Audience

Open to the Public

Date

Thursday, January 9, 2014

Time

2:00 pm

Location

Teleconference

Phone #: 888-494-4032 Access Code: 1469835118

QUALITY CARE BOARD MEETING MINUTES

January 9, 2014

2:05 p.m. - 3:05 p.m.

Teleconference

Present: Susan Keegan, Chairperson; Thane Dykstra; Untress Quinn; Neil Posner; Inspector General Michael McCotter; Deputy Inspector General Robert Furniss; and Chris Milbrandt

Absent: Ginny Conlee

Before the meeting officially started, there was discussion regarding the already expired terms

of certain Board members. Chairperson Keegan will contact the person in the Governor's

Office regarding the extension of the expired terms.

1. Request for additional staff report - Chairperson Keegan/Neil Posner

- Letter to the Governor

IG McCotter stated Secretary Saddler was very receptive of his letter requesting additional

staff and that she will go forward with the request. The request has been sent to the Budget

Office in order to assess the dollar value of the new hires. It is estimated that it will cost

$1 million inclusive of salaries and all other costs involved.

2. Meeting with IARF

Bob, Mike and Lois McCarthy met with IARF (Illinois Association of Rehabilitation Facilities) and Art Dykstra, Trinity Services. They raised issues with respect to some of our investigative work. It was a very productive meeting and a lot of major points were raised. One of the issues to consider was having the agencies/facilities take over investigating allegations of mental abuse. We are required to do that under the Rule and by Statute. We agreed with them that it is the most problematic aspect of what we do because most of these are being properly handled administratively. From our perspective, is it really worth the time sending out an investigator to have them interview six or seven people or staff? The problem we would have is until that responsibility is removed from our purview, we would have to continue to do it. We try to refer as many of these to the agencies that have an investigative protocol as we can.

Josh Evans is the head of Legislative Affairs. He, Lois McCarthy, Mike McCotter and Bob Furniss have agreed to continue to study the matter to see if we can refine the definition of mental abuse. A lot of the inappropriate interactions with client cases can be handled administratively by an agency and would free us up. In the last fiscal year, we had 600 of these cases. We are substantiating 10% of them. We know that it is difficult to craft definitions legislatively, but we would like to try to do that.

Some of the other issues: They expressed some concern over our clinical coordinators in the past had been detailed as the primary investigator in neglect cases. We have stopped that practice. Some of the time the cases turn into an audit of the operations and are not focused on the actual allegation or conduct of the case. They will still be doing the death reviews and consults on death cases, but no longer be the primary investigator on neglect cases.

There were two other issues: 1:1 supervision - When an agency gets funding from the division for 1:1 supervision, they are getting hours that are paid hours. What our investigators were seeing was something would happen, we would go in and investigate a case, the client would be listed as having 1:1 supervision. Because the agencies have a limited number of hours that they can allocate to 1:1, the people in charge of the care of an individual sometimes have to make a bet when something might happen based on client experience. They would observe that client and determine if the client was agitated before going to bed, did something happen at lunch time, etc. The problem OIG is having is the agency staff needs to improve documenting that because some time our investigators see that someone is supposed to be on 1:1 and he/she is not on 1:1 when something happens. There is nothing in their file indicating differently. Thane indicated that community agencies do not receive funding for "1:1s" the way this term is commonly used in state facilities. Agencies may apply for enhanced behavioral supports, but this is often time-limited and required prior authorization and re-authorization from the DD Division. Thane noted that the DD division is currently exploring alternative procedures to the current system to make the process for requesting enhanced behavioral supports less cumbersome.

The final issue is a division problem. There is one facility that has 10 people on administrative leave, some of whom should not be on administrative leave because they were witnesses or their presence around individuals poses no danger to them.

Bob intends to talk to people in BQM about this issue. DIG Furniss understands the liability issue, but it seems like it really has gone over to the other side. It puts a lot of burden on the facilities/agencies and on us. We will be having another meeting in the next month or so. The meeting was very productive. It gives us something to think about when we do our work. The group also offered to provide training to our clinical staff to see how nursing services are provided throughout the agencies. We thought it might not be a bad idea to have some informational sessions with them. It is so different in the community. Thane noted that community agencies are not funded to provide the extensive nursing supports found in state operated developmental centers. He indicated that nursing ratios in community settings might be close to one nurse per 100 individuals served.

Thane also spoke on the pilot project - The division is committed to agencies reporting unusual incidents to them. DIG Furniss stated that OIG has veered away from tracking serious injuries because tracking or investigating all serious injurious would severely strain OIG's resources. Many of these injuries do not even involve staff. OIG will continue to investigate serious injuries if there is a neglect component.

3.  FY13 Annual Report

Chairman Keegan asked if OIG is the only organization that is reviewing the Annual Report. IG McCotter responded that it had to be reviewed by the Secretary's Office. The Annual Report has been published. Thane stated it has been the historical trend that most of the data focuses

on institutions and then community agencies. It is interesting given that the information is published on the web listed by provider agency. Is there any thought to changing that since it is already public knowledge? Typically OIG has not done that because statistics about reports of

allegations by themselves can be misleading.

DIG Furniss has been contacted by a couple of providers that aren't very happy about it because the data just talks about allegations. DIG Furniss told them they should be looking at the substantiation rate of the cases. One person could, in the course of a year, call in 12

allegations. OIG is more concerned about agencies that never have any reported allegations because that defies credibility.

Chairman Keegan asked for discussion on areas that could use some focus - p. 15 Investigative timeliness - up from 2012 almost 20%. Has something happened to increase that?

DIG Furniss stated he presumes lack of staff, and an increase in reports. OIG has had had three to five investigative positions that have been vacant for up to a year. We finally have two that we just filled within the last month. The publicity we had with the Belleville News Democrat articles spurred some of these calls. Because of these articles we are taking more calls on our hotline than before.

Chairman Keegan stated the only timeline that she sees with respect to reports is on p. 12 by fiscal year - 1,923 - 2,584 self-reports which is quite a large increase. Is that what you are referring to by saying there are more reports? That is 25%. That is pretty even with the

increase in the number of days to complete investigations (about a 20%) as well.

We were at a point several years ago where our completion average was around 43 days which was probably the best we are ever going to be able to do. From 2006 or 2007, the number of allegations/reports have increased almost 75%. One thing OIG have any more is domestic

cases. We are hoping once those investigators become acclimated to doing Rule 50 investigations we might start seeing a decline. If IG McCotter is able to get additional staff, we might see further reductions. Until we get more investigators, the numbers are going to get

worse.

IG McCotter stated that we got approval to rehire a former bureau chief to assist with southern investigations who will not require training. We are only getting him on a 60-day contract. We are hiring someone at Charleston for the central bureau. We hired a former investigator for the

southern bureau. Until we get approval, this is the best we can do. Metro and Cook (areas of greatest need) - We have had staff who recently retired who are willing to come back, but don't have any up in this area. The bulk of new Rule 51 investigators are here.

Thane stated that in past annual reports we talked about vacancies and how long the fill rate can take, but it was not included this time. He questioned whether it should be in future reports.

Neil - If we think it is a significant factor, it is worth mentioning.

DIG Furniss stated that over the last eight years OIG has had to really fight any time to keep vacant positions. OIG ended up losing almost 1/5 of our investigative staff. We are hoping that in this climate this is the time to increase staff.

Chairperson Keegan - p. 22 - For 2013, how do you think things went overall?

DIG Furniss responded that 2013 was a challenging year. We had to spend a lot of time responding to FOIA requests. We had a legislative initiative. We ended up having to close out all of our DAP cases and get help from other people to do that. We hope things have stabilized and cases will begin to go down. Even though most of the negative things are over, it affected everyone.

How is FY14 going to shape up?

We are going to see an increase in the amount of time to do cases because we have four Rule 51 investigators with no experience doing Rule 50 cases. It is a learning process and we think the numbers for the first half are not going to be good.

Thane asked if we keep statistics on the active caseload.

Yes, we have three investigators in those two bureaus with active caseloads of over 70 each. At one time, we had an investigator with 40% of the cases over 60 days old. It really depends on being able to hire these ten investigators. Anywhere from three to five investigators are contemplating retirement. Of those, three of them, in terms of productivity, are in the top five. We hired a person in Chester who was the ISI there. He had previously worked with us while at the facility. He has been with us for less than a month and is already doing cases. Chairperson Keegan ask who we are talking to about hiring.

 DIG Furniss responded that all of these are union positions. For example, in Coles County we posted a position and no one applied within the bargaining unit so we had to repost. You have to put in a request to hire. The request has to be approved by the Governor's and Budget offices. The vacancy was then posted. CMS and Labor Relations determine who the candidate(s) are. We have no guarantee that we are going to get someone with experience. If we reject the candidate, we have to start the process over. We have not been able to place clerical staff for eight months because there were no bidders. We hired someone contractually and now we found out we can't hire her. We have no input and virtually no guarantee they will have any investigative experience even though it is part of the job requirements.

DIG Furniss stated that it appears our bureau chiefs are going to be taken out of the union. That means we will have more of a say who will be put in the positions. In addition, as union members, they cannot take any disciplinary action against their staff or conduct a hearing.

Only DIG Furniss can conduct a predisciplinary hearing. IG McCotter stated it has been his

limited experience that to get someone hired, this whole process is so layered it takes forever.

DIG Furniss stated the other issue is grading. CMS grades these people. People are getting "A" grades for investigative positions that have no experience.

Are these rules embedded in the contract? History or tradition? In the contract for CMS? Are they in the administrative code?

They are negotiated provisions of the union contract. In OIG, there are four people not in the union. Mike, Bob, Deb DiLello and Lois McCarthy. Lois McCarthy is the only one who has no supervisory duties Our bureau chiefs are in the same union as the investigators, so cannot conduct pre-disciplinary hearings on their employees.

Chairperson Keegan asked if we have done any administrative rules in the last year that they should look at.

No.

Any operation or policy manuals?

There are a couple of the investigative directives that we are revising. We are in the process of streamlining some of these procedures. DIG Furniss will talk to Lois to see where she is on that.

Chairperson Keegan stated the Board would like to review them as part of the monitoring and oversight.

Chairperson Keegan stated OIG does a lot of oversight visits. Would it be good if the board went on the site visits?

We will look into that possibility. It would also be valuable to attend a Rule 50 training. We will check with Kelly on training dates that he has. Invite Deb DiLello and Mary Carolyn Garriott and they can discuss the process and what is involved. We will invite them to our April

10th meeting for an overview.

4. Approval of November 15, 2013's meeting minutes

 Motion to approve the minutes - Neil

 Motion seconded - Thane

 All in favor - Minutes approved as written

5. Miscellaneous issues/questions

 Next Quality Care Board meeting is April 10, 2014 at 2:00 p.m. at McFarland MHC.

 Motion to adjourn the meeting by Neil. Motion seconded by Thane. Meeting adjourned at 3:05 p.m.