REGULAR MEETING OF THE ALLEGHANY HIGHLANDS COMMUNITY SERVICES BOARD
Thursday, September 18, 2014

The Alleghany Highlands Community Services Board held its regular meeting on September 18, 2014 at 5:00 p.m. at the First Christian Church Family Life Center located at 231 E. Fudge Street in Covington, Virginia, following the Annual All Employee Meeting.

PRESENT: Robert H. Johnson, Jr., Robert McCallister, Teresa Johnson, Anne Dean, Connie Back, Carla Dobbs, Charli Laws, and Lisa Hicks.

ABSENT: Nolan Nicely, Jr.

Also present: Ingrid W. Barber, Executive Director; Angie Goodbar, Director of Intellectual Disabilities Services; Cara Major, HR Manager; QuoVadis Washington-Brown, Director of Outpatient and Support Services; Nancy Curry, QI Manager; and Adam Kenny, IT Manager.

Teresa Johnson, Chairwoman, called the meeting to order at 5:10 p.m.

APPROVAL OF MINUTES OF July 17, 2014 REGULAR MEETING
MOTION: That the Board approve the minutes of the July 17, 2014 regular meeting.
MOTION: Carla Dobbs
SECOND: Charli Laws
VOTE: Unanimous

Recognition of Retirement: Eva Edwards was recognized following her retirement with the agency on August 29, 2014 after 14 years of service at Merryfield Residence.

Communication: A Thank You card was received from Rosemary Simmons and was read to the Board.

Introduction of New CFO – Ann Bostic: The new CFO, Ann Bostic, was introduced to the Board and her work experience was reviewed.

PROGRAM REPORTS

Mental Health & Substance Abuse
QuoVadis Washington-Brown provided the following report:

• QuoVadis attended a HPR III Regional Meeting at Mount Rogers Community Services on August 8, 2014, regarding the Wounded Warrior Program.
• QuoVadis met with Pam Meador, Executive Director of the Council of Community Services’ Drop-In Center, on August 18, 2014. The Council of Community Services will begin providing HIV and STD testing for SA clients who were interested in participating. The Council of Community Services Drop-In Center will also assist AHCS in hosting a TB Screening and Testing Event in October for individuals in the community born between the years 1945-1965.
• On August 19, 2014, QuoVadis, Ingrid Barber, and AHCS Children Services Supervisor (Debbie Burns), met with the Director of Department of Social Services, Suzanne Adcock, and Alleghany County/Covington City Comprehensive Services Act Coordinator, Lisa Boggs, to discuss development of protocols for Mental Health Initiative Funding to be utilized for children that are non-mandated and may present for services with severe emotional disturbance and/or at risk of emotional disturbance. Children and families may seek services to include respite, crisis stabilization, inpatient, outpatient, skill building, and in-home services and receive payment for services via Mental Health Initiative Funding.
• QuoVadis reported that on August 25, 2014, Department of Behavioral Health and Developmental Services Forensic Services Office met with Region 7 Forensic Team members to include Blue Ridge Behavioral Healthcare staff and AHCS NGRI Coordinator, Sarah Deffinbaugh, AHCS Recovery Specialist and Hospital Discharge Planner, Ashley Smith, and QuoVadis. At this time, AHCS has one individual at Catawba Hospital in an NGRI status. AHCS has not had any request to date for Adult Outpatient Restoration Services. AHCS will be marketing this service to local judges, attorneys, and clerk of court. This service can assist an individual to learn how to become competent to stand trial. The inmate would work with a restoration counselor to learn the importance of his/her charge, understand the legal terminology, layout of the courtroom, the legal process to include plea agreement, etc. DBHDS will assist in payment for these services provided by the CSB.
• QuoVadis reported that on August 27, 2014, she met with Region 7 Recovery Oriented Systems of Care Team at Catawba Hospital. The team has decided to explore M.A.P. (My Action Plan) cards for clients in the Region that may want to have information regarding preferred psychiatric hospital, medications list, Wellness Recovery Action Plan on a laminated card that could be carried in their wallet. The card would assist law enforcement, emergency services clinicians, hospital personnel, or other stakeholders identify client wishes and needs during a time of crisis.
• QuoVadis reported on a new Peer Bridger position which could assist individuals in state and local hospitals to link with services post-hospitalization. The individual employed in this position would be an individual with lived mental health/substance abuse experience. Information regarding job descriptions, rate of pay, and the most ideal setting for a Peer Bridger to be utilized will be discussed at a subsequent meeting.
• QuoVadis reported that on September 3, 2014, she, Angie Goodbar and Ingrid Barber, met with representatives of Alleghany County Schools, Covington City Schools, Department of Social Services, and Comprehensive Services Act Coordinator to discuss services provided in Children services to include telepsychiatric services provided by UVA Psychiatry via a grant fiscally and operationally managed by Mount Rogers CSB. Additional meetings will be held with Jan Hobbs of Alleghany County Schools and Melinda Snead-Johnson of Covington City Schools to discuss how this program may be implemented within the school systems in the fall of 2014.
• QuoVadis reported that Emergency Services staff have continued to monitor changes in ES performance standards to include updates to the TDO Exception report. The TDO Exception report now includes information for the Executive Director to report to the Department of Behavioral Health and Developmental Services. The report includes any unexecuted Emergency Custody Orders, Temporary Detention Orders, and any orders that cannot be executed due to medical complications.
• QuoVadis reported that AHCS Emergency Services has also begun the process of looking at how to provide a crisis hotline for immediate access to a qualified emergency services clinician. Additional details regarding this will be provided next month.
• QuoVadis attended the following meetings: Catawba Regional Partnership (September 8, 2014); Local Interagency Council (Early Intervention) (September 10, 2014); Recovery Oriented System of Care (August 27, 2014 and September 17, 2014); Reimbursement Meetings; All Supervisors Meeting (September 9, 2014); Meaningful Use Meetings with IT Manager, QI Manager, and Psychiatric Nurse Manager.
• QuoVadis is scheduled to present information to DBHDS and Crisis Stabilization Unit Managers regarding Collaborative Documentation on September 23, 2014.

Intellectual Disabilities
Angie Goodbar provided the following report:
• Angie reported on the new waiver amendments that went into effect on July 1st for Virginia to come into compliance with the 2011 CMS regulations. The state of Virginia will have five years to come into compliance with the CMS Finale Rule that was introduced in March 2014. The state was awarded 25 waiver slots for 2015 but CMS is not willing to fund their portion of the slots until additional amendments are made to the waiver regulations. These amendments go into effect January 1, 2015 and will address integration activities at day support programs and changes to supported employment regulations. Day Support services will provide more skill-building activities. The staff to individual ratio will be 1:3 with a preference of 1:1. Services will need to be more community based involving individuals in activities with non-disabled individuals. The focus will be to offer services in the most integrated settings in order to build natural supports with unpaid individuals.
• Angie reported that AHCS and other CSB’s throughout the state will be working on a plan to come into compliance with the CMS Finale Rule which dictates a need for the state to provide conflict-free case management. Virginia will need to come up with a plan to mitigate conflict of interests in the provision of community long-term services and supports. The CSB’s in Virginia will be developing a conflict-free management system based upon the Balancing Incentives Program Design Elements.
• Angie reported that AHCS received notification in July that grant funding from the Department of Rail and Public Transportation was awarded to fund 80% of the cost of a 14 passenger van. A grant application was submitted to KOVAR in September in hopes of receiving the remaining 20% cost of the vehicle. This van will be utilized by Life Skills Day Support Program and for Medical Logisticare Transportation.
• Angie reported that a grant application was submitted to the Alleghany Foundation on September 1, 2014 requesting funding for restoration of the Moody Building in Clifton Forge. The building houses the AHCS Day Support Program, Adult Day Care Center of the Highlands and the Shenandoah Autism Center. If funding is provided, the restoration will include repairing the front columns, reworking the doors to the entrances and installing new flooring in the stairway landings on the second and third floors.
• Angie and Amanda Webb, Public Guardianship Director, attended the 2014 Virginia Guardianship Association/Virginia Elder Rights Conference from July 23-25 in Richmond. AHCS Public Guardianship Program will be presenting at the 2015 Conference and planning sessions are already in progress. Amanda Webb presented an Advance Directive Training at the Senior Center in Bath County in August. The Public Guardianship Partnership Board and Multidisciplinary Team continue to meet on a regular basis.
• Angie reported that on July 18th, Cindy Gwinn, Autism Specialist with DBHDS, provided a training at DSLCC titled “Strategies for Supporting Adolescents and Adults with Autism Spectrum Disorder”. On August 19th, REACH (Regional Education Assessment Crisis Services Habilitation) visited with AHCS and conducted an in-service on the availability of children’s crisis services. Wall Residences is a new private provider in the area that visited with the ID Support Coordinators to share information about a sponsored home in the area. The Support Coordinators will add this private provider to the information shared with families so individuals and families can make informed choices about their service delivery. Sue Childs, Support Coordination Supervisor, and Linda Mack, Day Support Supervisor, attended the 2014 ARC State Convention “Together We Achieve” in Richmond, VA.
• Angie reported that AHCS continues to provide transition planning for five individuals at Central Virginia Training Center. The training center is projected to close by 2020. No transition dates have been established for these individuals due to their major medical issues that cause barriers to community discharge. AHCS currently holds nine individuals on the non-urgent wait list and four individuals on the urgent wait list, all of which anticipate a waiver slot in order to receive appropriate services.
• Angie thanked all board members who attended the ID picnic.

Quality Improvement
Nancy Curry provided the following report:

UR, Compliance and EHR:
Credentialing:
• Nancy reported that Pam DuBose, Licensure Specialist, is in the process of reviewing all of our programs. The licenses for all programs are up for renewal. She has visited Merryfield, Life Skills, Friendship Residence, and New Beginnings. She will be back to visit Guinan Center. We have not received her report yet but she had positive feedback on these programs. Items she identified for possible corrective action were minor fixes.
• Nancy reported that she is working with Adam and Quovadis on meaningful use.
• Nancy reported that QI began conducting regularly scheduled safety inspections at all facilities. All residential facilities will be inspected once each quarter and all other facilities once each year. To date four inspections have been completed.
• Nancy reported that she worked with Adam on the Telepsych Survey and Security Risk Audit and that they submitted the VACSB Conflict Free Case Management Survey.
• Nancy attended the Quarterly LHRC meeting and facilitated the Annual Affiliates meeting prior to the LHRC meeting. Jock Wedlowe is the staff member providing administrative support.
• Nancy reported only one staff in the credentialing process and is waiting on word from two panels.

Staff Development:
• Nancy reported that AHCS finished FY14 with an average of 88% compliance on Annual training. As of 9/11/14 there were 151 staff enrolled in Relias. This month there is a significant drop. Several classes were added to the required training during the past month which was a result of the DBHDS audit and other regulatory requirements. Most were due 8/31/14.
• Nancy participated in one New Hire Orientation training.
• Nancy reported that Jill Upchurch taught the Heimlich Maneuver Review to the staff of Merryfield, Life Skills, and InHome. This was also discussed at the All Supervisors meeting and each supervisor was asked to go over this in their next staff meeting.
• Nancy reported that Jill Upchurch taught a Diabetes and Insulin training for staff of Merryfield and Inhome.

Other:
• Nancy reported that Region Ten requested assistance with developing their Medication Administration. We shared our policies and processes with them. Jill has been assisting their new training supervisor in understanding requirements, etc.
• Nancy was a member of the Human Resources P&P Workgroup.
• Nancy attended the Ruby Payne presentation.
• Nancy attended the VACSB QM Meeting in Richmond as well as VACSB DMC meetings.

IT Manager Report:
Adam Kenny provided the following report:

Help Desk:
• Adam completed 41 help desk requests.
• Adam completed 101 Credible change requests.

EHR:
• Helped complete End of Year CCS reporting and cleanup.
• Set up prescription eligibility in Credible.
• Configured new payers in billing.
• Signed up for Availity.
• Configured new CCC payers and test billing.
• Completed forms for syndromic surveillance data and immunization registries.
• Configured new approval role structures.

Hardware and Networking:
• Adam converted ID office fax to Lumos.
• Adam repaired three laptops with failed hard drives.
• Adam met with Ricoh to discuss future projects and hardware needs.
• Adam visited ARH with Andrea Dilley to check on wireless and printer issues.

Other:
• Attended monthly DMC meetings in Richmond.
• Attended all supervisors meeting.
• Participated in Recovery Run meetings.
• Attended billing meetings.
• Completed VACSB telepsych survey.
• Completed Recovery Run which raised over $3,000.
• Participated in Timetrak trainings/meeting.
• Attended Credible online billing meetings.

Human Resources
Cara Major reported the following:

Turnover:
• For FY14 there were 62 new hires and 57 separations with a turnover rate of 38%.
• For FY15, thus far, there have been 6 new hires and 9 separations with a turnover rate of 6%.
• For the F15 Separations, 4 accepted other employment, one moved, one went to school, two retired and one was terminated.

Loss Report:
• Cara reported that there was one Worker’s Comp Claim which was a back strain and no medical attention needed.
• There were three auto claims. One was a fender bender with no damage to AHCS property and not the fault of AHCS driver. The second was an unknown driver scraped an AHCS car in an AHCS parking lot and was not reported to insurance. It cost $60 to buff out. The third claim was an AHCS van was hit by a flying object from a vehicle on the interstate, resulting in a dent on the hood. It is currently being repaired.
• There were no property claims.

Advertising/Recruitment:
• Advertising was done through the VEC, Indeed, Virginian Review, The Recorder, Shentel website, Chamber of Commerce, and Big Country 103.5.
• A job fair was held at the Administration Office on September 4, 2014.

Filled Positions:
• Intellectual Disabilities – DSP (Friendship 1, Merryfield 1, Residential 1); Registered Nurse (Part-time)
• Mental Health – Support Service Provider (QMHP-E)
• Administration – Janitor; CFO

Open Positions:
• Intellectual Disabilities – Direct Support Professional (InHome, Merryfield)
• Mental Health – Clubhouse Psychosocial Technician (Full-Time)
-New Beginnings Support Provider (Full-Time)
– New Beginnings Technician (Part-Time)
-Community Supports Supervisor (Full-Time)
-Emergency Services Clinician (Part-Time)
-Intake/Emergency Services Clinician (Full-Time)

General Updates:
• Cara discussed preparations for the DBHDS audit.
• Cara reported that the Merryfield Agency contracts are still being worked on.
• Cara discussed the HR Policy and Procedures Employee handbook which is still being reviewed.
• Cara reported that the Open Enrollment was completed and that it went very smoothly.
• Cara reported that Driving Training was conducted on July 22 and the next one is scheduled for November 4th. John Bolling sees this as beneficial and it is decreasing our claims.
• Cara reported that she and Michael Garcia are reviewing vehicle maintenance expenses and are in the process of comparing costs at JRTC and different garages. Michael and Cara are working to reduce the vehicle maintenance costs.
• Cara updated all the Mental Health position descriptions and the ID position descriptions are in progress.
• Cara will be attending an HR Committee meeting at the VACSB Conference in Roanoke on October 2nd. One of the topics being discussed is the S.A.M. Database (System for Award Management) which is required by Magellan.

Participation:
• Cara attended the Virginia Wounded Warriors meeting at Mt. Rogers CSB on August 4th.
• Cara attended the Virginia Employment Commission Conference on August 6th.
• Cara attended the Ruby Payne presentation on poverty at DSLCC on August 13th.
• Cara participated in New Hire Orientations.
Upcoming:
• Cara will be participating in the VACSB Innovation and Best Practices Workgroup on September 29th.
• Cara will be attending the HR Committee meeting at the VACSB in Roanoke on October 2nd.

Financial Reports
There was no End of Year Financial Report due to transitioning of fiscal staff. Robinson, Farmer & Cox had not completed the division audit and haven’t closed the year yet. The year will close with a deficit due to decreased Mental Health Support Services and Merryfield overpayments, two Mental Health floods, and repairs made to the Alleghany Group Home basement. Most likely 50% of the boards will end in the red. We will be reviewing programs to see what programs we can support and will be doing a modification of the budget going forward. On October 6th, Dickson and Hughes is coming out to meet about ICF and to review the cost report to ensure that nothing was missed.
EXECUTIVE DIRECTOR’S REPORT AND RECOMMENDATIONS
Ingrid Barber provided the following report:
Old Business:
• Ingrid presented a flooring estimate from Carpetland for Life Skills.
• Ingrid discussed the KOVAR grant-percentage match for the Restoration of the Moody Building. A grant was submitted for 20% of a vehicle and another grant was submitted for the remaining 80%. On September 23rd Mr. Fike is coming to review the 80% grant. This is for a bus at Life Skills, however, the lift is an issue.
• Ingrid discussed the DBHDS Audit follow-up for October 7-10. The HR Audit will be the first audit.

New Business:
• Dates were set for the Jingle Mingle for December 16th at the Administration Office and December 17th at Life Skills.
• A Leadership Staff Retreat will be held October 27th at Douthat with Mary Ann Bergeron as the facilitator.
• Ingrid discussed the Grant Submission to the Alleghany Foundation – Life Skills building. We requested $140,107.21 and should know by December by if it is approved. Anne questioned whether the building was in a historic district.
• Ingrid reviewed the Data Dash Board information provided by DBHDS.
• Ingrid reported that the Performance Contract by the Alleghany County Board of Supervisors and Covington City Council had been approved. Covington gave $5,000 additional funding for their annual local contribution.
• Ingrid discussed establishing a Nominating Committee for Officers and Personnel Committee. A report is to be given at the November meeting
• A Legislative Forum Breakfast is scheduled for October 6th at 8:00 a.m. at Life Skills. Sen. Creigh Deeds and Delegate Terry Austin are both scheduled to attend. The Planning and Advisory Committee (Charli, Ann and Robert) will meet on September 30th to work on questions for the Legislative Breakfast.
• Ingrid advised the Board of a visit with the new DBHDS Commissioner, Deborah Ferguson, on October 29th from 10:30 a.m. – 3:00 p.m.
• Ingrid discussed information regarding the VACSB Conference which is scheduled for October 1-3 at Hotel Roanoke.
• Ingrid provided a VACSB/Budget update which includes a $2.4 billion shortfall for the State of Virginia.
• Ingrid discussed revisions to the performance contract, including attending 10 board meetings per year, trainings which may be on Relias, conflict of interest, FOIA, Human Rights, and regulatory training. She discussed performance measure standards going into effect next year; position descriptions for board members which would be put into effect January 2015, the adoption of HR policies and procedures, and the fact that reports may go out one week prior to the meetings.
• Ingrid discussed the TDO exception process and her role.
• In December, the Task Force will do a report to the General Assembly. We anticipate another revision.

CLOSED SESSION
CODE OF VIRGINIA: PERSONNEL 2.2-3711.A.1
MOTION: That the Board enter closed session to discuss Personnel Matters, as authorized by the Code of Virginia Sections 2.2-3711A.1.
MOTION: Anne Dean
SECOND: Lisa Hicks
VOTE: Unanimous
TIME: 6:55 p.m.

CERTIFICATION OF EXECUTIVE SESSION
A signed roll call was taken for each member present who certified that to the best of the member’s knowledge that:
-Only public business matters lawfully exempted from opening meeting requirements by Virginia law were discussed in the closed meeting to which this certification applies; and only such public business matters as were identified in the motion convening the closed meeting were heard, discussed or considered by the Alleghany Highlands Community Services Board.

ADJOURNMENT
MOTION: That the September 18, 2014 regular meeting of the Alleghany Highlands Community Services Board be adjourned.
MOTION:
SECOND:
VOTE: UNANIMOUS
TIME: 9:05 p.m.

NEXT MEETING
The next scheduled Board Meeting will be on Thursday, November 20, 2014 at 5:30 p.m. at the Administration Office located at 205 E. Hawthorne Street, Covington, VA.