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5#5 ervice Ca,a6ility of an Acte-Chronic Psychiatric Care Facility:
5#5#5 Provides medical service+ nrsin. care+ ,harmacolo.ical
treatment and ,sychosocial intervention for mentally ill,atients5
55 The health facility shall render 7ality health services a,,ro,riate to thelevel of care 6ein. ,rovided5
SER%ICE A%AILA&ILITY
2" if Availa6le4 REMAR+S
Gene#"l A,$init#"ti-e
Se#-ice
Clinic"l Se#-ice'edical and Psychiatricervices
Crisis 3ntervention
Nu#in. Se#-ice
Psychiatric Nrsin. Care
Ancill"#/ Se#-ice
Psychosocial ervices 8
Referral ervices
'edical-r.ical ervices
Dental ervicesClinical La6oratory
Radiolo.y
8 For ,sycholo.ical evalation of ,atients+ affiliation &ith a service ,rovider is allo&ed5 A memorandm of a.reement &ith the service ,rovider mst 6e secred as a ,rere7isite for licenseto o,erate5
An or.ani/ational chart is ,laced in a location readily seen 6ythe ,6lic5 ) * 9es ) * No
The health facility has docmented ,olicies and standardo,eratin. ,rocedres for the follo&in.:(eneral Administrative ervice ) * 9es ) * No
Clinical ervice'edical and Psychiatric ervices ) * 9es ) * NoCrisis 3ntervention ) * 9es ) * Nose of Restraint ) * 9es ) * No3solation of Patient ) * 9es ) * NoPatient Trans,ort"Condction ) * 9es ) *No
Nrsin. ervice
Psychiatric Nrsin. Care ) * 9es ) *
No Ancillary ervicePsychosocial ervices ) * 9es ) * NoReferral ervices ) * 9es ) * No
5$55 (eneral Administrative ervice
Ne& ,ersonnel receive an orientation ,ro.ram that covers theessential com,onents of the service 6ein. ,rovided5
) * 9es ) * No
Dties and res,onsi6ilities of the ,ersonnel are identified and
docmented5 ) * 9es ) * No
5$5$5 Clinical ervice
Personnel to deliver care are availa6le for ! hors5) * 9es ) * No
All e7i,ment+ medicines and s,,lies necessary to ,rovidecare are availa6le5 ) * 9es ) * No
The se of restraint is covered 6y doctor;s order5) * 9es ) * No
Nrsin. care is ,rovided at all times5 ) * 9es ) * No
A Nrsin. Procedre 'anal and a ,ro,erly tili/ed <arde=are availa6le in all ,atient care nits5Nrsin. Procedre 'anal ) * 9es ) * NoPro,erly tili/ed <arde= ) * 9es ) * No
The delivery of nrsin. care tili/es the nrsin. ,rocess5
The health facility has a docmented ,sychosocial ,ro.ramfor ,atients+ delineatin.+ amon. others+ the ,ro.ramo6ectives+ activities and res,onsi6ilities of ,ersonnel5
) * 9es ) * No
5!55 Disaster 'ana.ement
The health facility has a docmented emer.ency and disaster mana.ement ,lan5 ) * 9es ) * No
5!5$5 Hman Resorce Develo,ment
The health facility im,lements a hman resorcedevelo,ment ,ro.ram that identifies+ ,lan+ facilitate andrecord trainin. and edcation for all ,ersonnel5
) * 9es ) * No
An a,,raisal system identifies and revie&s the effectivenessand a,,ro,riateness of the trainin. ,rovided5
) * 9es ) * No
5!5!5 ality 'ana.ement
The health facility has an esta6lished+ docmented andmaintained 7ality mana.ement ,ro.ram that reflectscontinos 7ality im,rovement ,rinci,les5
) * 9es ) * No
There is an e=ce,tion re,ortin. system that incldes therecordin.+ re,ortin.+ investi.ation+ analysis+ corrective actionand revie& ,rocess for adverse+ n,lanned+ or nto&ardevents sch as:
Accidents+ incidents+ near misses+ and adverse clinical events
$5#5 The health facility a,,oints and allocates ,ersonnel &ho are sita6ly7alified+ s?illed and"or e=,erienced to ,rovide the service and meet,atient needs5
$5#5#5 @ach ,ersonnel is 7alified+ s?illed and"or e=,erienced toassme the res,onsi6ilities+ athority+ acconta6ility and
fnctions of the ,osition5 ) * 9es ) * No
$5#55 Professional 7alifications are validated+ incldin. evidenceof ,rofessional re.istration"license+ &here a,,lica6le+ ,rior toem,loyment5 ) * 9es ) * No
$5#5$5 An or.ani/ed medical and nrsin. staff shall 6e res,onsi6lefor the 7ality of ,atient care and for the ethical condct and,rofessional ,ractices of its mem6ers5 ) * 9es ) * No
POSITION RE3UIREMENT COMPLIANCE
2" if Com,liant4
STATUS 2FT if
Fll Time4 2PT if
Part Time4
REMAR+S
Gene#"l
A,$init#"tie Se#-ice
Administrator #
Administrative Assistant #
Coo? (May becontracted out)E
#
Driver (On call and May be contracted out) F4
#
Landry Gor?er (May be contracted out)E
#
E A contract of service or memorandm of a.reement &ith a service ,rovider mst 6e secred as a
,rere7isite for license to o,erate5
F4 The Driver refers to the driver of the Patient Trans,ort Behicle5 3f the services of the Driver arecontracted ot+ there mst 6e a contract of service or memorandm of a.reement 6et&een the Driverand the health facility5
8 A 1oard Certified Psychiatrist is a di,lomate or fello& of the Phili,,ine Psychiatric Association5
8 3f there is already a flltime Psychiatrist+ he"she may also act as the fll time Physician5 Ths+another flltime Physician is no lon.er re7ired5
Nu#in. Se#-ice
Re.istered Nrse #:! 6eds"shift 8
Nrsin. Attendant #:# 6eds"shift 8
8 For all ,ersonnel re7irements e=,ressed as a ratio 2e5.5 #:! 6eds4+ an e=cess of not more than
%0I of the nm6er of 6eds in the ratio &ill 6e allo&ed5 For e=am,le: if the health facility has # to !6eds+ one Re.istered Nrse ,er shift is re7ired5 3f the health facility has % to $J 6eds+ oneRe.istered Nrse ,er shift is re7ired5 3f the nm6er of 6eds is $K 2the e=cess nm6er of 6eds is
more than %0I of !4+ an additional Re.istered Nrse ,er shift is re7ired5
Ancill"#/ Se#-ice
Re.isteredPsycholo.ist (Full
#
E The Psycholo.ist mst have at least t&o 24 years of relevant e=,erience5
ASSESSMENT TOOL FOR LICENSING AN ACUTE-CHRONIC PSYCHIATRIC CARE FACILITY
Name of Health Facility :
Address of the Health Facility :
1( E3UIPMENT6INSTRUMENT
!5#5 All e7i,ment and instrments necessary for the safe and effective,rovision of services are availa6le and are ,ro,erly maintained5
!5#5#5 Records of e7i,ment are maintained and ,dated re.larly5) * 9es ) * No
!5#55 A ,reventive maintenance ,ro.ram ensres that alle7i,ment are maintained and"or cali6rated to an a,,ro,riatestandard or s,ecification5 ) * 9es ) * No
ITEM RE3UIREMENT COMPLIANCE
2" if Com,liant4
CON!ITION2" if ervicea6le4
REMAR+S
Gene#"l
A,$init#"ti-e
Se#-ice
@mer.ency Li.ht #
Fire @=tin.isher #
Patient Trans,ortBehicle (Available for 24 hours) 8
#
ecred Filin. Ca6inet #
Ty,e&riter"Com,ter #
8 The Patient Trans,ort Behicle may 6e contracted ot5 3f contracted ot+ the vehicle mst 6e availa6lefor ! hors+ altho.h not necessarily &ithin the ,remises of the health facility+ and the health facilitymst have a Contract of ervice or 'emorandm of A.reement &ith the o&ner of the vehicle5
Protective devices are sed on doors and &indo&s:Gard ) * 9es ) * NoO6servation Room ) * 9es ) * NoNrse tation ) * 9es ) * No
%5%5
Toilet
ecrity
) * 9es ) * No
The health facility ensres the secrity of ,erson and ,ro,erty &ithinthe facility5 ) * 9es ) * No
%5J5 Li.htin. and Bentilation
Areas sed 6y ,atients and ,ersonnel are ade7ately li.hted andventilated5 ) * 9es ) * No
%5K5 Patient 'ovement
Ade7ate s,ace is ,rovided to allo& ,atients and ,ersonnel to move
safely arond ,atient 6ed areas5 ) * 9es ) * No
Patients &ho se mo6ility aids are a6le to safely manever &ith theassistance of their aid &ithin their 6ed area5 ) * 9es ) * No
%55 Aditory and Bisal Privacy
Ade7ate ,rivacy for ,atients is ,rovided sch that sensitive or ,rivatediscssion+ e=amination+ and"or ,rocedre are condcted in a manner or environment &here these cannot 6e o6served or the ris? of 6ein.overheard 6y others is minimi/ed5 ) * 9es ) * No
%5M5 Po&er ,,ly
The health facility has an a,,roved ,o&er s,,ly system5
) * 9es ) * No
%5#05 Gater ,,ly
The health facility has an a,,roved &ater s,,ly system5
) * 9es ) * No
%5##5 Gaste 'ana.ement
%5##5#5 Li7id Gaste
Li7id &aste is dischar.ed into a mlti-cham6er se,tic tan?5) * 9es ) * No
%5##55 olid Gaste
olid &aste is collected+ treated and dis,osed of inaccordance &ith the Health Care Gaste 'ana.ement 'analof the De,artment of Health+ 00!5 ) * 9es ) * No
The health facility o6serves se.re.ation+ codin. and la6elin.of &aste51lac? Trash 1a.2(eneral > Non-3nfectios > Dry4 ) * 9es ) * No(reen Trash 1a.
2(eneral > Non-3nfectios > Get4har, Container
) * 9es ) * No
2har,s4 ) * 9es ) * No
Protective e7i,ment and clothin. a,,ro,riate to the ris?sassociated &ith the handlin.+ stora.e+ and dis,osal of &astesare ,rovided to and sed 6y ,ersonnel5 ) * 9es ) * No
%5#5 anitation
The health facility o6serves ,est and vermin control:3n-Hose ) * 9es ) * NoContractor ) * 9es ) * NoCom,any Name 55555555555555555555555555555555555555555555555555555
Records are availa6le and ,dated5 ) * 9es ) * NoFre7ency 55555555555555555555555555555555555555555555555555555
%5#$5 'aintenance
A 6ildin."facility inventory is maintained and ,dated re.larly5) * 9es ) * No