We welcome feedback on the development and/or
implementation of this policy

POLICY MEMORANDUM CLIENT WELLNESS

Penny Lane’s Residential Program is committed to providing an environment that promotes and protects children’s health, well-being and ability to learn by supporting healthy eating and physical activity. The residential staff will engage clients, parents, counselors, food service professionals, health professionals, and other interested community members in developing, implementing, monitoring and reviewing nutrition and physical activity policies.   All clients will have opportunities, support and encouragement to be physically active on a regular basis.  Penny Lane recognizes that children need access to healthy foods and opportunities to be physically active in order to grow, learn and thrive.

Penny Lane encourages involvement of parents, clients, school food service representatives, school board, school administrators and community in the development of the client wellness policy by making the Wellness Policy available upon request and having it posted on the Penny Lane website www.pennylane.org   The Wellness Policy is posted in each facility and copies are available upon request.  The Wellness policy is part of the Penny Lane Group Home Program Statement which is available to the public upon request.  Copies are kept at the Penny Lane Corporate Office at 15305 Rayen Street North Hills California.       

The Wellness Policy is also provided to the client and parents/caregivers at the time of intake into the residential program.  Clients are able to review and provide feedback on the Wellness Policy during the month Resident Policy Committee.

Clients Rights Regarding Their Wellness 

•  Clients have the right to adequate voluntary medical, dental and psychiatric, mental health care. 

•  Clients can select, obtain, or decline medical, dental, vision, and mental health care and related services at his or her discretion. 

•  Non-medical staff will not make medical decisions about the severity of an illness or injury or screen clients’ requests for medical attention without consultation with a physician, a nurse or a trained health practitioner. 

•  Psychotropic medications will not be administered without parental consent, court order or compliance with court policy for administration of psychotropic medications. 

•  Facility staff will respect the confidentiality of clients’ medical or psychiatric treatment. Information about this treatment will not be generally available to staff. 

•  Clients have the right to a second opinion if requested before being required to undergo intrusive medical, dental or psychiatric procedures provided there is a resource for payment such as private insurance coverage for the client, Medi-Cal authorization, etc. 

•  Clients have the right to contact their county social worker regarding receiving or rejecting medical care or health related services. 80072(a)(9) 

•  Clients have the right to refuse care, treatment or services in accordance with the laws and regulations.  

•   Clients have the right to involve their families in decisions about their care, treatment and/or services.  

•   Clients have the right to the name of the staff member who has primary responsibility for their care, treatment and services.  The clients will be informed of the name of the staff members who will provide their care, treatment and services.   

Physical/Dental 

Penny Lane’s residential program ensures that all clients receive a physical and dental examination conducted by a practitioner qualified by the scope of his/her license within 30 days of admission, or sooner if warranted by the clients’ health needs.  The examination will include motor development and functioning; sensorimotor functioning; speech, hearing and language functioning; visual functioning; immunizations; oral health and oral hygiene.   The examination will include a vision test and if required a referral to an ophthalmologist will be made.  If the qualified practitioner orders follow up appointments, medication station staff will ensure appointments are made promptly and the client receives timely follow up care.  Any verbal order given to the medication staff by the qualified practitioner must be “read back” by the staff.  The verbal order must be documented in the facility log and on a Special Incident Report.    

Staff will be notified of appointments via email no later than Thursday of the week prior to the appointment.  The medication station staff will also put a list of the appointments in each Satellite House Medication Book.  To ensure a client arrives for his/her appointments, the Satellite House Supervisors will call the Main Facility each Sunday to confirm the client’s appointment.  After the appointment call in, the supervisor receiving the call and the supervisor making the call will document the contact in the respective facility log.    

As part of their job qualifications, all residential staff are required to have a knowledge of the recognition of early signs of illness and the need for professional assistance.  This knowledge includes, but is not limited to the recognition of medical, dental and psychiatric emergencies.  As part of every new employee’s orientation, all staff are informed of the Penny Lane emergency procedure which includes the handling of medical, dental and psychiatric emergencies.  In addition, Penny Lane has posted emergency numbers for police, fire, paramedics, poison information center and Penny Lane’s after-hours emergency response number.  Also posted are the phone numbers of doctors/dentists to be called in emergencies and the location of the nearest emergency hospital.  In case of a psychiatric emergency or the need for crisis intervention, Penny Lane staff have access to the psychiatrists’ phone numbers.  

In case of any life-threatening emergency such as respiratory arrest or cardiac arrest, staff are required to call 911. So that all clients may be treated in emergencies, no client is admitted to the program without a medical authorization signed by their authorized representative.  Current Medi-Cal number are usually provide at admission, but if a client does not health insurance, the client will be taken to the emergency room for services until insurance can be obtain.              

Any residential staff who accompanies a client who receives routine or emergency medical or dental services, or who learns of medical or dental treatment which has been rendered to a client, that staff is responsible for determining whether or not there are instructions for after-care treatment.  The staff is responsible for communicating the circumstances of medical/dental care to other staff on duty; communicating what if any, instructions there are for after-care treatment; and, recording this information on a SIR and in the facility log. 

In cases when there is not a staff present during medical or dental treatment (i.e. during a home visit or school) and it cannot be immediately determined if there are instructions for after-care, the staff will make a reasonable and diligent effort to determine if there are any instructions and record the results of his/her efforts on a SIR and in the facility log.  In the absence of any information, the medication station staff will consult with the client’s physician to determine appropriate after-care.

It is the responsibility of the facility supervisor on each shift to monitor all medical or dental after-care and to ensure it is being properly carried out and that there are no complications.

All residential staff are trained in First Aid and CPR.  If needed, all trained staff are required to provide First Aid and/or CPR to residential clients.  Each residential facility is equipped with stocked First Aid kits. 

Pain Assessment 

Penny Lane recognizes that physical pain can have a physiological and psychological consequence.  Therefore, during the initial physical examination that occurs within 30 days of admission, the qualified practitioner will assess the residential clients for physical pain by utilizing the Pain & Nutrition Screening Form.  A client that is determined to have physical pain will be treated by a qualified practitioner or will be referred for additional treatment. 

Each time a Main Facility client has a physical complaint he/she will be brought to the medication station and the medication station staff will complete the Pain & Nutrition Screening Form if the client rates the pain a 7 or higher using the Universal Pain Assessment Tool.  Each time a Satellite House client has a physical complaint, the staff on duty will complete the Pain & Nutrition Screening Form if the client rates the pain a 7 or higher using the Universal Pain Assessment Tool.  If indicated, the client will be taken to Urgent Care or the Emergency Room immediately.  In addition, at the time of the Quarterly Needs and Service Plan, the therapist will complete the Pain & Nutrition Screening Form and incorporate the results in the Needs and Service Plan.  Whenever there is an Administrative Review, the Penny Lane social worker will complete the Pain & Nutrition Screening Form. Also, during the Discharge Planning Review, the Penny Lane social worker will complete the Pain & Nutrition Form.  A client that is determined to have physical pain will be treated by a qualified practitioner or will be referred for additional treatment.  Copies of the completed Pain & Nutrition Forms will be kept in the client’s file.    

Goals for Physical Activities 

Recreation and other planned activities are important program components.  They are a means by which diversity and uniqueness may be introduced into a youth’s life.  Activities provide a vehicle for the development of the client’s socialization skills and values. Recreation also provides a normalizing link with the community. Social and recreational activities are viewed as opportunities for the clients to develop socially conscious and acceptable behaviors and to learn the values of self-control, difference between right and wrong, compassion, morals, patience, respect, responsibility, sharing and helping others.

Penny Lane will strive to provide the clients with as normal of a life as possible.  The Residential Program will ensure that clients are given an opportunity to participate in age-appropriate extracurricular, enrichment and social activities.   Penny Lane will take reasonable steps to determine the appropriateness of the activities in consideration of the client’s age, maturity and developmental level. 

Penny Lane will provide the following activities: 

•   Group interaction: group outings, satellite house outings, dances, barbecues, Big Sisters, Level B and C outings/parties  

•   Physical activities: gym, equipment at satellite houses, basketball courts, team sports, volleyball court, gardening, dancing, yoga 

•   Individual and family-oriented leisure time: video games, on/off site libraries, TV, radio, computer, board games, movie night, slumber parties, photo albums/Life Books 

•   Penny Lane will provide each client with a life book at admission.  The treatment team will encourage and assist the client in creating and updating a life book of items that relate to childhood memories.  The treatment team will ensure that the life book accompanies the client when he/she leaves Penny Lane. 

•   Educational activities: living skills,  Career Night, poetry writing and reading, library activities, pet care and training, Planned Parenthood, alumni clients, Learning Tree 

•   Daily living skills activities: menu planning, cooking classes, money management, nutritional education, hygiene/grooming, healthy lifestyle. 

•  Cultural activities: drama, Black History Month, Jazz Festival, Cinco de Mayo, arts and crafts, singing, museums, plays   

•   Special events: Prom, Graduation, New Years Eve, Halloween, birthdays, Valentine’s Day Dance, Award Ceremonies 

•   Community activities: mentoring program, Special Olympics, AIDS Walk LA, tutoring, volunteer work, beaches, parks, recreational centers, local sporting events.

When developing and planning activities, several important factors are taken into account: 

•   A review of program and community resources is made to ensure the activities are consistent with program services.  The Quality Improvement Department does this regularly as well as the Program Directors.    

•   Potential activities are assessed in terms of their cultural diversity, educational value, challenge and age-appropriateness. Clinic staff is often consulted and activities are consistent with the needs and service plans and treatment plans.  Furthermore, Penny Lane plan activities and events that will correlate with what the clients are learning, i.e., Black History Month, Cinco de Mayo.             

•   Activities are scheduled at times that ensure the maximum number of clients that may participate. Indoor and outdoors are offered daily. 

•   Activities are carefully and systemically evaluated to ensure safety.  All residential staff receive training on Penny Lane activities policy and procedures during new staff orientation.  A portion of the orientation test covers activities.  

•  Clients are instructed about appropriate behavior on activities during their orientation period.  The clients are also tested on this material.  

•   Clients on Red Flag Status are not permitted to attend outside planned activities.  

•   All vehicles used for outside activities will be equipped with first aid kit, fire extinguishers, medical authorizations, medical information and copies of medi-cal numbers for every client on the activity.  

•   Activities will not be planned at areas that do not have an on duty lifeguard.  

•   Staff are not to engage in any contact or physical activities.  

•   The Safety Committee will regularly review agency planned activities. 

•   Each client who is capable is given the opportunity to participate in the planning, preparation, cleanup and critique of the planned activity.  The Resident Policy Committee regularly reviews and provides feedback about the planned activities.

Goals for Nutritional Education 

During the initial physical examination, the qualified practitioner will also conduct a nutritional screening to identify clients who may have nutritional risk.  For those clients who are determined to be a nutritional risk after the assessment, a nutritional treatment plan will be created by the qualified practitioner and/or the client may be referred for treatment outside of Penny Lane such as Children’s Hospital.  Nutritional assessment is also conducted by the qualified practitioner when a client experience a change in weight, change in appetite, dental problems, noncompliance with a special diet and/or food allergies.   Clients are educated by the qualified practitioner at this time and as further assessments are needed or occur.  Clients also attended Living Skill and Cooking Classes to further their nutritional education and further promote healthy living.

Food is not used as an incentive for behavior.                     

Foods and beverages served at the facility will meet the nutritional recommendations of the U.S. Dietary Guidelines for Americans.  Qualified child nutrition professionals will provide clients with access to a variety of affordable, nutritious, and appealing foods that meet the health and nutrition needs of clients; will accommodate the religious, ethnic, and cultural diversity of the clients in meal planning; and will provide clean, safe, and pleasant settings and adequate time for clients to eat. Nutrition guidelines for all foods are available at each facility. 

The medication station staff and/or the qualified practitioner will provide or coordinate nutritional education and physical education to foster lifelong habits of healthy eating and physical activity, and will establish linkages between health education and facility meal programs, and with related community services.  Special diets and altered diet schedules will be accommodated.  Cultural, religious and ethnic food preferences are served to clients.  Staff will assist clients if and when they need help eating.   The dining areas will be adequately supervised by staff when used by the clients. 

Facility Meals served at Penny Lane will: 

•  Be appealing and attractive to the youth; 

•  Be served in clean and pleasant settings; 

•  Meet, at a minimum, nutrition requirements established by local, state, and federal statutes and regulations; 

•  Offer a variety of fruits and vegetables; 

•   Serve only low-fat (1%) and fat-free milk and 

•   Ensure that half of the served grains are whole grain.

Meal Times and Scheduling  

•   Penny Lane will provide clients with at least 10 minutes to eat after sitting down for breakfast and 20 minutes after sitting down for lunch and dinner; 

•   Penny Lane will schedule meal periods at appropriate times, e.g. lunch will be scheduled between 11 a.m. and 1 p.m.; 

•   Penny Lane will not schedule tutoring, group sessions, or organizational meetings during mealtimes, unless clients may eat during such activities; 

•   Penny Lane will schedule lunch periods to follow recess periods; 

•   Penny Lane will provide clients access to hand washing or hand sanitizing before they eat meals or snacks.

Qualified Food Service Staff will administer the meal programs. Food and Nutrition Services will provide continuing professional development for all staff. Staff development will include appropriate certification and/or training programs to staff according to their levels of responsibility. 

Food Storage & Labeling 

Food and nutrition products will be stored and prepared under proper conditions of sanitation, temperature, light, moisture, ventilation and security. Proper food storage ensures that clients receive fresh, unspoiled food and reduces risk of illness caused by food contamination. Since product dates aren’t a guide for safe use of a product, staff must consult the FDA chart and follow the following guidelines when purchasing, storing or preparing food that requires refrigeration or freezing.  The FDA chart must be posted on each facility’s refrigerator. 

•   Purchase the product before “sell-by” or expiration dates. 

•   Follow handling recommendations on product. 

•   Keep meat and poultry in its package until just before using. 

•   If freezing meat and poultry in its original package longer than 2 months, overwrap these packages with airtight heavy-duty foil, plastic wrap, or freezer paper, or place the package inside a plastic bag. 

•   LABEL all food with the expiration date per the FDA chart. 

•   Discard food that has reached its expiration date. 

•   If food ever looks or smells unfit for consumption error on the side of caution. Do not eat or serve this food to clients and discard it.

Refrigerators containing food and beverages must be kept between 37 and 45 degrees at all times.  The staff on duty will check the thermostat two times per day and initial the Food Refrigerator Temperature Log.  The Food Refrigerator Temperature Log will be maintained by each facility and submitted to the Training Coordinator at the end of each month.  A copy will be retained at each facility.  If the temperature varies below 37 or over 45 degrees the staff on duty will adjust the refrigerator thermostat and re-check the refrigerator’s temperature in 2 hours.  If the problem persists, the staff on duty will immediately notify the supervisor and the maintenance department.   

Developmentally Appropriate Wellness Education 

Penny Lane will schedule regular educational classes for clients to address developmental changes that occur during adolescence.  Health, human sexuality, abstinence, birth control, Sexually Transmitted Diseases, etc. will be covered by community resources that specialize in this type of education and training. Such resources will be Planned Parenthood, YMCA, Boys and Girls Club, etc.         

Monitoring and Evaluation 

The Residential Director will ensure compliance with established nutrition and physical activity wellness policies.  Food and Nutrition Services will ensure compliance with nutrition policies within food service areas and will report on this matter to the Associate Executive Director. In addition, the facility will report on the most recent USDA School Meals Initiative (SMI) review findings and any resulting changes. If the facility has not received a SMI review from the state agency within the past five years, the facility will request from the state agency that a SMI review be scheduled as soon as possible. The Residential Director will develop a summary report every three years on compliance with the facility’s existing nutrition and physical activity environments and policies. The results of the assessment will be compiled to identify and prioritize needs. The facility will, as necessary, revise the wellness policies and develop work plans to facilitate their implementation.  Implementation of the Client Wellness is reviewed annually in the Residential Leadership Meeting.  Revisions are made at that time if necessary.  Implementation Review includes reviewing the grievance logs to identify any food or food service issues; compliance with medical/dental appointments; feedback for the food service representations; client satisfaction feedback; feedback from the nutritionist;  results state and county compliance reviews; client participation in physical activities.    The public will be able to review any changes or revisions to the Wellness Policy and/or implementation on the Penny Lane website www.pennylane.org.  The Residential Director is designated official in charge of Wellness Compliance and School Meal Program Oversight.