RCFE Residential Care Facilities for the Elderly Expert Witness

Provides Opinion & Testimony In:

Licensed Nursing Home Administrator, Community Care, Medical Care, Elder Abuse, Elder Neglect, Adult Abuse, Adult Neglect, Elder Fall Precautions, Adult Fall Precautions, Dementia Care, Elderly Residential Care Facility, Adult Residential Care Facility, Disabled Adult Residential Care Facility, Licensed Nursing Home Administrator, Community Care Facility, Convalescent Nursing Facility, Residential Care Facilities Elderly, Adult Residential Facilities Developmentally Disabled, Adult Residential Facilities Mentally Ill, Regulatory Compliance, RCFE, CCF, ARF, Adult Day Care

Expert Witness No. 3117

California

Areas of Expertise — Standards of Care – Facility Types

Types of Facilities/Homes: Case experience in corporate chains, multi-level care facilities, stand-alone communities and all types of small care homes. My specialty is adult and elderly care in Home and Community Based Services (HCBS) which are based on federal standards.

I review cases that I choose for both Plaintiffs and the Defendants. My experience in reviewing cases covers Corporate Chains; Government Agencies; and Large, Medium and Small Facilities/Homes. I have over 40+ years in the long-term care field specializing in Community Care Home Based Services (HCBS) which includes Assisted Living Facilities (ALFs) also called Residential Care Facilities and programs for the Elderly (RCFE); Residential Care Facilities (RCF); Adult Residential Care Facilities (ARF); Group Homes (GH); Case Management Agencies; and Adult Day Care (ADC), Adult Day Health Care (ADHC) and Day Treatment Programs (DTP) for the Elderly, Developmentally Disabled and Mentally Ill adults.

If I accept a case, I based my expert opinion on my standard of care experience as a:

  • Patient
  • Patient and Care Provider Advocate
  • Licensed Care Home Provider & Vendor
  • Care Services Teacher, Vendor, and Teacher’s
  • Provider & Family Care Consultant
  • Teacher
  • Family / Responsible Party
  • Public Policy Advocate
  • Family Home Provider
  • Writer, Law and Government Policy Publisher, and Standard of Care Publisher

Licenses and Certificates

  • 1981 – 2019 Licensed Nursing Home Administrator (LNHA)
  • 1978 Certified Activity Director
  • 1988 Certified Medical Assistant
  • 1989-1990 Certified Red Cross First Aid Instructor
  • 1992-1994 Registered Lobbyist for the Community Care Industry
  • 1990-2013 State approved Community Care Teacher for all types of Community Care Homes and Home and Community Based Service (HCBS) programs for the elderly, developmentally disabled, and mentally ill adults.

See classes and vendor approvals below. I still teach through writing policies, procedures, articles, and training programs which are published on online. I am currently working on a new book on abuse in community care facilities.

Experience

I. Chief Executive Officer, ProvidersWeb, Inc
2000 – Present: ProvidersWeb.com Inc. Angels Camp, CA – (central California area)
ProvidersWeb is an international assisted-living residential care organization which has over 30,000 members through its website.From 2003 to 2007 ProvidersWeb published most all 50 State laws and regulations for Community Care on the ProvidersWeb website. Back then many of the states did not have the laws and regulations online. It was very expensive to keep updated. Eventually, most states started publishing online, and so we quit providing this service in 2007. In May of 2019 we added GOV Pages and are now linking to the various government websites.

On average have around 5500 free and paid members using our website every month. We have around 7300 subscribers to our newsletter. ProvidersWeb publishes over 4000 documents, and I probably authored 3000+ of those documents. I spend ample time every month developing, researching and updating the care and service standard of care documents. I usually tackle some of the most important and latest issues in the community care industry. Recent articles include video surveillance (affects every type of care business), sex and dementia, disasters, generators, emergencies preparedness and marijuana use by residents and staff, etc.

I wrote many of the ProvidersWeb’s documents before ProvidersWeb. Many documents stem from my first published book in 1990 and many other books. I have been updating some documents since the 1980s. Due to laws and standards changing I have updated some documents as many as seven times since they were first published in 2004 on ProvidersWeb.

Below are example documents on behaviors and eloping that I wrote or published:

BEHAVIOR TEACHING MATERIALS AND DOCUMENTS

  • Do’s and Don’ts for a Resident with Aggressive Behavior
  • Effects of Behavioral Medications
  • Eviction, Disruptive and Violent Behavior
  • Facility – Physician Plan for Behavior Medication Use
  • How to Handle Wandering, Eloping, and Exit Seeking Behaviors
  • Mood and Behavior Log
  • Protective Supervision Log – for documenting possible harmful actions and behaviors
  • Behavior Observation
  • Behavior Problems
  • Behavior Provision Sample House Policy
  • Behavior Report Form
  • Behavioral Assessment
  • Dealing with Behavior Problems

WRITTEN BY EXPERT ON ELOPEMENTS:

  • Wanderer Risk Assessment Form
  • Wandering, Elopement or Missing Resident Procedures
  • Agitation and Elopement Preventative Measures for Care Givers & Care Facilities
  • Monthly/Quarterly Elopement Drill – Missing Resident Drill Sample
  • Wandering, Elopement or Missing Resident Procedures
  • How to Handle Wandering, Eloping, and Exit Seeking Behaviors
  • Past Teaching Approvals: (note: I let these teaching approvals go because I thought I was going to be retiring. I have decided to work for 5 more years in the care service field.

Board of Medical Examiners — Nursing Home Administrator Program

Board of Registered Nursing

Community Care Licensing

Course Approvals:

  • A Higher Calling – Caring About Care,
  • Quality Assurance and Risk Management

II. Chief Executive Officer, Owner/Operator Experience RCFE with Elderly, DD, and MI
October 1986 – Present – Grace Estates Retirement Centers, Inc. Angels Camp, CA
As Administrator and CEO, I designed and built a 30-bed residential care facility for the elderly and expanded to a 49-bed facility within a year. Gracewood Manor CCL was a Residential Care Facility for the Elderly (RCFE) with an approved Dementia Waiver and secured perimeter. Due to having so many programs my duties included a lot of case management and supervision of case management to meet the various levels of need. Gracewood was also vendorized by Valley Mountain Regional Center to care for 4 Developmentally Disabled individuals. Gracewood was one of the only large (over 16 beds) community care homes in the State of CA to have an approved program for Developmentally Disabled. Gracewood was also approved by the County Mental Health Dept to care for the Mentally Ill. My facility also had its Hospice Waiver and provided day program services. For ten years we handled all of the County APS’s adult abuse emergency placements. In total there were eight programs at Gracewood Manor mainly due to the care home being in a rural community and the community citizens needing those services.

I worked every job in the facility when I wrote the corresponding books:

CARE SERVICES – I worked as a Direct Care Provider; Supervisor of Direct Care Aides/Providers; Facility Care Manager who is over the Supervisors; Administrator who is over the Facility Care Manager; Owner/Licensee over the Certified Administrator

MEDICATION MANAGEMENT: I worked as the Medication Aide to assist residents directly with the medications; I worked as the Med Manager who supervised the Medication Aides and Direct Care Providers.

DIETARY SERVICES: I worked as the Dietary Manager for about a year for my 49 Bed. I also worked as a dietary aide.

I felt it was best to work the jobs that I was writing about. Over the 20 years that I was in business when someone called in sick, I would often cover their shift because I like taking care of dependent people and I wanted to make sure my systems were working well.

There are 11 areas that I cover on ProvidersWeb that were derived from the operating programs of Gracewood Manor, and based on my education, experience and what I have learned from teaching and consulting:

  • Activities
  • Admissions
  • Business Operations
  • Care Services
  • Dietary Services
  • Emergency Management
  • Household Maintenance
  • Medication Management
  • Rights, Culture, and Beliefs
  • Staff Management
  • QA-RM – Quality Assurance Risk Management for community care homes

Gracewood Manor was closed by eminent domain by Cal-Trans for a highway bypass in December 2004. The S-corporation still has real property assets, and the corporation still exists. Our 2019 – 2020 future plans include developing “Living Centers” which will provide community care.

III. Consultant/Expert Witness

1990 to Present Self-Employed
Expert Witness Work — Self-employed as an expert witness specializing in residential care for the elderly, developmentally disabled, mentally ill. I have reviewed cases in 18 States thus far. I review case files and provide oral and written reports on legal cases. Currently, I do about 35% defendant work and 65% plaintiff work. I have been an expert witness since 1990 with most of my cases settleing without going to court. I have been tracking Home and Community federal laws since at least 1993

Consultant Work — Trouble-shoot problem areas in Community Care for both small business owners and large corporations. Help set up new community care HCBS businesses. Conducted facility surveys, audits, and I make recommendations for improvements. I also design community care programs which are required to meet the standard of care policies and procedures for various types of community care and HCBS facilities.

IV. Publisher/Writer/Editor

1996 to 2000 – Residential Care Publications (RCP)

V. Chief Executive Officer / Instructor/ Public Policy Advocate

1990 to 1995 – American College of Community Care Education “ACCCE”

As Lead Instructor, I taught thousands of care providers and supervised over ten professional teachers, including Shelia Burley, RN, the person who wrote most of the original RCFE regulations for the State of California especially the restrictive health conditions. I created various regulation subscription “How to” manuals that ACCCE published that pertained to residential assisted-living/community-care facilities.

In 1990 under American College of Community Care Education (ACCCEs) I created the first law-regulation-policy subscription service for Community Care in the State of California. Under the Freedom of Information Act, I forced the CA State Department Division of Community Care Licensing to handover their inspectors’ policies and procedures called “the blues.” CCL’s state inspectors were using the “blues” to mandate compliance for the various types of facilities, but they would not let providers see them. Today CCL publishes them online. Today CA’s OAL publishes the fact that policies are not considered the law and are considered “underground regulations.” We were the first to publish just the community care regulations and laws for:

  • Residential Care For The Elderly
  • Adult Residential Care for the Developmentally Disabled, Including T17
  • Adult Residential Care for the Mentally Ill
  • Adult Residential Care
  • Foster Family Home Agencies
  • Group Homes for the Developmentally Disabled
  • Group Homes for Kids

I led ACCCE’s Network of 15 to 26 Associations, which coordinated advocacy efforts for industry improvements statewide. See more under advocacy below. From 1990 to 1996 I was the on-call expert for the associations. I consulted with attorney’s that helped all types of licensed community care providers/vendors (mostly elderly, developmentally disabled and mentally ill) and occasionally I testified in court cases. Mostly, I just advised defendant attorneys and most cases settled. I did hundreds of cases over about a five year period.

Chief Writer/Editor of ACCCE’s Network News, which had over 12,000 readers.

Books authored and published by American College of Community Care Education:
1994 Personal Care Aide Training
1993 ARF-DD Administration Manual (Co-authored with Marylyn Meredith)
1990 – 1995 RCF Administration Manual

Created curriculum and instructed the following courses:

  • Certified Residential Care Administrator for the Elderly (CRCA-E) State Approved
  • I taught the first California RCFE Administrator Certification Class in 1990.

Before they were required by the State of California I also taught:

  • Certified Residential Care Administrator—Developmentally Disabled (CRCA-DD)
  • Certified Residential Care Administrator—Mentally Ill/Disabled (CRCA-MD)

Continuing-Education classes instructed:

Residential Care Administrator Polices & Procedures, Business Management, Labor Laws—Staff Management, General Laws & Regulations, Business Management, Case Management, Psychosocial Needs, Medication Management, Building Maintenance, Admission-Retention Assessment, Dietary Services, Abuse Prevention, Business Operations, Activities, Resident Rights and Community and Support Services.

VI. Community Care Advocate

Over the years I served as an advocate/advisor on both regional, state and national government workgroups that helped to create the standards for the residential and community care industry. My advocacy efforts have been on behalf of residents and care providers. Some laws and regulations that I worked on in California include:

  • RCFE Secured Perimeters, Alzheimer’s and Dementia Care Standards by which the laws and regulations are based. At first Dementia Waivers were required, then the standards became regulations, and waivers were no longer required after 2004. My care facility’s policy and procedure manuals were used as the primary outline for developing the care standards for the dementia care standards for community care homes. The secured perimeter standards were created are now used for various types of care homes. My current dementia care documents contain the latest plans and interventions and are used all over United States.
  • R3 Fire Regulations for Community Care Homes – Transfer Dependency and Bedside Care Requirements. I spearheaded the draft regulations for care providers to provide care for transfer dependent and bedridden residents which relates to all types of community care facilities.
  • Transfer Dependent and Bedridden – I work on both the CCL and State Fire Marshall’s workgroup to develop these standards. Unfortunately, I was unable to get the training for staff to handle transfer dependent, and bedridden passed. I believe this training still needs to be mandated.
  • Death of the Licensee (family able to have time to get new license instead of closing the business down immediately) I wrote the original draft of this law.
  • Criminal Record Fingerprint Clearance – It was taking 3 to 9 months to get fingerprint clearances for care home staff. Lonnie Nolta, Registered Lobbyist and my mentor, and I pushed this bill through, and only DSS and two other state agencies got the funding to do Live Scan when it first came out. We had it years before other CA agencies due to our efforts.
  • Admission Agreement Requirements, charging for specific services, I worked on many, many, of the admission requirements and helped draft some of the proposed regulations that later became law.
  • Home Health Agency and RCFE Requirements – Requires medical HHAs to have a written agreement with RCFE specifying who is responsible for the various resident care needs. I wrote the original draft of this law. It took us two years to get this passed into law.

Administrator Certification Requirements

  • 1986-1990 CARCH advocate for improving training requirements for RCFE administrators and care staff. The new laws took effect in 1990. CA H & S 1569.616
  • 1990 – through ACCCE’s we used my Book on RCF Administration to develop the first 40 Hours Administrator Certification Class in CA.

1993-1996 ADMINISTRATOR CERTIFICATION – ACCCE’s advocate/registered lobbyist – I tried for several years to get new laws and regulations increasing the Administrator Certification class from 40 hours to 80 hours. I could not get the government agencies and some of the other provider organizations to support it, and my efforts were defeated.

August 2004 – November 2008 – the State of CA, DSS’s Community Care Licensing’s Central Operation’s Branch (COB) Administrator Certification and Education unit, under the direction of Gary Levenson Palmer, Chief of COB, used ProvidersWeb documents to help them establish standards for their community care vendors/teacher’s programs for Administrator Certification and Continuing Education Classes.

Family Subsidizing SSI for Care and Supervision Services – It took two years for me to research this issue. At that time CCL prohibited community care homes/facilities from accepting money from the families for care. If a care home was caught accepting money from a family, their license could be revoked. I was able to track down the federal law that allowed for families to subsidized SSI for care and supervision and I was able to get the law changed.

2017-2018 Current Advocacy – I am working on a book to help prevent abuse in community care homes worldwide. It is designed to teach care home staff newer information about abuse and how to prevent it, investigate it, and help the abused victim.

VII. RCFE Owner/Operator, 6-Bed Care Home

1984 – 1987 Grace Manor – Owner/Operator of a 6-bed RCFE facility in San Andreas, CA.
As the owner/operator, I did almost all the care and services myself. I had a part-time employee 20 hours a week and family to help me. The services provided included care and supervision, assistance with medical appointments, activities, special dietary needs, community integration, medication assistance, plus basic services such as baths, housekeeping, and incontinence issues. I did have two developmentally disabled residents and one with OCD at my home. This business evolved into the 30-bed facility.

VIII. Skilled Nursing Facility (SNF) Experience

Employed from 1977 to 1986 in various Skilled Nursing Facilities.

Administrator in Training “AIT” Positions held:

  • AIT — Acting Administrator, St. Michael’s Convalescent Hospital Hayward, CA
  • AIT — Asst. Administrator, Hayward Convalescent Hospital
  • AIT — Asst. Administrator, Majestic Pines Convalescent Hospital

Other positions held:

  • Admission Coordinator – St. Michael’s Convalescent Hospital, Hayward CA – Admissions, medical records audits (including MARs medication records) and Care Plans/Case Management. I also did a lot of discharge planning and placement location for local hospitals.
  • Assistant Administrator – Hayward Convalescent Hospital and Rehabilitation. My duties included auditing each department for both compliance and staying on budget. I worked under Roy Pappion, LNHA who was one of my AIT instructors.
  • Medical Records Coordinator – Majestic Pines Convalescent Hospital, Hayward, CA medical records audits (including MARs medication records) Admissions, and Care Plan Conferences & Case Management.
  • Social Service Director – Essex’s Convalescent Hospital, Oakland, CA and Mark Twain Convalescent Hospital, San Andreas, CA Supervised several restorative programs including feeding and walking. Was SS Director for 129 residents and was very involved in care plan conferences/case management.
  • Activity Director – Park Merritt and Alpha Convalescent Hospital Oakland CA
  • Program Manager – HRC Sunshine Program San Andreas – trained Home Health Aides and did case management for elderly and developmentally disabled in their homes. Developed Care Plans for the individuals and taught the HHA how to provide the care the individuals needed.
  • Program Manager – Pete’s Guest Home, (16 bed) Oakland CA. Adult Residential for Developmentally Disabled and Mentally Ill. My duties included Care plans and community integration. I was in charge of the ARF facility when the owner was gone.
  • Glen Haven DP, Eureka CA – Day Program for Developmentally Disabled Teacher, 3 hours a day, for about six months. I taught dance classes and fun activities.
  • College of the Redwoods, 1976-77 I worked for the college as the Asst, Physically Limited Coordinator. I help Vietnam Vets, and other disabled folks get assistance so that they could take classes. I also helped with adaptive PE for the disabled.
  • 1974-1975 Arroyo High School – I set up lunches for the Developmentally Disabled, tutored them, and put on special activity events.

IX. Family Caregiver Experience – the same job most direct care staff, caregivers and family home providers do:

  • Over the years I have taken care of several family members due to their illness or age.
  • Great-Grandma Christensen– broken hip, I took direct care of her in her home until she was able to walk again. 1975
  • Great Uncle Jack Myers– Cancer and Dementia, I took care of him at my own home for just under a year, and then had to place him in an SNF due to inappropriate and high risk behaviors. 1996
  • Grandpa Walt Denny – Severe Alzheimer’s and Heart Conditions. I was the responsible party and had to place him in an SNF, and later an SNF secured facility due to his Alzheimer’s inappropriate and high-risk behaviors. 1996
  • Brother-in-law – Bob Polvinale – Cancer – I provided 2 to 3 days a week direct care hospice for him in his home, until he passed. 1999
  • Grandma Fae Denny – Cancer, I took care of her for 11 years and lived with her the last few months of her life providing direct care hospice until she passed. 1996-2006
  • Grandpa Morgan White – 96-year-old with a seizure disorder, I took direct care of him at his home and our home for two years. 2005-2006
  • Mother Luana Myers – I moved (Sept 2015) my elderly mom into a house next to mine so I can take care of her and her business. May 2019, she had her left hip replaced and I provided all of her care.
  • Grandson Matthew Downs – I provide respite care as needed for my grandson who has developmental disabilities. (currently as needed)
  • Certified Foster Mom – I was the certified foster mother (through 3 different agencies) for three teens that all had special needs. They are still living, and I do not want to disclose their names on this CV. Two of them are still part of my life. I was successful in helping all three become productive adults.

Education

BA Equivalent
In 1978-1980, in order to be a nursing home administrator you had to take the classes required by the Board of Nursing Home Administrators, complete an extensive 1000-hour AIT program, and pass your state (250 questions) and federal boards (650 questions). The total of my course units via the Board of Examiners of Nursing Home Administrator’s (BENHA) program is equivalent to a Bachelor’s Degree (120+ units). I successfully completed the Health Care Administrator program and college unit requirements. I have been licensed as a Nursing Home Administrator since 1981. I have over 200 college credits.

Colleges

  • 1976-1977, College of the Redwoods Field’s Landing, Eureka, CA
  • 1978-1980 Chabot College, Hayward, CA
  • 1978-1979 CE classes through University of Berkeley Extension Program
  • 1981 Peralta College, Oakland, CA
  • 1988 Andon College, Stockton, CA Certified Medical Assistant program (30 units)
  • 2009 FEMA College – Emergency Management Institute, Emergency Management Training (12 units over 19 classes)

Over the years to keep my licenses current, I have taken several continuing education classes since 1981. That equates to about 72 CE classes. Therefore I don’t include all of them in this CV.

Most recent 23 classes:

  • Diagnosing and Treating Overweight and Obese Patients 2017
  • Caring for the Developmentally Disabled Adult 2017 Updated with Latest Trends
  • Elder Abuse: Cultural Contexts and Implications 2017
  • Cancer Screening 2017
  • Depression and Suicide 2017
  • Celiac Disease 2017
  • The Mechanism-Based Approach to Pain Management 2017
  • Aging and Long-Term Care 2015
  • The Role of Spirituality in Health and Mental Health 2015
  • Diabetic Hypoglycemia 2015
  • Osteoporosis: Diagnosis and Management 2015
  • A Review of Psychiatric Emergencies 2015
  • Sexual Assault: Evaluation and Care 2015
  • Caring for the Developmentally Disabled Adult 2013 Updated Class
  • OSHA and Healthcare Facilities 2013
  • Alzheimer’s Disease 2013
  • Influenza: A Comprehensive Review 2013
  • Women and Heart Disease 2011
  • Diagnosing and Managing Headaches 2011
  • The Role of Spirituality in Health and Mental Health 2011
  • Rheumatoid Arthritis 2011
  • Dental Considerations for Geriatric Patients 2011
  • Caring for the Developmentally Disabled Adult 2011

Boards, Committees, and Services:

  • 1997-1998: Executive Board – Served on Governor Wilson’s Secured Perimeter Committee for Alzheimer and Dementia (standards of care for Alzheimer and Dementia and secured perimeter requirements for residents residing in Residential Care Homes for the Elderly (RCFE).
  • 1995-1996: Served on the board as an Executive Board Member for the National Institutes for Health’s Residential Care Project under Dr. Newcomer, SFU – This projects helped set the standards for Community Care Homes for the elderly and DD & MI disabled adults all across the United States in a wide variety of areas: Direct Care, Medications, Staff Training, Dietary Services, Activities, Emergencies, and Case Management services.
  • 1993- Executive Board Member of the National Institutes for Health’s Residents and the Appropriateness of Placement In Residential Care for the Elderly Project under Dr. Newcomer, SFU. NOTE: In the introduction for both of these NIH Residential Care research reports I was given a special acknowledgment for my contributions. (Under Diane Downs, I now use my maiden name)
  • 1991-1994: Served on many committees, boards, and workgroups for California Department of Health and Human Services, Division of Community Care Licensing’s Central Operations Branch, Sacramento, CA.
  • 1996-1997: Served on the Board of Directors for CHAOS, a Group Home for Troubled Teens in San Andreas, CA.
  • 2003-2005: Served on the Board of Directors for Common Ground, a Tri-County Senior Meals-on-Wheels program based in Jackson, CA.

ORGANIZATIONS AND AFFILIATIONS

  • Subscribing Member to “CMS MLN Connects” and I regularly take/review CMS (Center for Medicare Services) classes so that I can teach the latest information.
  • I subscribe to HCPro – a Long Term Care organization
  • I subscribe to CA’s DHCS, DSS, and CCLD; AZ’s DES and DDD agency update services.
  • I regularly review updates to various regulations and laws from various States to keep up on the latest changes and trends.
  • Subscribe to Takacs McGinnis Elder Care Law
  • Subscribe to Health Leaders Media

MISC INFO:

BUSINESSWOMAN: In addition to the above, I qualify as a HUD builder and have built several commercial projects. I own a small apartment building and a couple of rentals, plus another investment property.

NOTE: I have never been arrested, and I have no criminal history. I had a great licensing record for the 20 years that I was a licensed provider for elderly, developmentally disabled, mentally ill, dementia, day program and hospice residents. I have an excellent teaching record.

Additional Information, References and Work Samples Available Upon Request

Groups

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