Georgia home care survey: the provisional license, initial survey and re-licensure inspections

Chapter 111-8-65 says "Providers shall be inspected by the department periodically", and DCH’s checklist puts a number on it: re-licensure surveys come roughly every 18 to 24 months. DCH checklist, pp. 2-3 DCH can also inspect at other times: "Nothing contained herein shall be construed to prohibit the department from conducting inspections of any provider as the department determines necessary." 111-8-65-.08(1)(b)

If you have had no clients for a while

A survey needs an agency in operation. DCH says: "If you have not had a client within three (3) months of the date of the scheduled survey, you will have 30 days from the date of notification of the scheduled survey to admit a client for services, so the survey can be conducted." If no client is admitted, DCH says "your permit will be considered void due to not providing services for greater than a 3-month period." DCH checklist, p. 3

Accredited agencies

DCH "may exempt a provider from such periodic inspections if it is certified or accredited by a certification or accreditation entity recognized and approved by the department". To ask for the exemption, you send DCH the certification or accreditation documents, including your most recent report. The exemption covers periodic inspections; DCH can still inspect whenever it decides it is necessary. 111-8-65-.08(1)

Follow-up visits

DCH’s fee schedule lists a $250 fee for a follow-up visit to a periodic inspection. This is a DCH fee, not a CareRulebook price. DCH Schedule of Licensure Activity Fees

A complaint investigation is an inspection too (111-8-65-.03(k)), so the same access and cooperation rules apply. Complaints reach DCH in two ways. Its Complaint Intake Unit takes calls on 1-800-878-6442 (DCH), and "You have the option of filing a complaint online against a facility or program licensed through the Division of Healthcare Facility Regulation if you believe you received poor quality care from the licensed facility or program." DCH, GaMap2Care

Your clients will know how to reach DCH, because your notice of rights must tell them: it gives DCH’s address and telephone number and explains that DCH licenses your agency and investigates client complaints that appear to break licensing rules. 111-8-65-.12(2)(i)

After a complaint investigation, DCH gives the outcome to the person who complained and to your agency on request, and keeps the complainant’s name confidential. 111-8-25-.06(5)

The best protection is your own complaint procedure. The rules require one that lets clients and others complain orally or in writing and have complaints "addressed and resolved as appropriate by the provider in a timely manner", with a file kept of each. 111-8-65-.12(3), .09(4)(d)

If an inspection finds violations, "the provider will be given a written report of the inspection which identifies the licensure regulations violated." You then send a written plan of correction "which states what the provider will do when to correct each of the violations identified." 111-8-65-.08(4)

A good plan names each rule cited, the fix, who is doing it and the date it will be done, and the record that will show it (for example, a training log or an updated personnel file). That last part is our suggestion rather than rule text, but it makes the plan easy for DCH to accept and easy for you to follow.

Clients can ask for your latest report. Item (j) of your notice of rights reads: "Right to obtain a copy of the provider's most recent completed report of licensure inspection from the provider upon written request." You do not have to release it until you have had the chance to file your plan of correction. 111-8-65-.12(2)(j) DCH’s GaMap2Care tool also gives access to inspection reports. DCH, GaMap2Care

Enforcement is set out in Chapter 111-8-25, DCH’s general licensing and enforcement rules, and your affidavit refers to it: "Deficient policies and procedures may subject the facility to sanctions pursuant to Ga. Comp. R. & Regs. 111-8-25." DCH Affidavit of Compliance

Sanctions can follow if a licensee knowingly makes a false statement of material fact to DCH, refuses access or information without legal cause, or does not comply with the licensing rules. 111-8-25-.04 DCH imposes them "subject to notice and opportunity for a hearing". 111-8-25-.05(1)

How fines are set

Fines are capped at $2,000 a day per violation, and at $40,000 for violations found in the same inspection. 111-8-25-.05(1)(e) They are graded by effect on clients. Administrative, reporting and notice violations sit in the lowest category, Category III, at $100 to $600 a day, and a first-time violation is fined at the bottom of its category. 111-8-25-.05(1)(e)1.-2.

Your plan of correction matters here. A violation can only be treated as a subsequent or repeat violation "unless the time frame identified in the acceptable plan of correction has passed and the facility nonetheless has failed to attain or maintain correction", and correcting a cited violation stops a daily fine from running once DCH confirms it. 111-8-25-.05(1)(e)2.-3.

Asking for a hearing

If DCH sends a notice of intent to impose a sanction, a request for a hearing must be in writing and reach DCH no later than 10 calendar days from receiving the notice. 111-8-25-.09 For anything about surveys, plans of correction or permits, DCH’s checklist points private home care providers to the Private Home Care Team at hfrd.phcp@dch.ga.gov. DCH checklist, p. 1