Name    Richard Apple

E-mail    richard.apple@illinois.gov

Facility Name    H. Douglas Singer Mental Health Center

Facility CEO    Mohammad Yunus

Facility Address    4402 N. Main St, Rockford, IL  61103

Facility Description (Brief)    Small psychiatric hospital operated by the state of Illinois.  Adult psych with non-secure forensics and transition unit from the maximum security behavioral facility

# Beds - Adult    76

# Beds - Child & Adol    0

# Beds - Sub Abuse    0

# Beds - Forensic    average 8-12

# Beds - MR/DD    average 4-6

# Beds - TotaL    76

# Beds - CMS Distinct Part    76

Survey Type    Unannounced

Surveying Agency    JCAHO

Survey Dates (inclusive)    1/10/2008-1/11/2008

Survey Days (e.g., Mon - Weds)    Thursday-Friday

Number of Surveyors    3

Priority Focus Areas    Physical Environment

• Assessment and Care/Services


• Medication Management
  
  


• Information Management
  
  

Last Survey Ending Date    4/6/05

Profile - Surveyor #1   Martin Macklin, MD, PhD, Team Leader

Very thorough but friendly and collegial

Profile - Surveyor #2    Nancy Paterson, MS, RN, Nurse

Very important that our nursing director established a close relationship with her and was willing to disclose areas of concern

Profile - Surveyor #3    Stephen Turner, Engineer

Extremely knowledgeable.  Focused on detail.

Went places and found things that nursing surveyors doing the environment never even thought of doing

Be sure to have clear records of all testing

# of Non-Compliant Standards    8

APR/NPSG Cites

RI/PC/MM/IC Cites 

• PC.2.120 - History and physical dated beyond 24 hours

PI/LD/HR/IM Cites 

• HR.1.20 - License renewal of one staff verified 8 days after expiration

EC Cites

• EC.5.40 and .7.40 - Multiple testing issues
  
  


• EC.5.20 - Multiple life safety issues
  
  

MS/NR Cites 

• MS.4.100 - By laws contained confusing locum tenens language but we were able to successfully clarify as we don't actually use locum tenens
  
  


• MS.4.15 - Peer review form did not have all required elements
  
  


• MS.4.60 - Language allowed temporary extension of privileges to theoretically go beyond 2 years
  
  


• MS.4.70 - Problems with peer references

**Surveyor Compliments (Policies, Procedures, etc noted by which surveyor)    **Surveyor Compliments (Policies, Procedures, etc noted by which surveyor)

Preliminary Survey Result    JC: Some Requirements for Improvement

Richard Apple