Mock Survey

Safety

100

What is your sign-in procedure? What is your process for handling a client grievance?

• Staff, clients and visitors sign-in using in/ out logs
• Staff sign-in using the clip board by Lizettes desk
• Clients/ visitors use the clip board located Lizette’s desk
• We record who is in the building so we can account for people if/when there is an evacuation
• We post our Client Grievance Policy and Reporting Forms for clients to see in English and Spanish. 

  We try to resolve the issue but if the client wishes to file a formal grievance, the forms are readily available.(entrance at both locations)

200

What is the procedure for reporting safety issues?What is your process for obtaining paperwork if your network goes down?

• We complete a maintenance request form to address any environmental safety concerns
• Maintenance request form is available through the SV intranet
• Each site has a site safety officer that is responsible for overseeing the site’s safety and environmental concerns
• We have hard copies of the paperwork we would need to remain operational if the network goes down.
• QA is our centralized location for hardcopy back-ups should we not be able to locate a needed file.

300

Tell me your process for fire drills.What does PASS and RACE stand for?

• Our Site Safety Officer conducts at least 1 fire drill per year
• Our evacuation location is across the parking lot (allergy clinic) our second location is across the parking lot to our left (people ready)
• The Fire Evaluation form is completed and submitted to the Safety Officer for review. 

We also have specific people designated to complete tasks during an evacuation

PASS and RACE refer to how to use a fire extinguisher and how to evacuate during a fire.

Fire Extinguisher

P –pull pin            A- aim extinguisher           S-squeeze handle   S-Sweep, side to side motion

Evacuation:

R-rescue person     A-alarm      C-contain window/doors     E-escape/Evacuate

400

Tell me your process for disaster drills

• Our Site Safety Officer conducts at least 1 disaster drill per year.
• The Emergency Management Critique form is completed and submitted to the Safety Officer for review. 
• We also have specific people designated to complete tasks during an evacuation. 

500

Tell me your process for emergency management.What is your process for assessing ligature risks

We have emergency response plans.  They are located in our emergency management flip charts. 

The Site Safety officers and the safety committee members conduct an Environmental Risk Assessment annually. 

We take the necessary sets to make the environment as safe as possible

• if there is a risk that cannot be entirely removed, we develop a plan to mitigate the risk.  That plan is discussed in our Staff meetings so all staff know how to manage that particular risk(s)

(show the reviewer the binder that has all of your completed forms in it).

Environment

100

Tell me your process for handling security related issues

• We have an emergency response flip chart that allows easy access to our procedures like lock down, workplace violence, etc. 
• If a security issue occurs we follow the instruction on the chart, contact administration, and complete a Critical Incident & Injury Report and submit it to Quality Assurance and Administration. 
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200

What is your process for handling hazardous materials?

• We have approved chemicals at Sierra Vista.
• Our SDS Binder has the associated SDS sheet for each product. 
• The SDS sheet tells us what to do in case of ingestions or eye exposure, etc. 
• Each site has a binder; our binder is located in our supervisor’s office (orange label)

300

What is your process for handling vomit on the floor?

• We use Spill Kits
• The back of the spill kit has detailed instruction that we follow. 
• Our sill kits are located in the staff bathroom
• In Waterford it’s in the kitchen drawer

400

Who is responsible for the environment of care?

• We are all responsible for the environment of care because we all promote a culture of safety within the agency.
• In a formal sense we have the Agency Safety Officer who oversees the environment of care. 
• We also have site safety officers working to ensure a safe environment.

500

What is your process for environmental tours to help ensure a safe working environment?

• Our Safety Committee designates people to conduct facility tours. 
• They complete a safety checklist and submit recommendations for improvement. 
• We also have Environmental Risk Assessments that are conducted by the Safety Committee Members and the mitigation activities are discussed in Staff Meetings.

Staff/Training

100

What ongoing training do you receive about safety?How do you promote a “Culture of Safety”

• We receive a monthly “safety Tip” emails.
• We have in person trainings
• We have online trainings through Relias
• Site Safety Officers at each site that promote a culture of safety
• The agency has monthly Safety Committee meetings
• We have facility inspections to help ensure safety
• Our Safety Committee sends out monthly Safety Tips.
• We complete safety trainings through Relias/Elevate
• Examples: Blood Borne Pathogens, Safety in the Filed
• Safety issues are included as standing agenda items for our staff meetings
• We also have our Illness and Injury Prevention Plan (IIPP).
• We track illnesses and send in monthly reports

200

Do all staff know their relocation site?

• Our relocation site  WFRC

WFRC is HFRC

300

Do all staff know their meeting site for a fire/disaster drill?

• Our relocation site is the parking lot across the peach man

For Waterford it’s the empty lot

400

What is your process for evacuation?

• In our site specific flip chart we have delineated the roles and duties of our staff during any type of evacuation.  Show the last page of your flip chart (Evacuation Duties and Role Assignment)

500

What do you do if a staff member is injured on the job, what is your process for handling it?

• We report the incident to HR 
• Staff can see the appropriate doctor (Workman’s Compensation Doctor/ Hospital)
• HR follows-up with Worker’s Compensation.

Infection Control

100

What is the process for reducing the spread of infections inside the agency?How do you handle clients with regard to infection prevention?

• We have anti- bacterial foam dispensers available to staff, clients and visitors. 
• We encourage good hand hygiene and have signs posted in the bathrooms teaching how to effectively wash hands. 
• Our Agency has a Flu Vaccination program where they send out information about the importance of getting the flu shot. 
• We also track staff and client illness.   We fill out the tracking from and send it to out IC chair person (Patty Martinez). 
• We encourage clients to use the anti-bacterial foam and to wash their hands and there is signage posted. 
• We encourage clients to stay home if they are ill and we reschedule them.
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200

What is your process for toy cleaning?

• Toy’s are cleaned after each group
• Toys are cleaned if the child is sick, mouthing, or if the toy is noticeably soiled. 
• We use either the approved disinfectant wipes or spray. 
• We complete the Toy Cleaning log.

300

What temperature range should a refrigerator be set? What is your process for monitoring it?What temperature should a freezer be set?  What is your process for monitoring it?

• Our refrigerators are set between 33-40 degrees Fahrenheit.
• Staff check the thermometer daily and log the temperature.  If the temperature is out of range we follow the instructions on the log. 
• We store client food. Thus, we have a recordable thermometer that displays the temperature on Saturday and Sunday and those temperatures are also logged.
• Our freezers are set for 0 degrees Fahrenheit or lower.
• Staff check the thermometer daily and log the temperature.  If the temperature is out of range we follow the instructions on the log.  
• We store client food. Thus, we have a recordable thermometer that displays the temperature on Saturday and Sunday and those temperatures are also logged..

400

If you supply food to clients, what is your process for ensuring freshness?  Show me.

Walk to the Kitchen:

• We ensure freshness by checking the expiration date on the products.
• We use the “First In-First Out” system to ensure freshness. 
• We discard expired food/snacks.

500

Describe your agency’s smoking policy.

The Agency has a No Smoking Policy.

Safety/Services

100

How do you manage field safety (i.e. Home Visits)? When you leave your work station what is the process for securing your computer?

• We use the Outlook system so our supervisors know where we are. 
• We notify supervisors and front office staff of our visit and indicate that if we are not back by a designated time to check on us.
• We carry cell phones. 
• We have home visit/field safety trainings. 
• Our infection control committee also gave us portable hand sanitizer.
• We can lock our computers by pressing control, alt, delete. 
• Our IT Department has set up our computers to lock automatically when not in use.

200

Describe your Agency’s Interpreter/Translation Services policy.

• We have Spanish speaking staff on site.
• We use trained interpreters when indicated. 
• Our Cultural Service Director schedules the contacted staff.  
• We also can use Language Solutions (telephone service) if an interpreter cannot be found.

300

What is your process for preventing suicide?

(Refer to the Imminent Harm and DTS Policies)

• All clinical clients receive a Columbia (C-SSRS Lifetime Recent) at Intake.
• Clients for whom an imminent risk to self or others are identified will be referred to a local emergency room, a medical professional, or 911 will be called, whichever is most appropriate. 
• In cases of imminent risk all parties needed to ensure safety of the client will be contacted. 
• This may include but is not limited to the client’s legal guardian, emergency contact, and school administration (if applicable). 
• Staff will have “eyes on” the client until such time when client is either released to the legal guardian or appropriate authorities. 
• Clients for whom the risk of suicide appears to be low, staff will conduct a Safety Plan with the client and his or her family, if applicable.
• Staff will continue to assess the client for suicide risk upon client’s return to services by using the   C-SSRS Since Last Contact. Continuing assessment occurs as deemed appropriate by the clinician.

400

If you allow exclusionary time outs, what is your process for handling them?

We do not do time outs. We use redirection and provide 1:1 support by staff when needed.

• If an exclusionary time out occurs, we log it and report it in the client’s medical record. If necessary, a treatment goal will be developed to address the issue

500

What is a sentinel event?  What is your process for handling a SE?

• A Sentinel event is when a death of very serious injury has occurred.  We have a SE form that is completed and there is an extensive review and root cause analysis that occurs