29222 Rancho Viejo Rd, Ste 127
San Juan Capistrano, CA 92675
March 2020

How Do You Spend the First Hour of Your Day? 
Your morning routine can have a dramatic impact on your mood, your energy, your health, and even your overall life success. Our Clinical Market lead for Kansas, Maureen Purvis, walked our Nurse Leaders through the six steps of Hal Elrod’s Miracle Morning at the Annual ED/DNS meeting this year: Silence, Affirmations, Visualization, Exercise, Reading and Journaling. Maureen suggested starting with a few moments of each and working your way up to a full hour. The night owls out there may need to adjust their clocks to get to bed a bit earlier, but the results of doing so can truly be dramatic.

Chances are, if you study the life of a successful person, it most likely starts with a powerful morning platform. There is something truly magical about the mornings that can have a big impact on how we show up for our teams. For those of you trained in Heart Rate Variability (HRV) training, this is also the perfect time to get your neurological system into a state of coherence before you visualize or set your goals for the day. Daylight Savings Time starts March 8 — this is the perfect time to kick the grumpy, sleepy side of you to the curb and adopt a new morning routine! We can’t wait to hear your results!  
Leaders Made Here
Submitted by Chad Long, Therapy Resource
For those of you who have never had a chance to meet Tyler “TJ” Petty, DOR at Montecito Post-Acute and Rehabilitation in Mesa, AZ…you should. 

TJ is a leader full of charisma, compassion and focused on moving his team and facility forward in a CAPLICO manner. He started his journey with Montecito in 2008 as a PRN Physical Therapist, then a full-time staff member in 2009 and has been the DOR since 2010.

Over the last 10 years, TJ has developed a dynamic therapy department in a very successful facility. Montecito has grown to an average census of 190 with 100 skilled patients. It is also a large Ventilator and Trach-dependent facility caring for acutely ill patients and fragile LTC residents, boasting 156 admissions and discharges per month! I was able to ask TJ a few specific questions about his views on Leadership in order to gain a little insight into the success of Montecito: Read On...
From Ultra "High" to Ultramarathon
By Dennis Baloy, OTR/L, OTD/DOR,
St. Elizabeth Rehabilitation, Fullerton, CA
...I am an average joe. I hated running and could barely run a mile. My knees would start hurting, and it just didn't feel right. I know as a therapist, there are countless full-body workouts I can do to achieve the physical fitness that I want. But one thing I know about myself is I am always up for the challenge — physically and mentally. There is an inner adventurer in me wanting to experience life to its fullest. I love sunshine, the oceans and the outdoors. I can be a very laid-back person, yet I can switch it on to be a very competitive one. 
So why do I run, and why run an ultramarathon ? Read On...
By Julie Uychiat, Clinical Market Lead - Arizona
Discovering running at a much later stage in life has been the greatest gift life has given me. It came at a perfect time when I needed a lift, to be reminded of my life’s purpose and overcome my self-imposed limitations. Running has given me everything … my renewed self-love, my self-confidence, my fearlessness, my grateful attitude and my purpose. It has inspired my new direction and outlook. It has taught me to push forward when things get difficult. In return, I am giving it my heart ...I believe in Hal Elrod’s Miracle Equation: Unwavering Faith + Extraordinary Effort = Miracles.  My marathon journey is a true testamen t to this. In fact, this equation applies to every other area in our lives. We just need to first believe that WE.ARE.LIMITLESS and put forth the effort to see the miracles happen. Read On...
PDPM Lessons Learned
Section GG
 By Jennifer Raymond, Therapy Resource - Northern CA
During a recent NorCal Weekly DOR call, a question came up that prompted discussion regarding how Section GG scores are being determined when there is a discrepancy between Nursing and Therapy.  
When we have differences between Nursing and Therapy scoring for GG, this must be reconciled per the RAI MDS manual criteria by answering the following question:
“What is the usual/baseline performance (days 1, 2, 3) BEFORE therapeutic interventions occurred?”
We cannot average or modify the assist levels that have been documented but instead through discussion and chart review need to determine which of those scores best represents the “usual/baseline performance” for this patient before the onset of any therapeutic intervention.  Read On...
Group Therapy
Drumming Group at Westover Hills - Giving Our Residents a Reason to Love Life
Submitted by Andy Cisneros, DOR, Westover Hills, San Antonio, TX
Westover Hills has fully embraced the drumming groups. We had two-thirds of the residents in the building at our group today, at a headcount of 64 residents. We played music to help set the stage and bring energy to the room, and following with the theme of Mardi Gras, we played zydeco music. What is heard on this clip is something near and dear to the hearts of south central Texas: Selena. February 26 marks the 25th anniversary of her performance at the Houston Rodeo. It was one of her last and arguably most iconic moments.
Here's an Idea for Corn Hole Toss
Submitted by Seth Anderson, ED, Pinnacle Nursing & Rehabilitation, Price, UT
Cornhole Toss is one of the best group therapy interventions, with high participation and providing skilled intervention.

We found an online company that will add your facility logo for a good price . Here’s the link. There is a 15% off code on the front page, so using that, it ends up being around $190. You have to sign up for a free trial to get free shipping.
Highlights on Nursing and Therapy Partnership
5 Strengths of a DON/DOR Team           
By JB Chua, DOR, PT, CEEAA, Summerfield Healthcare, Santa Rosa, CA
“If you play for the name in front of the jersey, then everybody will remember the name on the back.”
— Sherwood Bassin

I did a book review with one of my employees this month, and we read The 5 Dysfunctions of a Team by Patrick Lencioni. After I finished the book, I reflected on these dysfunctions and how my relationship with my coworkers is, specifically with my Director of Nursing, Enedina De La Cruz. I am so proud to realize that we have overcome all these dysfunctions, and I would like to share the strengths (antonym of dysfunction) that we possess. Hopefully, it will serve as an inspiration to some of our partners. Read On...
Cluster Meetings DOR Involvement
Submitted by Rachel (Ray) Yarman, DPT/DOR, City Creek Post Acute,
Salt Lake City, UT
Roughly 1.5 years ago, the Seal Team Cluster from Utah started to include the DORs in cluster meetings. As the most novice DOR in our market, I was honored to be invited and to learn in a real cluster approach. I am lucky to have two other very strong and knowledgeable DORs in my cluster. Prior to our cluster meetings, I had a very difficult time coordinating learning from other DORs, or physical therapists in our market or cluster.

Our cluster meetings started out with mostly timidness from our DORs: learning, listening and digesting information. We all review therapy outcomes with our resource and have discussions about our building with the influence of DONs/EDs. We additionally review facility outcomes across the milestone market as a means of accountability. Learning about the financials of the building and seeing how therapy plays a role in the success of the buildings allowed us to have some crucial conversations. Our meetings have fostered a large amount of trust with one another. The trust that we now have is the building block of being able to have discussions at the table to celebrate, challenge and think big together to work to dignify long-term care.  Read On...
Passion for Learning
Endura Gets Ready for IDDSI Diets
Submitted by Elyse Matson, MACC/SLP, SLP Resource
We had a wonderful gathering of our SLPs and Dietary Managers in the Endura Market. Our Endura Dietary Resource, Emily Clark, led the training, which focused on what the IDDSI diets are and how to implement them. Erica Gradwell from Simply Thick explained the basics of the program before we got into the details with IDDSI. The consensus was that this is a huge change from the national dysphagia diets, but we look forward to the new system, which will create congruence across settings so our patients will be safer. We look forward to Endura being our test market for this new diet system. Stay tuned!
A Journey for a Passion for Learning
Submitted by John Patrick Diaz, DOR/DPT, CEEAA, RAC-CT, Magnolia Post Acute Care, El Cajon, CA
My journey with Ensign started five years ago when my current ED, Matt Oldroyd (shoutout for recently achieving the title of CEO) gave me the opportunity to be part of his team. Parkside was part of the huge acquisition that occurred in 2014 here in San Diego, where part of the transition was to hire new staff to complement previous staff who stayed on. He gave me a start date, which I begged to delay for a week as I was planning to attend the American Physical Therapy Association’s (APTA) Combined Sections Meeting (CSM) that was to be held in Indianapolis. This has been an annual commitment that I have made since being a member of the association and the Academy of Geriatrics. When he allowed me to start after my trip, this gave me the reassurance that I did make the right decision, considering that I would be working with an ED who supports my passion for being a lifelong learner in pursuit of clinical excellence. ... This year’s event was more meaningful to me, as the Academy of Geriatrics rebranded and created a video depicting the importance of the population we serve. With the changes that have occurred since October 2019, we all have tried to embrace and change our mindset on how we can meet the needs of our long-term population. I firmly believe that we all have the foundation to make a difference and be influential in making aging an intentional and meaningful experience for our patients. Gone are the days where aging was considered as something passive with the stigma of, “Once I enter the nursing home, that’s it for me.”  Read On...
Sharing the SLP Love
Submitted by Jennifer Raymond, Therapy Resource - Northern CA
(Pictured Left) Elyse Matson, MA CCC-SLP, Speech Language Pathology Resource/Ensign Services, provided an onsite half-day training course in January for the Flagstone NorCal Market Speech Language Pathologists and DORs.

The training content focused on how PDPM has changed SLP practice, including review of PDPM and SLP case mix, use of group and concurrent therapy, clinical documentation for both skilled and LTC patients, coding/goal writing, standardized testing, Medicare Part B utilization, dementia treatment utilizing Abilities Care, and the latest evidence-based practice and treatment techniques.

Since all of the SLPs in the NorCal market work independently in their facilities and many of them are geographically far apart, these therapists rarely are able to collaborate with each other in person. The course was an opportunity for them to meet face-to-face (some for the first time), share a meal, ask questions and discuss best practices with their colleagues, and update their learning together...  JB Chua, PT/DOR for Summerfield, shared: “Attending the SLP training course gave me tools on how to support my SLP in growing our program. It gave me insight on what to look for during our Daily Technical Meeting. Triggers that will make me ask my SLP to screen a particular patient to help us capture an accurate clinical picture of our patients. Lastly, it also helped me understand words/phrases that SLPs use that a PT seldom or never uses in their documentation. Overall, this training course is highly recommended not only for our awesome SLPs, but most especially for DORs without an SLP background.”  Read On...
Use of Modalities for Pain Management
Submitted by Sacchin Bhatia, Therapy Resource - Touchstone
Touchstone 2.0 therapists recently attended a pain management class with our local ACP consultant on the use of modalities for pain management in our residents. This is an area that some of our buildings have really tapped into for management of pain with great results with non-pharmacological interventions. The class went over the use of ultrasound, diathermy and electrical stimulation for management of pain, including precautions, contraindications and proper use for management of our residents. There were about 40 participants from six different facilities and there were positive reviews. Several of our facilities have started a leasing contract with ACP due to the research-based outcomes on their equipment, the built-in education that ACP provides, and the support for management of individual cases. Several buildings have already implemented modalities for management of pain in LTC residents to help improve QM. 
Orem Presents Lymphedema Recovery Suggestions for SHALL
Submitted by Mark Walker, DPT, DOR, Orem Rehabilitation, Orem, UT
Sandra Rivero, MOT, OTR/L, CLT, (L) and Catherine Sherwood, PTA, CLT, (R )of Orem Rehabilitation and Skilled Nursing, were invited to present at Utah Valley Hospital support group for lymphedema and lipedema. The support group has a Facebook page called “Support and Help Alongside Lymphedema & Lipedema,” or SHALL , whose members meet once a month about various topics relating to lymphedema and lipedema. Members can either watch live using their Facebook account, appear in person at the hospital or watch the recorded version on their Facebook page.

Sandra and Catherine focused their presentation on how these diagnoses affect recovery from total knee and total hip surgeries. For example, general information of how to prepare before surgery, risk factors and added risk factors that will be involved when having these diagnoses combined with these surgeries, post-surgery suggestions that included home exercise programs for both surgeries, and an introduction to adapted equipment to assist with Activities of Daily Living. Throughout the presentation, the importance of including physicians’ approval to open a dialogue of the recovery process with their lymphedema therapist was highlighted. Also, fun examples were incorporated to lighten the conversation, and presented the information in layman's terms, to educate the general public who have a variable range of knowledge about this subject. Both therapists enjoyed the experience, not only to market their knowledge about the subject at the hospital, but also to teach proven strategies to the general population.
They're ENspired!
ENspire is Ensign’s seed money grant program designed to support therapy graduate students who want to elevate evidence-based therapy practice in post-acute rehabilitation and dignify long-term care in the eyes of the world. Students can apply at: https://ensigntherapy.com/enspire/ . Two grants were awarded this quarter to OT graduate students at Dominican University in San Rafael, CA. Guided by our Gina Tucker-Roghi, OT, ACA Therapy Resource and Faculty Advisor, the students provided research and program development for the following projects:
         Implementing Environmental Modifications to Enhance the Dining Experience for Individuals with Dementia in Skilled Nursing Facilities
The purpose of this project is to explore and examine existing research related to environmental modifications, both physical and social, that can enhance the dining experience in SNF settings. Our collaborative partner from Legend Oaks Healthcare Rehabilitation in New Braunfels, TX, will provide the program participants. (Read the full transcript here.)
        Volunteer Training Program to Enhance Engagement in Meaningful Activities for Residents with Dementia in Skilled Nursing Facilities
Dementia is an increasing public health concern impacting much of the worldwide population with behavioral changes and disturbances, need for around-the-clock-care in advanced stages, significant care costs, and an unpredictable course of progression. As the prevalence increases, many individuals with dementia (IwD) are admitted to skilled nursing facilities (SNF). After admittance, the rate of caregiver visits declines, increasing the risk of social isolation of IwD. The purpose of this Dementia Volunteer Training program is to decrease social isolation by providing opportunities for volunteers to engage in meaningful occupations with IwD, which would increase visit satisfaction and frequency. T he project will be implemented at the Summerfield Healthcare Center in Santa Rosa, CA. (Read the full transcript here.)
Dry Needling Success Stories
Submitted by Adam Krahl, PT, The Healthcare Resort of Plano, Plano, TX

(Note: check with your Therapy Resource and verify with your State Practice Act before implementing a Dry Needling Program) 
We are continuing to see amazing results from dry needling here in Plano! Here are a few success stories from this week:
JH: Outpatient: Marine Corps Sergeant, Vietnam combat vet. L knee pain for 2-3 years. Patient reporting 4-5/10 pain, mostly with walking and standing. Was skeptical and joked that he would just tell me it worked so he didn’t hurt my feelings. After L knee needling session, he reported one spot where the sharp pain lingered and was able to pinpoint the location. Needled again at the point of pain. Patient stood up and walked and reported no pain. He stated that he couldn’t wait to do his ankle. Two days later, he returned and reported that he still did not have any pain.
KW: Outpatient: patient from two weeks ago who experienced two years of constant burning pain (6-7/10) in her knees and had recent rhizotomy to correct without success. Still pain-free after needling two weeks ago. Patient referring two of her church friends to us for back pain.
CN: Inpatient: Osteoporotic patient with dx of recent compression fractures — multiple thoracic and lumbar levels. Very apprehensive of needling. We had been discussing it for a few weeks. Patient finally allowed me to needle her back. Patient had significant reduction in pain and has been able to tolerate sessions, and her gait distance went from 150 feet with c/o pain to 350 feet with minimal pain in one day. Needling was performed early this week, and patient reported that the pain improved even more over the next 48 hours.
TC: Inpatient: 59-year-old MS patient with severe deconditioning and pain. Patient reporting severe pain in lower back and B traps. Needled lower back and upper traps. Patient reporting significant reduction in her low back pain and traps resulting in improved tolerance with PT and OT.
RB: Inpatient: A long-term-care resident of this facility with severe R knee pain due to years of working construction and trauma. Patient previously mod I using FWW and walking around the facility. Patient’s knee pain was so bad he had started using w/c. One needling session to R knee, and patient was able to get back out of wheelchair and return to ambulating with FWW.
JA: Outpatient: Pt had a needling session last Thursday for R knee and R hip OA pain. Patient text-messaged me on Saturday and reported that he was experiencing the lowest pain levels he has felt in several years. Patient eager to have another needling session today so he can enjoy his weekend without pain. Patient reports significantly improved QOL on the weeken ds due to not having pain.
Super Recruiters at Work Here!
Pictured L to R: Jenny Kuehn, DOR/CTO-Villas at Sunny Acres, Maryann Bowles, Therapy Resource-CO, and Jamie Funk, Therapy Recruiting Resource . Congratulations for a job well-done covering our booth at APTA Combined Sections Meeting in Denver, CO. They met and talked to over 300 PTs and PTAs, and thanks to their efforts, we have 289 new prospects in our therapy applicant tracking system!  
VASA Celebration
Submitted by Jenny Kuehn, PT, DPT, WCC, DOR/CTO Villas at Sunny Acres,
Thornton, CO
Showing off the artistic abilities of our team! To celebrate having the highest group/concurrent percentages in December and January, we attended a “Sip and Paint” class. Since PDPM dropped in October, some staffing shake ups, and me tearing my ACL, as a department we have been a little stressed. It was great to just enjoy each other as a team. This happened to coincide with our new COTA’s first day, so it was a fun welcome for her!
Loving One Another
Endura DONs Sharing the Love
Submitted by Kimberly Halper, DON, Colorado 
In an attempt to get Ridgeview ready for acquisition, these wonderful ladies dedicated an entire day to entering orders. I am happy to say, other than telephone orders and the three admits they have done in the last two weeks, all orders are entered. There was a lot of hard work that went into this, and I honestly would not have gotten this done without them. Not pictured here is Angel Burnham, who helped me two other half days to get this project done! So thank you for going out of your way (about 60 miles out of your way for Shannon Collins, Alissa O’Neal and Kelli Dossett )! Stacey Cross is going to do wonderful things with this building and has a great start to that now!
Resident Portraits
Submitted by Chase Gunderson, ED, Owhyee Health & Rehabilitation, Homedale, ID
Our nurse manager, Rita, did something for our residents and their families that meant so much to them. I just wanted to share because it's something that is easily done and means so much. She took portraits of each resident that wanted one and printed a copy for them and for their families. Here's a link to a video to see some of them. The video only has the portraits of the residents who signed the appropriate release, but almost all of them wanted them done for their families. There are so many things we can do to make a difference, and this had an enormous impact on everyone. I would highly recommend doing it!
AR Blitz at Provo
Submitted by Stacey Keith, Sunstone AR Resource, Provo, UT
We had an AR blitz at Provo Rehabilitation yesterday, and we got a lot accomplished as a group. Just wanted to say thanks to everyone for taking time to come together and help out your fellow partners. This is something that I would like to do every couple of months to help bring our BOM team together. See picture below, working hard or hardly working! ☺
ALF Love
Submitted by Jenny Kuehn, PT, DPT, WCC, DOR/CTO Villas at Sunny Acres,
Thornton, CO
Sarah Peterson, our LSVT BIG certified OTR started BIG Wednesday in the ALF! It’s an exercise group with LSVT BIG components. It’s been amazing showing the ALF some love and we had some great attendance!
CNA Appreciation
By Mark Walker, DPT, DOR, Orem Rehabilitation, Orem, UT
I know we were all thinking of our significant others on Valentine’s Day, but we took a moment and shared the love for our hard-working CNAs and nursing staff. Our team wanted to set a goal of showing more appreciation for staff this year, so each week we try to do something unexpected and a small gesture of appreciation. This photo was taken when I found this at CNA stations and in the break room from Lindsey, our PRN PTA. She grasps the importance of this idea and couldn’t care less about being recognized for it. I challenge all you amazing therapy teams to do something out of love for our nursing staff this week, and then share with all of us.
Getting Involved With Community Partners
Submitted by Mark Walker, DPT, DOR, Orem Rehabilitation, Orem, UT
Orem Rehab was invited to present at the Quality Improvement Network meeting held at American Fork Hospital. Other SNFs, home health and other health care providers were invited to attend. Orem was selected to present because we were noted to have a remarkable length of stay and hospital readmission rate for the BPCI patients that had been admitted to our facility. We were invited to share best practices that we believe attributed to such low length of stay, without sacrificing readmission. 

Ashton Casper, ED, and Mark Walker, DOR, educated the attendants on our process of our morning technical meeting and recently implemented clinical meetings held every morning. More detail was presented about our clinical meeting, in which we discussed new admits, 24-hour reports, and any abnormal clinical reports that require intervention, such as falls, infections, etc. It was a great opportunity to share our best practices that aren’t only utilized with this patient population, but across the board for all admits to our facility. We encourage all facilities to seek out opportunities to collaborate and get involved with community partners and share our values and best practices that set us apart from our competitors.
On March 1st the ENDURA team had the privilege of adding Irondale Post-Acute and Ridgeview Post-Acute to the family. 
Irondale is a 95 bed SNF located in Commerce City, Colorado. The team is led by ED Keith Englade, DON JayLee Davison, and TPM Dena Newberry-Meyer PTA.
Ridgeview is a 105 bed SNF with a 20 bed locked unit in Commerce City, Colorado. They are led by ED Jon Creason, DON is Stacey Cross, and DOR is Nicole King, SLP.