Health Care Department Operations Manual

Chapter 3 – Health Care Operations

Article 1 – Complete Care Model

3.1.10 Specialized Health Care Housing

Policy
- California Department of Corrections and Rehabilitation (CDCR) shall ensure appropriate specialized health care housing is available to meet the level of care needed for each patient. These services shall include access to both community and institution-based specialized health care housing. CDCR shall ensure that the continuum of services is available statewide including, but not limited to, all specialized health care housing.
- CDCR shall ensure the coordination of planned health care to patients needing services for preventive care interventions for acute illness and injury, and supportive care for patients unable to attend to their own activities of daily living. The scope of services provided to patients within this policy is specific to medical specialized health care housing and shall be interdisciplinary and include at a minimum: medical, mental health, dental, nursing, pharmacy, diagnostic, rehabilitative, and assistive services appropriate to maximize the quality of life and functional status and to reduce morbidity and mortality.
  - The Mental Health Services Delivery System (MHSDS) Program Guide and associated policies define the scope of mental health services provided in mental health specialized health care housing. The medical services provided in mental health specialized health care housing are outlined in this policy.
Responsibility
- Statewide
  - California Correctional Health Care Services shall designate a statewide committee with responsibility for the management of specialized health care housing facilities and beds statewide.
    - Standing members of the committee shall include at a minimum, the Deputy Directors of Medical, Nursing, Mental Health, Institution Operations, Dental Services, Health Care Placement Oversight Program (HCPOP), Utilization Management (UM), Pharmacy, Ancillary and Allied Health Services, and Regional Health Care Executives (RHCEs).
    - The committee shall be responsible for ensuring appropriate health care services are available for patients statewide, coordination of care, access to the appropriate level of care, and reducing the risks associated with handoff and transfer of patients between health care teams and specialized health care housing units.
  - Statewide health care leadership from all disciplines shall be responsible for developing and distributing tools to assist institutions in the development of Local Operating Procedures (LOPs) for their specialized health care housing units.
  - HCPOP shall endorse patients to specialized health care housing units in the event that the institution does not have any appropriate, non-contract inpatient level of care beds available.
  - UM has the primary responsibility for establishing and maintaining a standardized, auditable system for managing contracted and specialized medical beds resources.
- Regional
  - RHCEs are responsible for the implementation of this procedure at the subset of institutions within an assigned region. RHCEs shall, at a minimum, monitor timeliness, access, and admission and discharge rates to ensure that patients’ level of care within the medical specialized health care housing unit is appropriate for their health care needs.
- Institution
  - The Chief Executive Officer (CEO) has overall responsibility for implementation and ongoing oversight of a system to provide management of the scope of specialized health care housing within their institution. The CEO delegates decision making authority to designated health care executives for the daily operations of the specialized health care housing units and ensures adequate resources are deployed to support the system.
  - The CEO and all members of the institutional leadership team are responsible for ensuring:
    - All necessary resources are in place to support the successful implementation of this procedure at all levels including, but not limited to:
      - Institution level
      - Patient panel level
      - Patient level
    - Access to and utilization of equipment, supplies, health information systems, patient registries and summaries, and evidence-based guidelines.
    - Implementation of institution-specific LOPs that fully support and implement this procedure (refer to Section (e), Local Operating Procedure Requirements).
  - Institutional leadership shall review the operation of each element of the specialized health care housing unit ensuring that the patient is at the appropriate level of care; staff resources are available and distributed in order to provide the required patient care services; and that staff have access to the required resources, services, procedures, templates, equipment, supplies, and any other resources necessary to meet patient health care needs.
  - Each CDCR licensed facility (e.g., medical Correctional Treatment Center (CTC), CTCs with a mental health treatment program, Hospice, Skilled Nursing Facility) shall designate a Governing Body in accordance with the sections of the California Code of Regulations applicable to their licensure. An institution with multiple licensed facilities shall designate one Governing Body with responsibility for oversight of all licensed care within the institution. The Governing Body shall also communicate with the institution Quality Management Committee (QMC) at a periodic frequency to meet its oversight obligations but not less than quarterly.
  - Each institution shall designate a subcommittee that has responsibility for the administration of the specialized health care housing provided at their institution. The designated subcommittee shall report to the Institution QMC. This subcommittee shall address at a minimum the following operational elements within the specialized health care housing units:
    - Emergency Management
    - Infection Control and Prevention
    - Human Resources
    - Environment of Care
    - National Patient Safety Goals
    - Health Information Management (Electronic Health Record System)
    - Leadership
    - Life Safety
    - Medication Management
    - Performance Improvement
    - Provision of Care, Treatment, and Services
    - Clinical Laboratory Improvement Amendments/Waived Testing
  - The designated subcommittee shall be responsible for taking corrective action to resolve or elevate concerns identified in the review. The review and action taken shall be documented and forwarded to the Institution QMC pursuant to the pre-defined subcommittee report-out schedule.
  - Each institution that provides a licensed service within their specialized health care housing units shall ensure that they comply with all applicable laws, rules, regulations, and policies regarding facility organization, standing committees, and policy and procedure development and implementation.
All Specialized Health Care Housing Overview
- Nursing Services
  - Nursing Care shall be available 24 hours per day, seven days per week under the direction of a Supervising Registered Nurse (RN).
  - Nursing care services are designed to ensure an appropriate level of care is delivered to each patient through timely access to health care services, initial and ongoing assessment, planning, intervention and evaluation in a system designed to promote health maintenance, reduce risk of debilitative injury, improve function, and maximize the patient’s quality of life through application of evidence-based nursing practice.
  - Specialized health care housing units that do not have 24/7 RNs may have the CDCR 7362, Health Care Services Request Form, available for patients who request them and shall utilize the process described in the Health Care Department Operations Manual (HCDOM), Section 3.1.5, Scheduling and Access to Care. The institution LOP shall outline processes specific to each unit’s management of the CDCR 7362s.
  - For specialized health care housing units that do not utilize CDCR 7362s, daily nursing documentation shall include:
    - Patient’s requests for care
    - Patient’s concerns or complaints
    - Nursing interventions provided
  - Nursing care management services shall be provided to patients within the specialized health care housing units. The extent of care management services varies according to the complexity of the patient. Nursing care management services begin at the time of admission and continue through discharge. Nursing care management services shall be provided through a collaborative process of patient evaluation, advocacy, care planning, facilitation, and interdisciplinary coordination.
  - Nursing care management services shall be coordinated and continued across all levels of care (ambulatory, acute, and inpatient), in all physical locations where patients receive care within CDCR, and include the patient’s transition to community-based services upon parole or discharge.
- Medical Services
  - Medical services shall be available 24 hours per day, seven days per week under the direction of the Chief Medical Executive (CME).
    - Services shall be provided in person, telephonically, or through an approved telehealth solution.
    - The institution CME, or designee, shall ensure that a roster is available at all times to specialized health care housing unit staff designating the attending Primary Care Provider (PCP) who is responsible for patient care.
  - The attending PCP is responsible for initiating admission, determining and documenting the anticipated length of stay, identifying and documenting treatment goals and discharge planning for patients being admitted to, discharged from, or changing levels of care within the medical specialized health care housing units.
  - The frequency of rounding and documentation by medical providers is determined by the patient’s condition and health care setting as outlined in Appendix 1, Specialized Health Care Housing Rounding and Documentation Frequency.
  - Medical services shall be provided to patients within the specialized health care housing units in accordance with the HCDOM, Chapter 3, Health Care Operations, and any other applicable laws, rules, regulations, and court orders.
- Mental Health Services
  - Mental health services shall be available 24 hours per day, seven days per week under the direction of the Chief of Mental Health and Chief Psychiatrist.
    - Services shall be provided in person or through an approved telehealth solution.
  - For medical admissions, mental health shall provide services to patients within the specialized health care housing units in accordance with the MHSDS Program Guide and associated policies.
  - The designated mental health team, within their scope of practice, is responsible for initiating admission, determining the anticipated length of stay, identifying treatment goals and discharge planning for the mental health care of patients being admitted to, discharged from, or changing levels of care within the mental health specialized health care housing units.
- Dental Services
  - Under the direction of the Health Program Manager III (HPM III) and the Supervising Dentist (SD), dental services shall be available at least eight hours per day, Monday through Friday, excluding holidays. Emergency dental services shall be available 24 hours per day, seven days per week.
    - Services shall be provided in person or telephonically.
    - The HPM III and the SD shall ensure that a roster is available at all times to specialized health care housing unit staff designating a dental provider who is responsible for supporting the specialized health care housing units during dental services business hours and a dental provider who is responsible for after-hours emergency dental services.
  - Dental services shall be provided to patients within the specialized health care housing units in accordance with the HCDOM, Chapter 3, Article 3, Dental Care and all other applicable laws, rules, and regulations.
  - The designated dental provider is responsible for coordinating patient admission with the attending PCP as well as determining the anticipated length of stay; identifying treatment goals; and discharge planning for the dental care of patients being admitted to, discharged from, or changing levels of care within the specialized health care housing units.
- Pharmacy Services
  - Pharmacy services shall be available to ensure timely availability of medication 24 hours per day, seven days per week under the direction of the institution Pharmacist-in-Charge and the Statewide Chief of Pharmacy Services.
    - The licensed Correctional Pharmacy or Central Fill Pharmacy shall ensure furnishing or dispensing of medications to specialized health care housing unit staff for the treatment of patients.
    - Drugs shall be available through the appropriate use of automated drug delivery systems and approved clinic stock in licensed correctional clinics.
    - Appropriate after-hours services shall be made available through the use of centralized remote pharmacist verification services.
    - Centralized remote after-hours pharmacy services shall ensure offsite pharmacist verification of new medication orders will be utilized when the drug is available in an automated drug delivery system or licensed correctional clinic stock.
    - The use of voluntary call back pharmacist services after hours may be utilized if medications are not available in any medication storage area outside the pharmacy area or during hours when the centralized after hours pharmacy services are unavailable.
  - Pharmacy services shall be provided to patients within the specialized health care housing units in accordance with the HCDOM, Chapter 3, Article 5, Pharmacy, and all other applicable laws, rules, regulations, and court orders.
- Ancillary and Allied Health Services
  - Ancillary and Allied Health Services shall be available to patients within the specialized health care housing units under the administrative direction of the Chief Support Executive. Responsibility for the clinical supervision of ancillary and allied health care staff remains with the CME, or designee.
  - Ancillary and Allied Health Services include, but are not limited to:
    - Diagnostic Services (e.g., Laboratory, Radiology)
    - Nutritional (Dietary) Services
    - Medical Supply
    - Biomedical Maintenance
    - Durable Medical Equipment (DME)
    - Physical Therapy
    - Respiratory Therapy
    - Rehabilitation Services
    - Adaptive and Assistive Services
  - The institutional medical leadership shall ensure that specialized health care housing unit patients have access to the Ancillary and Allied Health Services necessary to comply with their interdisciplinary treatment plan.
  - Services shall be provided, as appropriate for the patient and as determined by the ordering PCP, through the following methods:
    - In person
    - Telephonically
    - Through an approved telehealth solution
  - Services provided to patients within the specialized health care housing units shall be performed in accordance with the appropriate HCDOM and any other applicable laws, rules, regulations, and court orders.
Procedure
- Admission
  - Patients shall be admitted to a medical specialized health care housing unit only upon the order of a PCP. Processes for the care of patients admitted to a mental health specialized health care housing unit shall be in accordance with the MHSDS Program Guide and associated policies.
    - The admitting PCP shall be responsible for ensuring that all admission orders are written within 24 hours and documented in the health record.
    - Verbal admission orders shall not be given; however, in emergent circumstances, telephonic admission orders may be provided to the RN. The admitting provider shall counter-sign the telephonic orders and document in the health record.
    - The admitting PCP is responsible for coordinating with other disciplines to ensure that health care actions specific to that discipline are completed (e.g., an admitting mental health clinician is responsible for coordinating the completion of the admitting history and physical [H&P] with the attending PCP).
    - The admitting PCP shall identify plans including, but not limited to, PCP rounding and follow-up, and anticipated length of stay if known.
  - Patients admitted to a specialized health care housing unit shall have an admitting H&P performed by a medical provider within 24 hours of admission. If an H&P has been performed within five days prior to this admission, it does not need to be repeated. The admission note shall include documentation that the H&P was reviewed and any changes to the review of systems noted and addressed.
    - If the patient is discharged within 24 hours of admission, the written discharge summary may take the place of the admitting H&P.
  - Patients admitted to a specialized health care housing unit shall have a nursing initial assessment at the time of admission performed by an RN, including the Level of Care Assessment Tool.
    - Other members of the nursing Care Team may collect data and assist in the development of the patient’s interdisciplinary care plan consistent with their licensure and scope of practice.
    - The RN retains responsibility for the finalization and documentation of the nursing admission assessment and the interdisciplinary care plan. The interdisciplinary care plan shall be completed within 72 hours of the patient’s admission and updated as the patient’s condition changes, treatments change and interventions change.
    - The RN shall complete the Level of Care Assessment Tool within 24 hours of admission and provide and document patient education that includes, at a minimum:
      - Frequency of provider visits
      - Frequency of nursing rounds
      - How to use the call light
      - How to request care
    - Patients admitted to a specialized health care housing unit for urgent mental health treatment shall be evaluated by a mental health treatment team within the timeframes specified in the MHSDS Program Guide and associated policies and directives. This evaluation is in addition to any examination or H&P completed by the PCP.
    - Patients admitted to a specialized health care housing unit for dental treatment shall be examined by a dental provider within the timeframes specified in the HCDOM, Section 3.3.5.13, Access to Dental Care. This examination is in addition to any examination or H&P completed by the PCP.
    - Each specialized health care housing patient shall be informed of their rights and responsibilities during the admission process as specified in the LOP.
- Patient Stay
  - The patient stay process includes minimum expectations for rounding (type, frequency and composition), communication, and documentation requirements. The frequency of rounds and the composition of the team conducting the rounds are determined by the patient’s condition and the patient’s care setting.
  - Rounds shall include, but are not limited to, nursing rounds, interdisciplinary rounds, team rounds, safety checks, supervisory rounds, and environment of care rounds.
    - Interdisciplinary rounds shall be performed every two weeks for medical specialized health care housing admissions.
  - Patients admitted to a medical specialized health care housing unit shall be assessed by a member of their Care Team through rounds at least daily. The purpose of the assessment is to:
    - Determine the patient’s ongoing health care needs.
    - Determine the appropriate level of care.
    - Determine the response to treatment.
    - Analyze progress towards identified goals.
    - Identify unmet health care needs.
    - Adjust the interdisciplinary plan of care to meet the current and anticipated health care requirements.
  - Care Team members shall document their patient care interactions in the health record.
  - Each member of the Care Team is responsible for communicating with other Care Team members regarding any change in the patient’s condition or any abnormal findings.
    - Communication shall be in a manner appropriate for the abnormal finding or change in condition consistent with the Care Team member’s level of licensure and scope of practice.
    - Communication shall be documented in the health record.
  - Daily Specialized Health Care Housing Huddles
    - In the specialized health care housing huddles, the attending physician of the primary discipline shall lead the huddle.
    - The Specialized Health Care Housing Huddle Report is designed to support multidisciplinary health care teams in conducting daily huddles with a focus on identifying high risk patients by reviewing concerning signs and symptoms relative to these patients and taking appropriate action.
    - Care team members shall review key medical and mental health data about their current patient census, add their own observations from interactions with patients, and share information gathered from third and first watch staff to identify patients whose condition is deteriorating.
- Transfers
  - Patients shall only be transferred between medical specialized health care housing units upon the endorsement from HCPOP.
  - Patients shall only be transferred upon written order of a PCP except for in the circumstances listed in Sections (d)(3)(C) and (D) below.
    - The PCP initiating the transfer shall be responsible for ensuring that all transfer orders are completed prior to the patient’s transfer.
    - Transfer orders shall be documented in the health record.
  - Verbal transfer orders shall be given in emergencies as described in the HCDOM, Section 3.7.1, Emergency Medical Response System or Section 3.7.1-1, Emergency Medical Response System.
  - In non-emergent exigent circumstances, telephonic transfer orders may be provided to the RN. The provider initiating the transfer shall counter-sign the telephonic orders and document in the health record.
  - The PCP initiating the transfer is responsible for coordinating the patient’s level of care change with the receiving specialized health care housing unit’s admitting PCP.
  - Transfers shall be completed in accordance with the requirements of the HCDOM, Section 3.1.9, Health Care Transfer; MHSDS Program Guide; HCDOM, Chapter 3, Article 3, Dental Care; and applicable court orders.
- Discharge
  - Discharge planning shall begin upon admission to the specialized health care housing unit.
  - The goal of the discharge planning process is to maximize the patient’s level of self-care, maximize and preserve functioning, improve quality of life, and to determine the appropriate level of housing post discharge.
    - The patient’s discharge plan shall be interdisciplinary.
    - Discharge planning shall include post-parole/post-CDCR release self-care needs when appropriate for the patient.
  - Patients shall only be discharged from a medical specialized health care housing unit upon the written order of a PCP.
    - The PCP initiating the discharge shall be responsible for ensuring that all discharge orders are completed prior to the patient’s discharge.
    - Discharge orders shall be documented in the health record.
    - Verbal discharge orders shall not be given.
    - In non-emergent exigent circumstances, telephonic discharge orders may be provided to the RN. The provider initiating the discharge shall counter-sign the telephonic orders and document in the health record.
  - The PCP initiating the medical discharge is responsible for coordinating the patient’s discharge with the receiving Primary Care Team (PCT). While verbal provider-to-provider communication is required for an effective transfer handoff, all patients, regardless of length of stay, shall have a written discharge summary which shall include, at a minimum:
    - Reason for admission.
    - Current diagnoses in the active problem list.
    - Description of major events during the stay and treatments rendered.
    - Pertinent diagnostic studies.
    - Current medications.
    - Future appointments, diagnostic studies, and treatments.
    - Supplies, assistive devices, and DME including items that are to be in the possession of the patient upon discharge.
    - Assistance with one or more activities of daily living.
    - Disposition.
  - The Patient Summary Sheet may be utilized as a supplement to the primary discharge summary documents. However, the specialized health care housing unit staff are responsible for ensuring compliance with discharge documentation requirements.
- Release from CDCR Custody
  - For patients being released from a medical specialized health care housing unit:
  - The institution UM nurse, Classification & Parole Representative, and clinical team shall coordinate with headquarters UM, Division of Adult Parole Operations (DAPO), Post Release Community Supervision and community based health care providers to identify appropriate placement for the patient.
    - For patients released from a mental health program in a specialized health care housing unit, refer to the Mental Health Pre-Release Program Policy and Procedure.
  - The specialized health care housing unit clinical team, the institution UM RN, Resource RN, and the Receiving and Release (R&R) nurse shall ensure documentation about the patient’s health history, current status, medications, treatments and pending follow-up is obtained, along with required releases of information, and provided to the community-based providers.
  - Whenever possible, conferencing with the receiving clinical team is recommended to ensure timely and seamless transition of care.
  - The patient’s PCT shall ensure the patient’s health care needs are coordinated between all disciplines involved in the patient’s current and future care. The Care Team may be assisted by UM:
    - The institution UM RN serves as the primary resource for coordinating services between CDCR facilities, contract facilities, and community resources. The specialized health care housing unit LOP shall refer to the HCDOM, Section 1.2.15, Utilization Management Program, for guidance on the utilization of health care resources at all levels of care.
Local Operating Procedure Requirements
- Each CDCR institution shall develop an LOP that outlines the policies and procedures for each level of care provided by each specialized health care housing unit within their institution to fully implement the requirements in this procedure.
- LOPs for areas licensed or accredited by a local, county, federal, state licensing agency, or accrediting body shall comply with all laws, rules, regulations, and requirements pertaining to the license or accreditation.
- Coordination of Services
  - Each specialized health care housing unit shall ensure that their LOP includes instructions on the coordination of services between each level of care including, but not limited to:
    - The current institution and its specialized health care housing units.
    - Other CDCR specialized health care housing units.
    - Non-specialized housing units with CDCR institutions.
    - Contract facilities.
    - DAPO managed facilities
    - Other community resources as appropriate to the patient’s health care needs and CDCR status.
- LOPS shall address topics including, but not limited to:
  - Admissions process.
  - Patient rounding regarding type, frequency, and composition.
  - Patient stay process.
  - Availability of CDCR 7362s.
  - Transfer process.
  - Discharge planning process.
  - Coordination of services process.
  - Patient release or parole process.
  - Transfer to county facilities or other outside facilities process.
  - Health record documentation frequency requirements for all patient care interactions.
  - Provisions for the implementation, structure, and operation of a quality assurance process.
  - Patient rights and responsibilities.
Appendices
Appendix 1: Specialized Health Care Housing Rounding and Documentation Frequency
References
- California Code of Regulations, Title 22, Division 5, Chapter 12, Article 5, Correctional Treatment Centers
- Health Care Department Operations Manual, Chapter 1, Health Care Governance and Administration
- Health Care Department Operations Manual, Chapter 2, Article 2, Confidentiality and Privacy
- Health Care Department Operations Manual, Chapter 2, Article 3, Section 2.3.1, Health Information Management Overview
- Health Care Department Operations Manual, Chapter 3, Article 1, Complete Care Model
- Health Care Department Operations Manual, Chapter 3, Article 3, Dental Care
- Health Care Department Operations Manual, Chapter 3, Article 5, Pharmacy and Medication Services
- Health Care Department Operations Manual, Chapter 3, Article 6, Durable Medical Equipment/Supplies and Accommodations
- Health Care Department Operations Manual, Chapter 3, Article 7, Emergency Medical Response
- Health Care Department Operations Manual, Chapter 3, Article 8, Public Health
- Health Care Department Operations Manual, Chapter 4, Special Circumstances
- Health Care Department Operations Manual, Chapter 5, Article 1, Section 5.1.3, Medical Bed Management
- California Department of Corrections and Rehabilitation, Mental Health Services Delivery System Program Guide, 2009 Revision, and associated policies and directives.

Policy Control
Executive Sponsor: Deputy Director, Medical Services
Effective: 04/2019
Revised: 10/12/2026

Appendix 1: Specialized Health Care Housing Rounding and Documentation Frequency

Correctional Treatment Center (CTC)

Clinical Setting	Minimum Medical Provider Rounding & Documentation Frequency
Initial H&P	Within 24 hours (If an H&P has been performed within five days prior to admission, it does not need to be repeated.)
Stable, within the first 30 days of admission	Every 7 calendar days, more frequently as clinically indicated
Stable, beyond the first 30 days of admission	Every 14 calendar days or more frequently as clinically indicated

Outpatient Housing Unit (OHU)

Clinical Setting	Minimum Medical Provider Rounding & Documentation Frequency
Initial H&P	Within 24 hours (If an H&P has been performed within five days prior to admission, it does not need to be repeated.)
Stable	Every 30 calendar days
Additional episodic care	As clinically indicated

Psychiatric Inpatient Program (PIP)

Inpatient Setting	Minimum Medical Provider Rounding & Documentation Frequency
Initial H&P	Within 24 hours (If an H&P has been performed within five days prior to admission, it does not need to be repeated.)
Stable	Every 90 calendar days
Additional episodic care	As clinically indicated and upon request

Skilled Nursing Facility (SNF), Hospice, or Mental Health Crisis Bed (MHCB)

Inpatient Setting	Minimum Medical Provider Rounding & Documentation Frequency
Initial H&P	Within 24 hours (If an H&P has been performed within five days prior to admission, it does not need to be repeated.)
Stable	Every 30 calendar days
Additional episodic care	As clinically indicated

Policy Control
Executive Sponsor: Deputy Director, Medical Services
Effective: 05/16/2023
Revised: 10/12/2026