LUFKIN, TX (KTRE) - According to a recent report by independent monitors about the Lufkin State Supported Living Center's efforts toward compliance with a 2009 settlement agreement between the state of Texas and the Department of Justice, the facility has made strides toward that goal.
"The Lufkin State Supported Living Center is now in compliance with 46 requirements of the settlement agreement," said Melissa Gale, a public information officer with the Texas Department of Disability and Aging. "During the most recent compliance review, the center was noted to be in compliance with 16 additional requirements and maintained compliance with 30."
In 2009, the State of Texas entered into a settlement agreement with the DOJ and agreed to "broad system-wide improvements." At that time, both parties "fully expected and acknowledged" the process would take a number of years, Gale said.
The settlement agreement did not set specific deadlines for achieving compliance. Gale said the first report by the independent monitors was due on the four-year anniversary of the settlement agreement, which would have been in June. However, both parties agreed to extend the deadline to June 2014.
Gale pointed out that is important for people to remember that settlement agreement requires that the monitors rate each of the 20 provision items as either being in "substantial compliance" or "non-compliance."
"It does not allow for intermediate ratings, such as partial compliance, progressing, or improving," Gale said. So a facility will receive a rating of noncompliance even when improvements have occurred."
The DAD public information officer explained that just counting the number of substantial compliance ratings doesn't tell the whole story; and "it does not provide an accurate measure of progress."
"Not all requirements are equal in weight or complexity," Gale said. "Some require significant systemic change to a number of processes, whereas others require only the facility to implement a single action."
Gale said although the Lufkin State Supported Living Center still has a long way to go to achieve full compliance, there are a number of areas where the monitors saw progress.
- More individuals are receiving preventive medical services and cancer screenings thanks to the addition of a new position – that of a clinical services director, who supervises physicians, pharmacy, psychiatry, lab, X-ray and dental.
- Progress was made in reducing the number of missed dental appointments. Several residents were even seen in their homes as part of the dental outreach program.
- Nursing made good progress in completing necessary training of staff and has an a very effective tracking system for training.
- The positioning and alignment of residents at mealtimes were greatly improved, which is important to prevent choking and ensure their health and safety.
- Since the last onsite review, 16 residents had chosen to move out of the center and into community-based settings. Record-keeping on those individuals had improved dramatically and teams were active in planning and placing residents in settings where their needs would be met.
The Lufkin facility still needs to improve in the follow areas, Gale said.
- There was an increase in the number of incidents of restraint, which the center attributes to challenging new admissions. The monitors want teams engaged in more discussion about the least restrictive response for handling residents' behavioral challenges. The center is making significant improvements in this area. Teams are trying to give residents more options when issues arise to try to keep them from escalating.
- Mortality reviews were completed, but corrective measures focused mostly on nursing issues. The center attributes this to a very involved nursing staff that has a strong desire to improve services, but the facility is working to broaden this effort beyond nursing.
- Monitors suggested that teams should focus on action plans that allow more opportunity for residents to learn new skills and explore new activities in community settings, such as shopping at the grocery store or working in the community. Many of the individuals at the center are involved in a community activity up to 20 times per month, but the center would like to concentrate on documenting the skills that are being learned or reinforced by these community activities.
- There is a need for continued progress on nursing assessments and developing comprehensive health care plans for individuals. The monitors noted improvements found across many areas, but the center will follow recommendations that nurses continue their training of staff so that changes in residents' health status are better understood.
- The center needs to further develop systems that ensure continued reduction in the number of medication administration errors and that adverse drug reactions are noted in formal reports. The center has a very low rate of medication errors, but it does need to improve the process so issues can be reviewed and addressed
To read the full report, visit this link.