Canyon Manor clients are chronically mentally ill adults who suffer symptoms of primary psychotic and/or substance abuse disorders and they are unable to provide for their own basic survival needs. Potentially dangerous clients and mentally disordered sexual offenders are considered unsuitable for admission to Canyon Manor. Physically disabled clients with psychiatric problems are accepted on an individual basis. Any clients requiring either acute psychiatric or medical services will be transferred to a treatment setting most appropriate for their problem. It is the policy of Canyon Manor in Novato, California, a Mental Health Rehabilitation Center, to accept all admissions of residents regardless of race, color, religion, sex, age, ancestry, or national origin, sexual orientation or disability. Clients will be accepted for care without discrimination. Referrals are submitted through county transitional services liaisons, various VA hospitals, Regional Centers and by individual referrals. Clients whose histories include the following behaviors or conditions are not generally considered appropriate for admission: 1. Clients who are actively suicidal or self-injurious. 2. Clients who pose a danger of injury or threat of injury to others 3. Clients having sexual offenses involving assault or child molestation 4. Clients who are charged or have been convicted of arson 5. Clients who abuse or are addicted to alcohol or drugs who have not been detoxified. 6. Clients with uncontrolled epilepsy. Exceptions to the above criteria may be made depending on variables such as recent history, length of time in treatment, response to medications. Under no circumstance will the following clients be accepted for admission: 1. No Clients may be admitted to this center whose condition requires more care or treatment than this center can efficiently provide, who has a diagnosis that the State of California Licensing Act prohibits for placement in this center. 2. Clients who require strict isolation procedures will not be admitted. 3. Persons who are deemed to be imminently dangerous to themselves or others will not be admitted. 4. If a client becomes imminently dangerous to self or others, he/she will be immediately transferred to the proper and appropriate treatment facility.

Primary medical care services are offered in our Canyon Manor medical clinic. A primary care family nurse practitioner is available on the premises 15-20 hours weekly for evaluation of physical problems. Medical Clinic is held twice weekly with our medical doctor from the community. Every newly admitted client receives a basic physical examination, routine medical laboratory test, and tuberculosis screening, nutritional, dental and vision assessment. Outside specialty consultants are ordered as needed. Coordination of all-in house and community-based medical care orders are the responsibility of the nursing staff, who maintain a high level of surveillance regarding resident needs, both physical and psychiatric.

Canyon Manor has a banking program which resident’s are encouraged to utilize as a portion of the treatment program which endeavors to build practical skills for living in the community. Banking is conducted one afternoon a week. Each client will have an account to which they can deposit and from which they can withdraw needed funds. Most clients ( who are Medicaid/Medi-Cal eligible) receive a monthly amount from SSI and/or SSD for discretionary spending. The maximum amount of money which a conserved client may receive is determined by the conservator (when applicable). Money management is an important and necessary skill for all of our clients to learn and develop. Families who are interested in contributing funds to a specific client on a regular basis should consult the Social Service Worker as to advisability, amount, and method.

Canyon Manor has used the Level System over the past 32 years as an integral part of the treatment program. Over that period it has proven to be an effective vehicle by which the Treatment Team can give Clients feedback regarding any individual’s progress within the treatment program in general and provide specific behavioral information towards particular treatment goals or objectives. This is a particular useful way for staff to feed back to Clients in writing as well as verbally, those next steps needed to further progress through the Program and towards their own personal goals. It also affords a graded structure upon which clinical staff can target their expectations and interventions. The Level System is integrally linked to the Pass program and is the vehicle by which Clients attain pass privileges in a progressively graded manner. The following pages are excerpts from the Resident Orientation Manual specifically detailing both the Level and the Pass components to the overall treatment program. Level I:A. ADL/Self Care – You are able to do the basic self-care tasks some of thetime, with direct assistance and/or moderate to maximum supervision by staff.B. Treatment Compliance – You receive staff assistance/frequent reminders, in taking your medications and/or complying with lab tests, treatments, other testing ordered by you physician, depending upon you right to refuse.C. Behavior Control – You may require staff assistance in controlling your behavior and/or taking PRNs.D. Program Participation – You may need staff assistance/reminders to attend and participate in Program groups and activities. You are attending some Core groups. You are working towards earning 108 units (27 hours) of Program participation each week**PASSES: If you have been able to do your ADLs, comply with your treatment and control your behavior for at least 2 weeks you may be able to qualify for a Staff Escorted Pass or one or more Patio Passes. Level 2: A. ADL/Self Care – You are able to do basic self – care tasks most of the time with moderate to minimal staff supervision and reminders.B. Treatment Compliance – You are able to comply with your medications, labs and treatments with only a few (moderate to minimum) staff reminders most of the time, depending upon your right to refuse.C. Behavior Control – You only require staff reminders to control your behavior and/or take PRNs.D. Program Participation – You only require staff reminders to attend and participate in Program groups and activities. You are attending at least 7 Core* groups per week. You are earning 80 units of Program participation each week.**PASSES: If you have met the standards for Level 2, for at least 2 weeks, in ADLs, Treatment Compliance, Behavior Control and Program Participation, you may qualify for a Staff Escorted Pass or one or more Progress Passes. Level 3:A. ADL/Self Care – You are able to do basic self-care tasks almost all of the time with minimal staff reminders.B. Treatment Compliance – You are able to comply with your medications, labs and treatments with just one reminder, depending upon your right to refuse.C. Behavior Control – You are able to control your behavior consistently. You often ask for PRNs on your own. Staff only have to suggest it on occasion.D. Program Participation – You can remember to attend your groups on your own most of the time. Staff only have to remind you occasionally. You are earning at least 108 units and attending at least 10 Core groups each week.**PASSES: If you have met the standards for Level 3, for at least 2 weeks, in ADLs, Treatment Compliance, Behavior Control and Program Participation, you may qualify for Peer Passes. Level 4:A. ADL/Self Care – You are completely independent with all ADL and Self-Care tasks.B. Treatment Compliance – You do not need reminders to comply with your medications, lab work or treatments.C. Behavior Control – You can control your behavior consistently. You either do not need PRNs or you know when to ask for them on your own.D. Program Participation – You are earning 108 units per week consistently and are actively participating in at least 12 Core groups each week.**PASSES: If you have met the standards for Level 4, for at least 2 weeks, in ADLs, Treatment Compliance, Behavior Control and Program Participation, you may qualify for Alone Passes.* Core Groups: Core groups are those groups indicated on the Program Schedule in the gray boxes. They are considered to be “core or central to your work in the Canyon Manor Treatment Program. Involvement in these Core groups is considered essential to your overall participation and eventual progress.

Clients are encouraged to take passes in a responsible, socially appropriate manner as part of preparation for return to living in the community. Passes are granted upon request of the client and are conditional upon mental status, program participation, behavior, treatment compliance, and nature of the request. Changes in any of the above may result in immediate revocation of passes are as follows: Canyon Manor Pass ProgramAll Canyon Manor Passes are subject to qualification via the Canyon Manor Level Criterion and to Staff discretion. Passes are a privilege and Staff can revoke that privilege if assessed as appropriate to do so. *Special Passes – Special Passes are those passes that are arranged beforehand (so that Staff can prepare any necessary medications, coordinate transportation, plans, etc.) and usually involve family or friends taking Clients out of the building upon Level Criterion, but applicants for Special Passes must be assessed by Staff as able to “handle” the Pass in question. *Staff Escorted Passes – Staff Escorted Passes are outings whereby Staff take one or more Clients out into the community, in order to assess how they tolerate situations outside the facility and whether or not they are candidates for more liberal Pass privileges. *Patio Passes – Patio Passes are one hour passes from 3:30 p.m to 4:30 p.m., up to a maximum of three times per week. They are limited to the front Patio area only. Anyone on a Patio Pass who leaves the Patio area is considered AWOL and will lose all other privileges. *Progress Passes – Progress Passes are three hour passes into the community with a Peer, up to a maximum of four times per week. Peers must have a mutually agreed upon Pass plan and stay together for the duration of the pass. *Peer Passes – Peer Passes are four hour passes into the community with a Peer, up to a maximum of nine times per week. *Alone Passes – Alone Passes are four passes into the community alone (or with a Peer if desired) for a maximum of nine times per week.

Under current California Legislation concerning confidentiality of mental health clients, only information limited to the following areas may be released by the facility to identified family members without consent of the client: — The client’s presence or absence in the facility; — The client’s AWOL (absent without leave) status and whereabouts if known. — The client’s transfer to another facility; — Any emergency medical information, i.e., serious physical illness; — The client’s general condition.

With the client’s written consent, designated facility staff may share with you information pertaining to diagnosis, medication issues, and treatment progress. The Social Services Worker is your contact person in this situation. If the above information is unsatisfactory, following approval of the facility and written consent by the client and the conservator (when applicable) , review of the health record is possible. Records from other mental health facilities and certain legally specified types of privileges communications may not be shared even under these circumstances. Contact the Social Services Worker in this situation as well.

Any client who is referred to Canyon Manor without a private psychiatrist is assigned to one, following admission, from a panel of independent practitioners. The Medical Director and various clinical staff members regularly meet with the private psychiatrist who have been assigned to our clients to review client’s progress and to make treatment suggestions. The Medical Director is also chairman of the Medication review Committee at Canyon Manor which regularly reviews individual medication regimens and makes consultative recommendations to the attending private psychiatrist regarding treatment. Generally, clients are visited by their psychiatrist once a week, depending on clinical need. In addition, our Pharmacy Consultant provides monthly reviews of client medication regimen to ensure compliance with recommended treatment management.

1. Visiting hours are 3:30pm to 7:00pm Monday through Friday, and 9:00am to 9:00pm on weekends and holidays. Visitors must be at least 16 years of age and Must visit a specific client. 2. Clients are allowed personal belongings which can be accommodated in one locker, one dresser, and one bedside stand. Clients are encouraged to mark their own belongings for easy identification and are discouraged from keeping valuables in the facility. Locks are issued to each client upon admission to keep belongings secure. Families are requested to store any excess items that the client may own. Personal televisions, razor blades, and any items considered to be potential hazards (knives, firearms, etc.) are not to be brought into or kept in the facility. 3. Smoking is allowed only in outside areas and only under the supervision of staff. There are 4 smoke breaks scheduled throughout the day. Clients who choose to smoke can buy into the Canyon Manor smoking program for a set fee per month. Clients are not permitted to hold smoking materials inside the facility. Staff hold all smoking materials. 3. A: CHANGE IN SMOKING POLICY 4. Clients are encouraged and expected to do their own laundry, at no charge, using Canyon Manor facilities and equipment. Clients are assisted as needed. 5. Medications (including over-the-counter drugs) not prescribed within the facility are discouraged and must be given to nursing staff if brought into the facility. 6. Violence and/or the use or possession of alcohol or illicit drugs is not allowed. 7. When a client is absent without leave, their AWOL status is reported to the conservator (when applicable), the physician, the Novato Police Department, and the family if so requested. 8. Clients who are unable to comply with house rules are managed on an individual basis, but may not be allowed to stay at Canyon Manor if their behavior persists.

Canyon Manor provides three well balanced, nutritious meals daily at 8:00am, 11:45am noon, and 5:00pm. Snacks are available in the evenings, and coffee breaks are held at 10:00am and at evening time. Families may dine at Canyon Manor by prior arrangement for a minimal charge. Families who wish to bring in additional food are encouraged to bring only nutritious snack foods in small amounts and in resealable containers. Canyon Manor does not provide refrigeration or storage. Any clients requiring or requesting special diets or double portions are referred to medical clinic for appropriate orders. Clients on special or restricted diets may not have food brought in from outside without prior approval. Caffeinated beverages (coffee, tea, coca-colas) may interfere with prescribed medications and are therefore not allowed at Canyon Manor. Again, clients who are unable to comply with the above or other expectations, i.e., appropriate storage of food stuffs, smoking materials, are restricted on an individual basis.

All Canyon Manor clients are immediately assigned to a Social Services Worker. Please direct concerns regarding information to the Social Services Worker, who is generally available Monday through Friday, 8:00 am to 4:00 pm. To find out who the Social Worker is, call Canyon Manor’s business telephone number (415) 892-1628 and ask for the Social Services Department. Leave your name and number if the Social Services Worker is not immediately available so that your call may be returned as soon as possible. After 4:00pm weekdays or on weekends, ask for the “shift supervisor”. This person can speak to your immediate concerns and refer you if necessary to the appropriate Social Services Worker for further information. If urgent or emergency concerns are not handled to your satisfaction, you may ask the shift supervisor to have the “on-call administrator contact you as soon as possible. If you need further assistance, you may contact any of the administrative staff (see introduction) during regular business hours.

It is recommended that the treating psychiatrist, Canyon Manor clinical staff, county social services, and conservator (when applicable) make these decisions collaboratively with the client. Average length of stay at Canyon Manor is 8-16 months. Post discharge placement is determined by social service personnel at community mental health services in the client’s county of origin or collateral support agencies and may depend on availability of appropriate placement accommodation.

The legal right to choose a doctor is a prerogative of all voluntary clients. Conserved clients do not possess this right, which is vested in the mental health conservator. Should a client or family member be dissatisfied with the services provided by an attending psychiatrist, open discussion among the client, the doctor, and the family member is recommended. If the problem is not solved at this level, contact the social service worker who may choose to include the Medical Director, county case manager, and conservator as needed in further examination of the problem.

Often, the family is the client’s best and/or only outside resource for support, caring and assistance. Family members can assist the client by working cooperatively with the clinical treatment group in the client’s best interest. A cooperative liaison between the family, the physician, the staff, the Social Service Worker, and the county case manager is a crucial factor in the resident’s recovery and on-going treatment process. Frequently, family members possess important information regarding the history of the client’s illness which can be of great help to the treatment team. Care planning Meetings and Treatment conferences with family members and the treatment team can be a beneficial adjunct to the client’s care and treatment. Social Service Workers coordinate these conferences when needed. Family members should feel free to contact the Social Service Worker to make their interest known. It generally works best if the initiative is taken by the interested family member. This information sheet was designed to provide answers in response to most frequently asked questions. Also, just being a supportive visitor can benefit your family member. If you lack transportation: For San Francisco County residents, the S.F. Office of Self Help offers freevan transportation to Canyon Manor on the first Saturday of every month. Just be at their office at 1095 Market St. between 9am and 9:50. The van will leave promptly at 10:00am. Please call the Office of Self Help at (415) 575-1400 to reserve a seat on the van. If you plan on eating lunch in our dining room, please call Social Services Manager at x 321 at Canyon Manor. The van will depart Canyon Manor by 2:00pm.

We are Non-denominational.

Canyon Manor has been tracking treatment outcome for the last 18 months and the results are dramatic. Below is a bar graph representing client’s improvement over time. Clients stability was rated at discharge on a 1 to 4 scale indicated along the vertical axis. 1 was no improvement or became less stable, 2 was stayed about the same as when admitted, 3 is clear progress in stability, and 4 is dramatic improvement. The horizontal axis is the length of time at Canyon Manor at discharge with the left side starting at a few days and going to over a year on the far right. This chart is able to visually display longer treatment time at Canyon Manor is associated with better outcomes. Over time clients tend to improve, becoming increasingly stable. Very few clients who discharged after 6 months showed little or no improvement. Nearly all clients made a clear improvement and several were dramatically more stable by one year. In general, the longer a client is treated at Canyon Manor prior to discharge the greater their level of rehabilitation. This level of improvement is likely to result in their ability to function successfully in a less restricted environment, such as a board and care home or independent living. Greater improvement and increased stability may also result in a decreased need to return to psychiatric hospitalization or require police involvement.

When a client is admitted to Canyon Manor, they are already on a medication regimen from the acute hospital. The psychiatrist assigned to the client at admission reviews the medications and may continue or alter them. The psychiatrists speak with the staff regularly about how the client is doing. Based on staff report and the psychiatrist’s own observations, the medication may be changed if it does not appear to be effective in helping the client. The psychiatrist also takes into consideration the client’s perspective. It can be extremely helpful to have past medication knowledge such as what has worked in the past and what has not. Family members or conservators may have access to this critical historical information and should pass this on to the Social Services Worker. Quarterly case conferences bring together multiple members of the treatment team including the social service worker, the rehabilitation staff, nursing staff, the medical director and the program director. Conservators are always invited and family members are invited if the client is open to this. Case conferences allow for an in-depth review of the clients progress including a review of medications. Medication may be changed after a case conference in response to this discussion.

At Canyon Manor, we recommend that clients reach level three before going to a lower level of care such as a board and care home. Reaching and maintaining level three helps the client demonstrate that they have the capability of being more independent in taking care of themselves. Although level 3 is recommended it is not required. Discharge planning is discussed with the team which consists of the Social Services Worker, Hall Staff, Case Manager, Conservator, and Psychiatrist. If appropriate, family members may be asked for their opinion as well. There is no time limit to treatment at Canyon Manor. Regardless of how long a client has been at Canyon Manor, the team looks at the progress they have made in the program and their ability to succeed in a less restricted environment. Once it has been decided that a client is ready for discharge, the Social Services Worker provides information to the county contact and sets up the transition from Canyon Manor to the next placement.

Family support is appreciated by all Canyon Manor staff and it is not uncommon for family to ask how to send money to their family member. A personal check can be sent but it is important to note that it takes 10 business days for it to clear.

Visiting hours are Monday thru Friday from 3pm to 730pm and 9am to 9pm on the weekends. We ask that visiting happens after 3 on the weekdays to allow clients to work the program and go to groups. If a family member is far away and cannot come during those times they are welcome to set up a visit with the person’s social services worker. If you would like to make the funds available immediately, please send a cashier’s check. DO NOT SEND CASH IN THE MAIL. We make this request because occasionally mail gets lost between you and Canyon Manor. It is best to send a money order to the P.O. box address which is Canyon Manor P.O. Box 678 Novato, CA 94948

Clients are not allowed to have cameras, glass, caffeine, perishable food, and metal such as aluminum cans. If you do bring clothing to a client please let staff know so that the items can be inventoried into their belongings list. Any type of hygiene products containing alcohol such as perfume or cologne are allowed but are put in a locked area for supervision purposes.

Many clients like to run errands and get things for themselves such as shampoo and snacks. Clients are able to sign up to go shopping when they request their weekly passes. The team evaluates whether that client has been doing well managing their behavior and either approves or denies the shopping outing. The client gets their answer on Thursday morning at Hall Meeting along with their other pass requests. The Consumer Skills group helps prepare the client for their shopping through reviewing their budget and making a shopping list. A client granted shopping one week will usually not be allowed to go the next week, so that more clients have an opportunity to go. If a client wants to shop for clothing and their finances allow it, a Social Services Worker can take the client shopping. This is different and is generally done with only one client and one staff.

Clients value contact with their family and supportive people in their lives outside of Canyon Manor. Clients very much enjoy phone contact and passes with their loved ones. When speaking with clients who are struggling, one can always tell them to speak with their Social Services Worker. Most clients’ goal is to be discharged as soon as possible. This is also the goal of the staff however; one would not want to discharge a client prematurely. It can cause harm to a client’s treatment rather than a successful discharge. If relevant to a conversation one is having with a client emphasize the importance of working the program at Canyon Manor. The four main areas include hygiene, behavior, medication, and group participation. Maintaining and working on sobriety as well as acknowledging the need to continue their medications after discharge should also be encouraged. Passes are a way to demonstrate their ability to be in the community without using illegal or dangerous substances and without causing difficulties to other community members. Problematic behaviors include loitering, panhandling, approaching strangers, touching others, not staying with their pass partners, or not returning on time. Purchasing items not allowed at Canyon Manor and bringing these items back into the building is also against the rules and will result in their passes being cancelled for a period of time. Such items include but are not limited to caffeine pills or drinks, cigarettes and lighters.