PROVIDER REPORT FOR	

	

	

	

	

	

	

	

	

	
	
The ARC of the South Shore
371 RIVER STREET
 North Weymouth, MA 02191    	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

Version	

	

	

	

	

	

	

	

	
Provider Web Report
October 4, 2018	

	

	

	

	

	

	

	
Prepared by the Department of Developmental Services
OFFICE OF QUALITY ENHANCEMENT	

	

	

	

	

	

	

				
	SUMMARY OF OVERALL FINDINGS	

				

	

	

Provider	

	
The ARC of the South Shore	

	

	

	

	
Review Dates	

	
9/17/2018 - 9/21/2018	

	

	

	

	
Service Enhancement 
Meeting Date	

	
10/4/2018	

	

	

	

	

	

	
Survey Team	

	
Leslie Hayes	

Michael Marchese	

Scott Nolan (TL)	

Michelle Boyd	

Katherine Gregory	

	

	

	

	

	

	
Citizen Volunteers	

	

	

		

	

	
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	
6 location(s) 12 audit (s) 	
Full Review	
76 / 79 2 Year License 10/04/2018 -  10/04/2020	
	
69 / 73 Certified 10/04/2018 -  10/04/2020	

Residential Services	
3 location(s) 7 audit (s) 	

Full Review	
20 / 22	

Placement Services	
1 location(s) 2 audit (s) 	

Full Review	
22 / 22	

Individual Home Supports	
2 location(s) 3 audit (s) 	

Full Review	
21 / 23	

Planning and Quality Management (For all service groupings)	

	
Full Review	
6 / 6	

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	
2 location(s) 6 audit (s) 	
Full Review	
60 / 63 2 Year License 10/04/2018 -  10/04/2020	
	
33 / 36 Certified 10/04/2018 -  10/04/2020	

Community Based Day Services	
1 location(s) 3 audit (s) 	

Full Review	
13 / 14	

Employment Support Services	
1 location(s) 3 audit (s) 	

Full Review	
14 / 16	

Planning and Quality Management (For all service groupings)	

	
Full Review	
6 / 6	

	

	

			
EXECUTIVE SUMMARY :	

			
The Arc of the South Shore (the Arc), which was incorporated in 1951, is a community-based non-profit agency that provides an extensive network of supports to adults and children with intellectual and developmental disabilities, including those diagnosed within the Autism Spectrum Disorder (ASD).  The agency opened an Autism Resource Center which serves individuals with ASD and their families. The agency also provides early intervention services to children, personal care management supports to individuals, adult foster care, day habilitation services and family support services.

The scope of the review was a full licensing and certification review, and included the following service types: 24 hour Residential, Placement, Individual Home Supports, and Community Based Day and Employment services. The agency organizational practices were also included as part of the review. 

Since the last DDS licensing and certification process, the agency has developed a new residential home and two new positions were created, a Chief Operations Officer and a finance position.   

A continued strength seen within Residential Services was its provision of health care supports.  The survey findings revealed that individuals received all routine and preventative health services as as well as met with specialists when recommended. Staff was proficient in documenting and coordinating health care to ensure timely follow-up and consulted with the agency nurse when questions arose.  In one instance, an individual who had an undiagnosed medical condition which impacted her ability to ambulate; was able to walk after being properly diagnosed by her doctor after staff's advocacy and monitoring and presentation of occurrence of symptoms. To achieve such outcomes, the agency used a team approach comprised of the nurse and staff to coordinate care of individuals with complex health care needs including timely follow-up, in addition to training in case management, safety improvements to address fall risks, dietary education  and  trainings that addressed the needs of an aging population.  Residential staff were observed to promote respect and affirm that individuals have privacy in their homes. Staff were respectful and encouraged individuals to communicate their wants regarding daily routines.  Individuals were observed to enjoy time socializing or quiet time the privacy of their rooms afforded.

The licensing review of the employment/day services group also resulted in positive findings which noted the environment was well maintained. Efforts were made to rearrange the limited space by adding dividers to promote privacy for individuals to participate in activities of interest.  Staff interactions were respectful and encouraged individuals to freely engage in conversation.
 
A review of organizational licensure indicators revealed the ongoing strength of the agency's Human Rights Committee which met composition requirements and on a regular basis. It was noted the HRC kept comprehensive notes on all investigations, incident reporting, and site visits while responding in a timely manner when questions were posed by the committee or when members identified concerns during site visits.  

In the certification areas, a strength across residential and CBDS services was the agency's efforts to offer individuals opportunities to access community activities and participate in interests of their choice.  For example, two sisters who lived with their placement provider were supported to pursue their separate interests for the first time such as one going on vacation to a ranch.  In the CBDS program, individuals selected the type of activities they chose to participate in such as golf or visiting a museum.  The use of schedules and a pictorial learning aids enhanced individuals ability to maximize their independence through the use of visual aids. 

A focus of the agency's strategic plan was to increase the variety and opportunities for individuals to access community activities of personal interest.  Strategies were in place to monitor progress and make the necessary service improvements for individuals to experience success in this area.  As evidenced by the agency receiving a met for supporting individuals to participate and be involved in community activities, across all residential services, efforts have been successful.  Individuals were found to participate in community activities and supported to pursue individual interest such as horseback riding or choral group.  

It was evident in the survey process, staff at all levels of the organization communicated with family members to keep them informed and involved in the well-being of their family members  and soliciting feedback on services. In one instance, a mutually respectful, long-standing relationship built with one family led to a continuity of health care for one individual, when the agency assumed this responsibility when family members could no longer keep up with medical care.

The current DDS licensure and certification review also identified areas that needed additional strengthening across all services including: ensuring that medication treatment plans are in place when individuals are supported with behavior modifying medication and that individuals are supported to assess, and identify assistive technologies/and or modifications that can maximize their independence.   

Within day services, additional efforts are needed to ensure that when supporting people with health related protections that the required components and reviews are in place.  
Organizationally, although documentation demonstrated that staff had required training, it was identified the agency's data based tracking system was not accurate. Additionally, across all services it was identified that the agency needs to strengthen its process for individuals to provide feedback on the performance of staff.  It is suggested that an agency wide system is developed to track all required training and incorporate individual feedback into staff evaluations.

Based on the findings of this report, The Arc, South Shore has earned a Two-Year License and is Certified for both the Residential Supports group and the Employment and Day Supports group.  Residential scores were 96% in licensing and 95% in certification; employment/day support scores were 95% for licensing and 92% for certification.   Within sixty days, the agency will conduct its own follow-up on any licensing indicators rated Not Met and submit the results to the DDS Office of Quality Enhancement.	

	

	

LICENSURE FINDINGS	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
10/10	
0/10	

Residential and Individual Home Supports	
66/69	
3/69	

    Placement Services
    Residential Services
    Individual Home Supports

	

Critical Indicators	
8/8	
0/8	

Total	
76/79	
3/79	
96%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
3	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
10/10	
0/10	

Employment and Day Supports	
50/53	
3/53	

    Community Based Day Services
    Employment Support Services

	

Critical Indicators	
8/8	
0/8	

Total	
60/63	
3/63	
95%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
3	

	

	

			

	

	
Residential Areas Needing Improvement on Standards not met/Follow-up to occur:	

Indicator #	
Indicator	
Area Needing Improvement	

 L63	
Medication treatment plans are in written format with required components.	
For two out of six individuals, a medication treatment plan was either not developed or did not include all of the behavior modifying medications ordered.  The agency needs to ensure that medication treatment plans are in written format with the required components including all the medications ordered. 	

 L64	
Medication treatment plans are reviewed by the required groups.	
Two out of six Medication Treatment Plans (MTP's) did not have the required reviews.  The agency needs to ensure all treatment plans are reviewed by the required groups.	

 L91	
Incidents are reported and reviewed as mandated by regulation.	
For the three locations visited at which reportable incidents had occurred, there were instances in which incident reports had not been submitted and/or finalized within required timelines.  The agency needs to ensure that incident reports are  submitted and/or finalized as mandated by regulation.	

	

	

	
Employment/Day Areas Needing Improvement on Standards not met/Follow-up to occur:	

Indicator #	
Indicator	
Area Needing Improvement	

 L62	
Supports and health related protections are reviewed by the required groups.	
For one out of two support and health related protections a review by the required groups was not completed.  The agency needs to ensure support and health related protections are reviewed by the required groups.	

 L63	
Medication treatment plans are in written format with required components.	
One of two individuals, who were administered medication during day supports, did not have a Medication Treatment Plan (MTP) for the administration of a behavior modifying medication.  The agency needs to ensure that a Medication Treatment Plan includes all required components and is written for all individuals prescribed behavior modifying medications.	

 L79	
Staff are trained in safe and correct administration of restraint.	
A review of training records revealed the staff that performed an emergency restraint and had done so after the training expired. The agency needs to ensure staff are trained in safe and correct administration of restraint.	

		

						
	CERTIFICATION FINDINGS	

						
		
Met / Rated	
Not Met / Rated	
% Met	

Certification - Planning and Quality Management	
6/6	
0/6	

Residential and Individual Home Supports	
63/67	
4/67	

Individual Home Supports	
21/23	
2/23	

Placement Services	
22/22	
0/22	

Residential Services	
20/22	
2/22	

TOTAL	
69/73	
4/73	
95%	

Certified	

	

Met / Rated	
Not Met / Rated	
% Met	

Certification - Planning and Quality Management	
6/6	
0/6	

Employment and Day Supports	
27/30	
3/30	

Community Based Day Services	
13/14	
1/14	

Employment Support Services	
14/16	
2/16	

TOTAL	
33/36	
3/36	
92%	

Certified	

	

						

Individual Home Supports- Areas Needing Improvement on Standards not met:	

Indicator #	
Indicator	
Area Needing Improvement	

 C7	
Individuals have opportunities to provide feedback at the time of hire / time of the match and on an ongoing basis on the performance/actions of staff / care providers that support them.	
For three individuals there was no mechanism in place to solicit feedback on the ongoing  performance of staff supporting them in their homes.  The agency needs to ensure individuals have opportunities to provide feedback on staff that support them.	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
Two out of three individuals had not been assessed to determine how they might benefit from the use of assistive technology, and there was no evidence that assistive technology and/or modification was in place to maximize their independence.  The agency needs to ensure that individuals have been assessed regarding the need for assistive technology and modifications to maximize their independence.  	

	

	
Placement Services Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 C17	
Community activities are based on the individual's preferences and interests.	
The agency has encouraged and continues to encourage twin sisters who have been living in a  placement home for two years to pursue independent interests for the first time in their lives.  They are clearly excited to do this and have had separate vacations.  They express their excitement to continue to explore new activities and possibilities.  The agency is commend for supporting individuals to participate in community activities based on their individual preferences and interests.	

	

	
Residential Services Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 C17	
Community activities are based on the individual's preferences and interests.	
Staff provided ongoing support to ensure that individuals were offered opportunities to participate in community based activities based on their individual preference and interests. Staff used an interest inventory to learn more about individual interests and exploring community activities.  For example, one individual was supported to attend weekly Zumba classes at local community center and participate in horseback riding lessons on a regular basis, while another individual was supported to participate in a local choral group. The agency is commend for supporting individuals to participate in community activities based on their interests.	

	

	
Residential Services- Areas Needing Improvement on Standards not met:	

Indicator #	
Indicator	
Area Needing Improvement	

 C7	
Individuals have opportunities to provide feedback at the time of hire / time of the match and on an ongoing basis on the performance/actions of staff / care providers that support them.	
Two out of seven individuals had opportunities to provide feedback at the time of hire. Although the agency solicited feedback in house meetings, there was no a mechanism to solicit individual feedback on staff performance across all residential homes.  The agency needs to ensure individuals have opportunities to provide feedback on staff that support them.	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
Five out of seven individuals had not been assessed to identify any use of assistive devices and/or modify existing technology to maximize their independence. The agency needs to conduct assistive technology evaluations with each individual to determine which modifications or adaptive devices could help them to maximize their independence.  	

	

	
Community Based Day Services- Areas Needing Improvement on Standards not met:	

Indicator #	
Indicator	
Area Needing Improvement	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
Three individuals had not been assessed to identify and/or use any assistive technology and/or to maximize their independence. The agency needs to conduct an assessment with each individual to identify if there are any areas that modifications or assistive technology could help them to maximize their independence.  	

	

	
Employment Support Services- Areas Needing Improvement on Standards not met:	

Indicator #	
Indicator	
Area Needing Improvement	

 C35	
Individuals are given feedback on job performance by their employer.	
One out of three individuals who was competitively employed was not provided with feedback on their job performance. The agency needs to ensure individuals are given feedback on their performance by their employer.	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
Three individuals had not been assessed to identify and/or use any assistive technology and/or to maximize their independence. The agency needs to conduct an assessment with each individual to identify if there are any areas that modifications or assistive technology could help them to maximize their independence.	

	

		

					
	MASTER SCORE SHEET LICENSURE	

					
	Organizational: The ARC of the South Shore	

					
	
Indicator #	
Indicator	
Met/Rated	
Rating(Met,Not Met,NotRated)	

O	
 L2	
Abuse/neglect reporting	
7/7	
Met	

 L3	
Immediate Action	
9/9	
Met	

 L4	
Action taken	
4/4	
Met	

 L48	
HRC	
1/1	
Met	

 L65	
Restraint report submit	
1/1	
Met	

 L66	
HRC restraint review	
1/1	
Met	

 L74	
Screen employees	
4/4	
Met	

 L75	
Qualified staff	
2/2	
Met	

 L76	
Track trainings	
20/21	
Met(95.24 % )	

 L83	
HR training	
20/21	
Met(95.24 % )	

							
	Residential and Individual Home Supports:	

							
	
Ind. #	
Ind.	
Loc. or Indiv.	
Res. Sup.	
Ind. Home Sup.	
Place.	
Resp.	
ABI-MFP Res. Sup.	
ABI-MFP Place.	
Total Met/Rated	
Rating	

 L1	
Abuse/neglect training	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L5	
Safety Plan	
L	
3/3	
2/2	
1/1	

	
6/6	
Met	

O	
 L6	
Evacuation	
L	
3/3	
2/2	
1/1	

	
6/6	
Met	

 L7	
Fire Drills	
L	
3/3	

	

3/3	
Met	

 L8	
Emergency Fact Sheets	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L9	
Safe use of equipment	
L	
3/3	
2/2	

	
	
5/5	
Met	

O	
 L11	
Required inspections	
L	
3/3	
1/1	
1/1	

	
5/5	
Met	

O	
 L12	
Smoke detectors	
L	
2/3	
2/2	
1/1	

	
5/6	
Met
(83.33 %)	

O	
 L13	
Clean location	
L	
3/3	
1/1	
1/1	

	
5/5	
Met	

 L14	
Site in good repair	
L	
3/3	
1/1	
1/1	

	
5/5	
Met	

 L15	
Hot water	
L	
2/3	
1/1	
1/1	

	
4/5	
Met
(80.0 %)	

 L16	
Accessibility	
L	
3/3	
2/2	
1/1	

	
6/6	
Met	

 L17	
Egress at grade 	
L	
2/3	
2/2	
1/1	

	
5/6	
Met
(83.33 %)	

 L18	
Above grade egress	
L	
1/1	
2/2	

	
	
3/3	
Met	

 L19	
Bedroom location	
L	
3/3	
2/2	

	
	
5/5	
Met	

 L20	
Exit doors	
L	
3/3	
2/2	

	
	
5/5	
Met	

 L21	
Safe electrical equipment	
L	
3/3	
1/1	
1/1	

	
5/5	
Met	

 L22	
Well-maintained appliances	
L	
3/3	
1/1	
1/1	

	
5/5	
Met	

 L23	
Egress door locks	
L	
1/1	

	

1/1	
Met	

 L24	
Locked door access	
L	
3/3	

	

3/3	
Met	

 L25	
Dangerous substances	
L	
3/3	
1/1	

	
	
4/4	
Met	

 L26	
Walkway safety	
L	
3/3	
1/1	
1/1	

	
5/5	
Met	

 L28	
Flammables	
L	
3/3	
1/1	

	
	
4/4	
Met	

 L29	
Rubbish/combustibles	
L	
3/3	
1/1	
1/1	

	
5/5	
Met	

 L30	
Protective railings	
L	
2/3	
2/2	
1/1	

	
5/6	
Met
(83.33 %)	

 L31	
Communication method	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L32	
Verbal & written	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L33	
Physical exam	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L34	
Dental exam	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L35	
Preventive screenings	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L36	
Recommended tests	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L37	
Prompt treatment	
I	
7/7	
2/2	
2/2	

	
11/11	
Met	

O	
 L38	
Physician's orders	
I	
5/5	
2/2	

	
	
7/7	
Met	

 L39	
Dietary requirements	
I	
4/4	

	

4/4	
Met	

 L40	
Nutritional food	
L	
3/3	
2/2	

	
	
5/5	
Met	

 L41	
Healthy diet	
L	
3/3	
2/2	
1/1	

	
6/6	
Met	

 L42	
Physical activity	
L	
3/3	
2/2	
1/1	

	
6/6	
Met	

 L43	
Health Care Record	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L44	
MAP registration	
L	
2/2	

	

2/2	
Met	

 L45	
Medication storage	
L	
3/3	
1/1	

	
	
4/4	
Met	

O	
 L46	
Med. Administration	
I	
5/5	
1/1	

	
	
6/6	
Met	

 L47	
Self medication	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L49	
Informed of human rights	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L50	
Respectful Comm.	
L	
3/3	
2/2	
1/1	

	
6/6	
Met	

 L51	
Possessions	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L52	
Phone calls	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L53	
Visitation	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L54	
Privacy	
L	
3/3	
2/2	
1/1	

	
6/6	
Met	

 L56	
Restrictive practices	
I	
1/1	

	

1/1	
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	
4/5	
0/1	

	
	
4/6	
Not Met
(66.67 %)	

 L64	
Med. treatment plan rev.	
I	
4/5	
0/1	

	
	
4/6	
Not Met
(66.67 %)	

 L67	
Money mgmt. plan	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L68	
Funds expenditure	
I	
7/7	
2/2	
2/2	

	
11/11	
Met	

 L69	
Expenditure tracking	
I	
7/7	
2/2	
2/2	

	
11/11	
Met	

 L70	
Charges for care calc.	
I	
6/7	
2/2	
2/2	

	
10/11	
Met
(90.91 %)	

 L71	
Charges for care appeal	
I	
7/7	
2/2	
2/2	

	
11/11	
Met	

 L77	
Unique needs training	
I	
5/7	
3/3	
2/2	

	
10/12	
Met
(83.33 %)	

 L80	
Symptoms of illness	
L	
3/3	
2/2	
1/1	

	
6/6	
Met	

 L81	
Medical emergency	
L	
3/3	
2/2	
1/1	

	
6/6	
Met	

O	
 L82	
Medication admin.	
L	
2/2	

	

2/2	
Met	

 L84	
Health protect. Training	
I	
2/2	

	

2/2	
Met	

 L85	
Supervision 	
L	
3/3	
2/2	
1/1	

	
6/6	
Met	

 L86	
Required assessments	
I	
6/7	
1/1	
2/2	

	
9/10	
Met
(90.0 %)	

 L87	
Support strategies	
I	
7/7	
2/2	
2/2	

	
11/11	
Met	

 L88	
Strategies implemented	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L90	
Personal space/ bedroom privacy	
I	
7/7	
3/3	
2/2	

	
12/12	
Met	

 L91	
Incident management	
L	
0/2	
0/1	

	
	
0/3	
Not Met
(0 %)	

#Std. Met/# 69 Indicator	

	

	

66/69	

	
Total Score	

	

	

76/79	

	

	

	

	
96.20%	

		
							
Employment and Day Supports:	

							
	
Ind. #	
Ind.	
Loc. or Indiv.	
Emp. Sup.	
Cent. Based Work	
Com. Based Day	
Total Met / Rated	
Rating	

 L1	
Abuse/neglect training	
I	
3/3	
	
3/3	
6/6	
Met	

 L5	
Safety Plan	
L	

1/1	
1/1	
Met	

O	
 L6	
Evacuation	
L	

1/1	
1/1	
Met	

 L7	
Fire Drills	
L	

1/1	
1/1	
Met	

 L8	
Emergency Fact Sheets	
I	
3/3	
	
3/3	
6/6	
Met	

 L9	
Safe use of equipment	
L	
1/1	
	
1/1	
2/2	
Met	

 L10	
Reduce risk interventions	
I	
2/2	
	
3/3	
5/5	
Met	

O	
 L11	
Required inspections	
L	

1/1	
1/1	
Met	

O	
 L12	
Smoke detectors	
L	

1/1	
1/1	
Met	

O	
 L13	
Clean location	
L	

1/1	
1/1	
Met	

 L14	
Site in good repair	
L	

1/1	
1/1	
Met	

 L15	
Hot water	
L	

1/1	
1/1	
Met	

 L16	
Accessibility	
L	

1/1	
1/1	
Met	

 L17	
Egress at grade 	
L	

1/1	
1/1	
Met	

 L20	
Exit doors	
L	

1/1	
1/1	
Met	

 L21	
Safe electrical equipment	
L	

1/1	
1/1	
Met	

 L22	
Well-maintained appliances	
L	

1/1	
1/1	
Met	

 L25	
Dangerous substances	
L	

1/1	
1/1	
Met	

 L26	
Walkway safety	
L	

1/1	
1/1	
Met	

 L28	
Flammables	
L	

1/1	
1/1	
Met	

 L29	
Rubbish/combustibles	
L	

1/1	
1/1	
Met	

 L31	
Communication method	
I	
3/3	
	
3/3	
6/6	
Met	

 L32	
Verbal & written	
I	
3/3	
	
3/3	
6/6	
Met	

 L37	
Prompt treatment	
I	
2/2	
	
1/1	
3/3	
Met	

O	
 L38	
Physician's orders	
I	
1/1	
	
3/3	
4/4	
Met	

 L39	
Dietary requirements	
I	

2/2	
2/2	
Met	

 L44	
MAP registration	
L	

1/1	
1/1	
Met	

 L45	
Medication storage	
L	

1/1	
1/1	
Met	

O	
 L46	
Med. Administration	
I	

3/3	
3/3	
Met	

 L49	
Informed of human rights	
I	
3/3	
	
3/3	
6/6	
Met	

 L50	
Respectful Comm.	
L	
1/1	
	
1/1	
2/2	
Met	

 L51	
Possessions	
I	
3/3	
	
3/3	
6/6	
Met	

 L52	
Phone calls	
I	
3/3	
	
3/3	
6/6	
Met	

 L54	
Privacy	
L	
1/1	
	
1/1	
2/2	
Met	

 L61	
Health protection in ISP	
I	

2/2	
2/2	
Met	

 L62	
Health protection review	
I	

1/2	
1/2	
Not Met
(50.0 %)	

 L63	
Med. treatment plan form	
I	

1/2	
1/2	
Not Met
(50.0 %)	

 L64	
Med. treatment plan rev.	
I	

1/1	
1/1	
Met	

 L67	
Money mgmt. plan	
I	

3/3	
3/3	
Met	

 L68	
Funds expenditure	
I	

3/3	
3/3	
Met	

 L69	
Expenditure tracking	
I	

3/3	
3/3	
Met	

 L72	
DOL requirements	
I	

1/1	
1/1	
Met	

 L77	
Unique needs training	
I	
3/3	
	
3/3	
6/6	
Met	

 L79	
Restraint training	
L	

0/1	
0/1	
Not Met
(0 %)	

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

 L81	
Medical emergency	
L	
1/1	
	
1/1	
2/2	
Met	

O	
 L82	
Medication admin.	
L	

1/1	
1/1	
Met	

 L84	
Health protect. Training	
I	

2/2	
2/2	
Met	

 L85	
Supervision 	
L	
1/1	
	
1/1	
2/2	
Met	

 L86	
Required assessments	
I	
2/2	
	
3/3	
5/5	
Met	

 L87	
Support strategies	
I	
1/1	
	
3/3	
4/4	
Met	

 L88	
Strategies implemented	
I	
3/3	
	
3/3	
6/6	
Met	

 L91	
Incident management	
L	

1/1	
1/1	
Met	

#Std. Met/# 53 Indicator	

	

50/53	

	
Total Score	

	

60/63	

	

	

	
95.24%	

		
							
	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	
1/1	
Met	

	

	

							
Community Based Day Services	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff / care provider performance	
3/3	
Met	

 C8	
Family/guardian communication	
3/3	
Met	

 C13	
Skills to maximize independence 	
3/3	
Met	

 C37	
Interpersonal skills for work	
3/3	
Met	

 C40	
Community involvement interest	
3/3	
Met	

 C41	
Activities participation	
3/3	
Met	

 C42	
Connection to others	
3/3	
Met	

 C43	
Maintain & enhance relationship	
3/3	
Met	

 C44	
Job exploration	
3/3	
Met	

 C45	
Revisit decisions	
3/3	
Met	

 C46	
Use of generic resources	
3/3	
Met	

 C47	
Transportation to/ from community	
3/3	
Met	

 C51	
Ongoing satisfaction with services/ supports	
3/3	
Met	

 C54	
Assistive technology	
0/3	
Not Met (0 %)	

Employment Support Services	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff / care provider performance	
3/3	
Met	

 C8	
Family/guardian communication	
3/3	
Met	

 C27	
Job benefit education	
1/1	
Met	

 C28	
Relationships w/businesses	
1/1	
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	
2/3	
Not Met (66.67 %)	

 C36	
Supports to enhance retention	
3/3	
Met	

 C37	
Interpersonal skills for work	
3/3	
Met	

 C47	
Transportation to/ from community	
3/3	
Met	

 C50	
Involvement/ part of the Workplace culture	
3/3	
Met	

 C51	
Ongoing satisfaction with services/ supports	
3/3	
Met	

 C54	
Assistive technology	
0/3	
Not Met (0 %)	

Individual Home Supports	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff / care provider performance	
0/3	
Not Met (0 %)	

 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	
3/3	
Met	

 C15	
Personalize living space	
2/2	
Met	

 C16	
Explore interests	
3/3	
Met	

 C17	
Community activities	
3/3	
Met	

 C18	
Purchase personal belongings	
3/3	
Met	

 C19	
Knowledgeable decisions	
3/3	
Met	

 C20	
Emergency back-up plans	
2/2	
Met	

 C21	
Coordinate outreach	
3/3	
Met	

 C46	
Use of generic resources	
3/3	
Met	

 C47	
Transportation to/ from community	
3/3	
Met	

 C48	
Neighborhood connections	
3/3	
Met	

 C49	
Physical setting is consistent 	
2/2	
Met	

 C51	
Ongoing satisfaction with services/ supports	
3/3	
Met	

 C52	
Leisure activities and free-time choices /control	
3/3	
Met	

 C53	
Food/ dining choices	
3/3	
Met	

 C54	
Assistive technology	
1/3	
Not Met (33.33 %)	

Placement Services	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff / care provider performance	
2/2	
Met	

 C8	
Family/guardian communication	
2/2	
Met	

 C9	
Personal relationships	
2/2	
Met	

 C10	
Social skill development	
2/2	
Met	

 C11	
Get together w/family & friends	
2/2	
Met	

 C12	
Intimacy	
2/2	
Met	

 C13	
Skills to maximize independence 	
2/2	
Met	

 C14	
Choices in routines & schedules	
2/2	
Met	

 C15	
Personalize living space	
1/1	
Met	

 C16	
Explore interests	
2/2	
Met	

 C17	
Community activities	
2/2	
Met	

 C18	
Purchase personal belongings	
2/2	
Met	

 C19	
Knowledgeable decisions	
2/2	
Met	

 C20	
Emergency back-up plans	
1/1	
Met	

 C46	
Use of generic resources	
2/2	
Met	

 C47	
Transportation to/ from community	
2/2	
Met	

 C48	
Neighborhood connections	
2/2	
Met	

 C49	
Physical setting is consistent 	
1/1	
Met	

 C51	
Ongoing satisfaction with services/ supports	
2/2	
Met	

 C52	
Leisure activities and free-time choices /control	
2/2	
Met	

 C53	
Food/ dining choices	
2/2	
Met	

 C54	
Assistive technology	
2/2	
Met	

Residential Services	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff / care provider performance	
5/7	
Not Met (71.43 %)	

 C8	
Family/guardian communication	
7/7	
Met	

 C9	
Personal relationships	
7/7	
Met	

 C10	
Social skill development	
7/7	
Met	

 C11	
Get together w/family & friends	
7/7	
Met	

 C12	
Intimacy	
7/7	
Met	

 C13	
Skills to maximize independence 	
7/7	
Met	

 C14	
Choices in routines & schedules	
7/7	
Met	

 C15	
Personalize living space	
3/3	
Met	

 C16	
Explore interests	
7/7	
Met	

 C17	
Community activities	
6/7	
Met (85.71 %)	

 C18	
Purchase personal belongings	
7/7	
Met	

 C19	
Knowledgeable decisions	
7/7	
Met	

 C20	
Emergency back-up plans	
3/3	
Met	

 C46	
Use of generic resources	
7/7	
Met	

 C47	
Transportation to/ from community	
6/6	
Met	

 C48	
Neighborhood connections	
6/7	
Met (85.71 %)	

 C49	
Physical setting is consistent 	
3/3	
Met	

 C51	
Ongoing satisfaction with services/ supports	
7/7	
Met	

 C52	
Leisure activities and free-time choices /control	
7/7	
Met	

 C53	
Food/ dining choices	
7/7	
Met	

 C54	
Assistive technology	
2/7	
Not Met (28.57 %)