1 FACILITY MONITORING October 30, 2008 Presenter: Theresa Gálvez, Chief Patients’ Rights Advocate Riverside County

2 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

3 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. 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. County contract boiler plates should include monitoring by the Patients’ Rights Program.

4 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.

5 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.

6 TYPES OF LICENSED HEALTH FACILITIES 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.

7 General Acute Hospitals Title 22 C.C.R. Section et. seq., specific provisions for the psychiatric unit, 22 C.C.R. Section 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.

8 Acute Psychiatric Hospitals Title 22 C.C.R. Section 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 short- term basis.

9 Psychiatric Health Facilities (PHF) Title 22 C.C.R. Section et. Seq. These acute inpatient psychiatric facilities are licensed and monitored by the Department of Mental Health, Licensing and Certification Section. They are non- medical 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.

10 Skilled Nursing Facilities (SNF) Title 22 C.C.R. Section 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

11 Institutes for Mental Disease (IMD) Title 22 C.C.R. Sections 72001, 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.

12 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 et. seq. The regulations cover physical space, staff, records, service activities and procedures. In addition, federal law covering nursing homes applies to these facilities.

13 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.

14 Adult Residential Facilities (B&C’s) Title 22 C.C.R. Section 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.

15 Group Homes (Title 22 C.C.R. Section 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).

16 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.

17 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

18 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!