. We need especially to watch our consumers who steal food as they may have large pieces in their mouth and hurry to swallow without completely chewing food.

    What do we watch for?
    - Meals are a pleasure but in our care for our consumers, we need to watch for the dangers.
    - Carefully monitor anyone who gags or coughs when eating and refer for an assessment.
    - Please follow orders for food texture, eating positioning, amount of spoonfuls, and rate of eating.
    - Please monitor all consumers when eating for any problems and that they have the correct meal.
    - Please be ready to help and give first aid: If a person suddenly gets agitated, holds their throat, cannot speak, looks as though they have choked, use the abdominal thrusts, call 911 and follow up as you are trained to do in the first aid classes.

    What orders will we need to follow?
    It is important that all consumers who have a risk of choking are evaluated, a plan made out, doctor’s orders made, and that everyone who cares for them knows what they are. This includes the way we position the consumer, the speed of eating, the size of mouthfuls, and the texture of the food and liquids. Each caregiver will need to agree on the textures and what texture orders mean.
    - Bite-sized pieces are usually one inch square.
    - Chopped is one inch or less and bread is soaked and cookies are crumbled.
    - Finely chopped is about the size of a rice grain for all food (including soups).
    - Pureed is baby food texture.
    - Liquids may be thickened to syrup or pudding texture.
    - Follow up on those that gag or cough.
    - Tell all the care team about all orders that involve feeding.
    - Be ready to give first aid.
    - With care, meals can be safe and enjoyable for all of our consumers and staff.

    SDRC Vendor Bulletin – Written by “Graeme Johnson M.D.”

  2. admin says:

    California Department of Public Health: Online News

    Date: 2/16/2011
    Number: 11-012
    Contact: Al Lundeen (916) 440-7259
    Goldstar Rehabilitation and Nursing Center of Santa Monica, LLC has received an “AA citation, the most severe penalty under state law, and a $100,000 fine, the highest fine under state law, from the state of California after an investigation concluded that the inadequate care led to the death of a patient, announced Dr. Mark Horton, director of the California Department of Public Health (CDPH).

    The facility failed to ensure the health and safety of a patient when it did not follow its patient care policies and procedures which resulted in the patient’s death.

    All nursing facilities in California are required to be in compliance with applicable state and federal laws and regulations governing health care facilities. Facilities are required to comply with these standards to ensure quality of care.

    California has the statutory authority to impose fines against nursing facilities it licenses as part of enforcement remedies for poor care. State citations that require a civil monetary penalty be imposed are categorized as Class B, A or AA. The associated fines range from $100 to $1,000 for Class B, $2,000 to $20,000 for Class A and $25,000 to $100,000 for Class AA. The citation class and amount of the fine depend upon the significance and severity of the substantiated violation, as prescribed and defined in California law.

    By providing nursing facilities it licenses with consequences for substantiated violations, CDPH strives to protect the health and safety of vulnerable individuals. The citation process is part of CDPH’s ongoing enforcement efforts in improving the quality of care provided to residents of the state’s approximately 1,400 skilled nursing facilities.

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