SUMMARY OF OVERALL FINDINGS

Provider:  GROW Associates, Inc.
Review Dates:  December 8 – 12, 2014
Service Enhancement Meeting Date:  December 29, 2014
Survey Team:  Steve Abreu (TL), Laura K. O’Connor, and Edward Sutka

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 Locations 8 Audits 	Full Review	56 / 62       Two-Year License 12/29/2014 - 12/29/2016	 

 	 

 	
Community-Based Day Services	1 Location   3 Audits 	 
 	 
 	Full Review	8 / 8    Certified	
Employment Support Services	1 Location   5 Audits 	 
 	 
 	Full Review	17 / 17 Certified	
Survey Scope and Findings for Planning and Quality Management	
Service Group Type	Sample Size	Licensure Scope	Licensure Level	Certification Scope	Certification Level	
Planning and Quality Management	N/A	N/A	N/A	Full Review	6/6      Certified	

EXECUTIVE SUMMARY

GROW Associates, Inc. is a non-profit organization that provides a variety of day services for people with disabilities living in the south shore area.  Founded in 1973, GROW has over 40 years of experience working with people with disabilities, their families, and local businesses.  The agency endeavors to design services that encompass the unique needs of individuals and offer opportunities to enhance skill development by offering employment training, finding jobs that match people's unique interests in community settings, as well as opportunities to give back to the community through volunteering and participation in local enterprises.  The agency offered people the opportunity to participate in any or all of these options, such as Employment Services, Community-Based Day Supports (CBDS), and Day Habilitation Services.  Transportation Services for greater than 197 people was also provided.  This Licensure and Certification review focused on reviewing 5 Employment service audits and 3 CBDS audits through an examination of 62 Licensing and 31 Certification indicators on the specific service types.  

Since the last survey, the agency had fully embraced the Department of Developmental Services (DDS) 'Employment First Initiative.'  In July 2013, the agency moved into a newly renovated, accessible space in Randolph and officially closed its sheltered workshop program in April 2014.  The new facility provided more space to allow for continued growth in work training options and provide a more visible presence in the Randolph community.  The agency also identified that additional space in the building currently occupied by another tenant may become available and they were considering expanding their supports.  The direction of those supports had not been finalized as the agency was in the process of filling the position of Executive Director.  

Survey findings revealed that employment services focused on assisting people with skill development and obtaining competitive employment within the community.  The agency also offered employment options that paid at least minimum wage within the work center.  These included food management in the agency operated 'Bistro,' custodial services, and landscaping.  These positions provided higher wages than the previously offered, as the agency no longer provided any work that paid less than minimum wage.  The agency's new site included a training kitchen, a computer center and media room that allowed people to be assessed and receive training in a variety of areas.  Of the sixty eight people receiving employment supports, sixty-three had positions that paid at least minimum wage.     
 
The agency has also focused significant attention on the development and implementation of a comprehensive approach to assisting people to explore, find and develop personally meaningful options with the Community-Based Day Support service.  People were provided assistance to pursue personal endeavors within the community such as physical fitness classes at the YMCA, volunteering at local animal shelters, and preparing meals at the Randolph Senior Center.  A variety of recreational and cultural activities such as visits to the Boston Aquarium and Georges Island were also offered.  These efforts were consistent with the agency's commitment to a person-centered approach in creating services that supported the whole person's personal goals and ambitions.  

In its effort to continually enhance support, the agency should provide increased over sight in several areas involving regulatory timelines and expectations such as the submission and review of physical Restraint Reports by agency managers to ensure that DDS established time-

lines are met.  Additionally, there were a number of items that need to be improved upon relative to the operation and functioning of the Human Rights Committee, such as consistent attendance of members, meeting frequency that adheres to a quarterly pattern and submission of a waiver if a member has a financial interest in the agency.  Other areas of consideration for enhancing include ensuring ISP assessments and Support Strategies are submitted within 15 days of an individual's ISP and that information on the progress on agreed upon goals is reviewed to ensure issues effecting success are addressed. 

Based on the findings of this review, the agency is congratulated on attaining a rating of 90% on the Licensing indicators.  In addition, for each of the various services (Employment, Community-Based Day), 100% of all Certification indicators were met.  These ratings demonstrate the agency's continued overall effectiveness in promoting positive outcomes for individuals they support and reflect a focus on the agency's mission to promote continued growth and success.  The agency received a Two-Year License for Employment/Day Supports.

 

LICENSURE FINDINGS

Met / Rated
	
Not Met / Rated	
% Met	
Organizational	7/9	2/9		
Employment and Day Supports	49/53	4/53	
	
  Community-Based Day 
    Services
  Employment Support 
     Services
  Center-Based Employment				
Critical Indicators	8/8	0/8		
Total	56/62	6/62	90%	
Two-Year License				
# Indicators for 60 Day Follow-up	
	6	

 

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 (HRC).	The following items need to be ensured:  at least annual policy review; consistent atten-dance of members, including at least three who are individuals, family, or advocates; meeting frequency that adheres to a quarterly pattern;  at least annual policy review; greater frequency of site visits; submission of meeting minutes to required parties; submission of a waiver if the member with a financial interest in the agency is to continue to serve; review of supportive and protective devices.

 
 	 L65	Restraint Reports are submitted within required timelines.	The agency needs to ensure that Restraint Reports are reviewed by managers within the required timelines.

 
  
Employment/Day Areas Needing Improvement on Standards Not Met/Follow-up to Occur:	
 
 	Indicator #	Indicator	Area Needing Improvement	

 
 
 	 L60	Data are consistently maintained and used to determine the efficacy of behavioral interventions.	One Behavioral Support Plan had not been reviewed and/or revised in two years.  Although data had been maintained it had not been reviewed to ensure efficacy of behavioral interventions.  Additionally, the reinforcement practices identified in the plan needed to be revised.
	
	 L86	Required assessments concerning individual needs and abilities are completed in preparation for the ISP.
	The agency needs to ensure that ISP assess-ments are submitted to the DDS Area Office within 15 days of the ISP meeting.	
	 L87	Support Strategies necessary to assist an individual to meet their goals and objectives are completed and submitted as part of the ISP.
	The agency needs to ensure that Support Strategies are submitted to the DDS Area Office within 15 days of the ISP.	

 
  
 	 L88	Services and Support Strategies identified and agreed upon in the ISP for which the provider has designated responsibility are being implemented.
	The agency needs to ensure that information on the progress of ISP goals is reviewed to ensure that support matches the criteria identified related to frequency and duration of goals.	

CERTIFICATION FINDINGS

 	
Met / Rated
	
Not Met / Rated	
Certification - Planning and Quality Management	6/6	0/6	
Employment and Day Supports			
Employment Support Services	17/17	0/17	
Community-Based Day Services	8/8	0/8	

Employment Support Services Commendations on Standards Met:	
 	Indicator #	Indicator	Commendation	

 

 

 	 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 is commended for supporting individuals and guardians to be knowledge-able in understanding how an individual's entitlements can be managed in a way that allows for successful employment.  Twice a year the agency held evening training with support from the local Social Security Office to provide information and answer questions about how earned wages and entitlements co-exist.

 

 
 
	 C34	The agency provides the optimal level of support to promote success with a specific plan for minimizing supports.	Each person in a competitive employment situation had supports that allowed for initial and ongoing success.  The agency developed individualized strategies such as initial one   to one job coaching, transition to natural supports and routine review of current supports to deter-mine effectiveness.  The agency is commended for promoting individual success for each individual's employment.

 

Community-Based Day Services Commendations on Standards Met:	
 	Indicator #	Indicator	Commendation	

 

 
 	 C42	Individuals are involved in activities that connect them to other people in the community.	The agency is commended for providing an array of activities that provided frequent opportunities for people to be in contact with the community.  Activities offered included educational and cultural trips as well as based on personal interests such as volunteering and gym membership.

 

 
  	 C45	Individual's decisions of what to do during the day are revisited on a regular basis.	The agency is commended for its ongoing practices of seeking individual input into daily offerings.  Each day a variety of options within the building and in the community were avail-able and people could choose which activity they would like to participate in.  

MASTER SCORE SHEET LICENSURE
Organizational: 
 
 	Indicator #	Indicator	Met/Rated	Rating                                   (Met, Not Met, Not Rated)	
O	 L2	Abuse/Neglect reporting	1/1	Met	
 	 L3	Immediate Action	1/1	Met	
 	 L48	Human Rights Committee	0/1	Not Met (0%)	
 	 L65	Restraint report submit	0/2	Not Met (0%)	
 	 L66	HRC restraint review	1/1	Met	
 	 L74	Screen employees	1/1	Met	
 	 L75	Qualified staff	1/1	Met	
 	 L76	Track trainings	3/3	Met	
 	 L83	Human Rights training	3/3	Met	

Employment and Day Supports:

	Indicator #	
Indicator	Location or Individual	Employ-ment Supports	Center- Based Work	Commun-ity Based Day	Total Met / Rated	
Rating	
 
 	 L1	Abuse/Neglect training	I	5/5	 
 	3/3	8/8	Met	
 	 L5	Safety Plan	L	 
	 	1/1	1/1	Met	
O	 L6	Evacuation	L	 
	 	1/1	1/1	Met	
 	 L7	Fire Drills	L	 
	 	1/1	1/1	Met	
 
 	 L8	Emergency Fact Sheets	I	4/5	 
 	3/3	7/8	Met
(87.50%)	
 
 	 L9	Safe use of equipment	L	 
 	 
 	1/1	1/1	Met	
 
 	 L10	Reduce risk interventions	I	2/2	 
 	 
 	2/2	Met	
O	 L11	Required inspections	L	 
 	 
 	1/1	1/1	Met	
O	 L12	Smoke detectors	L	 
 	 
 	1/1	1/1	Met	
O	 L13	Clean location	L	 
	 	1/1	1/1	Met	
 	 L15	Hot water	L	 
	 	1/1	1/1	Met	
 	 L16	Accessibility	L	 
	 	1/1	1/1	Met	

 	 L17	Egress at grade 	L	 
 	 
 	1/1	1/1	Met	
 	 L20	Exit doors	L	 
	 	1/1	1/1	Met	
 
 	 L21	Safe electrical equipment	L	 
 	 
 	1/1	1/1	Met	
 
 	 L22	Clean appliances	L	 
 	 
 	1/1	1/1	Met	
 
 	 L25	Dangerous substances	L	 
 	 
 	1/1	1/1	Met	
 
 	 L26	Walkway safety	L	 
 	 
 	1/1	1/1	Met	
 	 L28	Flammables	L	 
	 	1/1	1/1	Met	
 
 	 L29	Rubbish/Com-bustibles	L	 
 		1/1	1/1	Met	
 
 	 L31	Communication method	I	5/5		3/3	8/8	Met	
 
 	 L32	Verbal & written	I	5/5		3/3	8/8	Met	
 
 	 L37	Prompt treat-ment	I	5/5		3/3	8/8	Met	

Employment and Day Supports, cont.

	Indicator #	
Indicator	Location or Individual	Employ-ment Supports	Center- Based Work	Commun-ity Based Day	Total Met / Rated	
Rating	
O	 L38	Physician's orders	I	4/4		2/3	6/7	Met
(85.71%)	
 
 	 L39	Dietary requirements	I	3/3		 
 	3/3	Met	
 
 	 L44	MAP Registration	L			1/1	1/1	Met	
 
 	 L45	Medication storage	L			1/1	1/1	Met	
O	 L46	Medication administration	I	5/5		2/2	7/7	Met	
 
 	 L49	Informed of human rights	I	5/5		3/3	8/8	Met	
 
 	 L50	Respectful communication	L	 
 		1/1	1/1	Met	
 	 L51	Possessions	I	5/5
	 	3/3	8/8	Met	
 	 L52	Phone calls	I	5/5
	 	3/3	8/8	Met	
 	 L54	Privacy	L	 
	 	1/1	1/1	Met	
 
 	 L55	Informed consent	I	1/1		  	1/1	Met	

 	 L57	Written Behavior Plans	I	2/2		1/1	3/3	Met	
 
 	 L58	Behavior Plan component	I	2/2		1/1	3/3	Met	
 
 	 L59	Behavior Plan review	I	2/2		1/1	3/3	Met	
 
 	 L60	Data mainten-ance	I	2/2		0/1	2/3	Not Met
(66.67%)	
  
 	 L61	Health protection in ISP	I	2/2			2/2	Met	

 	 L62	Health protection review	I	2/2		 
	2/2	Met	
 
 	 L63	Medication Treatment Plan form	I	 
 		1/1	1/1	Met	
 
 	 L64	Medication Treatment Plan review	I	 
 		1/1	1/1	Met	
 
 	 L77	Unique needs training	I	5/5		3/3	8/8	Met	

 	 L78	Restrictive Intervention Training	L	1/1		1/1	2/2	Met	

Employment and Day Supports, cont.

	Indicator #	
Indicator	Location or Individual	Employ-ment Supports	Center- Based Work	Commun-ity Based Day	Total Met / Rated	
Rating	
 
 	 L79	Restraint training	L	1/1	 
 	1/1	2/2	Met	
 
 	 L80	Symptoms of illness	L	1/1	 
 	1/1	2/2	Met	
 
 	 L81	Medical emergency	L	1/1	 
 	1/1	2/2	Met	
O	 L82	Medication administration	L	 
 	 
 	1/1	1/1	Met	
 
 	 L84	Health Protection Training	I	2/2	 
 	 
 	2/2	Met	
 	 L85	Supervision 	L
	1/1	 	1/1	2/2	Met	
 
 	 L86	Required assessments	I	2/3	 
 	1/3	3/6	Not Met
(50%)	
 
 	 L87	Support Strategies	I	2/3	 
 	2/3	4/6	Not Met
(66.67%)	
 
 	 L88	Strategies implemented	I	1/4	 
 	1/3	2/7	Not Met
(28.57%)	

 	#Std. Met/53 Indicators	 

 

 	 

 
 	49/53	 

 
 	Total Score	 

 	 
 	 
 	56/62	 
 	
 	 	 	 	 	 	 	90.32%	 

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 Reviewed By DDS	
Indicator #	Indicator	Met/Rated	Rating	
 C7	Feedback on staff performance	3/3	Met	
 C8	Family/Guardian communication	3/3	Met	
 C13	Skills to maximize independence 	3/3	Met	
 C40	Community involvement interest	3/3	Met	
 C41	Activities participation	3/3	Met	
 C42	Connection to others	3/3	Met	
 C43	Maintain & enhance relationship	3/3	Met	
 C45	Revisit decisions	3/3	Met	

Employment Support Services Reviewed By DDS	
Indicator #	Indicator	Met/Rated	Rating	
 C7	Feedback on staff performance	5/5	Met	
 C8	Family/Guardian communication	5/5	Met	
 C22	Explore job interests	5/5	Met	
 C23	Assess skills & training needs	5/5	Met	
 C24	Job goals & support needs plan	4/5	Met (80%)	
 C25	Skill development	5/5	Met	
 C26	Benefits analysis	5/5	Met	
 C27	Job benefit education	5/5	Met	
 C29	Support to obtain employment	4/5	Met (80%)	
 C30	Work in integrated settings	4/5	Met (80%)	
 C31	Job accommodations	5/5	Met	
 C32	At least minimum wages earned	4/4	Met	
 C33	Employee benefits explained	5/5	Met	
 C34	Support to promote success	4/4	Met	
 C35	Feedback on job performance	4/4	Met	
 C36	Supports to enhance retention	4/4	Met	
 C37	Interpersonal skills for work	5/5	Met