Daily Update August 27, 2014 - HR 1723 Study Committee Meeting Aug 25

HR 1723 Study Committee Meeting
August 25, 2014

Rep. Andy Welch, Chair
Rep. Joyce Chandler
Rep. Penny Houston
Rep. Mary Margaret Oliver
Rep. Kevin Tanner
Rep. Tom Weldon (teleconference)
Rep. Wendell Willard

The August 25 meeting was designed to be informational to hear from agencies. Those presenting included:

  • Department of Public Health

  • Department of Human Services (RCC and DFCS)

  • Department of Juvenile Justice.  

DHS Power Point - http://www.gahsc.org/ms/2014/dhsdocs20140811.pdf

DJJ Power Point - http://www.gahsc.org/ms/2014/DJJ_RBWO_ Presentation_8-8-14.pptx

Next Meeting Sept 8 10:00 CLOB 606 

HR 1723 Study Committee Meeting
August 25, 2014

Department of Public Health
Chris Rustin, Director of Environmental Health

The first presentation was delivered by DPH. Chris reviewed the requirements and process noting that DPH requires food service permits from the local departments for residential care with 13 or more children. Providers will average two inspections per year based on the type of facility and risk, i.e. coffee shop would be risk 1; risk 2 – cooking and cooling processes (2 inspections/year); type 3 high risk goes beyond the scope of rules (3 inspections/year). They may add inspections as needed.   

Approximately 380 staff work with local health departments to standardized rules and implementation.  The inspection process is the same as with restaurant grading.  Violations are based on risk – higher risk carries a higher point reduction.  DPH scoring does not get factored with the overall scoring with DHS.   

Rep. Willard inquired about doing inspections in tandem with others and inspections of family model agencies.  Chris responded that inspections are unannounced in order to get an accurate picture.  When they announce visits it takes away from seeing activities during the busiest time, therefore they do not see accurate picture of day-to-day activities.  It was stressed that agencies have to be prepared at all times.  Based on inspection history, DPH can reduce the number of inspections.  It was noted that in the family model, most are only licensed up to 12, so this is not a problem.

Every department posts inspection scores on a website.  Generally, DPH posts the last five inspections.  Once the program is initially permitted, a follow up routine inspection is completed within the first 60 days. If the score is Unsatisfactory there is a follow up inspection is within 10 days. If risk is present, the provider is required to make correction with inspectors on site.  In the second year, follow up inspections might be optional based on the score of the first annual inspection.  Rep Welch noted it will be helpful to see the full number of inspections.   

Department of Human Services
Ashley Fielding, Legislative Liaison
Residential Child Care - Carol Winstead
Office of Provider Management – Dianne Kelly and Catrecia Stokes

It was noted that the process has allowed DHS to be introspective in how they can remove some of the burden.  They reviewed roles for each of these groups. 

RCC covers minimum standards. Licensing is required to care for six or more children. The initial licensing visit is announced.  Providers are issued a preliminary license and RCC revisits in 6 months. The provider receives an assessment the end of the first year and review of citations, if any.  RCC gives citations a scope and severity level.  An agency can receive a second temporary license if needed.  The maximum they can give is two temporary licenses.  After one year, if approved, the provider receives a continuing license. Annual visits are unscheduled and completed within one month of the previous year’s visit. Other visits are on an as-needed basis.    

RCC sets the licensing standards and OPM sets contractual requirements, which might be in addition to RCC requirements.  A list of statutes that guide the work was provided to the committee.   

Carol Winstead provided further review of the RCC process noting that they inspect and require a plan of correction for deficiencies. It was noted that they have a triage unit that addresses complaints received through RCC reports mailbox (self reported or outside). They evaluate whether or not the complaint needs investigation – only 30% are usually investigated.  Clarification was provided noting the difference between a complaint versus incident - an incident is self-reported.   

Ashley Fielding reviewed a list of proposals to reduce oversight.    

It was reported that there are 300 licensed facilities in the state.  RCC sets the licensing standards; OMP holds the contract and may set additional requirements.  OPM responds to complaints based on severity.   

Rep. Oliver asked a number of questions asking of the 300 facilities, how many are used by DJJ or other (Mental Health). RCC does not maintain this number. RCC is the only licensing authority and they regulate all the same.  DJJ investigates complaints.  Rep Oliver further asked of the 470 CPS complaints from 300 facilities, how many are child on child versus child on adult. How many confirmed/substantiated? She expressed interest in incident of arrest of children in foster care and asked what happens, i.e. is there programmatical protection.   

It was noted that RCC inspects (unannounced) 5% of foster homes or 10 per licensing agencies, which ever is greater. Providers are down to two CCIs that have foster care. It was reported that 45% of children in foster care are placed with private providers – of this number, 30% are in family foster homes (approx 1,300 CPA foster families).  The remainder 55% of foster children are in DFCS homes or with relative placements.  Group home placements account for 18% of DFCS children.  It was stressed that PRTFs are hospitalizations, not placements.  

Rep.  Tanner inquired about the 55% of DFCS placements asking if the case manager approves relative placements.  It was noted that the county office handles approval of foster homes – the same list is used that private agencies use to approve homes.   

Interest was expressed in the level of care needed.  It was noted that in therapeutic foster homes, foster parents are supported to a level that they can take a child with high level need. An estimate was provided noting there are approx. 150-200 children in Maximum Watchful oversight.   

A review was provided of the ranking system. Dianne Kelly explained base program designations noting the staff to child ratios differ based on designation.   

Ranking of children coming into DFCS


BWO – Base 1:15

AWO – Additional 1:10

MWO – Maximum 1:5

SMWO – Specialty; additional training and supports to foster parents.

Rep Houston expressed interest in the normalcy issue raising questions about use of shampoo.  DHS reiterated the issue with keeping hazardous materials away from children. It was reported that this was cited five times in past 1.5 year.  They are looking more closely to see if it was appropriately cited and/or if there is another way to look at this. Products that do not have, “keep out of reach of children” do not have to be secured.  

Carol Winstead responded to questions about refutation and the appeals processes.

A provider may refute inconsistencies with a surveyor’s citation that is without validity. Carol noted that approx. 10 years ago they evaluated and put into place the refutation process. A surveyor should conduct an exit interview so the provider can correct errors on site.  A plan of correction is required within 10 days for citations rated B or higher. A provider can refute and reference the rule they are refuting and include additional information in the Plan of Correction. RCC will then review and delete, revise, or uphold. It was noted that this is a voluntary process put into place by RCC. Carol noted that they can evaluate patterns around rules and surveyors. 

The appeal process is a right of the provider when enforcement action is taken.  They have the right to appeal.  RCC offers a settlement conference with the provider.  Rep. Willard asked if an appropriate due process is in place. It was noted that if the provider appeals, it goes to an administrative law judge. If appealed, they can go to Superior Court.   

The Associate General Counsel for RCC provided information. She acknowledge they the concern around the appeals process.  It was stressed that Georgia’s process is in line with other states.  The Office of Administrative Hearings issues an initial decision; either party has opportunity to seek an appeal review decision by someone who does not have contact with the case and is appointed by the DHS Commissioner -  they issue an opinion. There is not a right to the settlement conference – RCC offers this.  It was reported that in the last five calendar years there has not been a request for a judicial review.  After the administrative decision, providers did not seek additional review.   

It was noted that there is an independent APA review.  It was further noted that not all citations rise to an adverse action - APA only applies to sanctions [adverse action].   The provider has 10 days to request a hearing only if there is an adverse action.  It was noted that there have been 33 adverse actions out of more than 2,000 citations.  Representatives clarified that providers do not have the right to appeal a citation that does not have sanctions, although citations are published.  It was noted that this is an internal process.  Rep. Tanner expressed concern with the adverse action posted on the website and requested that they think about a way that they can have a good process to clear these up.   

When asked what numbers by law judge were brought to review by the Commissioner are changed, it was noted that of three appeals requests one was overturned in favor of RCC and another appeal was won. A question was raised asking why go through LJ (law judge) if reviewed internally. The LJ decision is not considered final.  [Can go to Superior Court after opinion]  

PPT from DFCS Office of Provider Management (OPM)

Catrecia Stokes reported that there are currently 179 CCIs and 71 CPAs. She referenced the RBWO minimum standards, management of risk and education of providers. It was noted that the Performance Based Placement scoring requires a score of 70 or above out of 100 to ensure placements of children.   

Safety reviews are unannounced based on the number of children placed.  

The QFH Study Review is looking at safety and foster home study.   

The Ga Score system was explained noting that it is used by providers to enter data. The system was created for providers to use. It was stressed that the SHINES system is specific to the child.   

Rep Welch asked who reported into the score card. Those with RBWO contract report.  RCC reports part of the survey and they are part of the comprehensive review score.  The goal is for OPM to use the score card to determine which contracts will be issued/reissued.  Some providers have needed more technical support.  Termination of providers is rare - more often they suspend placements, limit numbers, or change approval level to lower level children. DJJ can also utilize Ga Score - it could be helpful to have information from DPH.   

Rep. Oliver expressed interest in the education achievement criteria and asked if they check to see that every child has a surrogate appointed and ensure IEP is being followed. This is the responsibility of the county case manager. They try to use the birth parent as surrogate or foster parent.  

Clarification was noted that RCC and OPM are two different oversight entities.  

Rep Oliver asked how to consolidate requirement of criminal background checks stressing we would like to see this happen.  Reference was made to legal issues and Rep Oliver challenged this and requested that they seek help with a solution.  

It was agreed that it is possible for the Divisions to combine annual inspections.  OPM goes out once per year and could propose every two years. They can further look at inspection schedule based on performance. OPM and RCC are in conversation about how to decrease visits with foster homes.  

Rep. Welch raised the suggestion that the Departments look at software and data base for intra-agency communication. Rep. Houston also noted that we are not using technical data enough.   It was noted that the Department has internal monthly meetings and have talked about a calendar system for all to enter information to cross check visits. It was noted that yes, inspection forms overlay with OPM and RCC. OPM is looking from safety perspective.   

A question was posed asking if there is an appeal process for termination of a contract. It depends on why the contract is terminated. The Department can give 30 day notice – there is not an appeal to this.   

A suggestion was made to look at the PCP scoring to correspond with what RCC is reviewing.    

Rep. Willard suggested the use of advisory panels that are the regulated bodies and have providers give information from advisory group to review. Recognize those who need to get out of the business.   

Clarification was provided on the response time to providers.  Policy is that RCC has 30 days from exit date to get the report to the provider.   

Rep. Welch asked if we have looked at other states for interagency data sharing. It was noted we are working on enhancements with Ga Score (contract management system.) and allowing RCC and DJJ to be part of the system.  RCC emails every adverse action to OPM. Dianne Kelly reported that DFCS leadership meets monthly with the provider leader associations. Also, Practice Matters meetings are offered to every contracted RBWO provider to talk about child welfare practice.   

Rep. Welch asked how many children are transferred to privately funded homes like WinShape and Eagle Ranch.  It was noted there are none because OPM does not have a contract with them. Rep. Welch stressed that we want to incentivize those who have funding and asked, how do we incentivize. Can we look at monitory or tax incentives?  

Dianne Kelly reported that the Department is also looking at predictive analytics starting with CPS when a report comes in, noting previous risk factors - this could create a system of red flags.   

Department of Juvenile Justice
John Smith, Racquel Watson and Carl Brown 

An overview was provided of the Department and its oversight.  There are:

  • 78 residential facilities for CCI and CPA

  • 1,400 beds are shared with DFCS

  • 65 joint facilities contract with DJJ and DFCS

  • 13 DJJ only providers 

Staff providing oversight include four regional treatment specialists and six residential placement specialists.  There are three planned site visits per calendar year – one announced and two unannounced.  It was announced that they will team together a calendar with other departments. Some standards that they have to oversee are DJJ specific based on safety and security as an agency.  DJJ reports back to facilities within 72 hours. They are addressing an appeals process. 

Timelines for a corrective action plan depends on the deficiency:

  •  7-10 business days for critical issues

  • Within 30 days for physical plant issues  

A question was raised about YDC and RYDC, RBWO youth – there are 800 hard beds.   

Placement by level: 

  • 30 - Base

  • 70 - AWO

  • 221 – MWO 

Rep Oliver asked about cross over children and the federal law/ payments through IV-E funding. 

Rep Willard asked about the joint working relationship and what is done differently from DFCS.  Racquel noted this is addressed in the Power Point, i.e. a PREA (Prison Rape Elimination Act) incident has to be immediately addressed which is outside of how we as agencies address joint audits.  It was suggested that consideration be given to inter governmental agreement for regular annual regular visits. Carl Brown noted they can discuss this.     

Rep. Welch suggested consideration for interagency operations allowing OPM to oversee the contracts and inspections associated with the contracts. It was noted that DJJ has a substantial contracting department and focus solely on residential contracts would not result in substantial savings.   

Rep. Tanner cautioned that the reasons kids are in [DJJ] custody are different from reasons they are in DFCS custody. He encouraged consideration of ways to do inspections at the same time. It was noted that DFCS inspectors do not have the same expertise as DJJ inspectors – they are not there for the same reasons.  Rep. Welch asked if we could we cross train. It was noted that DJJ has to look at the most critical needs, i.e. sexual offenders. DJJ is charged with safety, security of child and community.  If DFCS takes on inspections and they do not receive information until 7-10 days later, this creates issues. 

Rep. Oliver asked for a report out of the 470 – where they come from and what they reflect. Reference was made to the RCC Power Point slide on complaints of abuse and neglect Rep Oliver asked how many are DJJ. How many in DJJ or DFCS are arrested from facility and sent to jail?  She asked if this happens, should your facility post bond.  

Rep. Welch provided closing remarks stressing that they want more concrete identified code statuary provision that need to be addressed, i.e. assignment, duties to streamline this and rules/regulations.  He asked for ways to incentivize privately funded providers.   

Next Meeting Sept 8 at 10:00am,  CLOB 606








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