29222 Rancho Viejo Rd, Ste 127
San Juan Capistrano, CA 92675
December 2019

Cultivating Peace and Joy this Holiday Season
By Deb Bielek, Therapy Resource
Holidays are a time of traditions, childhood memories, and reuniting with family. For many of us who have lost loved ones, it can also be a time of mixed emotions and even sadness when we miss their presence during this time. There is great comfort in knowing that we don’t have to be a victim to our emotions. Practicing the tools of heart-centered breathing that many of us have learned with HeartMath™ helps to use the intelligence of the heart to shift to regenerative emotions right in the moment when sadness arises. With practice and intention, before you know it you will be celebrating the memories of those gone before us, and will have renewed joy to create loving memories with the people near and dear in our lives. We have the control! And just as Stephen Covey teaches us, the Circle of Control is expansive, contagious, and powerful. The more we take control, moment by moment, the more we can find peace in this joyful season. 

Earlier this year we lost my mom, Judi, and just the month prior we lost Mary’s mom, Bert. The practice of shifting my mind to a place of gratitude for the time I had with my mom and the joy-filled moments ™throughout my life helped to shift away from the thoughts of illness that had come over her. I smile when I think about mom helping me with my list for Thanksgiving dinner or her offering of suggestions on the best way to decorate for the holiday. My heart is warm when I picture her smile last year as we lit up the Christmas tree adorned with the bows she had made. 

Many of us have stories of loved ones who are no longer with us and the gifts of positive memories and emotions they left with us. We have the power to choose our emotion in those memories. 

We also share another special bond in the work we do as affiliates of Ensign. Every day we are brought together by our purpose, to dignify long-term care in the eyes of the world through moments of truth. These moments of truth are expressions of the heart and are present in so many ways as we connect to our patients and residents. When we share with them lessons on the circle of control, we are sharing with them a treasure of empowerment. When we can give them the gift of heart-centered breathing and help them to find those positive regenerating emotions, we are giving them a tool to strengthen their resiliency. And we know the science behind the benefits of the positive neuro chemicals that are released when we connect with our heart brain and shift our emotion. Connecting with our patients and residents through their stories and memories provides them with the right tool to create that emotional shift. Our time spent in this connection are gifts of the heart, and these moments of love are the greatest gifts of all.

If you have not yet been trained in the HeartMath™ technique, reach out to your therapy resource, or you can email Mary or me:

Happy Holidays! Our hearts are grateful for you and all that you do for the lives of so many. 
Holiday background with little golden stars isolated on white

 PDPM All Stars!
Coral Desert, St. George, Utah
Submitted by Kelly Alvord, Therapy Resource - Sunstone/Utah
Pictured L to R: Clint Nielson, ED; Paula Mangiaracia, ADON; Kinny Stubbs, Medical Records; Lynn McCown, MDS; Asa Gardine, DOR; Maria Tolbert, BOM
Coral Desert really owned the daily technical meeting way before Oct. 1. Once they fine-tuned their system, they went to sister facilities and trained them. One example of success with sharing best practices is from Cedar Health and Rehab. They not only implemented the best practices from Coral, but they are also leading with NTA success. 
St. Joseph Villa, Salt Lake City, Utah
Submitted by Lisa Brook, DOR/PT, St. Joseph Villa, Salt Lake City, UT
St Joseph Villa in Salt Lake City, Utah, has embraced the PDPM process and developed a daily technical and weekly skilled system that optimizes efficiency in their operation. The system they have adopted is one where individuals have accepted specific roles in the process and then those individuals come together as an interdisciplinary team to determine appropriate capturing of each patient’s specific medical condition.   Read On....
Thriving (Not Just Surviving!) With PDPM
By Shelby Donahoo, Bandera Therapy Resource, and Tonya Haynes, DOR, Mountain View Care Center, Tucson, AZ
Pictured: Heather Stiles, DON; Talitha Thrasher, Med Records; Jessica Ganz, ADON; Della Richardson MDS; Juanita Skidmore, BOM; Tris Rollins, ED; Tonya Haynes, DOR
Mountain View Care Center in Tucson, Arizona, has been an “all team on board example” of how to manage and succeed with PDPM. Here are some reasons why:
  • Consistent IDT team participation: DON, ADON, MDS, Medical Records, Business Office, DOR, Case Manager and ED!
  • They have a system in regards to timeline of PDPM components to investigate starting day of admission, day two, day three and so on.
  • Day one, they start looking for missing hospital documents; if not present, they are requested immediately in the PDPM meeting. They keep a log of documents and labs requested, reviewed and followed up on daily.
  • They keep looking — not just once, but repeatedly through the five-day assessment process, adding or altering diagnoses, comorbidities, NTAs; daily floor and rehab updates included.
  • They create fun competition — challenging each other to find patient PDPM components first. “We sound like an auction during PDPM meeting!”
  • Their goal is to stay one step ahead; their tracker is color-coded for followup. Red: urgent; yellow: missing info; green: ready to submit
  • They do a full team MDS review to ensure score matching before submission
  • Success is in the data and feedback from staff, patients and providers.
No Anonymous Altered Textures! 
 By Lori O'Hara, MA, CCC-SLP, PDPM Resource
In general, altered textures and swallowing problems go hand in hand. While you will occasionally have a patient who wants mechanical soft because they don't want to struggle with cutting meat, or a patient with severe dysphagia who is NPO, you should almost always see those things happening together. In PDPM-land, this means that the case mixes that indicate "either" a swallowing component or a mechanically altered diet should be pretty darn rare (less than 10% of the total case mix distribution). For the curious types, those case mixes are SB, SE, SH and SK.

According to ASHA, as many as 45% of patients in nursing homes have swallowing problems, and in most cases those problems (at least in the early days) will be managed with some type of texture alteration. Here are some tips to capture everything that goes along with those conditions: Read On....
Highlights on Nursing and Therapy Partnership
Sunstone's DON/DOR Retreat
By Vickie Warren, Sunstone Clinical Market Leader
We had a great turnout for our first combined DON/DOR Retreat! It was amazing to hear our teams sharing best practices, improving on leadership development, focusing on COO/CTO criteria and setting our vision for a great 2020!   The teams worked together to build bicycles, which they took back to the facilities to give to an employee who may need help this Christmas. Thank you all for your participation, sharing and insights on how we can take Sunstone to the next level!  
Optima Update
What’s So Great About Clinisign?
By Mahta Mirhosseini, Therapy Resource
I recently had a chance to interview Lana Mathis about her experience with Clinisign. Lana is an OTA who has been with Ensign since 2012 as a DOR at Granite Mesa and now at Legend Oaks Kyle in Texas. When she is not “DORing,” she loves archery, and likes to travel, fish, take long motorcycle trips, and read. Her favorite ice cream flavor is Haagen-Dazs® Caramel Cone.

How long have you been using Clinisign?
I have been using CliniSign since 2017.

Did you have any challenges in getting started and how did you overcome them?
The main challenge that I had was getting the Physicians to sign.  Once I explained how it works and gave them a copy of the Clinisign for Physicians, they were more open to it.  I think the key words here are “time saving” and “it’s as easy as punching a button.”   It is a lot easier to get Nurse Practitioners to sign up.   I signed on a Nurse Practitioner here at Legend Oaks Kyle.   She stated, “Oh that was really easy and very convenient.” Read On....
Therapist Profiles
From Therapist to AIT: Matt Scott Mission Hills, San Diego, CA
Submitted by Jamie Funk, Therapy Recruiting Resource
Why did you decide to make the leap from DOR to AIT?
Loaded question. Before I started as DOR at The Springs, I worked for a contract therapy company. At one time I had been approached by the Admin in one of the buildings we were contracted into. My answer was a hard “no.” Nothing about it appealed to me. It was so corporate, and the only things the Admin seemed to do was discipline people and put out fires. Then, I started at The Springs and worked with administrators like Matt Rutter and Matt Stevenson. It was eye-opening to see the autonomy and freedom they had to operate. They were disciplined yet were able to have fun. They acted like true owners of the operation. This sparked my adventurous and entrepreneurial spirit. And after being in therapy management since 2008, I was ready to start a new challenge, and they inspired me to be an ED. Read On...
Dana Chatham, Rowlett Nursing & Rehabilitation, Rowlett, TX
Submitted by Jon Anderson, PT, Therapy Resource
Our amazing Keystone DORITO program continues to find the most amazing and innovative therapists in the industry. Since its inception in 2018, the mentorship program has resulted in seven DORITOs with a 100% placement rate as a DOR and a 0% turnover rate. The DORITO opportunity is an actual position within Keystone, meaning we interview and hire specifically for this role, which consists of 50% treating therapist and 50% mentorship as a DOR. The mentorship training hours fall on the topside of the market, and not on the facility, thus an intelligent risk for each market to invest a great deal of front-side training. Generally, the program runs from one to three months, depending on the training needs of the individual and the opportunities available.

Dana Chatham, PT, is our latest graduate of the Keystone DORITO program. Dana has been a PT for over 23 years and has worked in multiple settings (hospital, outpatient, SNF), and she is now our new DOR at our new acquisition in Rowlett, Texas, at Rowlett Nursing and Rehabilitation. Dana found out about our DORITO program while she was a PT from her local DOR, Tiffany Bishop, SLP, DOR at Greenville. Dana’s program consisted of training at multiple facilities in Keystone North: urban, suburban, large and small, to give her an idea of what it would take to make any therapy program thrive. Dana shares that her favorite experience during her DORITO program was being able to be at Golden Acres during the flag ceremony, where she got inspired and set a goal to bring the flag to her future facility.

Dana is already off to an incredible start at Rowlett and isn’t wasting any time to scale programs up, as she has hired five new therapy staff to the team and is implementing the Abilities Care Approach program, while elevating the skill set of her team. Dana’s vision is a facility where no resident is left behind, five stars in QMs and a deficiency-free survey.

Below is a picture of Dana’s therapy gym on day one of acquisition. Dana created a superhero theme, and every therapist was given a different hero cape.
Combining Heart Rate Variability Training and SLP COPD Treatment 
Pictured Left: Lois Ferguson and therapist Taylor Webb-Culver at San Marcos Nursing & Rehab, San Marcos, TX

By now, many of us are aware of the benefits of using Heart Rate Variability Training (HRVT) with our patients: improved resilience, improved function, reduction in pain and increased therapeutic activity tolerance. At San Marcos Rehab, we have begun to integrate HRVT with a COPD protocol developed by Michele Scribner, SLP, at our affiliate Northeast Nursing and Rehab in San Antonio, Texas, which was based on the work of Jocelyn Alexander. We have seen some truly excellent outcomes as a result.

COPD patients often present with increased anxiety during completion of daily functional tasks and social interactions due to difficulty breathing. This labored breathing often results in increased blood pressure, coughing, fatigue and loss of appetite. This barrage of symptoms in COPD patients is often advanced enough that social isolation becomes a risk due to voice deficits and insufficient respiratory support for communication needs. Read On...
SLPs' Role in Discharge to Home/Community
Submitted by Tamala Sammons, MA CCC-SLP, Senior Therapy Resource
Contributed from the American Speech and Hearing Association (ASHA.org)

SLPs can help increase the rate of discharge back to the community and decrease avoidable re-hospitalizations. Specifically, SLPs can positively influence the following factors that contribute to discharge back into the community: Read On...
WELL (We Embrace Living/Loving Life!
human and love spirit powerful energy connect to the universe power abstract art watercolor painting illustration design hand drawn
A Few Minutes of Meditation Can Transform Your Day
By Angela Ambrose, contributing writer
The hectic holiday season is in full swing and chances are your to-do list has more than doubled in length. When you’re feeling harried and overwhelmed, this is the best time to hit the pause button and find a few minutes to just sit and breathe.
Meditation involves bringing your full attention to a single point, such as following your breath as it flows in and out, repeating a soothing word or phrase to yourself, gazing at an object such as a candle flame or listening to an inspirational song.
“We live in the 21st century where the fast-paced world we’ve built is inundating us with floods of energy constantly, if we allow it. A 10-minute break from that can be very beneficial,” says Benjamin Decker, meditation teacher and author of Practical Meditation: a Holistic Three-fold Approach to Meditation. Read On...
Cupping Techniques to Improve Quality of Life for Geriatric Patients
By Jimmy Dale Smith, PT, DPT, The Healthcare Resort of Plano, TX
The Physical Therapy department at Plano HCR is currently one of our affiliates in Keystone that is piloting usage of cupping across patients with differing diagnoses, which has resulted thus far in varying degrees of success.

Myofascial decompression (MFD), or cupping, is a form of IASTM (Instrument Aided Soft Tissue Manipulation), where a pump and a cup are used to create negative pressure and placed on the skin to improve circulation/blood flow, reduce pain, improve tissue pliability/mobility and to improve healing.

Additional benefits of cupping may include improved quality/quantity or ROM, improved tolerance to ROM/PROM exercises, and excellent neural input to improve motor output. Contraindications include open wounds, fever/active infection, severe disease (cardiac, renal failure, bleeding disorder, hemophilia, active cancer and dermatitis), first trimester of pregnancy, unhealed or possible fracture, severe strain/sprain, or already inflamed/swollen tissue, burns and acute flare-ups of skin disease (psoriasis, eczema or rosacea). Read On...
A Beautiful Thanksgiving Dinner
Submitted by Josie Gorman, DOR/PT, Pueblo Springs Rehabilitation, Tucson, AZ
It all started during REHAB Week — the celebration, the festivities and the gifts. Wow! The therapy team felt loved and valued.

With all the appreciation, the therapy team decided to give back by enhancing the lives of our long-term care residents at Pueblo Springs. Josie, the Director of Rehabilitation, loves Zumba, so in collaboration with Liz, Director of Activity/Recreation department, a “Zumbathon @ Pueblo” was set as a fundraising event. On a Saturday afternoon Pueblo Springs hosted a Zumba class for the community, with dancing for two hours! Funds were earned through class attendance fees and donation of raffle baskets and cash.

It was such a successful event that we surpassed our fundraising goal. Pueblo Springs used the proceeds to throw a beautiful Thanksgiving dinner for our residents, prepared by Chef Linke (husband to our OTR).

So many people came together to support therapy and therapy families, vendors, staff, residents, attendees, community partners and the Pueblo leadership team, showing the true spirit of CAPLICO. S pecial thanks to our fantastic Zumba instructors, Joan Adano from Hacienda Home Health, and a friend, Debbie Nieves. And thanks to Leony Henson from Sage Desert Assisted Living Facility for providing the molten chocolate cake with ice cream for dessert! Our residents appreciated everyone and loved the Thanksgiving dinner. 
Congratulations, Sarah Scott, SLP
Pointe Meadows, Lehi, Utah
By Kelly Alvord, Therapy Resource - Sunstone/Utah
Sarah Scott, our amazing SLP at Pointe Meadows, was awarded the distinguished Alumni Achievement Award at BYU. Below is a link to the article written about Sarah and her impact on the lives around her. We are grateful to have Sarah as part of our team because of her passion and influence as an incredible person and therapist.
Click here to read the complete article.  https://education.byu.edu/alumni/alumni-awards-2019
Congratulations, Carlos Pineda, PT
Our Newest CTO
By Lito Ortiz, Therapy Resource - Flagstone
Congratulations to our newest Chief Therapy Officer (CTO), Dr. Carlos Pineda PT, DPT, CEEAA. He is the Director of Rehab at Southland Care Center in Norwalk, CA, and the innovator of the Southland Octagon , created in order to have functional, skilled, and evidence-based group programming. Each bar was carefully measured to also allow for functional assessments such as the seated step test, functional transfer group and sit to stand group.  Click here for more information .
Welcome Aboard!
An Acquisitions Update
By Brian Del Poso, Therapy Resource
Growth in our organization is never a set goal, but, as you may have heard in the past, it is something that occurs when it makes sense for the organization. With the ever-changing post-acute world, we’ve been fortunate enough to transition a few new facilities into the Ensign family of affiliates. Over the past month or so, our leaders in the field, with the support of the Service Center, have welcomed 12 new Ensign-affiliated facilities where we can spread some CAPLICO love and impact the lives of a broader range of residents! 

On Nov. 1, we welcomed six facilities in the Keystone South Central market and one in the Flagstone-Touchstone 2.0 market. In addition, on Dec. 1, four more came on board from the Keystone North market and one from the Bandera-East market. Please join me in giving a warm welcome to our new therapy staffs and DORs!

Nov. 1, 2019 (Keystone South Central):
Hunters Pond — Led by Andy Cisneros, PTA
Keller Oaks Healthcare Center — Led by Amy Eccleston, SLP
Kirkwood — Led by Heidi Gulley, PTA
Pecan Valley — Led by Kasey Shaw, PTA
Treasure Hills — Led by Juan Benavidez, PT
Westover Hills — Led by Sonia West, COTA

Nov. 1, 2019 (Flagstone-Touchstone 2.0)
Channel Islands Post Acute — Led by Kenneth Marion, PTA

Dec. 1, 2019 (Keystone North):
Beacon Harbor — Led by April Trammell, SLP
Crestwood — Led by Casie Savage, PTA
Pleasant Manor — Led by Amy Thompson, COTA
Rowlett Health and Rehabilitation — Led by Dana Chatham, PT

Dec. 1, 2019 (Bandera-East):
Mission Palms — Led by Kathleen Deichert, OT
Hurricane Rehab Addition: We Love the New Rehab Space!
By Spencer Box, Construction PM – Hurricane, Utah
Please join me in welcoming Sunstone’s newest square footage. Hurricane has been planning for this addition for quite some time. They recently received all clearances to occupy their new space. This will dramatically impact Hurricane Rehab’s ability to offer more to their community and residents. 

The new addition includes:
        12 private patient rooms
        New therapy gym 
        Nurses station 
        New main lobby and bistro 
        New covered drop-off portico 
        Conference room 
        Three new offices 

Congratulations, Hurricane Rehab! We are excited to see what the future brings with this new opportunity.