Provider:  COMMUNITY ENTERPRISES, INC		Provider Address:  441 Pleasant St , Northampton	
						
Name of Person Completing Form:  Noreen Miller		Date(s) of Review:  21-JUN-13 to 25-JUN-13	

Follow-up Scope and results :	 	 	
Service Grouping	Licensure level and duration	  # Indicators std. met/ std. rated 	
Employment and Day Supports	2 Year License	2/2	

 

 

 

Summary of Ratings
 
Employment and Day Supports Areas Needing Improvement on Standard not met - Identified by DDS	
Indicator #	L8	
Indicator	Emergency Fact Sheets	
Area Need Improvement	Emergency fact sheets needs to contain all required information including medical and psychological diagnoses, medical conditions that could affect the health or well-being of the individual as well as known allergies, current medications.	
Process Utilized to correct and review indicator	A standardized Emergency Fact Sheet form, approved by DDS, was distributed by CE Directors to DDS funded staff in all service locations. The staff received training from their supervisors on the proper way to complete the forms.	
Status at follow-up	All Emergency fact sheets that were cited during the review have been replaced by correctly completed versions.	
Rating	Met	
 	
Employment and Day Supports Areas Needing Improvement on Standard not met - Identified by Provider	
Indicator #	L86	
Indicator	Required assessments	
Issue Identified	A number of assessments not submitted 10 days prior to ISP.	
Actions Planned/Occurred	Effective immediately staff will be trained and required to use a ISP tracking tool to track all assessments due prior to ISP. Office will use a Data Stamp mechanism to record when assessments are sent out.	
Process Utilized to correct and review indicator	Employment staff received training on the new ISP Tracking tool so they will be able to better manage ISP Assessment due dates and meet prescribed deadlines. Staff people were also trained on and required to use a Date Stamp mechanism on their email programs or their fax machines.  This will allow staff supervisors to hold staff more accountable to send ISP assessments on time to the DDS Area offices.	
Status at follow-up	By using the ISP tracking tools and Date Stamp mechanisms, staff now meet ISP deadlines.	
Rating	Met