PROVIDER REPORT FOR
ALTERNATIVE SUPPORTS INC
47 Calvary St
 Waltham, MA 02453    

 
Date Of Report: 2/8/2011

 

 

Prepared by the Department of Developmental Services
OFFICE OF QUALITY ENHANCEMENT	

SUMMARY OF OVERALL FINDINGS
 
Provider	
  ALTERNATIVE SUPPORTS INC	

Review Dates	
  1/4/2011 - 1/10/2011	

Service Enhancement 
Meeting Date	
  1/21/2011	

Survey Team	
 
  Mark Boghoian (TL)	

  Cheryl Hampton	

  Joyce Herrmann	

  Chris Malley	

  Kevin Layden	

 	

 
 
Survey scope and findings for Residential and Individual Home Supports	
Service Group Type	Sample Size	Licensure Scope	Licensure Level	Certification Scope	Certification Level	
Residential and Individual Home Supports	7 location(s) 9 audit(s)	Full Review	76 / 78 2 Year License 01/21/2011 - 01/21/2013	 

 	 

 	
Residential Services	4 location(s) 6 audit (s) 	 

 
 	Full Review	14 / 14 Certified - with all indicators std. met	
Individual Home Supports	3 location(s) 3 audit (s) 	 

 
 	Full Review	15 / 15 Certified - with all indicators std. met	

Survey scope and findings for Employment and Day Supports	
Service Group Type	Sample Size	Licensure Scope	Licensure Level	Certification Scope	Certification Level	
Employment and Day Supports	4 location(s) 8 audit(s)	Full Review	49 / 49 2 Year License 01/21/2011 - 01/21/2013	 

 	 

 	
Community-based Day Services	1 location(s) 3 audit (s) 	 

 	 

 	Full Review	9 / 10 Certified - with partial indicators std. met	
Employment Support Services	2 location(s) 3 audit (s) 	 

 
 	Full Review	17 / 17 Certified - with all indicators std. met	
Center-based Employment	1 location(s) 2 audit (s) 	 

 	 

 	Full Review	12 / 14 Certified - with partial indicators std. met	

 
EXECUTIVE SUMMARY
Alternative Supports Inc. (ASI) is a private non-profit agency located in Waltham, Massachusetts that provides supports to adults funded through the Department of Developmental Services (DDS) in the Metro-Boston and Northeast Regions of the Commonwealth.  The agency currently provides residential services to approximately sixty individuals and employment, center based work and community based day supports to approximately forty individuals.  

Across all settings, ASI continues to pride itself on respecting the people it serves through supporting them to be seen as valued and contributing members of their communities.  To effectively support this, management staff at all levels, including the Executive Director and the Program Managers remained highly visible and well known by the individuals and their guardians.  ASI provided individuals with valued environments in both residential and day settings.  The exteriors of the agency's homes were at and more often above the neighborhood standard.  Residential staff also supported people to have positive relationships with their neighbors and ensured that people regularly accessed community resources.  Likewise, the agency operated employment/day programs were well maintained.  Staff supported people to access the community for employment and recreation and be viewed as valued adults.  Employment/Day staff also provided educational opportunities through on-site training and assisted people to participate in preferred activities of their choice.  

ASI collected information from various sources and used it to continuously make improvements to its core service delivery system.  The agency could benefit from further developing its strategic plan to include measurable initiatives that may serve as a guide for future organizational planning.  The agency continued to operationalize its well developed systems used to safeguard individuals and ensured that it tracked incidents, medication occurrences, complaints and investigations; and, it demonstrated that it acted expeditiously to analyze and remedy matters requiring action.  The agency also had a fully constituted Human Rights Committee that met regularly to review matters under its purview.  In addition, the agency had a well established system in place to track mandated staff training and it encouraged all staff to acquire Human Rights Systems and Fire Safety Officer Certification.  

With specific regard to residential services, the agency generally ensured that people's healthcare needs were met through the collaboration of staff and the agency's nurses, however, the agency needs to ensure that special diets ordered from people’s practitioners are well documented and being followed.  Likewise, the agency needs to ensure that staff have immediate access to keys for doors that can be locked in people’s homes.  The agency also needs to ensure that evaluative measures utilized to develop money management plans are documented and that those plans contain information relative to reducing/eliminating the need for staff assistance.  

The employment and day services division supported people to engage in center based and off-site work opportunities, training and/or community based activities.  The agency could benefit from taking steps to ensure that people in the center based work program are supported to identify job goals and support needs and develop skills that would lead to movement into supported employment.  Likewise, the agency needs to ensure that it supports people receiving community based day supports with increased opportunities to connect with others in their community.  In addition, the agency should continue its practice of re-evaluating individuals' interests and advocating with DDS for people to be placed in employment/day service program models that may be more appropriate given their skill levels and interests.  ASI received a Two-Year License for both its Residential and Day Support services.	

 
LICENSURE FINDINGS

 	
Met / Rated	
Not Met / Rated	
% Met	

Organizational	
8/8	
0/8	

Residential and Individual Home Supports	
68/70	
2/70	

 	

    Residential Services
    Placement Services
    Respite Services
    Individual Home Supports	

 

 

 

 

 	

Critical Indicators	
8/8	
0/8	

Total	
76/78	
2/78	
97%	

2 Year License	

 	

# indicators for 60 Day Follow-up	

2	

	 

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
8/8	
0/8	

Employment and Day Supports	
41/41	
0/41	

    Community-based Day Services
    Employment Support Services
    Center-based Employment	

 

 	

 

 	

 

 	

Critical Indicators	
7/7	
0/7	

Total	
49/49	
0/49	
100%	

2 Year License	

 	

# indicators for 60 Day Follow-up	

0	

	

 	 	
Residential Areas Needing Improvement on Standards not met/Follow-up to occur:	
Indicator #	Indicator	Area Needing Improvement	
 L24	Locks on doors not providing egress can be opened by the individuals from the inside and staff carry a key to open in an emergency.	The agency did not ensure that staff readily had access to people's bedrooms if they chose to lock them.  The agency needs to ensure that all staff have the ability to quickly unlock doors in the event of an emergency.  	
 L67	There is a written plan in place accompanied by a training plan when the agency has shared or delegated money management responsibility.	The agency had documented money management assessments for those individuals for which it had a shared or delegated money management responsibility; however, it did not formally document information used to form the basis for the assessment, nor did assessments contain a plan for reducing or eliminating the need for staff assistance.  In the future, the agency needs to maintain documentation used to derive information utilized in financial assessments; and, those assessments need to include plans for reducing or eliminating the need for staff assistance.  	

 
 
CERTIFICATION FINDINGS

 
 	
Met / Rated	
Not Met / Rated	

Certification - Planning and Quality Management	
5/6	
1/6	

Residential and Individual Home Supports 	

 

    Residential Services
    Individual Home Supports	
14/14 15/15 	
0/14 0/15 	

 
 	
Met / Rated	
Not Met / Rated	

Certification - Planning and Quality Management	
5/6	
1/6	

Employment and Day Supports 	

    Community-based Day Services
    Employment Support Services
    Center-based Employment	
9/10 17/17 12/14 	
1/10 0/17 2/14 	

 
Planning and Quality Management Areas Needing Improvement on Standards not met:	
Indicator #	Indicator	Area Needing Improvement	
 C6	The provider has mechanisms to plan for future directions in service delivery and implements strategies to actualize these plans.	The agency's strategic plan did not include documented mechanisms relative to planning for future directions in service delivery.  The agency needs to ensure that its strategic planning process includes measurable long range plans relative to individual’s current and future needs.  	

 
Center-based Employment- Areas Needing Improvement on Standards not met:	
Indicator #	Indicator	Area Needing Improvement	
 C24	There is a plan developed to identify job goals and support needs.	The agency had not further developed ISP goals that had already been met.  The agency needs to ensure that goal development and support needs are reflective of people’s current interests, strengths and needs. 	
 C25	Staff assist individuals to work on skill development for job attainment and success.	The agency had not further developed ISP goals that had already been met.  The agency needs to continually build on addressing skills needed to enhance job attainment and success.	

 
 
Community-based Day Services- Areas Needing Improvement on Standards not met:	
Indicator #	Indicator	Area Needing Improvement	
 C42	Individuals are involved in activities that connect them to other people in the community.	The agency provided opportunities for people to access the community and engage in volunteer opportunities.  However, the agency needs to ensure that it more fully supports people to connect with others in their community.	

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MASTER SCORE SHEET LICENSURE
Organizational: ALTERNATIVE SUPPORTS INC
Indicator #	Indicator	Met/Rated	Rating (Met, Not Met, Not Rated)	
 L3	Immediate Action	6/6	Met	
 L4	Action taken	6/6	Met	
 L48	HRC	1/1	Met	
 L66	HRC restraint review	5/5	Met	
 L74	Screen employees	5/5	Met	
 L75	Qualified staff	14/14	Met	
 L76	Track trainings	14/14	Met	
 L83	HR training	14/14	Met	
 
Residential and Individual Home Supports:
Indicator #	Indicator	Location or Individual indicator	Residential Supports	Individual Home Support	Placement Support	Respite Support	Total Met/Rated	Rating	
 L1	Abuse/neglect training	I	6/6	3/3	 

 
 	9/9	Met	
 L2	Abuse/neglect reporting	L	2/2	1/1	 

 
 	3/3	Met	
 L4	Action taken	L	2/2	1/1	 
 	 
 	3/3	Met	
 L5	Safety Plan	L	4/4	2/2	 
 	 
 	6/6	Met	
 L6	Evacuation	L	4/4	2/2	 	 	6/6	Met	
 L7	Fire Drills	L	4/4	 	 	 	4/4	Met	
 L8	Emergency Fact Sheets	I	6/6	3/3	 

 
 	9/9	Met	
 L9	Safe use of equipment	L	3/4	1/1	 

 
 	4/5	Met
(80.0 %)	
 L11	Required inspections	L	4/4	2/2	 

 
 	6/6	Met	
Indicator #	Indicator	Location or Individual indicator	Residential Supports	Individual Home Support	Placement Support	Respite Support	Total Met/Rated	Rating	
 L12	Smoke detectors	L	3/4	2/2	 
 	 
 	5/6	Met
(83.33 %)	
 L13	Clean location	L	4/4	2/2	 
 	 
 	6/6	Met	
 L14	Site in good repair	L	4/4	2/2	 

 
 	6/6	Met	
 L15	Hot water	L	4/4	2/2	 	 	6/6	Met	
 L16	Accessibility	L	3/3	2/2	 
 	 
 	5/5	Met	
 L17	Egress at grade 	L	4/4	2/2	 
 	 
 	6/6	Met	
 L18	Above grade egress	L	4/4	2/2	 

 
 	6/6	Met	
 L19	Bedroom location	L	3/3	2/2	 
 	 
 	5/5	Met	
 L20	Exit doors	L	4/4	2/2	 	 	6/6	Met	
 L21	Safe electrical equipment	L	4/4	2/2	 

 
 	6/6	Met	
 L22	Clean appliances	L	4/4	2/2	 
 	 
 	6/6	Met	
 L23	Egress door locks	L	3/3	 

 	3/3	Met	
 L24	Locked door access	L	1/2	 

 

 	1/2	Not Met
(50.0 %)	
 L25	Dangerous substances	L	4/4	2/2	 

 
 	6/6	Met	
 L26	Walkway safety	L	4/4	2/2	 
 	 
 	6/6	Met	
 L28	Flammables	L	3/3	2/2	 
 	 
 	5/5	Met	
 L29	Rubbish/combustibles	L	4/4	2/2	 

 
 	6/6	Met	
 L30	Protective railings	L	3/3	1/1	 
 	 
 	4/4	Met	
Indicator #	Indicator	Location or Individual indicator	Residential Supports	Individual Home Support	Placement Support	Respite Support	Total Met/Rated	Rating	
 L31	Communication method	I	6/6	3/3	 

 
 	9/9	Met	
 L32	Verbal & written	I	6/6	2/2	 
 	 
 	8/8	Met	
 L33	Physical exam	I	6/6	3/3	 
 	 
 	9/9	Met	
 L34	Dental exam	I	6/6	2/2	 
 	 
 	8/8	Met	
 L35	Preventive screenings	I	6/6	3/3	 
 	 
 	9/9	Met	
 L36	Recommended tests	I	6/6	2/2	 
 	 
 	8/8	Met	
 L37	Prompt treatment	I	5/5	2/2	 
 	 
 	7/7	Met	
 L38	Physician’s orders	I	5/5	1/1	 
 	 
 	6/6	Met	
 L39	Dietary requirements	I	2/2	 

 

 	2/2	Met	
 L40	Nutritional food	L	4/4	2/2	 
 	 
 	6/6	Met	
 L41	Healthy diet	L	4/4	2/2	 
 	 
 	6/6	Met	
 L42	Physical activity	L	4/4	2/2	 
 	 
 	6/6	Met	
 L43	Health Care Record	I	6/6	3/3	 

 
 	9/9	Met	
 L44	MAP registration	L	4/4	2/2	 
 	 
 	6/6	Met	
 L45	Medication storage	L	4/4	2/2	 
 	 
 	6/6	Met	
 L46	Med. Administration	I	6/6	2/2	 

 
 	8/8	Met	
 L47	Self medication	I	 
 	1/1	 
 	 
 	1/1	Met	
 L49	Informed of human rights	I	6/6	3/3	 

 
 	9/9	Met	

Indicator #	Indicator	Location or Individual indicator	Residential Supports	Individual Home Support	Placement Support	Respite Support	Total Met/Rated	Rating	
 L50	Respectful Comm.	L	4/4	2/2	 
 	 
 	6/6	Met	
 L51	Possessions	I	6/6	3/3	 
 	 
 	9/9	Met	
 L52	Phone calls	I	6/6	3/3	 
 	 
 	9/9	Met	
 L53	Visitation	I	6/6	3/3	 	 	9/9	Met	
 L54	Privacy	L	4/4	2/2	 	 	6/6	Met	
 L55	Informed consent	I	6/6	3/3	 
 	 
 	9/9	Met	
 L61	Health protection in ISP	I	2/2	 

 

 	2/2	Met	
 L62	Health protection review	I	2/2	 

 

 	2/2	Met	
 L63	Med. treatment plan form	I	2/3	1/1	 

 
 	3/4	Met	
 L64	Med. treatment plan rev.	I	2/2	1/1	 

 
 	3/3	Met	
 L67	Money mgmt. plan	I	3/6	2/2	 
 	 
 	5/8	Not Met
(62.50 %)	
 L68	Funds expenditure	I	6/6	2/2	 

 
 	8/8	Met	
 L69	Expenditure tracking	I	6/6	2/2	 
 	 
 	8/8	Met	
 L70	Charges for care calc.	I	6/6	3/3	 

 
 	9/9	Met	
 L71	Charges for care appeal	I	6/6	3/3	 

 
 	9/9	Met	
 L77	Unique needs training	I	6/6	1/1	 

 
 	7/7	Met	
 L79	Restraint training	L	1/1	 

 	1/1	Met	
 L80	Symptoms of illness	L	4/4	2/2	 
 	 
 	6/6	Met	

Indicator #	Indicator	Location or Individual indicator	Residential Supports	Individual Home Support	Placement Support	Respite Support	Total Met/Rated	Rating	
 L81	Medical emergency	L	4/4	2/2	 
 	 
 	6/6	Met	
 L82	Medication admin.	L	4/4	2/2	 
 	 
 	6/6	Met	
 L84	Health protect. Training	I	2/2	 

 

 	2/2	Met	
 L85	Supervision 	L	4/4	2/2	 
 	 
 	6/6	Met	
 L86	Required assessments	I	2/2	1/1	 

 
 	3/3	Met	
 L87	Support strategies	I	4/4	3/3	 
 	 
 	7/7	Met	
 L88	Strategies implemented	I	5/6	3/3	 

 
 	8/9	Met
(88.89 %)	
#Std. Met/# 70 Indicator	 

 

 	 

 

 	68/70	 

Total Score	 

 	 

 	76/78	 

 	 

 	 

 	97.44%	 

Employment and Day Supports:
Indicator #	Indicator	Location or Individual indicator	Employment Support	Center Based Work	Community Based Day Support	Total Met / Rated	Rating	
 L1	Abuse/neglect training	I	3/3	2/2	3/3	8/8	Met	
 L5	Safety Plan	L	 	1/1	1/1	2/2	Met	
 L6	Evacuation	L	 	1/1	1/1	2/2	Met	
 L7	Fire Drills	L	 	1/1	1/1	2/2	Met	
 L8	Emergency Fact Sheets	I	3/3	2/2	3/3	8/8	Met	
 L11	Required inspections	L	 
 	1/1	1/1	2/2	Met	

Indicator #	Indicator	Location or Individual indicator	Employment Support	Center Based Work	Community Based Day Support	Total Met / Rated	Rating	
 L12	Smoke detectors	L	 
 	1/1	1/1	2/2	Met	
 L13	Clean location	L	 	1/1	1/1	2/2	Met	
 L14	Site in good repair	L	 
 	1/1	1/1	2/2	Met	
 L15	Hot water	L	 	1/1	1/1	2/2	Met	
 L16	Accessibility	L	 	1/1	1/1	2/2	Met	
 L17	Egress at grade 	L	 
 	1/1	1/1	2/2	Met	
 L18	Above grade egress	L	 
 	1/1	1/1	2/2	Met	
 L20	Exit doors	L	 	1/1	1/1	2/2	Met	
 L21	Safe electrical equipment	L	 
 	1/1	1/1	2/2	Met	
 L22	Clean appliances	L	 
 	1/1	1/1	2/2	Met	
 L25	Dangerous substances	L	 
 	1/1	1/1	2/2	Met	
 L26	Walkway safety	L	 
 	1/1	1/1	2/2	Met	
 L29	Rubbish/combustibles	L	 
 	1/1	1/1	2/2	Met	
 L31	Communication method	I	3/3	2/2	3/3	8/8	Met	
 L32	Verbal & written	I	3/3	2/2	3/3	8/8	Met	
 L37	Prompt treatment	I	1/1	 
 	 
 	1/1	Met	
 L38	Physician’s orders	I	 
 	 
 	1/1	1/1	Met	
 L44	MAP registration	L	 
 	1/1	1/1	2/2	Met	
 L45	Medication storage	L	 
 	1/1	1/1	2/2	Met	
 L46	Med. Administration	I	 
 	 
 	1/1	1/1	Met	
 L49	Informed of human rights	I	3/3	2/2	3/3	8/8	Met	
 L50	Respectful Comm.	L	 
 	1/1	1/1	2/2	Met	

Indicator #	Indicator	Location or Individual indicator	Employment Support	Center Based Work	Community Based Day Support	Total Met / Rated	Rating	
 L51	Possessions	I	3/3	2/2	3/3	8/8	Met	
 L52	Phone calls	I	3/3	2/2	3/3	8/8	Met	
 L54	Privacy	L	 	1/1	1/1	2/2	Met	
 L55	Informed consent	I	3/3	2/2	3/3	8/8	Met	
 L72	DOL requirements	I	 
 	1/1	3/3	4/4	Met	
 L77	Unique needs training	I	3/3	2/2	3/3	8/8	Met	
 L80	Symptoms of illness	L	 
 	1/1	1/1	2/2	Met	
 L81	Medical emergency	L	 
 	1/1	1/1	2/2	Met	
 L82	Medication admin.	L	 
 	1/1	1/1	2/2	Met	
 L85	Supervision 	L	 	1/1	1/1	2/2	Met	
 L86	Required assessments	I	2/2	 
 	 
 	2/2	Met	
 L87	Support strategies	I	3/3	2/2	3/3	8/8	Met	
 L88	Strategies implemented	I	3/3	2/2	3/3	8/8	Met	
#Std. Met/# 41 Indicator	 

 

 	 

 
 	41/41	 

Total Score	 

 	 
 	 
 	49/49	 
 	
 	 	 	 	 	 	100%	 	
 
MASTER SCORE SHEET CERTIFICATION
Certification - Planning and Quality Management	
Indicator #	Indicator	Met/Rated	Rating	
 C1	Provider data collection	1/1	Met	
 C2	Data analysis	1/1	Met	
 C3	Service satisfaction	1/1	Met	
 C4	Utilizes input from stakeholders	1/1	Met	

 C5	Measure progress	1/1	Met	
 C6	Future directions planning	0/1	Not Met (0 %)	

Center-based Employment	
Indicator #	Indicator	Met/Rated	Rating	
 C7	Feedback on staff performance	2/2	Met	
 C8	Family/guardian communication	2/2	Met	
 C22	Explore job interests	2/2	Met	
 C23	Assess skills & training needs	2/2	Met	
 C24	Job goals & support needs plan	1/2	Not Met (50.0 %)	
 C25	Skill development	1/2	Not Met (50.0 %)	
 C27	Job benefit education	2/2	Met	
 C31	Job accommodations	2/2	Met	
 C33	Employee benefits explained	2/2	Met	
 C34	Support to promote success	2/2	Met	
 C35	Feedback on job performance	2/2	Met	
 C37	Interpersonal skills for work	2/2	Met	
 C38	Habilitative & behavioral goals	2/2	Met	
 C39	Support needs for employment	2/2	Met	
Community-based Day Services	
Indicator #	Indicator	Met/Rated	Rating	
 C7	Feedback on staff performance	3/3	Met	
 C8	Family/guardian communication	3/3	Met	
 C13	Skills to maximize independence 	3/3	Met	
 C37	Interpersonal skills for work	2/2	Met	
 C40	Community involvement interest	2/2	Met	
 C41	Activities participation	3/3	Met	
 C42	Connection to others	1/2	Not Met (50.0 %)	
 C43	Maintain & enhance relationship	3/3	Met	
 C44	Job exploration	1/1	Met	
 C45	Revisit decisions	3/3	Met	

Employment Support Services	
Indicator #	Indicator	Met/Rated	Rating	
 C7	Feedback on staff performance	3/3	Met	
 C8	Family/guardian communication	3/3	Met	
 C22	Explore job interests	3/3	Met	
 C23	Assess skills & training needs	3/3	Met	
 C24	Job goals & support needs plan	3/3	Met	
 C25	Skill development	3/3	Met	
 C26	Benefits analysis	3/3	Met	
 C27	Job benefit education	3/3	Met	
 C29	Support to obtain employment	3/3	Met	
 C30	Work in integrated settings	3/3	Met	
 C31	Job accommodations	2/2	Met	
 C32	At least minimum wages earned	3/3	Met	
 C33	Employee benefits explained	3/3	Met	
 C34	Support to promote success	3/3	Met	
 C35	Feedback on job performance	2/2	Met	
 C36	Supports to enhance retention	2/2	Met	
 C37	Interpersonal skills for work	3/3	Met	
Individual Home Supports	
Indicator #	Indicator	Met/Rated	Rating	
 C7	Feedback on staff performance	3/3	Met	
 C8	Family/guardian communication	3/3	Met	
 C9	Personal relationships	3/3	Met	
 C10	Social skill development	3/3	Met	
 C11	Get together w/family & friends	3/3	Met	
 C12	Intimacy	3/3	Met	
 C13	Skills to maximize independence 	3/3	Met	
 C14	Choices in routines & schedules	2/2	Met	
 C15	Personalize living space	2/2	Met	
 C16	Explore interests	3/3	Met	
 C17	Community activities	2/2	Met	
 C18	Purchase personal belongings	3/3	Met	
 C19	Knowledgeable decisions	3/3	Met	

Individual Home Supports	
Indicator #	Indicator	Met/Rated	Rating	
 C20	Emergency back-up plans	2/2	Met	
 C21	Coordinate outreach	3/3	Met	
Residential Services	
Indicator #	Indicator	Met/Rated	Rating	
 C7	Feedback on staff performance	6/6	Met	
 C8	Family/guardian communication	6/6	Met	
 C9	Personal relationships	6/6	Met	
 C10	Social skill development	6/6	Met	
 C11	Get together w/family & friends	6/6	Met	
 C12	Intimacy	5/5	Met	
 C13	Skills to maximize independence 	6/6	Met	
 C14	Choices in routines & schedules	6/6	Met	
 C15	Personalize living space	4/4	Met	
 C16	Explore interests	6/6	Met	
 C17	Community activities	6/6	Met	
 C18	Purchase personal belongings	6/6	Met	
 C19	Knowledgeable decisions	6/6	Met	
 C20	Emergency back-up plans	4/4	Met