SUMMARY OF OVERALL FINDINGS

Provider:  Becket Academy
Review Dates:  July 15 – 17, 2013
Initial Review Exit Meeting Date:  July 22, 2013
Survey Team:  Laura K. O’Connor

Survey Scope and Findings for Residential and Individual Home Supports	
Service Group Type	Sample Size	Licensure Scope	Anticipated Date for     Full Licensure and Certification Date	
Residential and Individual Home Supports	 1 Location 
 3 Audits 	 Initial Review	 
 	
Residential Services	 1 Location 
 3 Audits	 	 Full Review	

EXECUTIVE SUMMARY
The Becket Family of Services provides a variety of services in Maine, New Hampshire, and Massachusetts.  The agency specializes in working with youth and adults who present extreme behavioral challenges, generally the result of co-occurring mental health disorders, and who are at risk or who have already been placed out of their homes.  'Connections for Kids' provides a range of community-based services throughout Maine on behalf of the Becket Family of Services with a primary focus on children, adolescents and young adults, and their family systems.  'Solid Foundations' is a comprehensive family support and stabilization program offered to youth and families that reside in New Hampshire.  'Project Connect' is a comprehensive family support and stabilization program offered to youth and families that reside in New Hampshire and Massachusetts.

The focus of this Initial Licensing Review is to provide a baseline evaluation of the agency's recently opened DDS funded adult residential services that 'Becket Adult Services of Massachusetts' provides to three adults with significant intellectual and behavioral challenges in Lakeville, Massachusetts.  The agency plans to provide similar residential services to other adults with developmental disabilities in Westminster, MA; however, no one had moved into this home yet, at the time of this review.  Therefore, only the services provided to the three men who live in Lakeville were evaluated as part of this initial review.

Although the HRC met DDS requirements for the point and time of this Initial Review; technical support was provided to further enhance the bylaws and meeting minutes.  The following issues must be addressed/resolved to ensure that the HRC continues to meets DDS requirements in the future: 

•	The HRC, which currently reviews rights related issues for the agency's DDS and DMH funded programs, must periodically review the current regulatory requirements for both DDS and DMH to ensure that Becket continues to provide the HRC with information that is clearly identified by the type of program that the individual receives services from, and that the agency is in compliance with the current requirements of the relevant funding source;

EXECUTIVE SUMMARY, cont.

•	The HRC needs to review all restraint reports within 120 days; 

•	The agency also needs to submit a waiver to the DDS regarding how the HRC, which will cover two regions within the state when the Westminster home is opened, will ensure that both regions are sufficiently represented and reviewed by the committee.   

Prior to locating and opening this new home in Lakeville, the agency had primarily provided adult services nearer to its office located in Sudbury Massachusetts.  Therefore, all of the staff for the Lakeville home, except for the house manager, were newly hired by the agency.  All three of the individuals who moved into the home in Lakeville were also new to the agency.  These individuals had resided in institutional residential settings for many years, and were justifiably reluctant and nervous to move out of their familiar settings.  The agency and their ISP teams did a commendable job of working together with preferred staff from the previous provider, and family members, to reassure each individual and to make their transition as smooth and successful as possible.  Becket staff spent a considerable amount of time getting to know each individual and their preferences in their previous residential settings.  Efforts were made to personalize each individual's bedroom and the common spaces of the home using colors and items that they would feel comfortable with.  Moves were staggered to allow each individual and opportunity to become familiar and with their new surroundings and support staff.  The staffing ratios were also high enough to allow individualized attention, which also helped to make transitions into their new home more successful.  All three men seemed to have settled into their new home rather smoothly, which was evidenced by the significant decreases in their target behaviors, relaxed demeanors, and increased interactions with others.  Staff also appeared to be more comfortable and confident in their roles supporting individuals in their new home.

The agency’s management team members worked diligently to ensure that staff received required trainings, supervision, and oversight through initial performance evaluations.  Systems were in place to ensure that required renovations were made to the home before it was opened, and to promote consistent supports to the three individuals who lived there.  

The agency and its staff are congratulated for achieving ratings of “Met” on all of the indicators, with very few exceptions, of the indicators that were scored as part of this Initial Licensing Review.  As the agency goes forward in preparation for the full Licensing and Certification review that will take place in or around November 2013, it will be most helpful to focus on the licensing indicators that where issues were identified.  Additionally, since the agency as been providing services for such a short time, it should also remain cognizant of those indicators that were not applicable as those supports were not currently provided and consequently not evaluated.  When supports in these areas begin, the provider will need to ensure the applicable requirements are put into place.  These indicators include areas such as: ISP assessments, goal preparation and implementation, money management assessments/teach-ing plans, and making sure that behavior plan interventions are current.  The agency should also continue to contact the DDS Office for Quality Enhancement and/or Human Rights Specialist for consultation, training, technical support, and resources, as needed.  

	

LICENSURE FINDINGS
 
Residential Commendation on Standard Met:	
Indicator#	Indicator	Commendation	
 L31	Staff understand and can communicate with individuals in their primary language and method of communicating.	The agency is commended for their successful efforts to locate and hire bilingual Khmer/English speaking staff that can effectively communicate with all three of the individuals who live in this home.	

Residential Areas Needing Improvement on Standards Not Met:	
Indicator#	Indicator	Area Needing Improvement	
 L8	Emergency Fact Sheets are current and accurate and available on site.	Emergency Fact Sheets need to include all required information, including significant diagnoses.
	
 L34	Individuals receive an annual dental exam. 	One individual had a follow-up dental appoint-ment scheduled that he did not attend because it was during the period that he was transitioning into his new home.  The agency needs to reschedule this appointment and ensure that individuals are supported to receive dental care within a timely manner.
	
 L58	All Behavior Plans contain the required components.	The agency needs to ensure that Behavior Plans are periodically reviewed and modified to accurately reflect the actual supports that are provided.  Staff also need to be trained and knowledgeable regarding the most current behavioral support interventions and plan. 

 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 needs to implement plans to develop written money management assessments and training strategies to increase the individuals’ skills in this area, and ensure individuals’ financial assets and benefits are monitored/ protected.