DMR POLICY #: 89-10
DATE ISSUED: April 14, 1989
EFFECTIVE DATE: April 14, 1989

I. Family/Guardian Monitoring Process

The adequacy of supervision and quality of care provided within community programs is of major importance to all involved with the services. Staff, family members, the individual within the program each have a strong interest and investment in how well these services are provided.

Various mechanisms are currently in place to monitor and evaluate community services. The safety and general condition of the physical sites along with the adequacy of the services being provided are regularly evaluated by professional, trained staff. A missing element within this evaluation process however is the role of fami1y members. Although family members do participate in the development of ISPs and quality assurance review teams within a few Area Offices, there is no formal procedure to regularly access their input about programs.

Family members or guardians bring an important perspective to the monitoring process and a viewpoint unencumbered by established or minimal expectations. This perspective can substantially enrich the existing evaluation procedures by providing a heightened sensitivity to the needs of the individuals within the programs. For years family members and guardians have worked as effective advocates for quality services.

Through the establishment of Family/Guardian Monitoring Process, the Division of Mental Retardation wants to gain further information about quality of life issues and work to enhance the community service system. This process will provide the Division with a broader range of perspectives on how well services are being provided.

Members of the Family/Guardian Monitoring Process can serve to identify concerns that may be missed by existing procedures. These can include such things as how well the home blends into the neighborhood, are the residents participating in community activities, do they have input in decisions being made, how staff interact with the people receiving services. This process could also review selected items that may be monitored through other existing procedures. Although duplication of efforts needs to be avoided, family members or guardians observations about meals and food preparation, human rights or the quality of the environment for example would clearly be beneficial.

It is important to stress that the Family/Guardian Monitoring Process would serve as an adjunct to existing and newly developing quality assurance processes. It is not meant to duplicate or evaluate existing monitoring procedures. Its purpose will be to add to the current monitoring procedures the viewpoints of family members and guardians in specific areas of the services being provided. It is not meant to place family members or guardians in an adversarial role with programs. Rather it is hoped that this process will open communication and serve to enhance programs by providing an important perspective on services.

Information from the Family/Guardian monitoring visits will be incorporated into the overall quality assurance review process currently being planned for community programs. There are regional quality assurance coordinators and local service center program monitors proposed to be hired. This process is projected to be coordinated through these positions. (See Attachment A for a draft outline of proposed quality assurance procedures).

This policy defines procedures wherein monitoring by family members or guardians of residential programs is incorporated as a formal Departmental process. Principles to be observed while visiting programs are presented along with a family/guardian monitoring process model. Family members and guardians will continue to monitor the care and services provided to their own relative or ward. This proposed Family/Guardian monitoring process is designed to formally incorporate the views and recommendations a family member or guardian may make within the Department's monitoring of programs.

Principles

Since the programs which will be visited are also homes, it is important to observe the residents privacy. The process needs to respect and be sensitive to the rights of the individuals receiving services as well as the rights of their family members.

The following principles are presented as guidelines to be utilized during monitoring visits:

  1. The individuals receiving services and their families/guardian should be notified by the Department that this monitoring is a cooperative effort by all the parties involved.
  2. Residential programs are also, most importantly, homes. Every effort should be made to promote that atmosphere and to respect and preserve each individual's rights to privacy and personal dignity.
  3. Site visits may be both unannounced and conducted at varying times. The services being provided to the residents, however, should not be disrupted by these visits.
  4. In order to gain the most information, visits should be made when the residents are at home.
  5. Family members/guardians should not participate in this proposed monitoring process in order to evaluate their own relative's home. They should also not be employed by the residence being reviewed. It is felt that it would be difficult for the monitoring team to maintain their objectivity in those cases. Family members and guardians continue to be encouraged to visit their relative or ward in their home regularly and to contact service coordination or agency staff in the event of any concerns.
  6. Family/guardian monitoring teams will gain access to a great deal of information as a result of the review process. In order to protect the confidentiality of the individuals within the program and their families. Information gained through this monitoring should be given only to the Department, the provider agency and the administrative committees of the Family/Guardian monitoring process.

Family/Guardian Monitoring Process
The perspective of families/guardians and viewpoints which reflect the attitudes of local communities is lacking within established evaluation procedures. The goal of establishing a family/guardian monitoring process is to incorporate these views within the Department's oversight of programs.

During the monitoring visits, the overall ambience of the home, its appearance, atmosphere and sensitivity to the needs of the residents needs to be evaluated. Family members/guardians will visit program sites in pairs in order to broaden observations and share the administrative responsibility after the visit. Teams will be limited to two members to avoid overwhelming the program.

In order to assist the monitoring teams in completing a full review the attached checklist should be utilized (See Attachment B). This forms the basis for the monitoring visit, subsequent report and recommendations. The monitoring visit consists of observations made by the team as well as informal discussions with staff and clients during the visit. Members of the monitoring teams must complete the training which will be provided so that participants can become familiar with the survey guidelines and process before making their visits.

Structure
This process is expected to become a part of the quality assurance procedures developed for community programs. The Regional and Local Service Center quality assurance staff in conjunction with their respective Citizen Advisory Boards will be responsible for organizing and coordinating these family/guardian monitoring efforts. The Family/Guardian monitoring process is thus expected to become an important part of the program's overall quality assurance review. It will be incorporated into the established quality assurance procedures for all community programs to ensure that the recommendations and findings become a part of the program's review and receive an appropriate response (See Attachment A for a draft outline of the proposed quality assurance process).

All team members of the Family Guardian/Monitoring Process will be trained in the following areas before initiating monitoring visits:

  1. Basic guiding principles (1-6 described in the Principles section);
  2. Client/family confidentiality issues/Relevant regulations;
  3. Visiting procedures
    • what to look for
    • how to arrange for visit
    • goal of the visit
    • how to utilize monitoring tool
  4. How to write up report
    • positive and negative findings
    • recommendations for change
    • commendations
  5. Community system
    • description of areas and programs
    • description of other quality assurance mechanisms and functions.

The Regional and Local Service Center quality assurance staff will work in conjunction with their respective Advisory Boards to identify monitoring teams and implement the Family/Guardian Monitoring Process. Team members may include members of the Advisory Boards as long as at least one member of the team is a family member or guardian of a person with mental retardation.

If a program already has an existing review process it will be reviewed by the Local Service Center program monitor and Regional Quality Assurance staff in conjunction with their respective Advisory Boards. They will determine how it can best be incorporated into the Family/Guardian Monitoring Process piece of the quality assurance review.

Monitors have the option to make unannounced visits as noted in the principle section of these procedures. While surprise visits can be informative, they can also be upsetting to residents by interfering with their day-to-day routines. As a result, the great majority of visits by family/ guardian monitoring teams should be scheduled with provider staff. In this way, monitors can be assured that staff and residents will be home and that the visit would not be too disruptive. If monitors feel that an unannounced visit should be made to a particular program, they should inform the program monitor in the Local Service Center Office. A determination can then be made by the Local Service Center program monitor on the need for an unannounced visit and how it should be incorporated into the program's quality assurance review process.

Visits by the family/guardian monitoring teams will be coordinated to coincide with the program's quality assurance review. Each monitoring team will generate a brief report based upon the attached checklist (See Attachment B). Positive and negative findings will be identified along with commendations and recommendations for change. These reports will be sent to the Local Service Center program monitor to be incorporated into the program's quality assurance report.

A plan of correction will be developed for the program and monitored by the local Service Center Director in conjunction with Regional staff. Members of the Advisory Board for both the Regional Office and the Local Service Center will be active participants in both the quality assurance reviews of programs and the monitoring of plans of correction.


This information is provided by the Department of Developmental Services.