MINUTES

REGULAR MEETING OF THE ALLEGHANY HIGHLANDS COMMUNITY SERVICES BOARD

Thursday, May 17, 2018

The Alleghany Highlands Community Services Board held the May Board meeting on May 17, 2018 at 4:00 p.m. at the Administration Office located at 205 E. Hawthorne Street in Covington.

PRESENT:   Anne Dean, Lisa Hicks, Connie Back, Teresa Johnson, Bill Gilliland, Terrie Wright, Robin Mieras, and Robert Johnson, Jr.

ABSENT:   Nolan Nicely, Jr.

Also present:  Ingrid W. Barber, Executive Director; Adam Kenny, IT Manager; Crystal Homer, Human Resources Manager, Patty Flanagan, Finance Manager, Lynn Brackenridge, QI Manager, Angie Goodbar, Director of Developmental Services, and Cathy Schiffer, Director of Mental Health and Substance Use Services.

Lisa Hicks, Chairman, called the meeting to order at 4:01 p.m.

Communications:  Letters to the Editor – May is Mental Health Month

Thank You Letter – Alleghany Highlands Chamber of Commerce & Tourism

APPROVAL OF MINUTES OF March 15, 2018  REGULAR MEETING

MOTION:  That the Board approve the minutes of the March 15, 2018 regular meeting.

MOTION:         Anne Dean

SECOND:         Terrie Wright

VOTE:              Unanimous

PROGRAM REPORTS

Mental Health & Substance Abuse

Cathy Schiffer presented the following report:

Sarah Fahrer and Sarah Deffinbaugh attended a training in Charlottesville for ASIST called “Train the Trainer”.  ASIST (Applied Suicide Intervention Skills Training) is a two day interactive workshop in suicide first aid. ASIST teaches participants to recognize when someone may have thoughts of suicide and work with them to create a plan that will support their immediate safety. Participants don’t need any formal training to attend the workshop. Anyone 16 or older can learn and use the ASIST model.

Our Community Conversation on Opioids was held on March 6^th and was a huge success. Approximately 80 community members attended. Attendees were treated to pizza while they were able to visit resource booths from Safehomes, Covington Health Department, Alleghany Highlands CSB and Loving Life Fellowship. A story about the event was featured on WSLS Channel 10.

Tiffany Bowser, Prevention Services Supervisor, attended the Virginia Conference on Youth Tobacco Use in Richmond on March 21-11. Researchers at the event presented information regarding “juuling” which is a new vaping product being used by youth. It resembles a “usb” drive and can be easily used in school because it is not recognized as a tobacco product.

Shawna Jefferson was hired internally to fill our Adult Case Management position. Shawna has worked for the CSB for 5 years and transferred from Developmental Services to pursue a career as a Mental Health Case Manager.

Clubhouse restarted Soapy Club Carwash in April. They are currently scheduling agency vehicles to be cleaned weekly.

Dr. Bates has attended three conferences conducted by Harvard in the last quarter: “Substance Use Disorders”, “PTSD” and “Child/Adolescent Psychopharmacology”.

AHCS hosted the Arrive Alive Simulator at AHS and CHS on April 4^th and 5^th. This provided students and staff with a vehicle simulation of drinking and driving and texting and driving.

Sarah Fahrer completed all the requirements to receive her license in Clinical Social Work. She completed two years of supervision and passed her licensure exam. Sarah is now credentialed as an LCSW.

On February 28^th, we were awarded the Zero Suicide Grant and we are currently implementing the guidelines of the grant. Zero Suicide is a commitment to suicide prevention in health and behavioral health care systems, and also a specific set of tools and strategies.  Its core propositions are that suicide deaths for people under care are preventable. It aims to improve care and outcomes for individuals at risk. It represents a commitment to patient safety and also to the safety and support of clinical staff, who do the demanding work of treating and supporting suicidal patients.

We are on target with the timeline of Key Activities that include establishing a zero suicide implementation team, assessment of the agency’s protocol with suicidal clients, and training staff.

We are in the planning stages for Mental Health Awareness Month coming up in May. We will be hosting a week of activities relating to Fitness#4Mind4Body.

Developmental Services

Angie Goodbar provided the following report:

• New Initiatives – Developmental Services continues to stay abreast of state initiatives including DOJ requirements, Home and Community Based Settings Final Rule, Human Rights updates, and CMS Final Rule. Developmental Services is in the process of completing the case management self-assessment and preparing for a DBHDS site visit with case management scheduled for June 20^th. Case managers and providers are planning for the data exchange project that will enable the electronic health record to electronically send individual support plan data into the Waiver Management System (WaMS). Unfortunately, this transition will cause AHCS providers to complete duplicate documentation, resulting in increased workloads. Forms, including the person centered review, were modified in the AHCS electronic health record to capture DOJ outcome measures. According to the DBHDS data dashboard, AHCS Developmental Services remains in the 90-100 percentile of compliance with data measures. All day support and residential policies have been updated to reflect the home and community based waiver rights and expectations for person centered planning. Merryfield Residence policies and procedures were updated to reflect CMS emergency preparedness requirements. Employees have been educated about emergency preparedness, the communication plan, and continuity of operations plan. Tabletop discussions and drills are scheduled in the next month to examine employee preparedness for implementing procedures in the event of an emergency. AHCS continues to partner with the Alleghany County Local Emergency Management Team in coordinating emergency preparedness efforts.
• Waiver Slots – On May 8^th, AHCS allocated three waiver slots. Currently, there are thirty eight individuals on the waiting list for waiver services from the Alleghany Highlands catchment area.
• REACH Training – AHCS Developmental Services hosted a REACH Training in April. The training title was “How Biopsychosocial Stressors Impact Persons with Intellectual and Developmental Disabilities”. Leela Stone, Region 1 Project Manager, visited with the case managers in April to discuss REACH services and regional funding for housing for individuals with I/DD. The regional REACH program was awarded national certification. The REACH program received funding for one AHCS employee to participate in a Professional Learning Community (PLC) with the focus of the series being “Mental Health Aspects of IDD”. Jennifer Jarvis, DS Community Supports Supervisor was chosen to participate in the training.
• Residential Services: Merryfield Residence is at capacity with all nine beds occupied. Six out of eight beds are occupied at Friendship Residence.
• Grant updates

Westrock grant application update:  AHCS received funding in the amount of $3,500 to replace the security cameras at the Life Skills Day Support Program.

DRPT grant application update: AHCS received a tentative approval for one 15 passenger bus and one 5 passenger minivan.

Home Depot grant application update – AHCS was not awarded the Home Depot grant for exercise equipment.

• Marketing/Educating the Community: Lisa Pritt, Case Management Supervisor, attended the Special Education Advisory Committee meeting and gave an update on waiver services. Lisa participated in the Community Health Fair at Lewis Gale Alleghany Hospital and the Odd Fellows Special Needs Fishing Day. Lisa is a member of the Alleghany Highlands Network Group which is a newly developed team focusing on employment and how to help students in school develop the skill set needed for employment after graduation.

Amanda Webb attended the CAPP meeting and shared information about the Public Guardian Partnership Program.

• Conferences and Training: The Support Coordinators attended the DBHDS Slot Assignment Training at Rockbridge Area CSB. They also attended the “Behavioral Health Issues in Persons with Intellectual and Developmental Disabilities” training in Richmond.

Amanda Webb, Guardianship Director, and Angie Goodbar, DS Director, attended the Public Guardianship and Conservator 2018 Statewide Training in Staunton.

• The DS Director attended the Regional DS Council and REACH Advisory Meetings in Charlottesville. The DS Director attended the Public Guardianship Board Meeting and participated in the multidisciplinary team meetings for the guardianship program. The Director attended the VACSB Conference in Norfolk from May 2^nd-4^th.

Upcoming Events:

• May is Early Intervention Awareness Month – The Infant & Toddler Program will be celebrating by sharing appreciation baskets with referral sources, teachers, their aides and other providers, and community members. The participants of the AHCS day support program will be putting together appreciation gifts for community stakeholders again this year. The Infant/Toddler Program will be hosting a “Child’s Day” at Alleghany Regional Library towards the end of the month! Check out our agency facebook page for more information!

Quality Improvement

Lynn Brackenridge provided the following report:

UR, Compliance and EHR:

• Incident Reports Processed – 33 in March and 33 in April
• # CHRIS Reportable – 15 in March and 18 in April
• Safety Inspections – 2 in March and none in April

CAPS:

2/13/18 – ICF – DBHDS Licensure CAP

2/27/18 – NB – DBHDS Licensure CAP

2/27/18 – Clubhouse – DBHDS Licensure CAP

2/27/18 – MHCM – DBHDS Licensure CAP

3/25/18 – In Home – DBHDS Licensure CAP

• Licensure visit by Kevin Lassiter, Licensing Specialist, from DBHDS on 2/27/18. The unannounced visit reviewed the following areas for compliance – Clubhouse, New Beginnings and chart reviews. All corrective action plans have been accepted by licensure and implemented.
• DMAS audit conducted January 22-26, 2018. The timeframe for the audit review was July-September 2017. All corrective action plans have been accepted by DMAS and implemented. DMAS to revisit to ensure corrective action plans implemented are being followed.

Other:

Participation in Meetings/Trainings/Committees by QI staff:

• Safety Meetings, LHRC Meeting, VACSB QL Meeting, VA Credible Users Meeting and Regional Nursing Meeting
• Attended VACSB Legislative Conference May 2-4, 2018
• Attended Human Rights Train the Trainer Event April 4, 2018
• Attended Credible Conference March 27-29, 2018
• DBHDS case management quality improvement review scheduled 6/20/18
• DBHDS prevention review scheduled 6/20/18
• Participation with Near Southwest Preparedness Alliance with community table top drill May 23, 2018
• Participation with DSLCC table top drill May 24, 2018
• Artea Ambrose, Human Rights Advocate, site visit March 22, 2018

AUDIT schedule:

• 1Q18 audits are complete and have been distributed to Managers for review. QI continues to collaborate with programs to ensure compliance. The audits are weighted and scored which evaluate DMAS, Licensure, Agency Workflow Compliance and Best Practice.

SAFETY schedule:

• Service Modification Merryfield on May 14^th and 15th – remove linoleum and replace with floating vinyl tile and remove current fiberglass shower stall and replace with custom fit Re-Bath easy clean ADA shower unit.

QI Projects:

• Committee continues to review/update the COOP plan, Emergency preparedness policy, and Risk Management policy to match regulations.
• Unapproved visits have significantly decreased.
• Credible Super User Committee – Credible plan and EMAR.
• Policy Committee continues to review/update agency policies.

IT Manager Report:

Adam Kenny provided the following report:

Duties performed or in progress since March 2018:

Help Desk:

• Total number of Credible Requests – 513
• Total number of IT Tickets – 922

EHR:

• Assisted with form changes in DD and MH
• Attended the 2018 Credible Partner Conference
• Created custom reports for Life Skills, Merryfield and Friendship
• Reviewed Nurse Assessment tool for Merryfield
• Tested Credible eMar 2.0
• Started configuration process for Credible Plan (new treatment plan module)

Hardware and Networking:

• Deployed Streamline NX Badge software to Life Skills
• Met with Highland Computers to discuss the implementation of fiber services
• Created tutorial for using shared calendars and room reservations in Outlook
• Completed site surveys and completed pre-installation requirements for Shentel Fiber
• Reviewed quotes for camera systems at Life Skills
• Resolved issues with Life Skills voicemail system

Other:

• Attended TDT Regulatory meeting
• Attended monthly DMC meeting.
• Attended quarterly Credible User Group meeting.
• Attended reimbursement meeting.
• Attended bi-weekly leadership meetings.
• Presented in New Hire Orientation.
• Submitted monthly CCS report.

Human Resources

Crystal Homer reported the following:

Loss Report:

• Worker’s Comp Claims –
• No new claims for new fiscal year at this time
• Premium increase of $6,873.00 for 2018/2019
• Auto Claims – $1,359.65 YTD
• Auto Physical Damage – Merryfield $576.75 and Skillbuilding: $37.09
• Auto Liability Claims – Clubhouse: $355.81 and $410.00 paid for damage to other vehicles.
• Auto Renewal premium will increase by $1,361.00 for 2018/2019.
• Property Claims – 0

Separation Reasons – new reports coming soon from Bamboo with this information

FY 17 Reasons for Separation – 49 Total

10 other employment

8 moved

3 school

11 personal reasons

4 more money

1 retired

5 terminated

4 medical reasons

3 abandoned job

Separations July-February 2018 – 21 Total

4 retirement (Prescott, Burns, Childs, Curry)

3 job abandonment

6 other employment

1 medical reasons

4 personal reasons

1 relocation

2 termination

Staff Development:

• The following shows compliance (YTD) for required mandatory training courses. This report is completed around the 15^th of each month.

Jan 2018 – 144 staff with 96% completing required courses

Feb 2018 – 147 staff with 95% completing required courses

Mar 2018 – 145 staff with 93% completing required courses

April 2018 – 146 staff with 94% completing required courses

Recruitment: Please visit our website to link to the new BambooHR careers site – Recruitment reports attached.

General Updates:

• We have been live with BambooHR since March 1^st, there are a few items to continue to work on but we were successful with integrating Bamboo and Trax in April. We are working toward refining our internal process to align with the electronic system.
• VACSB HR Subcommittee meet at Valley CSB and received information on Barrier Crimes, Worker’s Compensation and Legal hot topics. The committee met again at the VACSB conference and focused on recruiting/retention strategies.
• Attended the VASHRM conference in April.
• Open enrollment is happening now for our transition to July 1^st insurance plan year.
• Jacob, the HR Specialist, continues to participate in internship, graduate and general recruitment fairs.
• Annual report was completed and mailed. We hope to mail our education postcards in May.
• Will begin work on updates to HR policies and procedures.

Financial Reports

• Financial reports were submitted by Patty Flanagan.

EXECUTIVE DIRECTOR’S REPORT AND RECOMMENDATIONS

Ingrid Barber provided the following report:

Agency Issues:

1. Alleghany Highlands 2017 Annual Report will be distributed. This is the final copy. I am very pleased with the quality of the report.
2. Guinan Center/Mental Health Clinic Roofing update – All roof work has been completed.
3. Intermediate Care Facility (ICF) Cost Report is still in the audit phase with CLIFTON GUNDERSON, LLP. The cost reports are due not later than 150 days after the provider’s fiscal year end. Our cost report audit will be completed no later than June 15, 2018.
4. Fiscal 2018/2019 Budget Development/Local Funding – The FY 2018/2019 Budget is complete. Fiscal staff have met with various departments and obtained operational and staffing information to complete the budgetary process. Letters of Notification from the state are due May 12, 2018. Thanks to Patty Flanagan, Phoebe Hicks, and Crystal Homer for having this ready for the finance committee and board meeting.
5. All locality budgets have not yet been approved, however, both Jon Lanford of Alleghany County and Richard Douglas of Covington City have been in contact with me. Alleghany County plans to honor our written budget request, but it is with regret that Covington City will level fund our request. Jail services will continue to be funded at the same amount as last year. A public hearing on the Covington City budget will be held May 29, 2018 at 6:30 p.m.
6. The 2018-2019 Proposed Fee Schedule was included in your packet. At this time, we are not imposing any fee increases.
7. Year-end closure of all financials and fieldwork will be completed by Mary K. Earhart Certified Public Accountants on August 14 and 15, 2018. Division audit by Robinson, Farmer, & Cox Associates is scheduled for August 27 and 28, 2018.
8. Waiting List – Developmental Disabilities – Medicaid Waiver Waiting List- Priority 1: SIX, Priority 2: SIXTEEN, Priority 3: NINETEEN for a total of 41.  Please note that the waiver slot advisory committee just met on Tuesday, May 8, 2018, and three slots will be awarded so that will make Priority 1 with three and the total 38.
9. Patti Miere of the Virginia Department of Aging and Rehabilitative Services who is the agency coordinator for the Public Guardianship Programs has not been back in contact with me regarding our program set-up. She questioned if our guardianship program was really a stand-alone program after I called her regarding backup decision making and pay in the absence of our Amanda Webb. She recommended that we seek legal advice on our structure, and I told her that we were not going to pay for legal advice since our structure had been this way for years.

DBHDS Issues:

1. It is anticipated that the FY 2019-FY 2020 Community Services Performance Contract (“State Performance Contract”) will be released on May 14, 2018, and the signed contract will be due to the Virginia Department of Behavioral Health and Developmental Services (DBHDS) on June 29, 2018.
2. The Department of Behavioral Health and Developmental Services (DBHDS) has a new Commissioner. Gov. Ralph Northam appointed Dr. Hughes Melton, former chief deputy health commissioner, to lead the Virginia Department of Behavioral Health and Developmental Services.

Melton is a nationally recognized family practitioner and addiction expert from Southwest Virginia. He will replace Dr. Jack Barber, a psychiatrist and 30-year veteran who has served as acting behavioral health commissioner for three years.

I had the pleasure of being selected as one of six Executive Directors to meet with the new Commissioner at the Virginia Association of Community Services Board’s May Conference. He is planning to have a strategic plan for DBHDS in the next 90 days.

Community Issues:

1. Cathy Schiffer, Susan Chittum and I met with Superintendent Eugene Kotulka, Elizabeth Heath, and Erin Bartley on April 4, 2018 to discuss regulatory changes with the school based Therapeutic Day Treatment program.
2. On April 5, 2018, I went to WestRock to have a picture made for the newspaper and pick up a check in the amount of $3,500 for the security system grant for Life Skills.
3. I attended the Alleghany Highlands Chamber of Commerce Board Meeting on March 27, 2018, at Jackson River Technical Center. I attended the League of Older Americans Board of Director’s Annual Meeting on March 29, 2018 in Roanoke, Virginia at the Holiday Inn. I attended the Healthy Youth Coalition Meeting on April 19, 2018 at the local YMCA.

State/Regional Issues:

1. Our state hospital census is currently as of this date, 6 individuals – 4 at Western State and 2 at Catawba.
2. With the Virginia General Assembly locked in a budget stalemate over expanding Medicaid and a must meet funding deadline this summer looming, Governor Ralph Northam said he’s confident lawmakers will reach a deal and pledged a shutdown will not happen. Last month, the General Assembly opened a special reconvened session after lawmakers failed to carve out a budget deal during the regular session. The Senate Finance Committee announced it won’t meet again until May 14. Lawmakers must approve a state budget by July 1. The House of Delegates approved a state budget last week that expands Medicaid with a work-requirement provision.

OLD BUSINESS:

1. Alleghany Highlands Community Services Fiscal Year 2017 Annual Report – The annual report has been completed and it was included in your packet.
2. Mental Health Clinic Roof Update – The roof has been completed and no problems have been reported. There was an issue with a pipe leaking which was unrelated to the roof, but it has since been corrected.
3. ICF Update – There is no report available but it is anticipated that we will receive it by June 15, 2018.

NEW BUSINESS:

1. Approval of FY 2018/2019 Proposed Budget – Patty Flanagan distributed the proposed 2018/2019 agency budget, and Ingrid provided a synopsis of the changes. The agency budget is $7,816,595.00.

MOTION:  That the Board approve the FY 2018/2019 Proposed Budget:

MOTION:  Bill Gilliland

SECOND:   Teresa Johnson

VOTE:         Unanimous

2. Proposed 2018-2019 Fee Schedule- There were no changes to the fee schedule

MOTION:  That the Board approve the proposed 2018-2019 Fee Schedule:

MOTION:  Teresa Johnson

SECOND:   Connie Back

VOTE:        Unanimous

3. Update of Waiver List/State Hospital Census – The Waiver Slot Committee met this week. There are 38 individuals on wait list.
4. Department of Aging and Rehabilitation Services Issue (DARS) – Ingrid reported that Patti Mier of DARS has concerns about how our PGP program is set up and whether Amanda Webb technically works for AHCS or PGP. DARS wanted Ingrid to reach out to our attorney about setup but Ingrid declined. Ingrid requested a resolution in writing from DARS.
5. Updates and Approval of Proposed FY 2018-2020 Performance Contract – Because the budget hasn’t been approved yet, there is no performance contract. Ingrid will send it to to the board once she receives it.
6. VACSB Update – The new Commissioner is Dr. Hughes Melton. He is planning to visit all the CSB’s, and he will be sending out a Strategic Plan. Dr. Hughes is emailing weekly newsletters.
7. Next VACSB conference – The next conference is October 3-5,2018 at the Hotel Roanoke and Conference Center.

ADJOURNMENT

MOTION:  That the May 17, 2018 regular meeting of the Alleghany Highlands Community Services Board be adjourned:

MOTION:  Teresa Johnson

SECOND:   Robin Mieras

VOTE: Unanimous

TIME:     4:35 p.m.

NEXT MEETING:   The next scheduled meeting will be on Thursday, July 26, 2018 at 4:00 PM at the Administration Office located at 205 E. Hawthorne Street in Covington, Virginia.