Staunton, Virginia and Lexington Virginia mental health services

Referrals to Wall Residences services are received from the individual needing services, a case manager, a natural family member, or a worker from any referring agency. At the point that a referral is received, arrangements are made to conduct an interview with the individual and with others who may know the individual’s needs and preferences. Through interaction to get to know the person, we make our best determination of what will work, what will not work, and what activities and relationships will help the person to achieve their highest level of personal success. It is only through this process of getting to know the person that we are able to make the best match to the dozens of available services. Once an appropriate service has been identified, we then request additional services documentation and arrange for visits with potential providers.

WALL RESIDENCES LLC http://www.wallresidences.com/
1281 Huckleberry Ridge Road NE, Floyd, VA 24091
Telephone: (540) 745-4216, Fax: 745-5367

POLICY - MISSION STATEMENT

The mission and purpose of WALL RESIDENCES LLC is to provide high quality community services to persons who have a primary diagnosis of mental retardation, developmental disability, or a long-term mental illness. The service is provided in home and community based environments and is designed to provide a high degree of individual attention, emotional support, and opportunity for self-expression and individualized routine.

The success of the service will be measured by 1) the level of improved self confidence and personal expression accomplished by the resident, and 2) the level of integration and acceptance into the life of the home and community achieved by the resident. How many friends does the individual have? What is the depth of relationships acquired? Is the person respected in the community as a contributing and valued member? Is love a part of the person’s life, both giving and receiving? Is the person learning to understand and express their emotions and values and able to relate to the needs and values of others? Is the person developing a spiritual, reverent response to life? Are hopes, dreams and fears explored? Is the person able to have confidence in physical expression through touching others, vigorous exercise, appropriate diet, careful consideration of medication usage, and other aspects of maintenance of physical, emotional and spiritual health?

The goal of WALL RESIDENCES LLC is to encourage the total health and well being of each person, both client and worker, through a holistic approach to services. All service providers and community support personnel will be evaluated to assure that they are emotionally healthy people who have the capacity and desire to respect and learn from the person with the disability label. The goal of the program will be met when all people in the community are able to see past the disability and know that each person is fully functioning when the appropriate supports are made available. The clients we serve have unique strengths and needs just like all other people. Acceptance of diversity will be encouraged through the inclusion of our clients in normal home and community activity and through involvement of the entire community in the support and acceptance of our clients.

I. Introduction
Wall Residences LLC was founded in late 1995. The Virginia Department of Mental Health,
Mental Retardation and Substance Abuse Services approved a set of policies and administrative
procedures for Jack Wall’s home in the Mount Sidney community of Augusta County to provide
residential services. With the approved license came eligibility to contract with the Department
of Medical Assistance Services to offer and bill for Medicaid Mental Retardation Community
Based Waiver Services. On January 1, 1996, the first client was received into services.
The impetus to develop the new private organization came out of the 25 years of government
experience by the founder (see resume attached). The knowledge of the need for fundamental
system reform of long-term care services through a managed care or other market driven model
has become clear. The demands from the public and from families of people with disabilities for
more flexible, client-centered services and for better mechanisms for cost containment so that
more people can be served at a reasonable cost are at the core of the argument for system reform.
The service model described here is in response to this widely understood need for quality at a
reasonable cost to the taxpayer.
The philosophy of Wall Residences is based upon the following principles:
· People with disabilities who require continuous available support often prefer to live in a
home rather than a segregated facility or group home.
· Providing services to people with disabilities within a family environment can provide high
quality care at a lower cost. This is because some families already possess the resources of a
spare bedroom and living space, food preparation and medication assistance capabilities,
transportation, people to provide support services and personal attention, stature in and
connections to the neighborhood and the community, and a recreational and social life which
can be modified to support a person with a disability. All of this is available 24 hours a day as
part of a flexible, coordinated unit of human service potential.
· The respect that the community grants to a well-established family unit will be naturally
extended to a person with a disability who lives with the family. Inclusion into the
community can occur naturally without the negative reaction and fear that can be generated
when a multiple bed group home is built in a neighborhood.
· Quality client care comes when quality direct services are offered. Time, attention, and money
are focused on client services. Administrative services are a support function to the family
providers so they may be able to do their work well. Administrative expenses are kept to a
minimum so that Family Providers receive wages comparable to the importance of the work
they do.
· Operation of Wall Residences LLC is team based and principle centered. All workers are
respected and included in information sharing and decision-making. Through the shared
efforts and expertise of all participants we can lead the way toward better lives for people
with disabilities and toward a better appreciation of diversity in our communities.

II. Home Study
Each prospective Family Provider will be evaluated for dependability, motivation, knowledge, and
the adequacy of the home environment. Information collected during the home study will help
verify suitability to care for a person with a disability and will verify that all requirements for
licensure have been met.
A. Resumes - A resume’ for each adult service provider (18 years old or older) will be
required. Included will be the educational and work background plus a listing of other
qualifications that pertain to the ability to provide training and support to a person in
your care within family and community environments.
B. References - Each adult service provider in the home must have at least two letters
of reference mailed to Wall Residences LLC. The letters should identify the person’s
relationship to the provider, the length of the relationship, the skills, abilities, and
attitude observed in the person’s work and a statement of recommendation as to the
person’s ability to provide quality human services. The letters must include the
name, address, telephone number, and occupation of the person providing the
reference. The person writing the reference should mail it directly to Wall
Residences LLC to assure authenticity.
C. Criminal History Checks –A Criminal History Record Name and Sex Offender
Search as well as a Department of Social Services Child Protective Services Registry Search
must be submitted for all family providers, respite workers, contractors, volunteers,
students, and live-in family members over the age of 18. Any worker who provides
paid services must have a criminal background check submitted and be determined to
be free from a criminal record which would indicate a risk for providing appropriate
care.
D. Driving Record Checks – Each driver in the household must submit a copy of their
driving record. These can be obtained through your local Department of Motor
Vehicles. The driving record will be evaluated by the person conducting the home
study.
E. Fire Evacuation Plan - Draw a floor plan of the house including the dimensions of
each room in feet, mark escape routes with arrows, locations of smoke detectors and fire
extinguishers, and list instructions for evacuation and fire department/emergency
personnel notification. A copy of the plan is to be given to the individual in your care
and their legally authorized representative at the time of initial orientation. At least
four fire drills are to be conducted each year and documented on the fire drill log form.
F. Emergency Response Plan - A description of procedures to be followed in the
event of an emergency must be developed for each home. This will include a plan for
moving to another location or emergency shelter in the event that the home cannot be
occupied and whom to call in the case of a medical, psychiatric, weather, or terrorist
attack emergency. The emergency response plan must include information about how
to turn off utilities and any special information provided by the local emergency
response coordinator.
G. Certificate of Occupancy (CO) - Contact the local building inspector to obtain a CO if you do not already have one. In some cases within rural counties or for older homes,
there may be no record of a CO. In this case you must ask the building official to
certify approval of the home, and verify that no building code violations exist, to their
knowledge, at the time of the construction of the home.
H. Approval of Water and Septic Systems - No inspection is required if your house is
on public water and sewer. Independent systems require verification of approval by
the Health Department in your area including a water test to verify freedom from
chloroform and fecal bacteria. Water tests must be conducted each year for well water
systems.
I. First Aid/CPR/TB Test/Medication Training - Each service provider must
provide documentation of having current First Aid/CPR certification. A record of TB
evaluation on each family member and service provider must be completed.
Medication training will be provided through Wall Residences LLC. All workers
assisting with the dispensing of medications must complete this state-approved
training.
J. Home Safety Inspection - An initial and annual inspection of the home safety will
be required. At least one fire extinguisher and smoke detectors in bedrooms and
hallways are required. Locked cabinets or storage areas must be used for medications
and poisonous materials. A First Aid kit including bandages, saline solution, and
a thermometer must be available in the home. No firearms or illegal substances are
permitted in the home. See the copy of the Annual Safety Inspection for information
on other items that are included in this inspection.
K. Financial Resources/Line of Credit - Licensure requires that financial resources or
a line of credit exist to operate the service for 90 days. The potential provider must
also obtain a copy of their credit history to submit to Wall Residences. This can be
done on-line by accessing Myfico.com. For $12.95 a credit check from one of the
three major credit bureaus may be obtained. If the potential provider has a poor
credit history, the home study will need to document how this problem will be
overcome.
L. Homeowners/Renters and Automobile Insurance Policies - Evidence of liability
and property damage coverage is required for home and vehicles. Notify your
insurance agent of your potential involvement with a foster care placement to assure
they will cover you for the risks involved with this paid service.
M. Agreement to Provide Medical Services - Contact a local physician or physician’s
group to assure that they will provide 24 hours a day, 7 days a week available medical
care for a person on Medicaid health insurance coverage. In some cases you may also
need to identify a psychiatrist willing to provide services to a person with Medicaid
insurance.
N. Interviews - The person assigned to do the home study interviews will meet with
family members in the home to review the opinions and philosophy of family members
about providing services to a person with a disability in their home. Also reviewed
will be the capacity of the family to handle special client needs and the arrangements
to provide backup so that service providers receive adequate breaks from their
responsibilities.

III. State Mental Retardation Orientation Workbook and Examination

Each person responsible to provide services to clients (all must be at least 18 years old) must
complete the state orientation course and make a satisfactory score on the examination.

IV. Licensure Standards and Agency Policy

Each provider is responsible for knowing and complying with State licensure standards and
agency policy. Each Family Provider will be given a copy of agency policy at the start of services
and will receive updates as they occur. Please be aware that State licensure standards require that
ceiling height in your home must be at least 7 ½ feet in all areas where services will be delivered.
Also, State requirements are that there are no more than four people living in the home for each
full bathroom and no more than seven people living in the home. These are minimum
requirements. As Wall Residences is working to create quality lives for people with disabilities,
we prefer that our clients have individual bedrooms whenever possible. Ultimately, the individual
receiving services and their families make a choice of where the individual will live. The better
quality living environment and better trained staff will be chosen over services without those
components.
All people who work for the provider must also comply with all standards and have a complete
personnel file at the Wall Residences office before they begin services. Review this process with
office staff or your regional Program Manager before talking with people you want to hire to
provide back-up services. We may have information about people who are qualified to do this
work.

V. Exposure Control for Bloodborne Pathogens

The Occupational Safety and Health Administration (OSHA) requires that all workers who
perform duties that could expose them to the blood of a non relative are to be trained in universal
precautions and offered Hepatitis B vaccinations. Wall Residences LLC has an approved
Exposure Control Plan to give specific information on the universal precautions to be used. We
also have procedures to identify and respond to an exposure incident, that is anytime a worker or
family member comes in contact with the blood of another or the individual in services is exposed
to the blood of someone else. All workers must receive initial training on these procedures with
annual updates to review questions or changes in nationally recommended practices. A copy of
the Exposure Control Plan will be provided to each Family Provider before they begin services.

VI. Human Rights Plan/Behavior Management Manual

All State licensed programs offering services to people with mental health, mental retardation or
substance abuse service needs must comply with Virginia’s Rules and Regulations to Assure the
Rights of Individuals Receiving Services from Providers of Mental Health, Mental Retardation,
and Substance Abuse Services. The Wall Residences LLC human rights policies comply with
these Regulations and have been approved by the State Human Rights Committee. Enforcement
of the regulations is through the Regional Advocate in the area and through a Local Human
Rights Committee (LHRC). Since Wall Residences LLC provides regional services, we are
affiliated with several Local Human Rights Committees.
The Wall Residences LLC Behavior Management Manual provides additional guidance for the
development of intervention techniques to work with inappropriate behaviors. All restrictive
techniques, except in an emergency, must be approved by the LHRC for the area in which
services are located. In the event that any emergency physical hold or other restrictive measure is
required, the provider is to report the incident to the Director or Quality Assurance Specialist immediately
and is to complete an Unusual Incident Report form. Evaluation of the
incident shall occur as soon as possible with appropriate measures to be taken as directed. All
service providers are to receive training in prevention and gentle physical hold techniques using
the Mandt or other approved training program.

VII. Documentation Systems

All billable activities with the individual in services are to be documented. Forms will be
provided by the organization or family providers may be helped to produce their own comparable
forms. Several systems exist to complete documentation requirements:
A. Client Notebook - A complete record of services and reports on the client will be kept in
a locked area to maintain confidentiality. The client notebook is a legal document. All
entries are completed in ink and no white out or erasures are allowed in the record.
Notebooks for client service records are provided to each Family Provider. General
information to be contained in the notebook are:
1. Emergency Medical Information
2. Face Sheet of Frequently Used Client Information
3. Individual Service Plan
4. Evaluations and Reports of Previous Services and Assessments
5. Progress Notes
6. Monthly and Quarterly Summaries of Services
7. Data Sheets for Training and Assistance Activities
8. Medical Reports and Copies of Physician’s Orders
9. Financial Information
10. Information on Family Contacts and Correspondence

B. Training Data Sheets, Activity Schedule & Billing Record and Medications
Administration Record
Records of current ongoing services being delivered can be kept on a clipboard to ease
access for ongoing reporting. Refer to sample forms for information about the data to
be collected.

VIII. Contract for Services

Each Family Provider is under contract with Wall Residences LLC and the State Medicaid system
to deliver the services agreed to in the Individual Service Plan, according to licensure standards
and to other agency policy and procedures. Many of the agency’s operating procedures are
specified in the Contract for Services. Responsibilities of the organization and conditions for
compensation and also specified in the Contract. Contracts are renewed each year for Family
Providers who have met training requirements for the preceding year.

IX. Individual Service Plan

The Individual Service Plan is developed and revised at least each year at a meeting of all parties
including the individual receiving services, natural family of the individual, family providers, Wall
Residences LLC representatives, the individual’s case manager, and others as appropriate. This
plan identifies the training, assistance, treatment procedures, and supervision required for the
individual and is used to document the reimbursable hours of service. Development of the
service plan requires careful review of documents about previous services, meetings with the
individual and discussions with family and previous service providers. Activities and supports identified
in the Plan are to be in the best interests of the individual to maintain safety and to
further his or her opportunities for skill improvement and independence.

X. Payment for Services

New providers are started as “Provisional Providers” at a pay rate of $10.00 per hour for services
authorized and delivered. This pay rate will be continued until the providers demonstrate the
skills to run a professional service. These skills include: the ability to collect and record
meaningful data on training that occurs; the ability to write a quarterly report that meets Wall
Residences LLC requirements and the ability to coordinate a comprehensive array of support
services. When these performance criteria have been met, the pay rate will be increased to $11.25
per service hour. Current billing rates for residential support services are at $13.45 per hour. The
total payment to the Family Provider is based on the number of approved hours in the service
plan. The hours of approved services can range from a low of about 20 hours per week to about
126 hours per week depending on the needs of the person in services. Medicaid reimbursement
comes after services have been delivered. For example, if services begin in January, then after
documentation of services have been completed for the month of January, billing reports are to be
transmitted to Wall Residences on the last day of January or the first day of February. Billing
reports are then prepared at the Wall Residences office for invoicing to Richmond at the
Department of Medical Assistance Services. Bills submitted during the first few days in the
month will be paid in about two weeks. Wall Residences LLC receives checks for payment on a
Monday, usually between the 15th and the 22nd day of the month. Payments to families are sent
within a few days of the receipt of the funds, sometimes by direct deposit.
Additional funds are available to the family through the assessment of room and board charges to
the individual’s personal funds. All individuals in services will receive approximately $572 per
month in Supplemental Security Income or Social Security Disability Income. Typically, the room
and board charge made is for $450 per month with the remainder of funds available to the
individual for personal purchases of clothing, entertainment costs, dental bills or other needs. All
of the individual’s income must be tracked separately to give full accounting of where the money
is spent. A separate checking account is kept in the individual’s name or in the name of the
representative payee as trustee for the individual. All income and expenses for the individual,
including room and board payments and co-pay for any excess income over what is allowed, are
tracked through this account. Cancelled checks and cash register receipts are kept to document
purchases and payments made.

XI. Supervision of Services/Peer Review

All families receive supervision or training from the Wall Residences LLC organization at least
once per month, usually in person but under some circumstances, the supervision could be
provided over the telephone. The titles of people providing this service are Quality Assurance
Specialists or Regional Program Managers. The Quality Assurance Specialist or Program Manager
will be a professional with at least a Bachelor’s degree and experience in the field who is
knowledgeable about your services and documentation requirements. Supervision is usually
focused on discussing issues regarding implementation of the Individual Service Plan and any
needs to modify the plan. This time can also be spent to discuss any difficult training issues,
needs for additional support for the provider, ideas about how to find new community training
opportunities for the individual in services, or any new information about regulatory procedures,
upcoming meetings or staff training opportunities. We also have regional family provider
meetings where providers from a region get together to review selected cases. These meetings are
used to compare ideas, documentation systems, and to plan activities and ways to better use back-up
personnel. We are always looking for ways to improve our services. We strive to continually
develop new opportunities for individuals with disabilities to actively participate in all aspects of
community life.
In addition to internal reviews, the Licensure Specialist, the case manager, the Department of
Mental Health, Mental Retardation and Substance Abuse Services, and the Medicaid Utilization
Review Specialist will also visit you. Sometimes you will have warning of when these reviews
will occur; you will also receive unannounced visits from licensure or Wall Residences LLC
personnel.

XII. Accountability/Responsibility/Liability

The Family Provider is an independent contractor for the services they deliver. As part of a
licensed organization, the Family Provider has access to many sources of advice and support.
However, Family Provider accountability for performing within the regulations and policy are
vital to the survival of our organization and each family based service. If a serious problem
occurs, such as a serious allegation of abuse or a failure to follow appropriate procedures and to
maintain appropriate records, the reputation of all of our services and the foster care model, as a
whole can be impaired. We are only as good as our weakest link. In addition to issues of
maintaining a reputation for quality, we must also be aware of the potential for financial loss. If
we do not comply with documentation requirements for Medicaid, we can have retroactive
funding penalties involving denial of funds for days when service documentation is not in
compliance. Requirements to return funds will be assessed to families in the same proportion as
are the assessed penalties. Also, if a placement fails or the individual needs an extended stay in
the hospital or a state institution, no funding will be received for those days when the individual
is out of your services. Families must be financially prepared to handle this potential reduction in
income. Liability and taxation issues are also to be reviewed and planned for by each Family
Provider. You will need to have access to good insurance, and legal and accounting advice to guide
you through these decisions. Wall Residences LLC can not provide legal or tax advice. It is the
Family Provider who must take responsibility to resolve these issues.

XIII. Technology: Computer, Fax, E-mail, Pager, and Radio Monitor

We are a decentralized organization with needs to keep in touch as well as to meet many caregiving
responsibilities. Technology can help us do our jobs better. Computers allow us to
develop more professional and readable letters, forms and reports. A facsimile machine and
secure e-mail service will allow providers to submit or receive important documents quickly,
particularly when regulatory reviews occur or at end-of-month verification of billable services.
Pagers can help if you have hired workers who could need your assistance when you are away.
Radio monitors in bedrooms are a good way to know if your assistance is needed during the night.
We will help you to develop these systems that are a requirement for your continued participation
in the Wall Residences LLC organization.

XIV. Professionalism and Marketing of Services

Many very well qualified family providers are becoming a part of what we do. We represent many
different skills and experiences and also have many individual weaknesses to overcome. To be
fully effective as an organization and as individual families we must be able to be a bridge
between two systems or paradigms of service. We must respond to the requirements of a highly
regulated, top-down, and bureaucratic Medicaid system while at the same time be able to help our
clients to be accepted as regular, valued people in their community. This means we must learn to
understand the jargon spoken by professionals, but also be able to speak in plain language about
what we do to other citizens and neighbors. Many opportunities exist to get our message
across. We will meet periodically to discuss the planning of our work, to educate ourselves about
how to do our jobs better and learn about how to share our skills and resources with each other.
We are professional workers who must never stop trying to do our work better. We must work at
our craft and show others a professional attitude through our knowledge and our actions.

EMERGENCY RESPONSE PLAN REQUIREMENTS

Each service location must have a written emergency response plan that contains the following
elements (regulation #: VAC 12 VAC 35-105-530):
1. Description of how communications with employees, contractors, and community
responders will occur;
2. Warning and notification of individuals receiving services (no client identifying
information should be included in this document- write in generalities);
3. Providing emergency access to locked areas;
4. Conducting evacuations to emergency shelters or alternative sites, and accounting for all
individuals receiving services;
5. Relocating individuals receiving residential services;
6. Notifying family members or legal guardian;
7. Alerting emergency personnel and sounding alarms; and
8. Locating and shutting off utilities.
Supporting documents that must be part of the plan include:
Building and site maps that show emergency evacuation routes and locations of utilities,
direction on how to shut off utilities, emergency call lists, and a list of local emergency shelters.
A schedule for testing the plan, conducting emergency preparedness drills and special evacuation
procedures for individuals with special needs (i.e.: deaf, blind, non ambulatory) is also required.
Information that must be kept current by telephones:
· Telephone number and location of nearest hospital
· Ambulance service
· Rescue squad
· Poison control center
· Fire station
· Police department
Mental health crisis services
A FLOOR PLAN OF THE HOME WITH DIMENSIONS OF EACH ROOM AND THE ROUTES OF EXITS MUST BE ATTACHED TO THIS DOCUMENT.

OPERATIONS – HIRING BACKUP SUPPORT PROVIDERS

Each family provider must have certified, available back-up support providers available for emergencies
and breaks. (Other identified family providers can meet this requirement).
Background Checks, CPR/First-aid Certification, application and reference checks must be
completed before someone starts to work. A file containing the following information must be
kept at the Wall Residences LLC office. THIS IS A LICENSURE REQUIREMENT.

• Criminal History Record Name and Sex Offender Search Forms AND Child Protective
Services Registry Search forms must be completed and received at the Wall Residences office
before the employee begins to work.
• Date of Hire – needs to be clearly identified. This date is the first day that someone delivers
services to a client without assistance from another certified worker.
• Resume or completed application;
• Two References;
• Signed Job Description;
• Program Procedure Manual for Back-Up Personnel – Acknowledgement Page;
• Personnel Orientation Checklist – Review each topic identified and sign;
• CPR/First Aid Certification;
• MANDT or other behavior management training;
• Driving Record from D.M.V. (if transporting clients);
• Copy of car insurance (if using own car for transportation);
• T.B. Test results;
• Hepatitis B Vaccination or signed Waiver (Least expensive place to get vaccine is the Health Dept.);
• Medication Training (required before giving medications);
• Waiver Orientation Exam – Must be given within 30 days of day of hire;
• Human Rights Review; and
• Confidentiality Agreement.
NOTE: SEND ALL OF THE ITEMS LISTED ABOVE TO Wall Residences LLC
AT THE SAME TIME

Additionally, you may need tax forms for your back-up worker, as you are responsible for the tax issues.
Check with your accountant.
Back-up workers are required to be knowledgeable about Wall Residences LLC Mission and Policies and
need to know where your policy notebook is located.
Wall Residences LLC has a reputation for quality services that will be maintained by good training of our
back-up personnel. Family providers will do most of the training with their hourly staff, using the Policy
Manual, “Best Practices Manual,” the Human Rights and Behavior Management Plans, and other resources.
Wall Residences LLC will also provide training on an as-needed basis.

HOME STUDY/LICENSURE COMPLIANCE CHECKLIST

Items needed from prospective providers:
• Resume for each adult who will participate in providing care;
• Letters of reference (at least two) for each adult providing care;
• Criminal History Record Check for each adult living in the home (and for Back-up workers);
• Child Protective Services Registry Search for each adult living in the home (and for Back-up workers);
• Current Department of Motor Vehicles driving record check for each service provider;
• Current Behavioral Management Training -TOVA, MANDT or like training (training to be provided by Wall Residences);
• Current First Aid certification for each service provider;
• Current CPR certification for each service provider - At least adult level certification;
• State approved medication administration training for each service provider (training provided by Wall Residences);
• Orientation to Mental Retardation (Medicaid Waiver Exam) for each service provider;
• Human Right Test Documentation for each service provider;
• Tuberculosis screening or test for each person living in the home;
• Hepatitis B Waiver or Documentation of Vaccine;
• Confidentiality Statement signed;
• Credit Report (one per household is sufficient); and
• 90 Day Operating Budget + documentation that you have cash or credit to cover the amount.

Requirements for the Home:
• Certificate of Occupancy for the home from County building official;
• Emergency Response Plan including floor plan with room dimensions and fire evacuation routes;
• Results of water supply testing (for independent water systems);
• Septic system approval (unless family is on a public sewer system);
• Documentation of Liability Insurance for home (current – showing expiration date); and
• Documentation of Liability Insurance for autos (current – showing expiration date).

Additional Requirements for Group Home Status:
• Kitchen Inspection (Completed by VDH); and
• Staffing Plan for DMHMRSAS.