The Department of Developmental Services (DDS) informed the Centers for Medicaid and Medicare (CMS) Friday that due to ongoing deficiencies at Sonoma Developmental Center (SDC) Intermediate Care Facility (ICF), the department is voluntarily withdrawing four living units from federal certification effective immediately.
The withdrawal will allow SDC to maintain certification and receive federal funding for the remaining residences, according to a news release. The action is in response to a federal notice in December from CMS that initiated a decertification action for this program at Sonoma.
SDC has two current government actions under way: the federal certification issue and the state licensing action.
"Today, DDS withdrew its appeal of the federal certification of the ICF-DD while we work on the issues at SDC," Nancy Lungren, assistant director for communications, told Patch by email.
"Our appeal with the state Department of Public Health is still in place regarding the state licensing action," she said.
In December, Department of Health threatened to revoke the primary license of the facility, after allegations of abuse of 12 patients there in 2011. Reports included rape that allegedly led to a pregnancy, reported use of a taser gun on residents and inadequate or non-existent investigation of abuse cases by the on-site police agency at the facility.
“The well-being of our residents at Sonoma Developmental Center (SDC) is a top priority and the department has made critical improvements in the ICF, but significant work still needs to be done,” DDS Director Terri Delgadillo stated in the news release. “The department is committed to correcting the problems on all ICF living units and will expeditiously pursue recertification of the four residences as the reforms are implemented.”
DDS has already made numerous changes in the leadership and culture at SDC, she said. Both the Executive Director and the Clinical Director at SDC have been removed.
DDS has launched a nationwide search for a new Executive Director. Several other employees have been terminated or disciplined and investigations continue which could result in additional actions, the news release states.
In addition to these steps, DDS has hired additional direct care staff and has established a Corrective Action and Quality Assurance Team, consisting of state and national experts, who have been reviewing the entire SDC system to implement immediate and ongoing improvements.
The Office of Protective Services continues to undergo substantial changes, including the appointment of an interim commander on loan from the California Highway Patrol to help foster the necessary staff and skills for an effective law enforcement department, according to the news release.
Patch asked why the interim commander is one with Highway Patrol background rather than experience investigating sexual crimes.
"The Acting OPS Commander, Assistant Chief Frank Parrish, has many years of experience in law enforcement investigations," Lungren responded.
DDS has engaged an external consultant who is a nationally-recognized expert and trainer in regulatory compliance for Intermediate Care Facility/ Developmental Disability programs to conduct onsite monitoring of the changes at the facility and provide immediate feedback to DDS management, facility management and staff regarding areas of concern, the news release stated.
Frequent unannounced onsite reviews, focused mock surveys, additional reporting requirements, and the provision of technical assistance and training are also key components of the plan of correction.
Delgadillo said DDS will continue to work with state and federal partners on long-term solutions to regain certification.
“We will continue to work with families, the Legislature, staff and their union representatives on further actions that will be taken to ensure that residents are receiving the care they deserve.”
The DDS letter to the Centers for Medicaid and Medicare Services appears below.
January 17, 2013
James R. Farris, M.D.
Centers for Medicare and Medicaid Services
Dallas Regional Office
1301 Young Street, Room 714
Dallas, TX 75202
Dear Dr. Farris:
The Sonoma Developmental Center Intermediate Care Facility-Developmental Disabilities (ICF-DD) consists of ten currently occupied residential units. They are known as: Malone, Cohen, Poppe, Stoneman, Roadruck, Bently, Corcoran, Lathrop, Bemis, and Smith. There are also four other residential units at the facility that are currently unoccupied. They are: Brent, Lux, Judah and Osbourne.
While there are deficiencies in the management, training, and staffing in the Sonoma ICF–DD units generally, the problems are more significant in Corcoran, Lathrop, Bemis and Smith. The Department of Developmental Services (DDS) is committed to fixing the problems in all of the units, but addressing the problems in these four units will take additional time. Therefore, DDS is amending the Medicaid Provider Agreement to discontinue Medicaid certification for these four units at the Sonoma Developmental Center. These units currently serve 112 of the 290 residents at Sonoma.
Enclosed is an amendment to the California Medicaid Provider Agreement confirming the deletion of the four units from certification. A detailed Performance Improvement Plan (PIP) will be implemented that will apply to the residential units at the ICF-DD remaining under Medicaid certification. The four non-certified units will be required to meet all the same requirements as those covered by the PIP in order to put them in a position to regain certification at a later date. The PIP will be developed in consultation with, and subject to approval and monitoring by, the Centers for Medicare and Medicaid Services (CMS) and the California Department of Public Health (CDPH).
The amendment to the state provider agreement and the planned correction of deficiencies is intended to promote the best interests of the residents by bringing the entire Sonoma ICF-DD into compliance with Medicaid and State requirements. As a consequence of the removal of the four residential units from the provider agreement, 178 beds within the remaining residential units will continue to be certified for federal financial participation in the operation of the ICF-DD. DDS will not seek to increase the 178 certified bed level, unless either: (a) CMS and the State Survey Agency (CDPH) approve such changes to the Medicaid provider agreement in advance; or (b) on the basis of the findings from a full revisit survey, CDPH certifies and CMS determines that the facility is in substantial compliance with applicable Medicaid certification requirements.
The decision to proceed with a Performance Improvement Plan covering the certified residential units and voluntarily removing from certification the other four units eliminates the need to proceed with the formal appeal of the December 12, 2012, notice of intent to decertify the entire Sonoma ICF-DD facility. Accordingly, enclosed is a withdrawal of the DDS’ December 2012 appeal. It is further understood that should satisfactory progress not be made under the PIP and certification of any or all of the certified residential units were to be terminated, DDS would have the right to a new appeal.
We recognize and accept that the recertification of the four non-certified units may take longer than the completion of the Performance Improvement Plan for the six certified units. As to the four non-certified units, recertification will not start until CDPH and CMS are in agreement that the systemic deficiencies appear to have been corrected. A recertification request will then be processed as an application to amend the existing provider agreement to increase the number of certified beds under the provider agreement and thereby restore Medicaid coverage for the specified unit(s) provided that during the period when the subject unit(s) were not Medicaid certified, such unit(s) were not converted to an alternative use that did not include services to individuals with developmental disabilities. DDS further recognizes and accepts as a condition to restoration to the existing Medicaid provider agreement that each and every such unit will be subject to reasonable assurance requirements, including, but not limited to, demonstrating the ability to maintain compliance, as verified through onsite surveys at the beginning of 90 consecutive days.
The Department of Developmental Services is committed to bringing the Sonoma Developmental Center ICF into full compliance with both state licensing and Medicaid Certification requirements as soon as possible.
Terri Delgadillo, Director