PROVIDER REPORT FOR	

	

	

	

	

	

	

	

	

	
	
Community Connections, Inc.
127 Whites Path
 South Yarmouth, MA 02664    	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

Version	

	

	

	

	

	

	

	

	
Provider Web Report
March 21, 2017	

	

	

	

	

	

	

	
Prepared by the Department of Developmental Services
OFFICE OF QUALITY ENHANCEMENT	

	

	

	

	

	

	

				
	SUMMARY OF OVERALL FINDINGS	

				

	

	

Provider	

	
Community Connections, Inc.	

	

	

	

	
Review Dates	

	
2/23/2017 - 3/1/2017	

	

	

	

	
Service Enhancement 
Meeting Date	

	
3/15/2017	

	

	

	

	

	

	
Survey Team	

	
Tina Napolitan (TL)	

Laura O'Connor	

Margareth Larrieux	

	

	

	

	

	

	
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	
24 / 26 2 Year License 03/15/2017 -  03/15/2019	
	
26 / 26 Certified 03/15/2017 -  03/15/2019	

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

Full Review	
20 / 20	

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	
4 location(s) 7 audit (s) 	
Full Review	
24 / 28 2 Year License 03/15/2017 -  03/15/2019	
	
35 / 42 Certified 03/15/2017 -  03/15/2019	

Community Based Day Services	
1 location(s) 2 audit (s) 	

Full Review	
12 / 14	

Employment Support Services	
3 location(s) 5 audit (s) 	

Full Review	
17 / 22	

Planning and Quality Management (For all service groupings)	

	
Full Review	
6 / 6	

	

	

			
EXECUTIVE SUMMARY :	

			
Community Connections Inc. (CCI) is a non-profit agency which was founded in 1985. CCI provides a variety of community and site based services to individuals with disabilities living in Southeastern Massachusetts.  It is CCI's mission to provide life-enriching services that promote optimal independence for people with disabilities through goal-driven services and community partnerships.  The agency has sites located in Fall River, Wareham, Fairhaven, Plymouth and Cape Cod.  Services offered include the following:  Day Habilitation and Life Skills Centers, Community Based Day Supports (CBDS), Employment Supports, Individual Home Supports (IHS), Active Treatment, Turning 22 Transition Services and Transportation Services.  CCI supports approximately 800 individuals annually; of that, approximately 260 people are funded through the Department of Developmental Disabilities (DDS). 
 
This review focused on services to adults with developmental disabilities receiving Individual Home Supports, Community Based Day Supports and Employment Supports.  A full Licensure and Certification review was conducted.   This licensure and certification process included the new and revised indicators developed in response to requirements set forth by the Centers for Medicare and Medicaid Services (CMS).  

The scope of the licensure review addressed a range of indicators which either impacted people directly or which related to the agency's organizational systems. Some of these indicators related to domains such as human rights, staff training, privacy, and respect and ISP development.  The agency developed tracking system that proved effective and showed significant progress towards meeting ISP timeline.  The scope of the certification review also encompassed a range of indicators including areas such as individual choice, community membership, personal relationships, and the collection and analysis of data regarding the quality of services provided by the agency and how this data is used to make service improvements.  

CCI has a well-developed training calendar and multiple training sites for staff to access trainings as evidenced by the score of 100% in this indicator. CCI offers the mandatory trainings to all staff as well as defensive driving, cultural diversity and positive behavioral supports.  Additionally, CCI accessed consultants and engaged in a series of trainings to increase skills.  CCI has contracted with the Institute for Community Inclusion (ICI) to provide on-site customized training for employment services staff.   The agency uses the SAFE (Sexuality Advocates for Education) consultants to assist the agency in supporting people with relationship development in addition to Circles training.

The review identified a number of optimal practices on the part of the agency which resulted in positive individual outcomes within the employment program.  Through consulting with ICI, CCI restructured its internal system for employees to secure and assist with retention of the person's employment.  As a result, CCI was able to increase the number of people supported within the employment program.  The agency is commended for its efforts to increase skill development for job placement and retention, supporting people to work in integrated settings and becoming a part of the work culture. Additionally, many individuals supported through Employment Services have been successfully employed for a number of years and like their current positions. 

In addition to employment supports, the agency offers CBDS services in New Bedford and Fall River.  People receiving CBDS were offered activities of their choosing in which they could participate.  It was evident within the CBDS program that individuals' goals, interests and desires were in the forefront of service planning and delivery.  The individual supported through the IHS program expressed great satisfaction with supports that facilitate her being more independent within her community, going to volunteer positions, shopping, running errands and building relationships.  
  
The current DDS review also identified certification indicators that need additional focus and strengthening.  As part of agency practice, assessments occur and information is gathered when individuals are starting a new program; however, information regarding individuals who have been part of the program for years has not been regularly updated.  In many instances, individuals who have been part of the program for several years, and may be successfully employed have not had assessments of their skills and career interests reportedly since the individual started the program.  Through periodically revisiting people's work interests and career goals, this information would be identified.  The agency also has a well-developed grievance procedure which is reviewed with individuals when they start the program but not on an ongoing basis.  A review of grievance procedures should occur annually along with the yearly human rights review. Additionally, supporting people to understand the relationship between paid employment and benefits/entitlements could serve as an effective resource for individuals and/or their guardians in making informed decisions regarding competitive employment choices.  Furthermore, the agency needs to assess individuals for any assistive technology wants or needs that could enhance autonomy.

Organizationally, a review of Human Rights Committee meeting minutes found them to be comprehensive including documentation of policies and review of investigations and incidents.  However, despite ongoing efforts to recruit new members to meet membership requirements, on multiple occasions it lacked a clinician and quorum.  It should be noted that at the time of the survey, the agency reported that it had recently recruited the required staff to support its HRC with a clinician joining the team in June 2017. 

The agency is congratulated on earning a Two-Year License for it Employment and Community Based Day Supports (CBDS) services as well as their Individual Home Support Services. The Employment and Day Support grouping received a rating of 24 of 28 Licensure Indicators as 'Met' (86%).   The Individual Home Supports received a rating of 24 of 26 Licensure Indicators as 'Met' (96%).  Also, the agency is certified in Employment and Day Supports with 83% of Indicators 'Met' and  Individual Home Supports with 96% of Indicators 'Met'.  Follow-up by DDS will occur within 60 days on the Licensure Indicators rated 'Not Met' within the Employment and Day Supports. The agency will conduct its own follow-up on Licensure Indicators rated 'Not Met' within Individual Home Supports.	

	

	

LICENSURE FINDINGS	

	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
6/7	
1/7	

Residential and Individual Home Supports	
18/19	
1/19	

    Individual Home Supports

	

Critical Indicators	
1/1	
0/1	

Total	
24/26	
2/26	
92%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
2	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
6/7	
1/7	

Employment and Day Supports	
18/21	
3/21	

    Community Based Day Services
    Employment Support Services

	

Critical Indicators	
1/1	
0/1	

Total	
24/28	
4/28	
86%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
4	

	

	

	

	

	

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 Human Rights Committee needs to meet quorum requirements and ensure the necessary participation, input and directions is obtained from members with the required expertise.  	

		

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L55	
Informed consent is obtained from individuals or their guardians when required; Individuals or their guardians know that they have the right to withdraw consent.	
The agency utilized a form called "Informed and Voluntary Consent for Public Identification to publicize and promote Community Connections Inc.".  Individuals/guardians were asked to sign this annually rather than for each situation in which the photograph/video is being shared.  Consent needs to be obtained for each specific photo and include timelines and the right to withdraw consent.	

	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L49	
Individuals and guardians have been informed of their human rights and know how to file a grievance or to whom they should talk if they have a concern.	
The CCI employee handbook grievance procedures were reviewed with individuals when they were beginning to receive services.  Individuals need to have grievance procedures including the agency's own procedures and the employer's grievance procedures reviewed with them at least annually.	

 L55	
Informed consent is obtained from individuals or their guardians when required; Individuals or their guardians know that they have the right to withdraw consent.	
The agency utilized a form called "Informed and Voluntary Consent for Public Identification to publicize and promote Community Connections Inc.".  Individuals/guardians were asked to sign this annually rather than for each situation in which the photograph/video is being shared.  Consent needs to be obtained for each specific photo and include timelines and the right to withdraw consent.	

 L56	
Restrictive practices intended for one individual that affect all individuals served at a location need to have a written rationale that is reviewed as required and have provisions so as not to unduly restrict the rights of others.	
One individual receiving CBDS supports had an intervention in place that is restrictive involving a locked money box for safety.  The agency needs to identify this support as the least restrictive and develop a written rationale including a description of the support provided, how the key will be stored and how it can be accessed.  This restriction must be reviewed as required by the Human Rights Committee.	

			

		

	

	

CERTIFICATION FINDINGS	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

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

Residential and Individual Home Supports	
20/20	
0/20	

Individual Home Supports	
20/20	
0/20	

TOTAL	
26/26	
0/26	
100%	

Certified	

	

	
	
Met / Rated	
Not Met / Rated	
% Met	

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

Employment and Day Supports	
29/36	
7/36	

Community Based Day Services	
12/14	
2/14	

Employment Support Services	
17/22	
5/22	

TOTAL	
35/42	
7/42	
83%	

Certified	

	

	

	

	

	

	
Community Based Day 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 and on an ongoing basis on the performance of staff that support them.	
While the agency did have mechanisms to solicit feedback from individuals regarding employees performance on an ongoing basis and for some individuals feedback was shared with staff for training and evaluation purposes, there was no mechanism for individuals to have input at the time of hire for new staff.   The agency needs to expand  its existing systems to ensure that individuals have opportunities to provide feedback at the time of hire.    	

 C8	
There are opportunities for communication between guardians, family members, and staff on a regular and timely basis. 	
For one individual who receives CBDS services, the agency was unaware that a medical guardian was appointed.   The agency needs to ensure that all guardian contact information is current and readily available so that staff can communicate on a timely basis.	

	

	
Employment Support Services Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 C25	
Staff assist individuals to work on skill development for job attainment and success.	
The agency is commended for supporting several individuals to work on skill development for job attainment and success.  For example, one man has been working at his job for nearly 20 years and has been supported by the agency, as needed to learn new job skills when his job description changed. Another individual was supported to secure a certificate in early childhood education, first aid and CPR to secure and be successful in her employment at a childcare center.    	

 C30	
Individuals are supported to work in integrated job settings.	
Three of the five individuals who received employment services had jobs at the time of the survey. The agency is commended for its strong commitment to supporting individuals to secure and work in integrated settings.  	

 C50	
Individuals are supported to understand and become a part of the culture of the workplace (including workplace social activities and events).	
The agency is commended for supporting individual who received employment services and were employed to understand and become a part of the culture of the workplace.  For example, one woman who worked at a restaurant was supported to celebrate her birthday with her co-workers.  Another person was supported to develop her job after a successful internship at an early childhood education center where she felt included in all staff events. 	

	

	
Employment Support 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 and on an ongoing basis on the performance of staff that support them.	
While the agency did have mechanisms to solicit feedback from individuals regarding employees performance on an ongoing basis and from some individuals feedback was shared with staff for training and evaluation purposes, there was no mechanism for individuals to have input at the time of hire for new staff.   The agency needs to expand  its existing systems to ensure that individuals have opportunities to provide feedback at the time of hire and more consistent opportunities to provide feedback as part of the staff performance evaluation process.    	

 C22	
Staff have effective methods to assist individuals to explore their job interests.	
Although the agency does a thorough interest assessment when an individual starts receiving services, many people have been with the agency for a very long time. The agency needs to periodically re-assess each individual's job interests, including information from their successful and unsuccessful job experiences.	

 C23	
Staff utilize a variety of methods to assess an individual's skills, interests, career goals and training and support needs in employment.	
The "Community Connections Employment Services" was updated this year, which described the support needs of the individual.  However, additional methods need to be used to periodically (re)assess the individual's skills, interests, and career goals.	

 C26	
Career planning includes an analysis of how an individual's entitlements can be managed in a way that allows them to work successfully in the community.	
The agency needs to assist individuals to understand how an individual¿s entitlements can be managed while allowing the individual to work successfully in the community.	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
The agency needs to support individuals to receive an assessment to determine if assistive technology would help to enhance their independence.  	

	

	

		

					
	MASTER SCORE SHEET LICENSURE	

					
	Organizational: Community Connections, Inc.	

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

O	
 L2	
Abuse/neglect reporting	
1/1	
Met	

 L3	
Immediate Action	
1/1	
Met	

 L4	
Action taken	
1/1	
Met	

 L48	
HRC	
0/1	
Not Met(0 % )	

 L74	
Screen employees	
1/1	
Met	

 L76	
Track trainings	
4/4	
Met	

 L83	
HR training	
4/4	
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	
	
1/1	

	
	
1/1	
Met	

 L8	
Emergency Fact Sheets	
I	
	
1/1	

	
	
1/1	
Met	

 L9	
Safe use of equipment	
L	
	
1/1	

	
	
1/1	
Met	

 L31	
Communication method	
I	
	
1/1	

	
	
1/1	
Met	

 L32	
Verbal & written	
I	
	
1/1	

	
	
1/1	
Met	

 L42	
Physical activity	
L	
	
1/1	

	
	
1/1	
Met	

 L49	
Informed of human rights	
I	
	
1/1	

	
	
1/1	
Met	

 L50	
Respectful Comm.	
L	
	
1/1	

	
	
1/1	
Met	

 L51	
Possessions	
I	
	
1/1	

	
	
1/1	
Met	

 L52	
Phone calls	
I	
	
1/1	

	
	
1/1	
Met	

 L53	
Visitation	
I	
	
1/1	

	
	
1/1	
Met	

 L54	
Privacy	
L	
	
1/1	

	
	
1/1	
Met	

 L55	
Informed consent	
I	
	
0/1	

	
	
0/1	
Not Met
(0 %)	

 L80	
Symptoms of illness	
L	
	
1/1	

	
	
1/1	
Met	

 L81	
Medical emergency	
L	
	
1/1	

	
	
1/1	
Met	

 L85	
Supervision 	
L	
	
1/1	

	
	
1/1	
Met	

 L86	
Required assessments	
I	
	
1/1	

	
	
1/1	
Met	

 L87	
Support strategies	
I	
	
1/1	

	
	
1/1	
Met	

 L88	
Strategies implemented	
I	
	
1/1	

	
	
1/1	
Met	

#Std. Met/# 19 Indicator	

	

	

18/19	

	
Total Score	

	

	

24/26	

	

	

	

	
92.31%	

		
							
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	
5/5	
	
2/2	
7/7	
Met	

 L8	
Emergency Fact Sheets	
I	
5/5	
	
2/2	
7/7	
Met	

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

 L10	
Reduce risk interventions	
I	
1/1	
	
1/1	
2/2	
Met	

 L31	
Communication method	
I	
5/5	
	
2/2	
7/7	
Met	

 L32	
Verbal & written	
I	
5/5	
	
2/2	
7/7	
Met	

 L37	
Prompt treatment	
I	
5/5	
	
2/2	
7/7	
Met	

 L49	
Informed of human rights	
I	
3/5	
	
2/2	
5/7	
Not Met
(71.43 %)	

 L50	
Respectful Comm.	
L	
3/3	
	
1/1	
4/4	
Met	

 L51	
Possessions	
I	
5/5	
	
2/2	
7/7	
Met	

 L52	
Phone calls	
I	
5/5	
	
2/2	
7/7	
Met	

 L54	
Privacy	
L	
3/3	
	
1/1	
4/4	
Met	

 L55	
Informed consent	
I	
0/2	
	
2/2	
2/4	
Not Met
(50.0 %)	

 L56	
Restrictive practices	
I	

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

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

 L80	
Symptoms of illness	
L	
3/3	
	
1/1	
4/4	
Met	

 L81	
Medical emergency	
L	
3/3	
	
1/1	
4/4	
Met	

 L85	
Supervision 	
L	
3/3	
	
1/1	
4/4	
Met	

 L86	
Required assessments	
I	
2/2	
	
1/1	
3/3	
Met	

 L87	
Support strategies	
I	
2/2	
	
1/1	
3/3	
Met	

 L88	
Strategies implemented	
I	
5/5	
	
2/2	
7/7	
Met	

#Std. Met/# 21 Indicator	

	

18/21	

	
Total Score	

	

24/28	

	

	

	
85.71%	

		
							
	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 performance	
0/2	
Not Met (0 %)	

 C8	
Family/guardian communication	
1/2	
Not Met (50.0 %)	

 C13	
Skills to maximize independence 	
2/2	
Met	

 C37	
Interpersonal skills for work	
2/2	
Met	

 C40	
Community involvement interest	
1/1	
Met	

 C41	
Activities participation	
1/1	
Met	

 C42	
Connection to others	
1/1	
Met	

 C43	
Maintain & enhance relationship	
1/1	
Met	

 C44	
Job exploration	
2/2	
Met	

 C45	
Revisit decisions	
2/2	
Met	

 C46	
Use of generic resources	
1/1	
Met	

 C47	
Transportation to/ from community	
1/1	
Met	

 C51	
Ongoing satisfaction with services/ supports	
2/2	
Met	

 C54	
Assistive technology	
2/2	
Met	

Employment Support Services	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff performance	
0/5	
Not Met (0 %)	

 C8	
Family/guardian communication	
4/4	
Met	

 C22	
Explore job interests	
2/5	
Not Met (40.0 %)	

 C23	
Assess skills & training needs	
2/5	
Not Met (40.0 %)	

 C24	
Job goals & support needs plan	
5/5	
Met	

 C25	
Skill development	
5/5	
Met	

 C26	
Benefits analysis	
0/4	
Not Met (0 %)	

 C27	
Job benefit education	
5/5	
Met	

 C28	
Relationships w/businesses	
3/3	
Met	

 C29	
Support to obtain employment	
5/5	
Met	

 C30	
Work in integrated settings	
3/3	
Met	

 C31	
Job accommodations	
3/3	
Met	

 C32	
At least minimum wages earned	
4/4	
Met	

 C33	
Employee benefits explained	
3/3	
Met	

 C34	
Support to promote success	
4/4	
Met	

 C35	
Feedback on job performance	
3/3	
Met	

 C36	
Supports to enhance retention	
3/3	
Met	

 C37	
Interpersonal skills for work	
5/5	
Met	

 C47	
Transportation to/ from community	
5/5	
Met	

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

 C51	
Ongoing satisfaction with services/ supports	
4/5	
Met (80.0 %)	

 C54	
Assistive technology	
3/5	
Not Met (60.0 %)	

Individual Home Supports	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff performance	
1/1	
Met	

 C8	
Family/guardian communication	
1/1	
Met	

 C9	
Personal relationships	
1/1	
Met	

 C10	
Social skill development	
1/1	
Met	

 C11	
Get together w/family & friends	
1/1	
Met	

 C12	
Intimacy	
1/1	
Met	

 C13	
Skills to maximize independence 	
1/1	
Met	

 C14	
Choices in routines & schedules	
1/1	
Met	

 C16	
Explore interests	
1/1	
Met	

 C17	
Community activities	
1/1	
Met	

 C18	
Purchase personal belongings	
1/1	
Met	

 C19	
Knowledgeable decisions	
1/1	
Met	

 C21	
Coordinate outreach	
1/1	
Met	

 C46	
Use of generic resources	
1/1	
Met	

 C47	
Transportation to/ from community	
1/1	
Met	

 C48	
Neighborhood connections	
1/1	
Met	

 C51	
Ongoing satisfaction with services/ supports	
1/1	
Met	

 C52	
Leisure activities and free-time choices /control	
1/1	
Met	

 C53	
Food/ dining choices	
1/1	
Met	

 C54	
Assistive technology	
1/1	
Met