PROVIDER REPORT FOR	

	

	

	

	

	

	

	

	

	
	
Cooperative Production Inc
PO Box 506
 North Dighton, MA 02764    	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

Version	

	

	

	

	

	

	

	

	
Provider Web Report
October 26, 2018	

	

	

	

	

	

	

	
Prepared by the Department of Developmental Services
OFFICE OF QUALITY ENHANCEMENT

	

	

	

	

	

	

	

			
	SUMMARY OF OVERALL FINDINGS	

			

	

	

Provider	

	
Cooperative Production Inc	

	

	

	

	
Review Dates	

	
10/10/2018 - 10/15/2018	

	

	

	

	
Service Enhancement 
Meeting Date	

	
10/26/2018	

	

	

	

	

	

	
Survey Team	

	
Michael Marchese (TL)	

Ed Sutka	

Tina Napolitan	

	

	

	

	

	

	
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	
7 location(s) 10 audit (s) 	
Targeted Review	
DDS 13 / 15
Provider 73 / 73

86 / 88 2 Year License 10/26/2018-  10/26/2020	
	
DDS 3 / 4
Provider 45 / 46

48 / 50 Certified 10/26/2018 -  10/26/2020	

Residential Services	
5 location(s) 5 audit (s) 	

DDS Targeted Review	
21 / 22	

ABI-MFP Residential Services	
2 location(s) 5 audit (s) 	

DDS Targeted Review	
21 / 22	

Planning and Quality Management (For all service groupings)	

	
DDS Targeted 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) 7 audit (s) 	
Targeted Review	
DDS 11 / 11
Provider 60 / 60

71 / 71 2 Year License 10/26/2018-  10/26/2020	
	
DDS 3 / 4
Provider 38 / 38

41 / 42 Certified 10/26/2018 -  10/26/2020	

Community Based Day Services	
1 location(s) 4 audit (s) 	

DDS Targeted Review	
14 / 14	

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

DDS Targeted Review	
21 / 22	

Planning and Quality Management (For all service groupings)	

	
DDS Targeted Review	
6 / 6	

	

	

	

	

EXECUTIVE SUMMARY :	

	

	

Cooperative Productions, Inc. is a non-profit human service agency established in 1972 that serves adults and transition age students with developmental and other disabilities, and individuals with acquired brain injury who work and reside in the greater Taunton area.  The agency now serves close to 300 people via a diverse offering of program and services, including residential, day, and employment supports.  The current survey focused on services provided to adults and included the following service types: 24-hour Residential, ABI/MFP Residential, Community Based Day, and Employment Support services.

As Cooperative Productions had earned a Two-Year License for its day and residential services during its previous review, the agency was eligible to conduct a self-assessment, and elected to do so.  In conjunction with the agency's self-assessment, the Department of Developmental Services (DDS) conducted a 'Targeted Review'.  This review consisted of the eight 'critical' licensing indicators, as well as any license and certification indicators that were rated 'Not Met' during their previous survey.  The results of the current survey represent a combination of the agency's self-assessment and the DDS targeted review.

The survey team identified a number of positive outcomes and strengths during the review. Organizationally, the agency demonstrated that it has effective policies and practices in place to ensure that staff is knowledgeable of their responsibility that allegations of abuse/neglect are reported as mandated by regulations.

Across all service types, homes and program locations were found to be clean, safe and in good repair, and met individuals' unique needs and preferences.  An example of the agency's person centered approach in this area was illustrated in the efforts made when moving an individual, due to health and safety reasons, into another bedroom in his home.  Staff made sure that his new bedroom was repainted and decorated the same as his previous bedroom so as to reflect his ardent interest in his favorite local sports team.

Effective systems were in place regarding health care particularly for ensuring adherence to Medication Administration Program (MAP) policies, and implementing individuals' physicians' ordered health care protocols.

Other areas where practices in place fostered desired outcomes included, in residential services, staff was trained and found to be knowledgeable in how to safely and consistently implement restrictive interventions, and in Day/Employment Services ISP assessments and support strategies were completed and submitted within required timelines.

The Certification domains reviewed in Residential services highlighted the following areas of strength.  Evidence was clearly present of staff efforts to support individuals to explore, discover and engage in activities of personal interest, and to provide them with opportunities to develop and/or increase personal relationships and social contacts.  For example, in one home there was an individual whom staff have supported to maintain a long term friendship with her previous caretakers.  In ABI Residential Services, it was evident that individuals' desires and interest in the area of intimacy and companionship have been assessed, and in a number of instances supports were being provided to assist them in exploring this area of their lives.

In CBDS, the program promoted person centered activities either individually or in small group settings.  Within Employment Services, a variety of approaches and strategies were utilized to assist individuals to explore their vocational interests, including the use of different interest inventories, job shadowing opportunities, and internships.

In Residential services, the review identified a need for additional attention to ensure that individuals' medication treatment plans are complete and include all behavior modifying medications.

Within the certification domain, the following areas were identified as needing strengthening.  In Residential and ABI Residential services, the agency needs to ensure that staff is familiar with and provide opportunities for individuals to connect with their neighborhoods, and in Employment Services, additional attention is recommended in order to ensure that individuals are assessed to determine their need for assistive technology or modifications to maximize independence in their community and at work.

Based on the findings outlined in this report, Cooperative Productions, Inc. has earned a Two-Year License and is Certified for both their Residential Support services, and their Day and Employment Support services.  The agency received a Licensing score of 98% for their Residential support services, and a 100% for their Day and Employment Support services.  Certification scores were 96% in Residential services, and 98% in Day and Employment services.  Within 60 days, the agency will conduct its own follow-up on any licensing indicators rated 'Not Met'.

The agency's description of their self-assessment process follows.	

	

	

	

	

	

Description of Self Assessment Process:	

	

	

Cooperative Production, Inc. remains committed to ensuring quality services are delivered to all individuals supported.  The self-assessment process utilized was comprised of a combination of existing monitoring systems and a comprehensive review of all applicable licensure and certification standards.

The following outlines numerous on going quality assurance systems that are relied on to ensure regulatory compliance, best practice and effective service delivery:

Comprehensive record reviews are completed at each residence at least two times annually.  This review is completed in coordination with the Director of Residential Service/Director of Specialized Services and a nurse.  Any critical issues identified are addressed immediately.  The program manager is provided with a copy of the report with specific timelines for corrective action. Day Program records are reviewed annually, and medication records are maintained and monitored on an ongoing basis by nursing staff.
  
CO-OP increasingly provides supports to individuals with highly complex medical needs. Subsequently the agency has developed many health care systems to minimize risk in efforts to assure individuals can maintain optimum health and well-being.  Tracking systems and individual curriculums have been developed for numerous specialized trainings including but not limited to G/J-tube, Oxygen, Clozaril, Coumadin, blood sugar testing and epipen administration.  A medical protocol resource manual has been developed and is reviewed at each program at least annually with specific attention to any individual protocols. New protocols are reviewed separately with staff when they are developed with an annual review thereafter.   The Director of Health Services tracks health encounters that are due, completed and monitors for follow up appointments and recommendations.  MOR's are tracked, with specific guidelines for performance feedback, retraining and determination of allowing staff to continue to administer medication.  Whenever possible the Director of Health Services serves as a liaison with hospital/ rehabilitation particularly for intakes and discharges.

Managers of all programs complete a monthly report verifying water temperature checks and repairs. Any measure of temperature outside the accepted parameters and or a significant property issue is immediately reported to the property manager for correction.   A facility visit and checklist is completed by at least two Senior Managers annually to coordinate and prioritize a plan for repairs, renovations, home d&#233;cor and furniture replacement.  The property manager has an established schedule with outside vendors for sprinkler, fire alarm, fire extinguisher and generator inspections. Outside vendors are also secured for routine landscaping, floor cleaning, trash removal, pest control, septic systems and snow removal.

In efforts to recruit the most qualified personnel CO-OP ensures that credentials and background checks are maintained for candidates and existing staff. All candidates must provide a minimum of two primary sources for references, nurses and licensed staff are verified through the MA licensing web site to be in good standing,, favorable MAP status is reviewed, successful CORI and fingerprinting check is required, a copy of vehicle registration and a satisfactory driving record is required. The Human Resource Department maintains a data base and tracking system for all required trainings which includes the following: First Aid, CPR, Bloodborne Pathogens, NVMAB, MAP Certification/Recert., Philosophy and Values, DDS Human Rights, DDS Fire Safety, DPPC/Mandated Reporting and Positive Behavioral Supports. CO-OP provides a regular schedule of trainings with many qualified in house trainers to ensure staff receives required training as quickly as possible. Additionally each program adheres to a monthly training calendar with an accompanying curriculum that includes, EESP Review, Basic Fire Safety, Human Rights, ISP, Documentation, Vehicle and Relationship Training. 

A recent reorganization of administrative positions afforded the opportunity to create a Director of Program Administration and Quality to develop and monitor a number of systems.  Newly developed systems include monitoring HCSIS for alerts and timelines for timely submission of incident and restraint reports and tracking EESP's for revisions and renewals.  Other systems managed include the distribution of satisfaction surveys to individuals, families, guardians and stakeholders to measure overall strengths and need for improvement.

CO-OP has a Human Rights Committee with the required composition that meets six times yearly.  Committee members have visited a number of programs in the past year.  The committee reviews incident reports, restraints, MORs, restrictive practices, behavioral support plans, investigations, supportive and protective device forms and human rights complaints or concerns.  Minutes are maintained and submitted to DDS in accordance with regulatory requirements.

Individuals personal funds are managed and monitored based on established guidelines that conform to DDS regulations.  Transaction sheets are turned into the finance office monthly where receipts, calculations, expenditures, and balances are checked and verified.  Funds are additionally checked during on site record review.  The finance office is responsible for sending out and adjusting charges for care letters on an annual or as needed basis. All charge for care letters include language informing an individual or guardian of their right to appeal.

CO-OP's Clinical Director has created a coordinated document that effectively streamlines information for the MTP and   the behavioral assessment.  Interaction guidelines may be included if a separate Behavioral Support Plan is not required.  The goal in developing this document was to coordinate and share information with staff in a more comprehensive way.  Layers of reviews are imbedded in the process to be certain each diagnosis is accurate and consistent across documents.  CO-OP remains committed to maximizing positive behavioral support strategies across all setting focusing on a variety of appropriate replacement strategies. The number of physical restraints has significantly decreased as a result of these strategies and consistently utilizing the least restrictive and minimally intrusive practices necessary.  A restraint review committee has been developed to assess situations where restraints were required and make recommendations accordingly.  The agency has targeted a variety of social skill areas where it was felt individuals may benefit from more training opportunities.  This has resulted in the following trainings being offered by the clinical department: social media, circles training and sexuality.

The following describes the targeted review that was completed:

Two teams were established to complete a targeted self-assessment review.  Each team was comprised of two senior managers and a nurse.  Programs selected were reviewed throughout the month of August 2018.  Both CBDS programs and Employment Supports were reviewed which included 20 individuals.  In total ten residential (2 ABI) homes and 30 individuals receiving 24 hour supports were reviewed.

Most of CO-OP's Residential Coordinators oversee more than one home.  The programs selected ensured that each manager participated in the process by having one of their programs selected. This approach allowed for a sampling across the management team while helping to identify if systems were in place throughout the agency.  The DDS Licensing and Certification Tool was used to complete each survey along with a corresponding worksheet to track results.  An 80% threshold was used to determine if an indicator was met.  Across all service components, licensing indicators were met well in excess of the 80% threshold.  Program Managers received immediate feedback at the end of each review on the rating of each indicator, with instructions to begin rectifying any issues  noted.  Although the results demonstrated that licensing indicators reached the met criteria there are still areas the agency should focus on developing and improving systems.  These include monitoring ISP and incident report timelines, increased training in completing AT/ whole person assessments.  AT and whole person assessments were completed consistently but in many cases they lacked a plan to improve skills or increase opportunities.  All certification indicators were met with the exception of C48, individuals are a part of the neighborhood.  This indicator was met at less than 80%..  Although staff interviewed were often able to share obstacles they had encountered there was not supporting documentation of these efforts.  It appears that both supervisory and direct support staff would benefit from increased guidance in this area. An action plan to systematically address this indicator will be completed.	

	

	

	

		
LICENSURE FINDINGS	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
10/10	
0/10	

Residential and Individual Home Supports	
76/78	
2/78	

    Residential Services
    ABI-MFP Residential Services

	

Critical Indicators	
8/8	
0/8	

Total	
86/88	
2/88	
98%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
2	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
10/10	
0/10	

Employment and Day Supports	
61/61	
0/61	

    Community Based Day Services
    Employment Support Services

	

Critical Indicators	
8/8	
0/8	

Total	
71/71	
0/71	
100%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
0	

	

	

		

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L63	
Medication treatment plans are in written format with required components.	
Two of eight Medication Treatment Plans did not include all of the behavior modifying medications a person is prescribed.  The agency needs to ensure that all Medication Treatment Plans contain the required components, including the accurate inclusion of all medications being administered to control or modify behaviors. 	

 L91	
Incidents are reported and reviewed as mandated by regulation.	
For three of seven locations where 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.	

	

	

	
CERTIFICATION FINDINGS	

	

	

	

	

Reviewed by	
Met / Rated	
Not Met / Rated	
% Met	

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

Residential and Individual Home Supports	
DDS 3/4
Provider 39/40	
42/44	
2/44	

ABI-MFP Residential Services	
DDS 1/2
Provider 20/20	
21/22	
1/22	

Residential Services	
DDS 2/2
Provider 19/20	
21/22	
1/22	

Total	
	
48/50	
2/50	
96%	

Certified	

	

	

Reviewed By	
Met / Rated	
Not Met / Rated	
% Met	

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

Employment and Day Supports	
DDS 3/4
Provider 32/32	
35/36	
1/36	

Community Based Day Services	
DDS 1/1
Provider 13/13	
14/14	
0/14	

Employment Support Services	
DDS 2/3
Provider 19/19	
21/22	
1/22	

Total	
	
41/42	
1/42	
98%	

Certified	

	

	

	

	

ABI-MFP Residential Services- Areas Needing Improvement on Standards not met From DDS Review:	

Indicator #	
Indicator	
Area Needing Improvement	

	
 C48	
Individuals are a part of the neighborhood.	
For two of five individuals there was a lack of evidence that staff had provided them with opportunities to explore possible connections with their neighbors.  The agency needs to support individuals by providing regular opportunities to take part in events and/or activities that connect them with their neighborhood.    	

	

	

	
Residential Services- Areas Needing Improvement on Standards not met From Provider review:	

Indicator #	
Indicator	
Issues identified	
Action planned to address	

 C48	
Individuals are a part of the neighborhood.	
For less than 80% of individuals reviewed there was no evidence that staff have supported individuals to facilitate any interactions with their neighbors.	
The agency needs to ensure that opportunities are provided to individuals to interact and connect with their neighbors.  The Director of Residential Service will work with the Coordinators/Supervisors for each site to identify opportunities for individuals to connect with their neighborhood/local community.  An individual program objective will be established and data will be maintained on opportunities provided.	

	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

	
 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
For one of three individuals, an assessment of potential assistive technology needs was incomplete.  The agency needs to ensure that assistive technology needs are identified and modifications are provided when necessary.  	

	

	

	

	

								
	MASTER SCORE SHEET LICENSURE	

								
	Organizational: Cooperative Production Inc	

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

O	
 L2	
Abuse/neglect reporting	
DDS	
9/9	
Met	

 L3	
Immediate Action	
Provider	
-	
Met	

 L4	
Action taken	
Provider	
-	
Met	

 L48	
HRC	
Provider	
-	
Met	

 L65	
Restraint report submit	
Provider	
-	
Met	

 L66	
HRC restraint review	
Provider	
-	
Met	

 L74	
Screen employees	
Provider	
-	
Met	

 L75	
Qualified staff	
Provider	
-	
Met	

 L76	
Track trainings	
Provider	
-	
Met	

 L83	
HR training	
Provider	
-	
Met	

								
	Residential and Individual Home Supports:	

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

 L1	
Abuse/neglect training	
I	
Provider	
-	

	

-	
Met	

 L5	
Safety Plan	
L 	
Provider	
-	

	

-	
Met	

O	
 L6	
Evacuation	
L	
DDS	
5/5	

	
2/2	
	
7/7	
Met	

 L7	
Fire Drills	
L 	
Provider	
-	

	

-	
Met	

 L8	
Emergency Fact Sheets	
I	
DDS	
5/5	

	
5/5	
	
10/10	
Met	

 L9	
Safe use of equipment	
L 	
Provider	
-	

	

-	
Met	

 L10	
Reduce risk interventions	
I 	
Provider	
-	

	

-	
Met	

O	
 L11	
Required inspections	
L	
DDS	
5/5	

	
2/2	
	
7/7	
Met	

O	
 L12	
Smoke detectors	
L	
DDS	
5/5	

	
2/2	
	
7/7	
Met	

O	
 L13	
Clean location	
L	
DDS	
5/5	

	
2/2	
	
7/7	
Met	

 L14	
Site in good repair	
L 	
Provider	
-	

	

-	
Met	

 L15	
Hot water	
L 	
Provider	
-	

	

-	
Met	

 L16	
Accessibility	
L 	
Provider	
-	

	

-	
Met	

 L17	
Egress at grade 	
L 	
Provider	
-	

	

-	
Met	

 L18	
Above grade egress	
L 	
Provider	
-	

	

-	
Met	

 L19	
Bedroom location	
L 	
Provider	
-	

	

-	
Met	

 L20	
Exit doors	
L 	
Provider	
-	

	

-	
Met	

 L21	
Safe electrical equipment	
L 	
Provider	
-	

	

-	
Met	

 L22	
Well-maintained appliances	
L 	
Provider	
-	

	

-	
Met	

 L23	
Egress door locks	
L 	
Provider	
-	

	

-	
Met	

 L24	
Locked door access	
L 	
Provider	
-	

	

-	
Met	

 L25	
Dangerous substances	
L 	
Provider	
-	

	

-	
Met	

 L26	
Walkway safety	
L 	
Provider	
-	

	

-	
Met	

 L28	
Flammables	
L 	
Provider	
-	

	

-	
Met	

 L29	
Rubbish/combustibles	
L 	
Provider	
-	

	

-	
Met	

 L30	
Protective railings	
L 	
Provider	
-	

	

-	
Met	

 L31	
Communication method	
I	
Provider	
-	

	

-	
Met	

 L32	
Verbal & written	
I 	
Provider	
-	

	

-	
Met	

 L33	
Physical exam	
I	
Provider	
-	

	

-	
Met	

 L34	
Dental exam	
I	
Provider	
-	

	

-	
Met	

 L35	
Preventive screenings	
I	
Provider	
-	

	

-	
Met	

 L36	
Recommended tests	
I 	
Provider	
-	

	

-	
Met	

 L37	
Prompt treatment	
I 	
Provider	
-	

	

-	
Met	

O	
 L38	
Physician's orders	
I	
DDS	
5/5	

	
5/5	
	
10/10	
Met	

 L39	
Dietary requirements	
I 	
Provider	
-	

	

-	
Met	

 L40	
Nutritional food	
L 	
Provider	
-	

	

-	
Met	

 L41	
Healthy diet	
L 	
Provider	
-	

	

-	
Met	

 L42	
Physical activity	
L 	
Provider	
-	

	

-	
Met	

 L43	
Health Care Record	
I	
Provider	
-	

	

-	
Met	

 L44	
MAP registration	
L 	
Provider	
-	

	

-	
Met	

 L45	
Medication storage	
L 	
Provider	
-	

	

-	
Met	

O	
 L46	
Med. Administration	
I	
DDS	
5/5	

	
3/3	
	
8/8	
Met	

 L47	
Self medication	
I 	
Provider	
-	

	

-	
Met	

 L49	
Informed of human rights	
I	
Provider	
-	

	

-	
Met	

 L50	
Respectful Comm.	
L 	
Provider	
-	

	

-	
Met	

 L51	
Possessions	
I 	
Provider	
-	

	

-	
Met	

 L52	
Phone calls	
I 	
Provider	
-	

	

-	
Met	

 L53	
Visitation	
I 	
Provider	
-	

	

-	
Met	

 L54	
Privacy	
L 	
Provider	
-	

	

-	
Met	

 L55	
Informed consent	
I 	
Provider	
-	

	

-	
Met	

 L56	
Restrictive practices	
I 	
Provider	
-	

	

-	
Met	

 L57	
Written behavior plans	
I 	
Provider	
-	

	

-	
Met	

 L58	
Behavior plan component	
I 	
Provider	
-	

	

-	
Met	

 L59	
Behavior plan review	
I 	
Provider	
-	

	

-	
Met	

 L60	
Data maintenance	
I 	
Provider	
-	

	

-	
Met	

 L61	
Health protection in ISP	
I 	
Provider	
-	

	

-	
Met	

 L62	
Health protection review	
I	
DDS	
4/4	

	
4/4	
	
8/8	
Met	

 L63	
Med. treatment plan form	
I	
DDS	
4/5	

	
2/3	
	
6/8	
Not Met
(75.00 %)	

 L64	
Med. treatment plan rev.	
I	
DDS	
5/5	

	

5/5	
Met	

 L67	
Money mgmt. plan	
I 	
Provider	
-	

	

-	
Met	

 L68	
Funds expenditure	
I 	
Provider	
-	

	

-	
Met	

 L69	
Expenditure tracking	
I 	
Provider	
-	

	

-	
Met	

 L70	
Charges for care calc.	
I	
Provider	
-	

	

-	
Met	

 L71	
Charges for care appeal	
I	
DDS	
5/5	

	
3/3	
	
8/8	
Met	

 L77	
Unique needs training	
I 	
Provider	
-	

	

-	
Met	

 L78	
Restrictive Int. Training	
L	
DDS	
3/3	

	

3/3	
Met	

 L79	
Restraint training	
L 	
Provider	
-	

	

-	
Met	

 L80	
Symptoms of illness	
L 	
Provider	
-	

	

-	
Met	

 L81	
Medical emergency	
L 	
Provider	
-	

	

-	
Met	

O	
 L82	
Medication admin.	
L	
DDS	
5/5	

	
1/1	
	
6/6	
Met	

 L84	
Health protect. Training	
I 	
Provider	
-	

	

-	
Met	

 L85	
Supervision 	
L	
Provider	
-	

	

-	
Met	

 L86	
Required assessments	
I	
Provider	
-	

	

-	
Met	

 L87	
Support strategies	
I 	
Provider	
-	

	

-	
Met	

 L88	
Strategies implemented	
I	
Provider	
-	

	

-	
Met	

 L89	
Complaint and resolution process	
L 	
Provider	
-	

	

-	
Met	

 L90	
Personal space/ bedroom privacy	
I 	
Provider	
-	

	

-	
Met	

 L91	
Incident management	
L	
DDS	
3/5	

	
1/2	
	
4/7	
Not Met
(57.14 %)	

#Std. Met/# 78 Indicator	

	

	

	
76/78	

	
Total Score	

	

	

	
86/88	

	

	

	

	
	
97.73%	

			
								
Employment and Day Supports:	

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

 L1	
Abuse/neglect training	
I 	
Provider	
	
-	
-	
-	
Met	

 L5	
Safety Plan	
L 	
Provider	
	
-	
-	
-	
Met	

O	
 L6	
Evacuation	
L	
DDS	

1/1	
1/1	
Met	

 L7	
Fire Drills	
L 	
Provider	
	
-	
-	
-	
Met	

 L8	
Emergency Fact Sheets	
I 	
Provider	
	
-	
-	
-	
Met	

 L9	
Safe use of equipment	
L 	
Provider	
	
-	
-	
-	
Met	

 L10	
Reduce risk interventions	
I 	
Provider	
	
-	
-	
-	
Met	

O	
 L11	
Required inspections	
L	
DDS	

1/1	
1/1	
Met	

O	
 L12	
Smoke detectors	
L	
DDS	

1/1	
1/1	
Met	

O	
 L13	
Clean location	
L	
DDS	

1/1	
1/1	
Met	

 L14	
Site in good repair	
L 	
Provider	
	
-	
-	
-	
Met	

 L15	
Hot water	
L 	
Provider	
	
-	
-	
-	
Met	

 L16	
Accessibility	
L 	
Provider	
	
-	
-	
-	
Met	

 L17	
Egress at grade 	
L 	
Provider	
	
-	
-	
-	
Met	

 L18	
Above grade egress	
L 	
Provider	
	
-	
-	
-	
Met	

 L20	
Exit doors	
L 	
Provider	
	
-	
-	
-	
Met	

 L21	
Safe electrical equipment	
L 	
Provider	
	
-	
-	
-	
Met	

 L22	
Well-maintained appliances	
L 	
Provider	
	
-	
-	
-	
Met	

 L25	
Dangerous substances	
L 	
Provider	
	
-	
-	
-	
Met	

 L26	
Walkway safety	
L 	
Provider	
	
-	
-	
-	
Met	

 L28	
Flammables	
L 	
Provider	
	
-	
-	
-	
Met	

 L29	
Rubbish/combustibles	
L 	
Provider	
	
-	
-	
-	
Met	

 L30	
Protective railings	
L 	
Provider	
	
-	
-	
-	
Met	

 L31	
Communication method	
I 	
Provider	
	
-	
-	
-	
Met	

 L32	
Verbal & written	
I 	
Provider	
	
-	
-	
-	
Met	

 L37	
Prompt treatment	
I 	
Provider	
	
-	
-	
-	
Met	

O	
 L38	
Physician's orders	
I	
DDS	

4/4	
4/4	
Met	

 L39	
Dietary requirements	
I 	
Provider	
	
-	
-	
-	
Met	

 L44	
MAP registration	
L 	
Provider	
	
-	
-	
-	
Met	

 L45	
Medication storage	
L 	
Provider	
	
-	
-	
-	
Met	

O	
 L46	
Med. Administration	
I	
DDS	

4/4	
4/4	
Met	

 L49	
Informed of human rights	
I 	
Provider	
	
-	
-	
-	
Met	

 L50	
Respectful Comm.	
L 	
Provider	
	
-	
-	
-	
Met	

 L51	
Possessions	
I 	
Provider	
	
-	
-	
-	
Met	

 L52	
Phone calls	
I 	
Provider	
	
-	
-	
-	
Met	

 L54	
Privacy	
L 	
Provider	
	
-	
-	
-	
Met	

 L55	
Informed consent	
I 	
Provider	
	
-	
-	
-	
Met	

 L56	
Restrictive practices	
I 	
Provider	
	
-	
-	
-	
Met	

 L57	
Written behavior plans	
I 	
Provider	
	
-	
-	
-	
Met	

 L58	
Behavior plan component	
I 	
Provider	
	
-	
-	
-	
Met	

 L59	
Behavior plan review	
I 	
Provider	
	
-	
-	
-	
Met	

 L60	
Data maintenance	
I 	
Provider	
	
-	
-	
-	
Met	

 L61	
Health protection in ISP	
I 	
Provider	
	
-	
-	
-	
Met	

 L62	
Health protection review	
I 	
Provider	
	
-	
-	
-	
Met	

 L63	
Med. treatment plan form	
I 	
Provider	
	
-	
-	
-	
Met	

 L64	
Med. treatment plan rev.	
I 	
Provider	
	
-	
-	
-	
Met	

 L67	
Money mgmt. plan	
I 	
Provider	
	
-	
-	
-	
Met	

 L68	
Funds expenditure	
I 	
Provider	
	
-	
-	
-	
Met	

 L69	
Expenditure tracking	
I 	
Provider	
	
-	
-	
-	
Met	

 L77	
Unique needs training	
I 	
Provider	
	
-	
-	
-	
Met	

 L78	
Restrictive Int. Training	
L 	
Provider	
	
-	
-	
-	
Met	

 L79	
Restraint training	
L 	
Provider	
	
-	
-	
-	
Met	

 L80	
Symptoms of illness	
L 	
Provider	
	
-	
-	
-	
Met	

 L81	
Medical emergency	
L 	
Provider	
	
-	
-	
-	
Met	

O	
 L82	
Medication admin.	
L	
DDS	

1/1	
1/1	
Met	

 L84	
Health protect. Training	
I 	
Provider	
	
-	
-	
-	
Met	

 L85	
Supervision 	
L 	
Provider	
	
-	
-	
-	
Met	

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

 L87	
Support strategies	
I	
DDS	
2/2	
	
4/4	
6/6	
Met	

 L88	
Strategies implemented	
I 	
Provider	
	
-	
-	
-	
Met	

 L91	
Incident management	
L	
DDS	
1/1	
	
1/1	
2/2	
Met	

#Std. Met/# 61 Indicator	

	

	
61/61	

	
Total Score	

	

	
71/71	

	

	

	
	
100%	

			
								
	MASTER SCORE SHEET CERTIFICATION	

								
	
Certification - Planning and Quality Management	

Indicator #	
Indicator	
Reviewed By	
Met/Rated	
Rating	

 C1	
Provider data collection	
Provider	
-	
Met	

 C2	
Data analysis	
Provider	
-	
Met	

 C3	
Service satisfaction	
Provider	
-	
Met	

 C4	
Utilizes input from stakeholders	
Provider	
-	
Met	

 C5	
Measure progress	
Provider	
-	
Met	

 C6	
Future directions planning	
Provider	
-	
Met	

	

	

	
								
ABI-MFP Residential Services	

Indicator #	
Indicator	
Reviewed By	
Met/Rated	
Rating	

 C7	
Feedback on staff / care provider performance	
Provider	
-	
Met	

 C8	
Family/guardian communication	
Provider	
-	
Met	

 C9	
Personal relationships	
Provider	
-	
Met	

 C10	
Social skill development	
Provider	
-	
Met	

 C11	
Get together w/family & friends	
Provider	
-	
Met	

 C12	
Intimacy	
DDS	
5/5	
Met	

 C13	
Skills to maximize independence 	
Provider	
-	
Met	

 C14	
Choices in routines & schedules	
Provider	
-	
Met	

 C15	
Personalize living space	
Provider	
-	
Met	

 C16	
Explore interests	
Provider	
-	
Met	

 C17	
Community activities	
Provider	
-	
Met	

 C18	
Purchase personal belongings	
Provider	
-	
Met	

 C19	
Knowledgeable decisions	
Provider	
-	
Met	

 C20	
Emergency back-up plans	
Provider	
-	
Met	

 C46	
Use of generic resources	
Provider	
-	
Met	

 C47	
Transportation to/ from community	
Provider	
-	
Met	

 C48	
Neighborhood connections	
DDS	
3/5	
Not Met (60.0 %)	

 C49	
Physical setting is consistent 	
Provider	
-	
Met	

 C51	
Ongoing satisfaction with services/ supports	
Provider	
-	
Met	

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

 C53	
Food/ dining choices	
Provider	
-	
Met	

 C54	
Assistive technology	
Provider	
-	
Met	

Community Based Day Services	

	

Indicator #	
Indicator	
Reviewed By	
Met/Rated	
Rating	

 C7	
Feedback on staff / care provider performance	
Provider	
-	
Met	

 C8	
Family/guardian communication	
Provider	
-	
Met	

 C13	
Skills to maximize independence 	
Provider	
-	
Met	

 C37	
Interpersonal skills for work	
Provider	
-	
Met	

 C40	
Community involvement interest	
Provider	
-	
Met	

 C41	
Activities participation	
Provider	
-	
Met	

 C42	
Connection to others	
Provider	
-	
Met	

 C43	
Maintain & enhance relationship	
Provider	
-	
Met	

 C44	
Job exploration	
Provider	
-	
Met	

 C45	
Revisit decisions	
Provider	
-	
Met	

 C46	
Use of generic resources	
Provider	
-	
Met	

 C47	
Transportation to/ from community	
Provider	
-	
Met	

 C51	
Ongoing satisfaction with services/ supports	
Provider	
-	
Met	

 C54	
Assistive technology	
DDS	
4/4	
Met	

Employment Support Services	

	

Indicator #	
Indicator	
Reviewed By	
Met/Rated	
Rating	

 C7	
Feedback on staff / care provider performance	
Provider	
-	
Met	

 C8	
Family/guardian communication	
Provider	
-	
Met	

 C22	
Explore job interests	
DDS	
3/3	
Met	

 C23	
Assess skills & training needs	
Provider	
-	
Met	

 C24	
Job goals & support needs plan	
Provider	
-	
Met	

 C25	
Skill development	
Provider	
-	
Met	

 C26	
Benefits analysis	
Provider	
-	
Met	

 C27	
Job benefit education	
DDS	
3/3	
Met	

 C28	
Relationships w/businesses	
Provider	
-	
Met	

 C29	
Support to obtain employment	
Provider	
-	
Met	

 C30	
Work in integrated settings	
Provider	
-	
Met	

 C31	
Job accommodations	
Provider	
-	
Met	

 C32	
At least minimum wages earned	
Provider	
-	
Met	

 C33	
Employee benefits explained	
Provider	
-	
Met	

 C34	
Support to promote success	
Provider	
-	
Met	

 C35	
Feedback on job performance	
Provider	
-	
Met	

 C36	
Supports to enhance retention	
Provider	
-	
Met	

 C37	
Interpersonal skills for work	
Provider	
-	
Met	

 C47	
Transportation to/ from community	
Provider	
-	
Met	

 C50	
Involvement/ part of the Workplace culture	
Provider	
-	
Met	

 C51	
Ongoing satisfaction with services/ supports	
Provider	
-	
Met	

 C54	
Assistive technology	
DDS	
2/3	
Not Met (66.67 %)	

Residential Services	

	

Indicator #	
Indicator	
Reviewed By	
Met/Rated	
Rating	

 C7	
Feedback on staff / care provider performance	
Provider	
-	
Met	

 C8	
Family/guardian communication	
Provider	
-	
Met	

 C9	
Personal relationships	
DDS	
5/5	
Met	

 C10	
Social skill development	
Provider	
-	
Met	

 C11	
Get together w/family & friends	
Provider	
-	
Met	

 C12	
Intimacy	
Provider	
-	
Met	

 C13	
Skills to maximize independence 	
Provider	
-	
Met	

 C14	
Choices in routines & schedules	
Provider	
-	
Met	

 C15	
Personalize living space	
Provider	
-	
Met	

 C16	
Explore interests	
DDS	
5/5	
Met	

 C17	
Community activities	
Provider	
-	
Met	

 C18	
Purchase personal belongings	
Provider	
-	
Met	

 C19	
Knowledgeable decisions	
Provider	
-	
Met	

 C20	
Emergency back-up plans	
Provider	
-	
Met	

 C46	
Use of generic resources	
Provider	
-	
Met	

 C47	
Transportation to/ from community	
Provider	
-	
Met	

 C48	
Neighborhood connections	
Provider	
-	
Not Met (0 %)	

 C49	
Physical setting is consistent 	
Provider	
-	
Met	

 C51	
Ongoing satisfaction with services/ supports	
Provider	
-	
Met	

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

 C53	
Food/ dining choices	
Provider	
-	
Met	

 C54	
Assistive technology	
Provider	
-	
Met