A Review of Selected Quality of Care Issues at Hudspeth Regional Center
Executive Summary
Introduction
In response to a legislative request, the PEER Committee reviewed selected quality of care issues (specifically, clients’ personal hygiene and inventory controls over clients’ personal belongings) at Hudspeth Regional Center. PEER conducted the review pursuant to the authority granted by MISS. CODE ANN. Section 5-3-57 et seq. (1972).
The requesting legislator expressed concern over allegations that Hudspeth Regional Center’s direct care staff were not providing adequate assistance to clients with physical care and personal hygiene, including bathing, grooming, and toileting, and that Hudspeth staff could not account for clients’ clothing items.
In response to this request, PEER focused its review on:
Because the complainant alleged that the problems with personal hygiene and inventory control were occurring on the campus of Hudspeth Regional Center, PEER limited its observations to the center. Also, while PEER only observed clients on two occasions, PEER staff reinforced assurance of the level of care being provided to Hudspeth clients by reviewing policies and procedures for care of residents, direct care worker staffing levels, training for direct care staff, complaint handling, and inventory control.
Background
The Hudspeth Regional Center at Whitfield is an intermediate care facility for the mentally retarded (ICF/MR), one of five such facilities operated in Mississippi by the State Department of Mental Health’s Bureau of Mental Retardation. Hudspeth serves twenty-two counties in central Mississippi and provides twenty-four-hour care to 281 clients residing on the center’s campus and provides services to another 1,430 clients through community services.
As is the case at other ICF/MR centers, direct care staff have the daily responsibility to manage, supervise, and provide direct care to individuals in their residential living units. According to federal regulations, direct care staff may also include professional staff such as nurses, social workers, and other support staff, if their primary assigned daily function is to provide direct care of clients’ daily needs.
Hudspeth’s direct care staff have a significant impact on the daily personal hygiene of the clients who reside on the grounds as part of the Campus Program. Direct care staff also have contact with clients’ grooming and clothing items through daily interaction with clients.
Conclusions
Does Hudspeth Regional Center provide for and monitor assistance with clients’ daily personal hygiene?
Yes, based on PEER’s observations of Hudspeth’s clients in their daily environment, the direct care staff’s preparation of clients for daily activities, and a review of the center’s policies and procedures for direct care staff training, staffing ratios, and complaint handling.
PEER conducted two unannounced inspections at Hudspeth Regional Center’s Campus Program. PEER observed the condition of Hudspeth clients’ personal hygiene in their regular environment at the center on March 7, 2005. PEER also observed the morning preparation (e.g., bathing, grooming, dressing) of Hudspeth clients on March 9, 2005, to determine the contribution of Hudspeth’s direct care staff and other staff to clients’ personal hygiene.
Based on the above inspections and reviews, PEER concluded that the Hudspeth Regional Center provides the proper assistance with and monitoring of clients’ daily personal hygiene. Hudspeth’s policies and procedures prescribe a planned daily routine for direct care staff in assisting clients with personal hygiene.
Regarding training, Hudspeth has developed and implemented a training program that supports and prepares direct care staff in providing assistance with clients’ personal hygiene. PEER verified that Hudspeth Regional Center provided the federal- and state-mandated courses for its staff multiple times in FY 2004. Also, within PEER’s sample of twenty direct care staff, all workers had completed the new employee orientation program and seven of the twenty direct care staff who completed orientation prior to PEER’s review period had completed an average of three hours per month of additional classroom training.
Regarding staffing, according to staffing records for the two days of PEER’s inspections, as well as two days on the preceding weekend, the center met or exceeded the recommended staffing ratio of 1 direct care staff employee to 3.2 clients over a twenty-four-hour period.
Hudspeth Regional Center has developed and implemented a system for identifying, investigating, and processing complaints related to alleged neglect, abuse, or mistreatment of Hudspeth clients. None of the complaints filed from January 1, 2004, through March 1, 2005, related to clients’ personal hygiene.
Has Hudspeth Regional Center implemented an adequate system of inventory control over clients’ clothing and personal belongings?
Although Hudspeth Regional Center staff label clients’ clothing and grooming/personal care items, the staff could not provide a record of the location of clients’ clothing that was not in the clients’ closets on the dates of PEER’s inventory audits.
Federal regulations require intermediate care facilities to ensure that clients have the right to retain and use appropriate personal possessions and clothing and to ensure that each client is dressed in his or her own clothing each day.
PEER conducted clothing inventory audits at three Hudspeth cottages on March 9 and April 11. On those two dates, PEER found that clothing and grooming/personal care items had been labeled with clients’ names. However, on those dates Hudspeth staff could not provide a record of the location of client’s clothing that had reportedly been sent to the laundry.
Additionally, PEER found that Hudspeth does not complete an annual audit of each client’s belongings to compare the items in the client’s closet or in storage to the master record of inventory. Since federal regulations state that clients have the right to retain and use appropriate personal possessions, it is important for Hudspeth Regional Center to have a system in place to protect client’s personal belongings. PEER acknowledges that taking frequent inventories of clients’ belongings and recording items sent to the laundry on an individual client level must understandably be assigned a lower priority than the primary task of caring for Hudspeth’s clients. However, Hudspeth’s staff could improve the current inventory control procedures to provide better protection of clients’ personal belongings.
Recommendation
Hudspeth Regional Center should require the Clothing Coordinator to complete an annual audit of each client’s belongings to ensure accountability for all items included on the master record of inventory. This would include all items in the client’s closet, seasonal items that might be in storage, items given to the seamstress for repair, and items sent to the laundry. The Clothing Coordinator could audit a specific number of clients each month to ensure that each client’s belongings are audited annually.