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PROVIDER REPORT FOR
Ascentria Community Services14 Worcester Street Worcester, MA 01604
Version
Provider Web Report
Prepared by the Department of Developmental ServicesOFFICE OF QUALITY ENHANCEMENT
SUMMARY OF OVERALL FINDINGS
Provider
Ascentria Community Services
Review Dates
7/17/2017 - 7/19/2017
Service Enhancement Meeting Date
8/2/2017
Survey Team
Jennifer Conley-Sevier (TL)
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
3 location(s) 3 audit (s)
Full Review
59 / 67 2 Year License 08/02/2017 - 08/02/2019
22 / 29 Certified with Progress Report 08/02/2017 - 08/02/2019
Individual Home Supports
3 location(s) 3 audit (s)
Full Review
16 / 23
Planning and Quality Management
Full Review
6 / 6
EXECUTIVE SUMMARY :
Ascentria Care Alliance is a faith-based, non-profit, human service agency providing programs and supports throughout New England. Its corporate headquarters is in Worcester, Massachusetts. There are 60 agency programs providing diverse services to children and families (inclusive of adoption, foster care services, and teen parenting programs), new Americans (inclusive of refugee and immigrant services), older adults, the economically disadvantaged, persons who are deaf, and disability services. The agency provides Individual Home Services to individuals with intellectual disabilities across the state, but primarily in the Central West part of the state. The scope of this survey conducted by the Office of Quality Enhancement (OQE) was a full review of all licensing and certification indicators within the agency's Individual Home Supports services for those receiving at least 15 hours of supports per week. These more intensive I H S services are provided in Andover, in an apartment building containing 8 studio apartments and a common space. Services to three people were evaluated. The review was inclusive of indicators which were new or revised in August 2016.Since the previous survey, the Andover program has undergone a substantial change in leadership in both the Program Manager and Team Leader positions. This transition has strengthened lines of communication between program staff and guardians. Specifically, feedback from stakeholders, via satisfaction surveys, as well as participation in stakeholder meetings or informal lunches that were, inclusive of individuals, family members, Ascentria and DDS staff, was taken and then utilized in development and implementation of measurable goals. Respectful communication and thoughtful regard of the suggestions garnered from individuals and family members via regular forums, meetings and agency social events was evident. Staff's ability to recognize and support individuals' unique needs was an agency strength. For example, at one of the apartments surveyed, the individual was displaying increased difficulty with ingestion during mealtimes and would frequently swallow food without thoroughly chewing. Agency staff liaised with the guardian and physician to ensure that this individual was fully supported to enjoy meals with a new chopped diet. In general, people's health and physical well-being were well supported by agency staff. Staff were trained in people's health related protocols and were familiar with specific health concerns, such as seizures and sleep apnea. Human rights were well supported by the agency. Ascentria is seeking a waiver renewal to operate a single Human Rights Committee across two regions. Committee minutes reflected thorough discussions on matters pertinent to the committee, including incidents and agency policies pertaining to human rights. A review of the minutes also elucidated the valuable input and participation that individuals supported had during each meeting. However, the agency needs to ensure that it its Human Rights Committee is fully constituted with regular participation of all voting members.Throughout the course of the survey, it was noted that the agency has incorporated many of the new or strengthened standards recently implemented by the Office of Quality Enhancement (OQE). For example, individuals were supported to utilize generic resources in the community and individuals participate in providing feedback on the staff with whom they work directly on an ongoing basis and during the hiring process. Some areas requiring further attention were identified during the survey. The agency has historically been operating this location as a collective grouping serving the individuals within this building together. For example, individuals typically dine together in the common area, the stoves in each apartment had been disengaged, and individuals did not typically store food or snacks within their unit. The individuals need to be supported to benefit from and use their own studio apartment. For example, the agency needs to ensure that individuals are provided with a wide array of meal and dining choices, including the support to cook and eat in their individual apartments alone or with people and at the time that each chooses. Individualized instruction and support to maintain an apartment, use appliances, and live independently could be increased. In addition, each individual could benefit from greater efforts to get to know their neighbors, their immediate neighborhood and to engage in community activities in line with their unique interests. In other areas of certification, while it was evident that staff encouraged individuals to engage in agency-sponsored activities, efforts to assist individuals to broaden their relationships with individuals other than paid staff, family members or residents of the apartment building were not noted consistently. Although staff are familiar with the individuals' preferences and support needs, further assessment and exploration of each person's interests for cultural, social, recreational and spiritual needs in both the neighborhood and the larger community would be beneficial to individuals supported. For example, one individual expressed his affinity for music. Staff were supporting him to use generic resources by visiting a local music store to purchase CDs, however the individual would benefit from expanding upon this interest by providing options to share his interest with others in the community such as supporting the individual to participate in local bands, concerts or music classes at the community college.In the area of licensure, several distinct items were noted. In the financial realm, it was evident through interviews and review of the financial assessments that staff were familiar with individuals' support needs. However, there were no financial management plans with accompanying training plans in place. The agency needs to assist the individuals to become more independent in financial management. In one apartment, the hot water in the bathroom sink was below the acceptable temperature range. Although medications were being administered according to physician's orders, the medication treatment plans did not have a viable data collection mechanism to sufficiently outline the clinical course of treatment and chart the efficacy of the medication. Lastly, assessments and support strategies in preparation for individual support plans should be submitted to DDS within the required timeline. . As a result of this review, Ascentria's Residential Services Program received a rating of met in 88% of licensing indicators with all critical indicators met. The agency met 76% of certification indicators reviewed. As a result, the agency will receive a Two Year License for Residential /Individual Home Service Grouping and is Certified with a Progress Report. Follow-up on all not met licensing indicators will be conducted by OQE within 60 days from the Service Enhancement Meeting.
LICENSURE FINDINGS
Met / Rated
Not Met / Rated
% Met
Organizational
5/6
1/6
Residential and Individual Home Supports
54/61
7/61
Individual Home Supports
Critical Indicators
8/8
0/8
Total
59/67
8/67
88%
2 Year License
# indicators for 60 Day Follow-up
8
Organizational Areas Needing Improvement on Standards not met/Follow-up to occur:
Indicator #
Indicator
Area Needing Improvement
L48
The agency has an effective Human Rights Committee.
The agency's Human Rights Committee meetings did not include the attendance of a nurse or physician for six of seven meetings The agency needs to ensure that the Human Rights Committee meets regulatory requirements for membership and be fully constituted. If this member is unable or unwilling to attend quarterly meetings consistently, the agency needs to recruit and obtain a new member for the Nurse/ Physician position.
Residential Areas Needing Improvement on Standards not met/Follow-up to occur:
Indicator #
Indicator
Area Needing Improvement
L15
Hot water temperature tests between 110 and 130 degrees.
In one of three apartments, the hot water temperature tested below the minimum standard. The agency needs to ensure that the water temperature in sinks is maintained between 110 and 120 degrees, and in showers between 110 and 112 degrees.
L22
All appliances and equipment are clean, operational and properly maintained
In all three apartments, the kitchen stove burners were not operational. The agency needs to ensure that all home appliances are clean, well-maintained, and in good working order.
L63
Medication treatment plans are in written format with required components.
For the two individuals surveyed who had medication treatment plans, plans did not include all required components. Data collection must occur for all identified target behaviors; this includes baseline and current data collection. The agency needs to ensure that medication treatment plans contain the required components.
L67
There is a written plan in place accompanied by a training plan when the agency has shared or delegated money management responsibility.
For the two individuals for whom the agency has shared or delegated money management responsibilities, money management plans had not been developed. The agency needs to ensure that financial management plans are in place and contain a training plan or teaching component to foster increased independence and skill-building.
L69
Individual expenditures are documented and tracked.
For one of the two individuals surveyed for whom the agency was holding funds, the agency did not include a gift card with the individual's cash on hand and were not tracking expenditures or the balance on this card. The agency needs to ensure that individual expenditures are accurately documented and tracked.
L86
Required assessments concerning individual needs and abilities are completed in preparation for the ISP.
For two of the individuals surveyed assessments were not forwarded to the Area Office 15 days prior in preparation for the ISP as required. The agency needs to ensure assessments are submitted to the Area Office in accordance with DDS regulatory requirements.
L87
Support strategies necessary to assist an individual to meet their goals and objectives are completed and submitted as part of the ISP.
For two of the individuals surveyed support strategies were not forwarded to the Area Office 15 days prior in preparation for the ISP as required. The agency needs to ensure support strategies are submitted to the Area Office in accordance with DDS regulatory requirements.
CERTIFICATION FINDINGS
Met / Rated
Not Met / Rated
% Met
Certification - Planning and Quality Management
6/6
0/6
Residential and Individual Home Supports
16/23
7/23
Individual Home Supports
16/23
7/23
TOTAL
22/29
7/29
76%
Certified with Progress Report
Individual Home Supports- Areas Needing Improvement on Standards not met:
Indicator #
Indicator
Area Needing Improvement
C13
Staff (Home Providers) provide support for individuals to develop skills to enable them to maximize independence and participation in typical activities and routines.
For all three individuals surveyed, staff were not providing support to maximize individuals' independence by assisting them in skill-building and participation in typical household activities and routines in their own apartments. The agency needs to ensure that staff provide individualized support that fosters skill-building and independence in typical home activities and routines and is specific to an individual's support needs.
C14
Staff (Home Providers) support individuals to make choices regarding daily household routines and schedules.
For all three individuals surveyed, there was no evidence to indicate that staff were supporting individuals' choices in the completion of household and personal activities. The agency needs to ensure that staff facilitate the exercise of personalized choices in daily routines in lieu of enforcing collective decision-making with regard to household routines and scheduling.
C16
Staff (Home Providers) support individuals to explore, discover and connect with their interests for cultural, social, recreational and spiritual activities.
For two individuals surveyed, there was no evidence that the process of exploration, discovery, and participation of integrated cultural, social, recreational and spiritual activities was occurring on a consistent and sustained basis. Activities occurring outside of the home were limited in variety and were often agency-sponsored events. The agency needs to ensure supports are provided to expose individuals to a wide range of integrated activities to explore and further connect individuals with their established or newly developed interests in cultural, social, recreational and spiritual activities.
C17
Community activities are based on the individual's preferences and interests.
For two of the individuals surveyed, there was no evidence that individualized community activities were occurring or had been offered to individuals based on their personal preferences and interests. Once identified, the agency needs to ensure that individuals are provided with frequent opportunities to engage in integrated community activities that are in line with the individual's preferences and interests.
C48
Individuals are a part of the neighborhood.
For the three individuals surveyed, there was minimal opportunity for individuals to establish connections with their neighbors. The agency needs to ensure that individuals are supported to connect with their neighbors through a variety of mechanisms; for example, participation in activities such as block parties, clean up days or yard sales. Individuals may also be supported to become part of their larger community by involvement in local politics or participation in town meetings.
C49
The physical setting blends in with and is a natural part of the neighborhood and community.
The building housing eight apartments for individuals with disabilities was set back and isolated from neighbors The building is atypical and does not blend in with the single family housing that predominantly defines the neighborhood. The agency needs to ensure that the residential setting is in a neighborhood that is comprised of similar housing stock for people with and without disabilities.
C53
Individuals are supported to have choice and control over what, when, where and with whom they want to eat.
All three of the individuals surveyed ate all of their meals in the common area with the individuals from the other five apartments. Meals were served family style. Individualized menu planning, meal time planning and dinners in one's apartment was not occurring. The agency needs to ensure that individuals are provided with a wide array of meal and dining choices, including the support to plan for, cook and eat in their individual apartments alone or with other people.
MASTER SCORE SHEET LICENSURE
Organizational: Ascentria Community Services
Indicator #
Indicator
Met/Rated
Rating(Met,Not Met,NotRated)
O
L2
Abuse/neglect reporting
3/3
Met
L3
Immediate Action
1/1
Met
L48
HRC
0/1
Not Met(0 % )
L74
Screen employees
3/3
Met
L76
Track trainings
3/3
Met
L83
HR training
3/3
Met
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
3/3
3/3
Met
L5
Safety Plan
L
3/3
3/3
Met
O
L6
Evacuation
L
3/3
3/3
Met
L8
Emergency Fact Sheets
I
3/3
3/3
Met
L9
Safe use of equipment
L
3/3
3/3
Met
O
L11
Required inspections
L
3/3
3/3
Met
O
L12
Smoke detectors
L
3/3
3/3
Met
O
L13
Clean location
L
3/3
3/3
Met
L14
Site in good repair
L
3/3
3/3
Met
L15
Hot water
L
2/3
2/3
Not Met(66.67 %)
L16
Accessibility
L
3/3
3/3
Met
L17
Egress at grade
L
3/3
3/3
Met
L18
Above grade egress
L
3/3
3/3
Met
L19
Bedroom location
L
3/3
3/3
Met
L20
Exit doors
L
3/3
3/3
Met
L21
Safe electrical equipment
L
3/3
3/3
Met
L22
Clean appliances
L
0/3
0/3
Not Met(0 %)
L25
Dangerous substances
L
3/3
3/3
Met
L26
Walkway safety
L
3/3
3/3
Met
L28
Flammables
L
3/3
3/3
Met
L29
Rubbish/combustibles
L
3/3
3/3
Met
L30
Protective railings
L
3/3
3/3
Met
L31
Communication method
I
3/3
3/3
Met
L32
Verbal & written
I
3/3
3/3
Met
L33
Physical exam
I
3/3
3/3
Met
L34
Dental exam
I
3/3
3/3
Met
L35
Preventive screenings
I
3/3
3/3
Met
L36
Recommended tests
I
3/3
3/3
Met
L37
Prompt treatment
I
3/3
3/3
Met
O
L38
Physician's orders
I
2/2
2/2
Met
L39
Dietary requirements
I
2/2
2/2
Met
L40
Nutritional food
L
3/3
3/3
Met
L41
Healthy diet
L
3/3
3/3
Met
L42
Physical activity
L
3/3
3/3
Met
L43
Health Care Record
I
3/3
3/3
Met
L44
MAP registration
L
2/2
2/2
Met
L45
Medication storage
L
2/2
2/2
Met
O
L46
Med. Administration
I
2/2
2/2
Met
L47
Self medication
I
3/3
3/3
Met
L49
Informed of human rights
I
3/3
3/3
Met
L50
Respectful Comm.
L
3/3
3/3
Met
L51
Possessions
I
3/3
3/3
Met
L52
Phone calls
I
3/3
3/3
Met
L53
Visitation
I
3/3
3/3
Met
L54
Privacy
L
3/3
3/3
Met
L63
Med. treatment plan form
I
0/2
0/2
Not Met(0 %)
L64
Med. treatment plan rev.
I
2/2
2/2
Met
L67
Money mgmt. plan
I
0/2
0/2
Not Met(0 %)
L68
Funds expenditure
I
2/2
2/2
Met
L69
Expenditure tracking
I
1/2
1/2
Not Met(50.0 %)
L70
Charges for care calc.
I
3/3
3/3
Met
L71
Charges for care appeal
I
3/3
3/3
Met
L77
Unique needs training
I
3/3
3/3
Met
L80
Symptoms of illness
L
3/3
3/3
Met
L81
Medical emergency
L
3/3
3/3
Met
O
L82
Medication admin.
L
2/2
2/2
Met
L85
Supervision
L
3/3
3/3
Met
L86
Required assessments
I
0/2
0/2
Not Met(0 %)
L87
Support strategies
I
0/2
0/2
Not Met(0 %)
L88
Strategies implemented
I
3/3
3/3
Met
L90
Personal space/ bedroom privacy
I
3/3
3/3
Met
#Std. Met/# 61 Indicator
54/61
Total Score
59/67
88.06%
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
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
0/3
Not Met (0 %)
C14
Choices in routines & schedules
0/3
Not Met (0 %)
C15
Personalize living space
3/3
Met
C16
Explore interests
1/3
Not Met (33.33 %)
C17
Community activities
1/3
Not Met (33.33 %)
C18
Purchase personal belongings
3/3
Met
C19
Knowledgeable decisions
3/3
Met
C20
Emergency back-up plans
3/3
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
1/3
Not Met (33.33 %)
C49
Physical setting is consistent
0/3
Not Met (0 %)
C51
Ongoing satisfaction with services/ supports
3/3
Met
C52
Leisure activities and free-time choices /control
3/3
Met
C53
Food/ dining choices
0/3
Not Met (0 %)
C54
Assistive technology
3/3
Met
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