Transcript Facility Monitoring - Disability Rights California

FACILITY MONITORING
October 30, 2008
Presenter: Theresa Gálvez, Chief
Patients’ Rights Advocate
Riverside County
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INTRODUCTION
The purpose of Monitoring Licensed
Health Facilities, County, Contract, or
Private Providers is to:
 Assure compliance with statutes and
regulations;
 Assure contract compliance;
 Provide feedback
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AUTHORITY FOR MONITORING
Facility monitoring for Patients’ Rights Advocates is mandated by
The California Welfare and Institutions Code, Section 5520 (b)
which reads:
 To monitor mental health facilities, services and programs
for compliance with statutory and regulatory patients’ rights
provisions.
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In addition, 5520 (d) reads:
To ensure that recipients of mental health services in all
licensed health and community care facilities are notified of
their rights.
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County contract boiler plates should include monitoring by the
Patients’ Rights Program.
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MONITORING
Monitoring is the systemic observation of a mental
health facility, its staff, its patients, and/or its records.
Monitoring is important because it provides
information about the way a facility functions.
Monitoring should include review of policies and
practices to ensure consistency with existing laws,
regulations, and court decisions. It will identify areas
of compliance and non-compliance and provides an
opportunity to provide technical assistance and
education.
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The development and use of a standardized form on which to
collect detailed and specific statutory, regulatory, or court
mandated case law decisions, directly related to the type of
licensed health facilities being monitored in the county, will benefit
you and the facility.
This will help the Advocate organize and standardize facility tour,
medical record review, review of written policy and procedures and
provides a format to prepare the report of findings.
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TYPES OF LICENSED HEALTH
FACILITIES
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General Acute Hospitals
Acute Psychiatric Hospitals
Psychiatric Health Facilities
Institutes for Mental Disease
Skilled Nursing Facilities
Mental Health Rehabilitation Center
Adult Residential Facilities
Group Homes & Community Treatment Facilities
Other: Day treatment/Partial Hospitalization, Jail
Inpatient, 23-Hour Emergency Crisis Services, special
contractors, etc.
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General Acute Hospitals
Title 22 C.C.R. Section 70001 et. seq., specific provisions
for the psychiatric unit, 22 C.C.R. Section 70575
These psychiatric units are located within or adjacent
to general acute care hospitals. They are separate
psychiatric units, which may or may not be locked.
They are licensed and regulated by the Department of
Health Services. They provide short-term care for
acutely ill patients, but do not provide care for
chronically ill patients on a long-term basis.
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Acute Psychiatric Hospitals
Title 22 C.C.R. Section 71001 et. seq.
These are freestanding, usually private, psychiatric
hospitals licensed and regulated by the Department of
Health Services. The regulations cover physical
space, staffing, records, service activities and
procedures with different, somewhat high standards for
psychiatric services than general acute care
psychiatric standards. Acute Psychiatric Facilities
(PHF) may be locked although there is no requirement
that they be locked and provide treatment on a shortterm basis.
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Psychiatric Health Facilities
(PHF)
Title 22 C.C.R. Section 77001 et. Seq.
These acute inpatient psychiatric facilities are licensed
and monitored by the Department of Mental Health,
Licensing and Certification Section. They are nonmedical facilities and are not licensed to treat patients
who are physically ill or chemically dependent. The
regulations for these facilities cover physical space,
staff, records, service activities and procedures.
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Skilled Nursing Facilities
(SNF)
Title 22 C.C.R. Section 72001 et. Seq.
Skilled nursing facilities provide 24 hour nursing
supervision for residents and are licensed and
regulated by the Department of Health Services.
The minimum services which should be available in
a SNF include: physician, skilled nursing, dietary, &
pharmaceutical services; activity program, special
disability resources/social services, transportation to
medical and therapeutic services and emergency
access to physician’s services. They are for the
individual requiring continuous nursing care but does
not meet requirements for acute hospital care or
home health care-related services
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Institutes for Mental Disease
(IMD)
Title 22 C.C.R. Sections 72001, 72443 et. seq.
These facilities are any inpatient facility that, under
federal criteria and guidelines, serves primarily mental
health patients. They are designated as IMD’s, are
typically long term nursing homes or facilities with 17 or
more beds. Counties contract with the facilities to
reimburse for basic services at the rate established for
Skilled Nursing Facilities and provide beds for
conservatees in exchange for patient fees (SSI) and
supplemental payments made by the counties.
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Skilled Nursing Facilities/Special Treatment Programs/
Institutes for Mental Health (SNF/IMD) are licensed and
regulated by the Department of Health Services.
Special psychiatric programming is certified by the
Department of Mental Health and covered under
Section 72443 et. seq. The regulations cover
physical space, staff, records, service activities and
procedures. In addition, federal law covering nursing
homes applies to these facilities.
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Mental Health Rehabilitation
Center (Title 9 C.C.R. Section 781 et. seq.)
These can be long term care facilities created under
legislation with the intent of providing innovative
programs with more individualized treatment for clients
in a treatment intensive setting. Nursing staff levels
are lower than those of SNF’s and other health care
settings. Unlike other treatment centers, MHRC’s are
licensed by the Department of Mental Health and
regulated in conjunction with local county mental health
authorities.
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Adult Residential Facilities
(B&C’s)
Title 22 C.C.R. Section 85000 et. seq.
These community care facilities provide services to persons who
need assistance with activities of daily living such as dressing,
bathing, receiving an adequate diet, etc. Residents may have
some functional disabilities, but should not require medical care
and supervision on a daily basis. Adult Residential Facilities are
licensed and regulated by the Department of Social Services,
Community Care Licensing. Regulations are very specific on
physical space, care provided, food, and provision of a Needs and
Services Plan for each resident.
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Group Homes
(Title 22 C.C.R. Section 84000 et. seq.)
Group homes provide 24 hour care and supervision
to seven or more children and/or adolescents in a
structured environment which is non-secured.
They are “community care facilities” licensed by the
Department of Social Services (DSS).
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Community Treatment Facilities
(CTF)
W&I Code 4094 et. seq. &Title 9 C.C.R. Section 1900 et. seq.
Community Treatment Facilities are secured residential
facilities which are governed by the above statutes and
regulations and are programs for seriously emotionally
disturbed minors and wards or dependents of the
juvenile court.
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REPORT OF FINDINGS
Should include the following;
 An introduction
 Explanation of the methodology, including a
description of the protocol and a copy of the tool
 Statement of findings-positive and negative
 Statement of relevant law
 List of recommendations
 Summary and conclusion, which includes a time
frame of response
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GUIDE
This presentation is a guide and serves as a reference.
If your Advocacy Program does not have tools it is
hoped that this information will enable you to develop
and/or adapt this information to fit the needs of your
Advocacy service for “Facility Monitoring”. You are
welcomed to use all or any part of the materials.
All counties licensed health facility categories vary
and some Advocacy Programs monitor outpatient
county programs and contractors.
Be creative and go forth!
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