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Please help me with this new job overseeing group homes

Posted

Specializes in Psychiatry, Pediatrics, Community, Nurse Manager. Has 5 years experience.

I've had no orientation. I'm the only nurse. 

I don't want to rant and I also don't want to quit because I like the job and I think eventually I will be good at it. 

There are 10 group homes each with 1 to 4 developmentally disabled residents.

Unlicensed staff passes meds. This is a bit stressful for me. 

Even insulin and opiates. 😬

Will I get used to that?

Right now I am fixing problems arising from having no nurse for a few weeks and also just problems.

This means I am upsetting the apple cart. I'm walking a fine line here between trying to fix whats wrong (unsecured meds, orders not matching meds, no labs for 3 years, no PCP, no psychiatrist) and developing rapport with staff.

Director asking me to do things that don't really make sense. Like schedule an appt for a specialist based on a referral that's over a year old. 😑

I worked in the community before but I had a team that met every single day and we provided most of the services ourselves. This is really different.

General info and advice appreciated in advance. 

Edited by FolksBtrippin

I’m an investigator for DES. Make sure that you review everyone’s care plan (ISP or whatever it’s called in your state) and follow that. Make sure staff is oriented to every member and that ratios are followed. And have orientation materials and signature sheets signed. Emergency numbers need to be posted and who is on call, menus also posted. Review MARS for med errors, make sure meds and cleaning supplies are locked. And if you have an incident, be familiar with you Agency (state or whoever) incident reporting timeline. I give out so many corrective actions because incident reports are late. Hope this helps. 

amoLucia

Specializes in LTC.

Am curious - is this Civil Service or privately owned?

FolksBtrippin, BSN, RN

Specializes in Psychiatry, Pediatrics, Community, Nurse Manager. Has 5 years experience.

23 minutes ago, amoLucia said:

Am curious - is this Civil Service or privately owned?

Privately owned 

FolksBtrippin, BSN, RN

Specializes in Psychiatry, Pediatrics, Community, Nurse Manager. Has 5 years experience.

10 hours ago, jobellestarr said:

I’m an investigator for DES. Make sure that you review everyone’s care plan (ISP or whatever it’s called in your state) and follow that. Make sure staff is oriented to every member and that ratios are followed. And have orientation materials and signature sheets signed. Emergency numbers need to be posted and who is on call, menus also posted. Review MARS for med errors, make sure meds and cleaning supplies are locked. And if you have an incident, be familiar with you Agency (state or whoever) incident reporting timeline. I give out so many corrective actions because incident reports are late. Hope this helps. 

This does help, thank you. The state is coming in November. I do not feel like I have enough time, but I am just going to do my best. 

amoLucia

Specializes in LTC.

My earlier question kind of tags into PP jobellstarr's response.  As a PVT facility, things may have been very lax for a long time. I suspect someone higher up has caught on and wants things cleaned up, like yesterday!

Just be careful that you don't become the fall-guy to be blamed for all the  shortfalls. It freq happens that someone, usually a new employee, becomes the scapegoat. Easy to be sacrificed in a facility's Plan of Correction.

And to add to PP's comments, make sure the staff is correctly credentialed and timely certified for their positions. Also, check if education requirements are lacking. In NJ, NH CNAs used to be required to have 12 hours yearly inservice for their certifications. And then there are also those mandatory ones, like HIPAA, OSHA, fire & safety, Resident Rights, abuse, etc. (I've been out of the loop for a while, so some things may have changed.)

Know what your state's specific R&Rs are for med admin. That may help your concerns a little. Also tap into your other dept heads, like social worker, admissions, maint, even your pharm service, for help. That might be tagged into their job descriptions or contracts,

You've got a GINORMOUS  job ahead of you. Good luck  to you.

 

FolksBtrippin, BSN, RN

Specializes in Psychiatry, Pediatrics, Community, Nurse Manager. Has 5 years experience.

5 hours ago, amoLucia said:

My earlier question kind of tags into PP jobellstarr's response.  As a PVT facility, things may have been very lax for a long time. I suspect someone higher up has caught on and wants things cleaned up, like yesterday!

Just be careful that you don't become the fall-guy to be blamed for all the  shortfalls. It freq happens that someone, usually a new employee, becomes the scapegoat. Easy to be sacrificed in a facility's Plan of Correction.

And to add to PP's comments, make sure the staff is correctly credentialed and timely certified for their positions. Also, check if education requirements are lacking. In NJ, NH CNAs used to be required to have 12 hours yearly inservice for their certifications. And then there are also those mandatory ones, like HIPAA, OSHA, fire & safety, Resident Rights, abuse, etc. (I've been out of the loop for a while, so some things may have changed.)

Know what your state's specific R&Rs are for med admin. That may help your concerns a little. Also tap into your other dept heads, like social worker, admissions, maint, even your pharm service, for help. That might be tagged into their job descriptions or contracts,

You've got a GINORMOUS  job ahead of you. Good luck  to you.

 

This is really helpful, thank you. 

I am in NJ, too.

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 19 years experience.

A couple of Questions before I give you answers. I did this job for 6 years and will give you my thoughts once answered.

What state are you in? 

How are the homes you oversee classified. 

IDH

IDH H

IDH RN 

These are California abbreviations so your state my differ?

Are your homes sanctioned under title XXII?

I will be happy to answer any questions you have once I know a bit about your situation. 

Hppy

amoLucia

Specializes in LTC.

A little voice was whispering 'New Jersey, New Jersey'. !

Big suggestion - check out your last survey. See where old problems were and that any corrections made back then for the POC are still in place and haven't fallen by the wayside.

Your admin should have access/availability to state R&Rs for DDD. Will be interesting reading!

to jobelle - been meaning to ask, what is DES? I'm thinking like a surveyor for DOH/Ombudsman Office? 

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

I'm familiar with PA regs, NJ is similar.

NJ Dept of health regs: https://www.nj.gov/health/healthfacilities/

Group homes covered under: Comprehensive Personal Care Home unless licensed as assisted living program

https://www.nj.gov/health/healthfacilities/about-us/facility-types/

 

NJ Regs covering assisted living and personal care homes:   N.J.A.C. 8:36

http://www.hpm.umn.edu/nhregsplus/ALF by State/New Jersey ALF in process.pdf

This is survey form that references above regulations:

AAS-24 Affidavit of Compliance Assisted Living Residences, Comprehensive Personal Care Homes and Assisted Living Programs

14.3 (b)  One joint drill with local fire department. (yearly)

14.3 (c) Facility tests one pull alarm per month and documents result.

7.4 (b) RN develops nursing practice policies and procedures 

AAS-45 Reportable Event Record/Report

 

Check that all personal care staff giving meds are certified medication aide with current cert --- office staff should maintain list.

Certified Medication Aide regs

CMA covid wavier

Hope this helps in addition to above nursing advice.

Very rewarding position once you get everything in order.

 

FolksBtrippin, BSN, RN

Specializes in Psychiatry, Pediatrics, Community, Nurse Manager. Has 5 years experience.

10 hours ago, hppygr8ful said:

A couple of Questions before I give you answers. I did this job for 6 years and will give you my thoughts once answered.

What state are you in? 

How are the homes you oversee classified. 

IDH

IDH H

IDH RN 

These are California abbreviations so your state my differ?

Are your homes sanctioned under title XXII?

I will be happy to answer any questions you have once I know a bit about your situation. 

Hppy

I'm in NJ.

I don't know the answers to your other questions, but I will try to find out. 

FolksBtrippin, BSN, RN

Specializes in Psychiatry, Pediatrics, Community, Nurse Manager. Has 5 years experience.

10 hours ago, amoLucia said:

A little voice was whispering 'New Jersey, New Jersey'. !

Big suggestion - check out your last survey. See where old problems were and that any corrections made back then for the POC are still in place and haven't fallen by the wayside.

Your admin should have access/availability to state R&Rs for DDD. Will be interesting reading!

to jobelle - been meaning to ask, what is DES? I'm thinking like a surveyor for DOH/Ombudsman Office? 

Thank you! I looked at the last internal nursing audit, which is quarterly, and it seems like the previous RN just checked off everything as passed. I know that not ALL of these problems happened since June! 

 

FolksBtrippin, BSN, RN

Specializes in Psychiatry, Pediatrics, Community, Nurse Manager. Has 5 years experience.

4 hours ago, NRSKarenRN said:

I'm familiar with PA regs, NJ is similar.

NJ Dept of health regs: https://www.nj.gov/health/healthfacilities/

Group homes covered under: Comprehensive Personal Care Home unless licensed as assisted living program

https://www.nj.gov/health/healthfacilities/about-us/facility-types/

 

NJ Regs covering assisted living and personal care homes:   N.J.A.C. 8:36

http://www.hpm.umn.edu/nhregsplus/ALF by State/New Jersey ALF in process.pdf

This is survey form that references above regulations:

AAS-24 Affidavit of Compliance Assisted Living Residences, Comprehensive Personal Care Homes and Assisted Living Programs

14.3 (b)  One joint drill with local fire department. (yearly)

14.3 (c) Facility tests one pull alarm per month and documents result.

7.4 (b) RN develops nursing practice policies and procedures 

AAS-45 Reportable Event Record/Report

 

Check that all personal care staff giving meds are certified medication aide with current cert --- office staff should maintain list.

Certified Medication Aide regs

CMA covid wavier

Hope this helps in addition to above nursing advice.

Very rewarding position once you get everything in order.

 

Thank you, I also feel like this will eventually be rewarding for me.

The regs we follow seem to be under DDD instead. Our direct support staff are not CNAs or HHAs. 

The medication aide stuff is especially concerning, because I am 99% sure that our DSP staff do not have any certification above the training they get internally from our organization. 

amoLucia

Specializes in LTC.

I repeat - you have a SUPER GINORMOUS task ahead of you!!

We're here to listen!

NRSKarenRN - TY for all your citations. Muy helpful. 

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

OK.  Here's the link to Division of Developmental Disabilities (DDD)

https://www.nj.gov/humanservices/ddd/home/about/

Mandated Training and Development

The following mandated training information applies in the Medicaid-based, fee-for-service system. 

Prevention of Abuse, Neglect, and Exploitation (PANE) Supervisor Q&A Guide

Prevention of Abuse, Neglect, and Exploitation (PANE) Competency Assessment Form

Medication Administration: On-Site Competency Assessment Forms

Medication Administration: Training Module Updates

 

 

On 9/23/2020 at 5:41 PM, amoLucia said:

A little voice was whispering 'New Jersey, New Jersey'. !

Big suggestion - check out your last survey. See where old problems were and that any corrections made back then for the POC are still in place and haven't fallen by the wayside.

Your admin should have access/availability to state R&Rs for DDD. Will be interesting reading!

to jobelle - been meaning to ask, what is DES? I'm thinking like a surveyor for DOH/Ombudsman Office? 

Department of Economic Security. I investigate complaints for anyone that receives services from Division of Developmental Disabilities.

amoLucia

Specializes in LTC.

jobelle - TY. I was almost close.  Like DOH or DHSS here. Which state? Don't think I ever heard of a DES, but a name  is just a name.

(Altho I do remember waaaay back when DES meant diethylstilbesterol. Showing my age.)

hppygr8ful, ASN, RN, EMT-I

Specializes in Psych, Addictions, SOL (Student of Life). Has 19 years experience.

On 9/24/2020 at 4:27 AM, FolksBtrippin said:

Thank you, I also feel like this will eventually be rewarding for me.

The regs we follow seem to be under DDD instead. Our direct support staff are not CNAs or HHAs. 

The medication aide stuff is especially concerning, because I am 99% sure that our DSP staff do not have any certification above the training they get internally from our organization. 

it is a rewarding job but there is a tremendous amout of fraud in the industry which is why I finally quit - It just didn't go with my personal code of ethics but if you have an ethical management It can be fun and rewarding.

 

Hppy