Questions to ask when touring an ICF

• Check the type. A DD-H home is for people whose nursing needs are intermittent and predictable; a DD-N home is for medically fragile people who need skilled nursing on and off; a DD-CN home provides skilled nursing around the clock. ICF/DD-H vs. DD-N vs. DD-CN explains the differences.
• Read the record. Each home's page in Facility Search shows its federal inspections since 2018, with what inspectors found, and its State citations. Note anything you want to ask about. How to read an ICF inspection explains the codes.
• Read the complaints. Complaints and incidents the home reported aren't in the federal data. They are on the home's CalHealthFind page, linked from its page here.
• Talk to the regional center. Placement in an ICF usually goes through a regional center. See Regional centers and ICFs.

Every resident must have an individual program plan, written by a team of professionals within 30 days of moving in, with the resident and their guardian taking part. The plan sets measurable goals, and the resident must get a continuous program of training and support toward them (what the rules call active treatment).

• Can we see how a resident's plan is written (with names removed), and how goals are tracked?
• Who is on the team, and how will we be invited to plan meetings?
• What does a typical weekday look like for a resident? Where do residents spend the day?
• How often is the plan reviewed? (The rules require at least a yearly review, and changes whenever a goal is met or a resident is losing skills.)

While you are there, look at what residents are doing. Are they taking part in activities, or mostly waiting?

Federal rules require nursing services that fit each resident's needs. A licensed nurse must review the health of residents without a medical care plan at least every quarter, by examining them. A pharmacist must review each resident's medications at least every quarter, medications must be given without error, and they must be kept locked.

• When is a nurse in the home, and who covers nights and weekends?
• Who gives medications, and how are they trained? What happens when a dose is missed or wrong?
• How are we told about a change in health, a hospital trip or a new medication?
• Which doctor and dentist do residents see, and how often?

The rules set minimum numbers of direct care staff for each living unit, and in many units require staff to be on duty and awake around the clock whenever residents are there.

• How many direct care staff are on each shift, including overnight? Are night staff awake?
• How long have most staff worked here? How is a new staff member trained before working alone?
• Who is the program coordinator (the QIDP) for each resident, and how do we reach them?

Evacuation drills must happen at least once a quarter on every shift, with residents actually taken out of the building at least once a year on each shift. A bedroom may hold no more than four residents unless CDPH grants an exception.

• When was the last evacuation drill, and how did it go?
• How are residents who use wheelchairs or can't walk moved out in an emergency?
• Where will our family member sleep, and where can they keep their own things?

Fire-safety findings (K-codes) and emergency-preparedness findings (E-codes) from the home's inspections are on its page here.

The rules protect residents from physical, verbal, sexual or psychological abuse and from punishment. Residents may meet privately with people they choose and receive unopened mail. The home must encourage visits by family, close friends, guardians and advocates at any reasonable hour without advance notice, unless the planning team decides a particular visit isn't appropriate. It must promptly tell parents or the guardian about significant incidents, such as a serious illness, an accident, abuse or an unexplained absence.

• Can we visit without calling ahead? Where can we visit privately?
• How and how quickly will you tell us about an incident or an injury?
• How are residents' own money and belongings kept track of? (The home must account for residents' funds separately from its own, and show the records to the resident or guardian on request.)

Every allegation of mistreatment, neglect or abuse, and every injury of unknown cause, must be reported right away to the home's administrator or other officials as State law requires, and investigated, with results reported within five working days.

• Who do staff report to, and how do you keep residents safe while something is investigated?
• What did the home change after its most recent inspection findings or citations?
• If we have a concern, who do we tell first? Anyone can also file a complaint with CDPH.

• Compare what you saw with the home's inspection record and its CalHealthFind page. Look for the same problem cited more than once.
• Visit more than one home, and if you can, visit again at a different time of day.
• Share your notes with the regional center service coordinator before deciding.