CRANSTON, R.I. (WPRI) — Amid ongoing turmoil at Eleanor Slater Hospital, a national accrediting agency has launched an unannounced examination of patient care and operations at the state-run health care system, Target 12 has learned.

The Joint Commission, a well-known nonprofit that accredits more than 22,000 health care organizations nationwide, showed up without advance warning Monday to begin its survey of Eleanor Slater, a process that typically happens every three years.

“The objectives of the survey are not only to evaluate the organization, but to provide education and ‘good practice’ guidance that will help staff continually improve the organization’s performance,” Joint Commission spokesperson Maureen Lyons wrote in an email Monday.

Randal Edgar, a spokesperson for the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals — which oversees Eleanor Slater — confirmed Monday evening The Joint Commission was conducting “a routine unannounced review” of the hospital that would likely span throughout the week.

“This visit had been expected last fall but was delayed because of the COVID pandemic,” Edgar wrote in an email. “It is our understanding that the review will be complete by Friday. We are deeply committed to providing safe, high-quality care at Eleanor Slater Hospital.”

The organization’s accreditation is taken seriously by hospital groups, as it’s a key requirement to receiving federal funding from the U.S. Centers for Medicare and Medicaid Services. Prior to 2019, CMS had funneled tens of millions of dollars into Eleanor Slater each year, but federal funding halted more than 18 months ago after the state stopped billing amid compliance concerns.

The Joint Commission’s arrival comes at the same the state-run hospital system is facing intense public scrutiny related to money problems, workforce concerns and building conditions. The embattled hospital system, also the focus of an investigation by R.I. Attorney General Peter Neronha, has emerged as one of Gov. Dan McKee’s most complicated challenges since he took over the state’s top job in March.

Most recently, McKee has pointed the finger at his predecessor — former Gov. Gina Raimondo — for providing his administration with inaccurate assumptions surrounding operational costs at the hospital.

“When we went through the budget time frame, there were assumptions that were given to us that were not real,” McKee said last week. “It was a fairy tale.”

The Joint Committee’s detailed findings after the survey is finished will likely be kept private, but the accrediting agency does disclose its overall decision, along with any cited issues of concern. And Eleanor Slater has had problems in the past.

During its most recent review of the facility in 2017, the Joint Commission threatened to revoke the hospital’s accreditation, citing life and safety problems with the facilities. Specifically, the facilities had too many “ligature risks,” or areas that would make it easier for patients to commit suicide.

The issues were cited at the hospital’s Cranston campus, which has historically been where the state cares for psychiatric patients. But in May hospital officials reported nearly 60% of patients at Zambarano in Burrillville are also considered psychiatric, raising new questions about federal compliance and the building conditions there. As Target 12 previously reported, a State Fire Marshal inspection in April revealed more than 100 life and safety code violations at Zambarano.

Rhode Island eventually secured the accreditation in 2017 by requiring staff to check up on patients every five minutes. State officials earlier this year said that practice continues in Cranston, as the building condition issues there hadn’t been resolved.

Not much has changed to the overall structure of the hospital and its building conditions since 2017, even though there have been various efforts to revamp operations. Earlier this year, McKee initially proposed consolidating the hospital’s operations at its three units in Cranston, and building a new $65 million skilled nursing facility to replace Zambarano in Burrillville.

But he paused those plans amid ongoing controversy. He’s since promised to offer the General Assembly a new proposal before the end of this month.

“The Joint Commission arrived today for a routine unannounced review of Eleanor Slater Hospital This visit had been expected last fall but was delayed because of the COVID pandemic. It is our understanding that the review will be complete by Friday. We are deeply committed to providing safe, high-quality care at Eleanor Slater Hospital.

Eli Sherman ( is a Target 12 investigative reporter for 12 News. Connect with him on Twitter and on Facebook.