BUREAU OF QUALITY ASSURANCE PROGRAM REPORT FOR

Transcription

1 S T A T E O F F L O R I D A D E P A R T M E N T O F J U V E N I L E J U S T I C E BUREAU OF QUALITY ASSURANCE PROGRAM REPORT FOR Miami-Dade Regional Juvenile Detention Center Department of Juvenile Justice (State-Operated) 3300 NW 27th Avenue Miami, Florida Review Date(s): November 15-17, 2011 PROMOTING CONTINUOUS IMPROVEMENT AND ACCOUNTABILITY IN JUVENILE JUSTICE PROGRAMS AND SERVICES W A N S L E Y W A L T E R S, S E C R E T A R Y J E F F W E N H O L D, B U R E A U C H I E F Office of Program Accountability Page 1 of 17

2 Detention Performance Rating Profile Program Name: Miami-Dade Regional Juvenile Detention Center QA Program Code: 490 Provider Name: Department of Juvenile Justice Contract Number: N/A Location: Miami-Dade County / Circuit 11 Number of Beds: 126 Review Date(s): November 15-17, 2011 Lead Reviewer Code: 50 Indicator Ratings 1. Management Accountability 4. Health Services 1.01 Background Screening of Employees/Vol Designated Health Authority 1.02 Provision of an Abuse Free Environment 4.02 Healthcare Admission Screening 1.03 Incident Reporting 4.03 Comprehensive Physical Assessment 1.04 Protective Action Response (PAR) 4.04 Sexually Transmitted Diseases 1.05 Pre-Service/Certification Requirements 4.05 Sick Call 1.06 In-Service Training Requirements 4.06 Medication Administration 1.07 Logbook Maintenance 4.07 Medication Control 1.08 Escapes 4.08 Infection Control % Indicators Rated Compliance: 100% Chronic Illness Treatment % Indicators Rated Limited Compliance: 0% Episodic and Emergency Care % Indicators Rated Failed Compliance: 0% Consent and Notification Prenatal/Neonatal Care 2. Youth Management % Indicators Rated Compliance: 100% 2.01 Admission and Orientation Limited % Indicators Rated Limited Compliance: 0% 2.02 Classification Limited % Indicators Rated Failed Compliance: 0% 2.03 Personal Property 2.04 Activities and Programming Limited 5. Safety and Security 2.05 Detention Reviews 5.01 Supervision of Youth 2.06 Release 5.02 Key Control 2.07 Grievance Process 5.03 Transportation 2.08 Gang Prevention and Intervention 5.04 Tool Management % Indicators Rated Compliance: 63% Disaster/Continuity of Operations Plan % Indicators Rated Limited Compliance: 38% Flammable, Poisonous, and Toxic Items % Indicators Rated Failed Compliance: 0% Behavior Management System Confinement 3. Mental Health and Substance Abuse Services % Indicators Rated Compliance: 100% 3.01 Designated Mental Health Authority % Indicators Rated Limited Compliance: 0% 3.02 MH and SA Admission Screening % Indicators Rated Failed Compliance: 0% 3.03 MH and SA Assessment/Evaluation 3.04 Treatment Plan/Team/Service Delivery 3.05 Suicide Prevention 3.06 Mental Health Crisis Intervention 3.07 Emergency Services % Indicators Rated Compliance: 100% 7 % Indicators Rated Limited Compliance: 0% 0 % Indicators Rated Failed Compliance: 0% 0 7 Overall Rating Summary Compliance: Limited Compliance: Failed Compliance: 93% 7% 0% * Percentages have been rounded to the nearest whole number. Percentages may not total 100% due to rounding. Office of Program Accountability Page 2 of 17

3 Methodology This review was conducted in accordance with FDJJ-1720 (Quality Assurance Policy and Procedures), and focused on the areas of (1) Management Accountability, (2) Youth Management, (3) Mental Health and Substance Abuse Services, (4) Health Services, and (5) Safety and Security, which are included in the Detention Standards (July 2011). Persons Interviewed Program Director DJJ Monitor DHA or designee DMHA or designee 2 # Case Managers # Clinical Staff # Food Service Personnel 2 # Healthcare Staff # Maintenance Personnel # Program Supervisors Documents Reviewed 6 # Other (listed by title): Citrus Administration, MAXIM Manager, Teachers, Consultant Pharmacist Accreditation Reports Affidavit of Good Moral Character CCC Reports Confinement Reports Continuity of Operation Plan Contract Monitoring Reports Contract Scope of Services Egress Plans Escape Notification/Logs Exposure Control Plan Fire Drill Log Fire Inspection Report Fire Prevention Plan Grievance Process/Records Key Control Log Logbooks Medical and Mental Health Alerts PAR Reports Precautionary Observation Logs Program Schedules Sick Call Logs Supplemental Contracts Table of Organization Telephone Logs Surveys Vehicle Inspection Reports Visitation Logs Youth Handbook 9 # Health Records 9 # MH/SA Records 10 # Personnel Records 9 # Training Records/CORE 7 # Youth Records (Closed) 9 # Youth Records (Open) 11 # Other: Volunteer Records 9 # Youth 9 # Direct Care Staff # Other: Observations During Review Admissions Confinement Facility and Grounds First Aid Kit(s) Group Meals Medical Clinic Medication Administration Posting of Abuse Hotline Program Activities Recreation Searches Security Video Tapes Sick Call Social Skill Modeling by Staff Staff Interactions with Youth Comments Staff Supervision of Youth Tool Inventory and Storage Toxic Item Inventory and Storage Transition/Exit Conferences Treatment Team Meetings Use of Mechanical Restraints Youth Movement and Counts Items not marked were either not applicable or not available for review. Office of Program Accountability Page 3 of 17

4 Rating Definitions Ratings were assigned to each indicator by the review team using the following definitions: Compliance Limited Compliance Failed Compliance No exceptions to the requirements of the indicator; limited, unintentional, and/or non-systemic exceptions that do not result in reduced or substandard service delivery; or exceptions with corrective action already applied and demonstrated. Exceptions to the requirements of the indicator that result in the interruption of service delivery, and typically require oversight by management to address the issues systemically. The absence of a component(s) essential to the requirements of the indicator that typically requires immediate follow-up and response to remediate the issue and ensure service delivery. Review Team The Bureau of Quality Assurance wishes to thank the following review team members for their participation in this review, and for promoting continuous improvement and accountability in juvenile justice programs and services in Florida: Gabriel Medina, Lead Reviewer, DJJ Bureau of Quality Assurance Patrick Morse, Program Administrator, DJJ Bureau of Quality Assurance Patrice Starks, Review Specialist, DJJ Bureau of Quality Assurance Thomas Mahoney, Review Specialist, DJJ Bureau of Quality Assurance Susan Gallen, Designated Mental Health Authority, Southwest RJDC Office of Program Accountability Page 4 of 17

5 Please note that this report refers to each indicator by number and title only. Please see the applicable standards for the full text of each indicator. The standards are available on the Bureau of Quality Assurance website, at Standard 1: Management Accountability Overview Miami-Dade Regional Juvenile Detention Center (MDRJDC) is a 126-bed, hardware secure facility operated by the State of Florida, Department of Juvenile Justice (DJJ) from a state owned complex. The detention center is part of the Juvenile Justice Center complex, which houses the Miami-Dade County s juvenile court system, State Attorney and Public Defender s offices, Department of Children s and Families (DCF) offices, and houses the Troy Academy Day Treatment program on its grounds, as well as Probation and Community Intervention offices, including the Circuit 11 Chief Probation Officer s office. There were ninety-seven youth in secure detention at the time of the Quality Assurance review. The center serves youth detained by various circuit courts, including youth from Miami-Dade, Broward and Monroe Counties. All youth detained are pending adjudication, disposition or placement in a commitment facility. The center s management team is comprised of a Superintendent, two Assistant Superintendents (ASs), and fourteen Juvenile Justice Detention Officer Supervisors (JJDOSs), including two Shift Commanders. In addition, the center had sixty Juvenile Justice detention Officers II (JJDO-II), twenty-nine Juvenile Justice Detention Officers I (JJDO-I), five Maintenance Mechanics, one Plumber, one Custodian Worker, one Secretary Specialist, and three Other Personal Services (OPS) workers. At the time of the Quality Assurance review the center had six positions vacant, including one Shift Commander/JJDOS, two JJDOSs, one Maintenance Supervisor, one Secretary Specialist, and one Food Support Worker. Further, the center had one JJDO-I on military leave. The center contracted medical services with MAXIM Healthcare Services, Inc. and mental health and substance abuse services with Citrus Health Network, Inc. The center had a partnership with the University of Miami (UM) School of Medicine, which benefited the youth. The center had a volunteer program with ninety-eight active volunteers composed of different community and religious organizations. Educational services were provided by the Florida Department of Education through the Miami-Dade County Public School System. The Juvenile Justice Center School consisted of a thirty-one member team that included one Assistant Principal, one Secretary/Treasurer, one Registrar, two Exceptional Student Education (ESE) staff members, a Guidance Counselor, two Counselors, a Transition Counselor, one Psychologist, thirteen teachers, one Custodial, and seven paraprofessionals. Office of Program Accountability Page 5 of 17

6 1.01: Background Screening of Employees/Volunteers Compliance The center conducts monthly driver s license check for every active employee and when issues were identified the staff were restricted from transporting youth until the staff obtained a valid license. The center conducts monthly Sexual Predators and Offenders check for every active employee, through the Florida Department of Law Enforcement. 1.02: Provision of an Abuse Free Environment Compliance 1.03: Incident Reporting Compliance 1.04: Protective Action Response (PAR) Compliance 1.05: Pre-Service/Certification Requirements Compliance 1.06: In-Service Training Requirements Compliance A review of eight applicable employee training files for in-service training requirements found that the staff completed all the required in-service trainings. Each staff exceeded the required in-service trainings with a minimum of fifty hours. Most of the trainings were instructor-led. A review of four supervisory training files confirmed that all the supervisors exceeded the minimum required eight hours of supervisory training. A review of eleven volunteer files indicated that the center provided two hours of Volunteer Orientation Training to each volunteer in the facility prior to the utilization of their services. The volunteer s training covered safety concerns, contraband, sexual harassment, child abuse/neglect and confidentiality. The center had an Annual In-Service Training Calendar for all staff and volunteers in the facility. 1.07: Logbook Maintenance Compliance Office of Program Accountability Page 6 of 17

7 1.08: Escapes Compliance Although the center has had no escapes since the last Quality Assurance review, documentation reviewed found that the procedures and practice exceeded the minimum requirements. The center conducted four escape drills throughout this calendar year, and have additional drills scheduled for the rest of the calendar year. Training documentation reviewed revealed that one hundred-four staff members completed the in-service Escape Prevention Training, this calendar year. Standard 2: Youth Management Overview All youth entering secure detention are screened by Juvenile Detention Officers utilizing the Juvenile Justice Information System (JJIS) Admission Wizard. If any significant medical, mental health, or allergy alerts are apparent, the intake officer places an alert in the Detention Facility Management System (DFMS) and in the Juvenile Justice Information System (JJIS). Detention personnel are responsible for conducting both frisk and electronic searches of the youth upon admission to the detention center. The classification procedure includes a review of all detention paperwork to ensure proper placement of youth in the modules. Parental notification is attempted in all cases to ensure that parents/guardians are properly notified when their child has been placed in secure detention. Upon admission, all youth are provided with an orientation to the rules, regulations, and services provided while detained. In an effort to keep track of the youth s property, the center maintains two property logs to document youth valuables upon admission into the facility and all unclaimed property is donated to a local charity. The center also maintains a process that outlines procedures for youth to file a grievance should they feel their rights have been violated. Most youth surveyed reported that, although they had never filed a grievance, they believed the process is very good. The center has a full activity and programming schedule in order to maintain constructive use of the youth s time in detention. Non-clinical life and social skill development group sessions are conducted almost daily. Educational services are provided by the Miami-Dade County School System. Youth are provided with all personal hygiene items and are provided clean bed linens, towels, and clothing during their stay. The facility utilized the Girls Advocacy Project (GAP) for gender-specific groups for females. GAP had one employee who provided services three days per week (Monday, Wednesdays, and Fridays) for one hour. The group topics were consistent with the needs of the youth currently in the facility. Detention Review Meetings are held weekly and are well attended. All youth in both secure and home detention are reviewed during this meeting, which includes the review of all active alerts. Information obtained, as a result of this meeting, is entered into the Juvenile Justice Information System (JJIS) and the Detention Facility Management System (DFMS). Office of Program Accountability Page 7 of 17

8 2.01: Admission and Orientation Limited Compliance There was no documentation to support that the facility was incorporating or reviewing the youth s inactive detention file into the active file. Two of the nine youth had different admission dates and there was no consistent practice to complete the re-admission paperwork when a youth re-enters the facility. 2.02: Classification Limited Compliance There was no documentation to support that the center s classification system included the youth s maturity, vulnerability, staff initial collateral contacts, and/or staff s initial interaction and observations of the youth. Two of the nine files did not document the youth s general physical stature during the classification process. The facility did not have a form to document the review of all classification requirements. Classification information was gathered from the Secure Detention Admission Wizard, Mug Shot Profile, and the Medical and mental Health Admission Screening form. Two youth did not have a Mug Shot Profile. One youth was classified to not have a roommate due to a previous sexual offense; however, the youth stated he had a roommate the whole time that he has been in the detention center. There was no documentation of or justification for the youth to have a roommate. 2.03: Personal Property Compliance 2.04: Activities and Programming Limited Compliance There was no documentation to support that the facility provided restorative justice groups. Documentation reviewed indicated that gender-specific groups for males were not consistently provided. It was difficult to determine that one-hour of large muscle activity was consistently provided on a daily basis. 2.05: Detention Reviews Compliance Detention Review minutes reviewed were detailed, instructional and all information was entered into the Juvenile Justice Information System (JJIS) where information sharing between detention and probation staff occur. A Juvenile Justice Detention Officer II (JJDO-II) conducts the weekly detention reviews and representatives from education, mental health, medical, and transportation attend and participate in the weekly reviews. The Juvenile Probation Supervisors (JPOSs) attended in person or telephonically to review the youth in secure and home detention. Office of Program Accountability Page 8 of 17

9 During the Detention Reviews all active alerts are reviewed in order to make sure that the alerts are appropriate. The JPOSs are informed to remove the alerts when they are not appropriate. All attendees exhibited a working knowledge of the youth s issues and worked collectively toward transferring the youth to a less restrictive placement and/or ensure each youth proceeded expeditiously in the court system. The JJDO-II maintained four binders with the youth information and their face sheet. The binders were organized based on the youth s classification within detention which included youth who were ordered for twenty-one days, youth to be released the following day, committed youth awaiting placement, and youth on location in other facilities that included other detention centers and absentee booking. The center maintained a protocol with the Department of Children and Families (DCF) to expedite the release of youth whose parents/guardians refused to pick-up their child(ren). 2.06: Release Compliance 2.07: Grievance Process Compliance Two of the nine grievances reviewed were not completed within the required timeframe. In one of the two applicable grievances, there was no youth signature or date to determine the youth s acceptance of the grievance. In one of the two applicable grievances, the supervisor entered the grievance into the Detention Facility Management System (DFMS) seven days after the youth filed the grievance. 2.08: Gang Prevention and Intervention Compliance Standard 3: Mental Health and Substance Abuse Services Overview Miami-Dade Regional Juvenile Detention Center provided mental health and substance abuse services to all youth in the facility. The center had a formal contract (Number X1672) with Citrus Health Network, Inc., for the development and implementation of the services. The center had a Licensed Clinical Psychologist that serves as the designated Mental Health Authority (DMHA)/Clinical Coordinator, who supervises and provided oversight of the services provided. The DMHA is on site forty-hours per week and in on-call twenty-four hours a day, seven days a week. The center also has one Licensed Mental Health Counselor (LMHC) that is on-site fortyhours per week, one LMHC that is on-site thirty-hours per week, including six hours Saturday and six hours Sunday, every other weekend, and one unlicensed mental health professional, under supervision that is on site six hours Saturday and six hours Sunday, every other Office of Program Accountability Page 9 of 17

10 weekend. On-call services are utilized for mental health and/or substance abuse emergencies when staff is not on site. In addition, the center had a contract with Citrus Health network, Inc. (Number X1673) for the provision of psychiatric services to the youth by a licensed psychiatrist. The Facility Superintendent and the DMHA approved, reviewed, updated, signed and dated all the required Facility Operating Procedures. The center has a Mental Health and Substance Abuse Plan, a Suicide Prevention Plan, and an Emergency/Crisis Intervention Plan in place. The Facility Superintendent or his designee actively participates in the service delivery process. Citrus Health Network s Human Resource Department maintains a training file in the mental health office that includes copies of all licensed mental health professionals credentials to include copies of diplomas and transcripts. The center provided an array of services for identified youth at risk of mental health and substance abuse problems. Mental health services provided consist of mental health assessments/evaluations, mental health counseling/therapy, crisis intervention and suicide prevention services. Substance abuse services provided consist of substance abuse assessments/evaluations, substance abuse counseling/therapy and interventions. Due to DJJ direct staff cut-backs, the groups schedule is not always adhered to. In addition to the services provided to all the youth in the facility, the center provided Intensive Mental Health and Substance Abuse Services to fifteen youth, and Specialized Mental Health Services to forty youth. All the services are provided in accordance with the Department of Juvenile Justice (DJJ) Mental Health and Substance Abuse Services Manual and the applicable Florida Administrative Code (F.A.C.) requirements. All facility staff received training to respond to medical emergencies and understand that they are to immediately call in a medical emergency that required urgent medical attention. The center utilized Citrus Health Network, Inc, as the crisis stabilization unit for the facility, and this arrangement highly enhances and facilitates the overall clinical coordination, communication and completion of the assessments and/or emergency services provided to the youth. The center documented the services provided in the Detention Facility Management System (DFMS), and in the Juvenile Justice Information System (JJIS). The DJJ Office of Health Services monitors the services provided by the center and provided technical assistance, as needed. 3.01: Designated Mental Health Authority (DJJ Program) Compliance 3.02: Mental Health and Substance Abuse Admission Screening Compliance 3.03: Mental Health/Substance Abuse Assessment/Evaluation Compliance Office of Program Accountability Page 10 of 17

11 3.04: Treatment Plan, Treatment Team, and Service Delivery Compliance One of the Individual Treatment Plans reviewed had none of the required signatures. In one of the applicable cases reviewed there was no documentation provided to verify that a copy of the Mental Health/Substance Abuse Treatment Discharge Summary was provided to the parents/guardians, and the Juvenile Probation Officer (JPO), as required. 3.05: Suicide Prevention Compliance The review of one case of a youth placed on Secure Observation indicated that the proper level of supervision, the completion of the youth s search, and the completion of the health status check list were missing on the Observation Logs. There was also no indication that a suicide risk assessment or follow-up was completed within eight hours of placement in Secure Observation, in the same case, as required. 3.06: Mental Health Crisis Intervention Compliance 3.07: Emergency Services Compliance Standard 4: Health Services Overview The center contracts with MAXIM Healthcare Services, Inc. to provide clinical and administrative oversight for the healthcare services. MAXIM Healthcare Services, Inc. provides the program with one licensed physician, one Advanced Registered Nurse Practitioner (ARNP), one Registered Nurse (RN), three Licensed Practical Nurses (LPNs) and one Medical Records Clerk. The licensed physician serves as the center s Designated Health Authority (DHA) and is on-site approximately five hours per week each Tuesday and is on-call twenty-four hours a day, seven days a week. In addition, the ARNP is scheduled to be on-site sixteen hours per week each Wednesday and Thursday. During the Quality Assurance review a new ARNP was hired to fill the vacant position. The ARNP position was vacant for one week with no lapse in services to the center. The ARNP maintained current Collaborative Practice Protocols with the DHA. The DHA/ARNP is responsible for the oversight of all healthcare provided at the program that also includes conducting physical examinations, periodic evaluations, medication management and sick call referrals. The RN is responsible for the day-to-day operations of the medical clinic to include medication administration, conducting sick call, maintaining youth healthcare records and maintaining inventories of all medications and sharps and supplies. The RN is on-site Monday through Office of Program Accountability Page 11 of 17

12 Friday. In addition, the MAXIM Healthcare Services, Inc. also employs three full-time LPNs. Nursing coverage is seven days per week from 6:00 am to 10:30 pm. Psychiatric services are provided by a licensed physician through a contract with Citrus Health Network, Inc. The psychiatrist is on-site six hours per week each Friday from 1:00 pm to 7:00 pm and provides psychiatric diagnostic interviews and psychiatric evaluation services, coordination of services with outside professionals, psychotropic medication management services, crisis intervention, suicide prevention services and any mental health ancillary services needed, and is on-call twenty-four hours a day/seven days per week. The center does not maintain an institutional pharmacy permit; however, they do have a Modified Class II permit. All medications are procured through Diamond Pharmacy Services in Indiana, Pennsylvania. The nursing staff sends the prescription via facsimile to the pharmacy and the pharmacy sends the medications overnight delivery (provided they receive the facsimile before 3:00 pm) and the center receives the medication(s) the following day. The program uses Walgreens Pharmacy, locally, for medications that have to be provided without delay. Publix Pharmacy is used to procure ordered antibiotics that are provided through the company s free antibiotic prescription program. The program provides sick call services seven days per week Monday through Sunday, two times per day. Approximately two to seven youth are seen during each scheduled sick call and are seen within twenty-four hours of submitting a Sick Call Request form. Documentation reviewed indicated that sick call is not always conducted in a location that maintains the youth s privacy. Although a majority of the sick call is conducted in the clinic, documentation reviewed did indicate that sick call was conducted in the classrooms, cafeteria and youth mods. The center housed three automated external defibrillators (AED) and maintained thirty-five first aid kits throughout the facility. The program utilizes the Dade County Health Department for immunizations and for sexually transmitted infection (STI) testing and treatment. Human Immunodeficiency Virus (HIV) testing and counseling is provided through the University of Miami (UM). UM staff are scheduled to be on-site two times each week; however, due to staff cut-backs, this schedule is not always adhered to. Documentation reviewed did validate that UM staff were on-site at least one day per week to provide services. Nursing staff have a standing order for youth to receive HIV testing. Nursing staff document declined on the order if the youth does not consent for testing and counseling. When the youth does give consent, UM staff have the youth sign the Department s HIV Youth Consent Form prior to testing and counseling. The nursing staff provide health education during the intake screening admission process and then throughout the youth s stay in the center. Documentation reviewed found that this practice was not consistent. There was limited or no health education provided to youth documented on the Health Education Record for the sample reviewed. The nursing staff are responsible for maintaining and updating the medical and mental health alert process for the center. The program maintains a limited supply of over-the-counter (OTC) medications on-site and weekly inventories were maintained. All prescription medications were stored in the locked medical cart and the OTC medications were stored in a locked medical cabinet located in the clinic. The program had clearly written medication administration protocols in place for nursing staff and all medications were administered by nursing staff. There were sixteen staff authorized to administer medications in the event nursing staff were not available. Office of Program Accountability Page 12 of 17

13 The clinic was observed very well organized and provided a private location to ensure privacy for youth receiving healthcare services. The youth healthcare records were observed to be organized and were secured in a locked cabinet in the clinic when not in use. The program had processes in place for appropriately managing youth with chronic conditions, ensuring that episodic or emergency care is timely and appropriate, and for minimizing potential infectious exposures. Medical and Mental Health Admission Screenings were completed by the Juvenile Justice Detention Officer s for each youth during the admission process and was reviewed within twenty-four hours by the nursing staff. The DJJ Problem List was updated by nursing staff at the time the admission screening was reviewed or when an issue became apparent. A new Medical and Mental Health Admission Screening was not consistently completed when a youth was sent to the Juvenile Addictions Recover Facility (JARF) or Citrus Mental Health Crisis Stabilization Unit. The center would release the youth from the detention population in the Department s Juvenile Justice Information System (JJIS) and re-admit upon his/her return to the center. A new and/or updated Health Related History (HRH) and Comprehensive Physical Assessment (CPA) were conducted on all youth within the required timeframe. 4.01: Designated Health Authority Compliance 4.02: Healthcare Admission Screening Compliance The Medical and Mental Health Admission Screenings were not consistently completed when there had been a changed in physical custody of the youth. Documentation reviewed did not support that the Designated Health Authority (DHA) was consistently notified within twelve hours for all youth identified as possessing a medical concern or chronic condition. 4.03: Comprehensive Physical Assessment Compliance 4.04: Sexually Transmitted Diseases Compliance Nursing staff were not consistently conducting a clinical screening and evaluated all youth for sexually transmitted diseases timely. One youth was admitted on August 22, 2011 and did not receive the screening until November 12, Three of the nine youth files reviewed validated that the youth were provided the opportunity to receive Human Immunodeficiency Virus (HIV) testing and counseling. All three youth declined. Office of Program Accountability Page 13 of 17

14 4.05: Sick Call Compliance Documentation reviewed did not consistently support that nursing staff and/or direct care staff oriented the youth to the sick call process at admission. Sick call is scheduled two times daily, seven days a week. However, documentation reviewed found incidents where sick call was provided outside the scheduled time periods. In addition, documentation reviewed indicated that sick call is not always conducted in a location that maintains the youth s privacy. Although a majority of the sick call is conducted in the clinic, documentation reviewed did indicated that sick call was conducted in the classrooms, cafeteria and on the youth modules. 4.06: Medication Administration Compliance 4.07: Medication Control Compliance 4.08: Infection Control Compliance Documentation reviewed did not support that youth received health education as required. Health Education Records documented that only two of the nine files reviewed documented the required health education. 4.09: Chronic Illness Treatment Compliance 4.10: Episodic and Emergency Care Compliance A review of the nine youth healthcare files found three episodic incidents provided by nursing staff that were not documented on the Episodic Log. 4.11: Consent and Notification Compliance 4.12: Prenatal/Neonatal Care Compliance Office of Program Accountability Page 14 of 17

15 Standard 5: Safety and Security Overview Miami-Dade Regional Juvenile Detention Center is a hardware-secure facility with fencing and barbed razor wire surrounding the facility. The Facility Superintendent and staff are responsible for the safety and security of the youth and personnel. There are areas assigned for youth to participate in outside recreation and a large gymnasium for indoor recreational activities. Staff were well informed of protocols for effectively supervising youth. Central Control monitors movement of all staff and youth in the center through radio communication and Closed Circuit Television (CCTV) video camera observation. The center has an effective key control system that requires daily check of all keys within the facility. Keys are recorded and stored for proper accountability. There is a clear, detailed master key inventory. Tools are inventoried daily throughout the center. Maintenance maintains two secure maintenance storage areas for all equipment. Kitchen knives and utensils are stored in a locked cabinet. There is a daily inventory of kitchen utensils along with a checkin/out process for the use of knives. Strict control of flammable, poisonous, and toxic items is maintained. The center provides transportation services relating to court, medical appointments, and other court-ordered requests. Transportation vehicles receive annual inspections to ensure safe travel for staff and youth. All vehicles transporting youth contain the required emergency equipment. The center has a comprehensive Behavior Management System (BMS) comprised of three levels, which allows the youth to earn extra privileges for positive behavior. Staff and youth responding to the surveys reported that the BMS is fair and highly effective. 5.01: Supervision of Youth Compliance 5.02: Key Control Compliance 5.03: Transportation Compliance 5.04: Tool Management Compliance Office of Program Accountability Page 15 of 17

16 5.05: Disaster and Continuity of Operations Planning Compliance The center maintains 157 fire extinguishers throughout the facility. The Assistant Superintendent and maintenance staff check all fire extinguishers and document the results on a monthly basis. On each shift staff check and document the condition of all fire extinguishers located in the modules where youth are housed. During the past year the center had conducted six facility wide mock Continuity of Operations Plan (COOP) drills, exceeding the two drill requirement. Fire drills were conducted twice a month on each shift, exceeding the requirement of the indicator. All fire drills were recorded in the Detention Facility Management System (DFMS). All fire drills were conducted by supervisory staff and appropriately critiqued. All staff have received training on center s COOP plan. 5.06: Flammable, Poisonous, and Toxic Items Compliance 5.07: Behavior Management System Compliance At orientation each youth admitted to the center received an overview of the Behavior Management System (BMS). At the daily rap session conducted at the beginning of the shift the behavior issues are addressed and reinforced. The BMS consisted of three levels along with points earned for positive behavior. Youth earned privileges as their levels increased throughout their stay in the center. As youth progressed through the BMS the accrued special privileges such as the following: additional telephone calls, later bed times, opportunities for additional snacks at the weekly canteen, and television viewing. Each week one module was chosen as Mod of the Week. The youth in this module received a special treat of several pizzas delivered by Little Caesars Pizza during the weekend. All youth surveyed indicated that the BMS was fair and effective. 5.08: Confinement Compliance A review of twenty-five Confinements Reports indicated that the times frames were met for entry, reviews with youth, continuation, extensions beyond twenty-four hours, and mental health reviews every twenty-four hours for youth in confinement beyond twentyfour hours. This practice continued to occur even through the Department no longer required it. The supervisory reviews with the youth were done every two hours instead of the three hour requirement. The Confinement Reports documented numerous counseling sessions with youth including the initial narrative of the event leading to the confinement. The center prepared a monthly report, which was sent to the Regional Office that contained a tracking log of confinement events. The Regional Office prepared graphs and quarterly reports that contained a trend analysis. Office of Program Accountability Page 16 of 17

17 Overall Rating Summary Compliance: 93% Limited Compliance: 7% Failed Compliance: 0% * Percentages have been rounded to the nearest whole number. Percentages may not total 100% due to rounding. Office of Program Accountability Page 17 of 17