Ten Invaluable
Risk Assessments and Mitigation
Audits 

Auditing the care of individuals with developmental disabilities (DD) and mental illnesses (MI) is a critical process to ensure services being provided meet high standards of quality, safety, and compliance. The audits below focus on various aspects of care and operations, ensuring your agency is effectively meeting the needs of its clients and adhering to legal, ethical, and regulatory requirements. Here are ten of the most important audits and what they cover:

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1. Clinical Care and Treatment 

 

Individualized Care Plans

Reviews whether each client has an up-to-date, individualized care plan that includes their goals, needs, preferences, and any relevant assessments (e.g., mental health diagnoses, behavioral challenges). Ensure that the care plan is being followed and adjusted as necessary based on progress or changes in condition.

Medication Management

Audits how medications are prescribed, administered, and monitored. This includes checking for:

• Correct Dosages and Timely Administration

• Verifying that medications are given on time and in the correct amounts.

Documentation

Ensures medication administration records are complete, accurate, and legible.

Side Effects and Interactions

Reviews whether staff are adequately monitoring for potential side effects, drug interactions, or missed doses.

Psychiatric and Behavioral Interventions

Ensures the spectrum of appropriate mental health treatments (e.g., therapy, counseling, psychiatric evaluations) are being provided as outlined in the care plan, and that behavioral interventions are evidence-based and person-centered.

Physical Health Monitoring

Audits physical health services to ensure that individuals receive timely health screenings, routine check-ups, dental and vision care, and appropriate management of chronic conditions.

Crisis Intervention Plans

Reviews the adequacy of crisis intervention procedures, including staff training on de-escalation and emergency interventions for mental health crises or behavioral outbursts.

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2. Compliance and Regulatory 

 

Licensing/Accreditation Compliance

Ensures that the facility is licensed by the appropriate state or national health authorities and is compliant with all applicable local, state, and federal regulations. Accreditation by bodies such as the Joint Commission or CARF (Commission on Accreditation of Rehabilitation Facilities) as required by best practices.

Health and Safety Standards

Audits the facility to ensure compliance with health and safety regulations, including:

• Fire safety and emergency procedures.

• Sanitation and cleanliness protocols.

• Adequate staffing ratios and staff certifications (CPR, first aid, etc.).

• Environmental hazards, including accessibility for people with physical disabilities.

HIPAA Compliance

Checks that the agency is adhering to the Health Insurance Portability and Accountability Act (HIPAA) guidelines for protecting client confidentiality and privacy of medical records.

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3. Staffing and Training 

 

Staff Qualifications and Background Checks

Reviews the credentials, training, and background checks of staff to ensure they are qualified to work with individuals with DD and MI. This includes ensuring that staff hold required certifications (e.g., direct care worker, social worker, mental health technician) and that they have undergone appropriate criminal background checks and abuse clearances.

Ongoing Training

Audits the facility’s training programs to ensure staff receive continuous professional development in areas such as:

• Person-centered care.

• Crisis intervention and de-escalation techniques.

• Mental health and developmental disability care.

• Abuse and neglect prevention.

Staffing Levels and Ratios

Checks that the facility maintains adequate staffing to meet the needs of the clients, ensuring appropriate ratios of staff to clients during different shifts and ensuring that care is not compromised due to understaffing.

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4. Incidents and Events 

 

Incident Reports and Investigations

Audits incident reports for completeness and accuracy. These may include reports of:

• Medical incidents (falls, injuries, medical emergencies).

• Behavioral incidents (aggression, self-harm, restraint use).

• Medication errors.

Follow-Up and Corrective Action

Ensures that incidents are investigated thoroughly and that corrective actions are implemented when necessary. This includes reviewing whether incidents lead to changes in care plans, staff training, or operational procedures.

Restraint and Seclusion Use

Reviews the use of restraints and seclusion. These should only be used as a last resort and must be carefully documented, including the justification for use, the duration, and whether the individual was monitored during the restraint. Auditing whether staff follow guidelines and legal requirements is essential to prevent abuse.

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5. Quality of Life 

 

Client Satisfaction Surveys

Conducts audits of client and family satisfaction surveys to gauge the overall experience of individuals receiving care. This feedback should help identify strengths and areas for improvement in the care environment.

Rights and Autonomy

Reviews how the facility respects the rights and autonomy of its clients. This includes verifying that clients are informed of their rights, have the opportunity to make choices about their daily activities, and are treated with dignity and respect.

Recreational and Social Activities

Audits the availability and accessibility of social and recreational activities. Clients should have access to activities that promote socialization, engagement, and quality of life, which are critical for mental health and development.

Family Involvement

Reviews how the facility communicates with and involves families in care decisions, including how regularly families are updated on their loved ones’ progress, and how they are included in the care planning process.

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6. Financial 

 

Billing and Financial Management

Audits the facility's billing practices to ensure that they are accurate and comply with relevant insurance and Medicaid/Medicare guidelines. This includes verifying that clients are billed appropriately for services rendered and that financial assistance or subsidies are provided as needed.

Resource Allocation

Reviews how resources are allocated within the facility to ensure that funding is being used effectively to provide care, staff, and facilities. This includes inspecting budgets, expenditure reports, and any financial audits to assess the facility's fiscal responsibility.

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7. Outcome and Performance 

 

Care Outcomes

Reviews measurable outcomes for individuals, such as improvements in behavioral health, cognitive skills, independent living, and quality of life. This may include:

• Tracking improvements or regressions in behavior or psychiatric symptoms.

• Measuring success in meeting individual goals as outlined in care plans.

• Ensuring that clients are participating in activities that promote their independence and integration into the community.

Program Evaluation

Audits whether programs and services are achieving their intended outcomes. This includes reviewing:

• Evidence-based practices being implemented.

• Success rates of treatment programs or behavioral interventions.

• Client feedback and progress toward care goals.

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8. Complaint and Grievance 

 

Complaint Handling Processes

Audits how complaints are handled and whether they are investigated thoroughly and resolved in a timely manner. This includes ensuring that clients, families, and staff have clear channels to report concerns.

Grievance Records

Checks that grievances are documented and tracked for patterns of issues that may need systemic changes, whether related to care quality, safety, staff behavior, or other facility operations.

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9. Emergency Preparedness 

 

Crisis Management/Emergency Procedures

Reviews the facility’s emergency preparedness plan, including responses to fire, natural disasters, medical emergencies, and behavioral crises. This audit ensures that staff are trained, the facility has proper equipment, and clients are supported during emergencies.

Evacuation and Safety Drills

Audits the frequency and adequacy of emergency drills, ensuring that both staff and clients are familiar with evacuation procedures and emergency responses.

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10. Environmental 

 

Facility Condition

Checks the overall condition of the facility to ensure it is safe, clean, and accessible for individuals with disabilities. This includes inspecting:

• Adequate lighting, temperature control, and ventilation.

• Properly maintained equipment and furnishings.

• Adequate space for mobility aids and easy access to exits and bathrooms.

• Health and Safety Protocols: Verify that the facility follows appropriate sanitation procedures, especially in communal areas like kitchens and bathrooms, to prevent the spread of infections and other health hazards.

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Conclusion

 

Effective audits in the care of individuals with developmental disabilities and mental illness must cover clinical care, safety, staffing, compliance, and client quality of life. Regular audits help identify areas for improvement, ensure compliance with laws and regulations, and ensure that individuals receive the highest standard of care in a safe, respectful, and effective environment. Auditing these key areas ensures that the facility is functioning optimally and that clients’ needs are being met in a comprehensive, ethical, and individualized manner.