Provider:  HILLTOP CHILD ADULT SERS INC.		Provider Address: 171 Park Ave Ste. 105 , West Springfield	

Name of Person Completing Form:  Darlene Montgomery		
Date(s) of Review:  19-APR-13 to 22-APR-13	

Follow-up Scope and results :	 	 	
Service Grouping	Licensure level and duration	  # Indicators std. met/ std. rated 	
Residential and Individual Home Supports	2 Year License	6/7	

 

 

 

Summary of Ratings
 
Residential and Individual Home Supports Areas Needing Improvement on Standard not met - Identified by DDS	
Indicator #	L7	
Indicator	Fire Drills	
Area Need Improvement	The agency needs to ensure that fire drills are conducted in the respective quarters of the calendar year. Additionally, fire drills' documentation needs to be accurate.  	
Process Utilized to correct and review indicator	Hilltop has 5 residential sites that require fire drills to be conducted on a quarterly basis. A fire drill calendar has been established with drills to occur every 90 days. The agency’s next scheduled drill is planned for April 23/24, 2013. Drill documentation will be forwarded to the program directors who will verify that drills were conducted as planned and that documentation is complete and accurate.	
Status at follow-up	Since the next fire drill is not scheduled until after this follow-up due date, no status can be reported at this time.	
Rating	Not Met	
Post 60 Day Area 
Office Follow-up 	 
 	
•	 Date 	 	
•	AO Actions	 	
•	Provider Status Rating by AO (Met or Not Met)	 	
 	
Indicator #	L9	
Indicator	Safe use of equipment	
Area Need Improvement	The agency needs to complete skill assessments to identify the person's ability to use equipment/machinery at home.   	
 Process Utilized to correct and review indicator	The agency will rely on the person’s ISP cycle to complete the safety assessment, which incorporates information about the person’s ability to use equipment/machinery at home.	
Status at follow-up	During the past 60 days there were 12 ISPs scheduled. All 12 ISPs included the person’s Safety Assessment.	
Rating	Met	
 	
Indicator #	L55	
Indicator	Informed consent	
Area Need Improvement	The agency needs to ensure that informed consent that is secured prior to utilizing the individual's photo has an expiration day of a year after it is signed.	
Process Utilized to correct and review indicator	The agency updated the informed consent form to include an annual expiration.	
Status at follow-up	The agency distributed (where applicable) the updated consent form to individuals and guardians. Each consent form will expire a year from the day the authorization was obtained.	
Rating	Met	
 	
Indicator #	L67	
Indicator	Money mgmt. plan	
Area Need Improvement	Where the agency staff hold an individual's money and provide support in the use of their funds, there needs to be a plan for the money management responsibilities outlining the details of how the individual will be assisted to manage and spend their funds. The plan needs to include a training component to eliminate or reduce the need for assistance.   There also needs to be agreement to this plan by the individual, guardian or conservator. 	
  Process Utilized to correct and review indicator	The agency designed a Money Management plan form that includes a training component, which it is to be developed based on the results of the individual’s money management skill assessment.	
Status at follow-up	There are 23 individuals that have money management plans that need to be reviewed to ensure these include an individualized money skills training component.  These reviews are taking place during the person’s ISP. At the time of this follow-up, there were 12 ISP that were completed, which now include individualized training plans to assist the person become more independent in managing their personal funds. The agency plans to address the remaining 11 money management plans throughout the year as the person has his/her ISP. Signatures from the individual, guardian and Hilltop will be obtained.	
Rating	Met	
 	
Indicator #	L69	
Indicator	Expenditure tracking	
Area Need Improvement	The agency needs to ensure that individual's expenditures are properly documented and tracked.	
Process Utilized to correct and review indicator	The Individuals Home Support program has begun utilizing a cash transaction sheet that has been designed to document all of the person’s personal expenditures. The form also requires that a current balance of the person’s available money be identified to insure accurate information of cash on hand at any time. This transaction sheet also includes a place for the individual to sign when receiving any cash from staff.	
Status at follow-up	As applicable, the agency staff has been utilizing the financial transaction sheets to document individual’s cash-on-hand and all money transactions.	
Rating	Met	
 	
 Indicator #	L80	
Indicator	Symptoms of illness	
Area Need Improvement	The agency needs to ensure that the all staff has access to information regarding how to recognize signs and symptoms of illness. 	
Process Utilized to correct and review indicator	The agency’s Individual Home Supports program staff were given access to signs and symptoms of illness information as outlined in the Health Promotion and Coordination Initiative Training and Resource Manual.	
Status at follow-up	Staff working for the agency’s Individuals Home Support program completed review of signs and symptoms of illness information by March 30, 2013. A training sign-off sheet is kept by the program.	
Rating	Met	

Indicator #	L86	
Indicator	Required assessments	
Area Need Improvement	The agency needs to implement a tracking system to ensure that required assessments are submitted within fifteen (15) days prior to the scheduled ISP.	
Process Utilized to correct and review indicator	The agency staff is aware of the new ISP assessment submission requirements and are identifying when assessments are due to be submitted based on the person’s last ISP date.	
Status at follow-up	During the 60 day period for follow-up there were 12 ISPs that took place. All 12 ISPs assessments were submitted within the required timeline. The agency saves the email that was sent to the person’s Service Coordinator as verification that assessments were submitted timely.	
Rating	Met