PROVIDER REPORT FOR	

	

	

	

	

	

	

	

	

	
	
THE JUDGE ROTENBERG EDUC CENTER 
240 Turnpike Street
 Canton, MA 02021    	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

Version	

	

	

	

	

	

	

	

	
Provider Web Report
March 8, 2016	

	

	

	

	

	

	

	
Prepared by the Department of Developmental Services
OFFICE OF QUALITY ENHANCEMENT	

	

	

	

	

	

	

				
	SUMMARY OF OVERALL FINDINGS	

				

	

	

Provider	

	
THE JUDGE ROTENBERG EDUC CENTER 	

	

	

	

	
Review Dates	

	
2/3/2016 - 2/9/2016	

	

	

	

	
Service Enhancement 
Meeting Date	

	
2/29/2016	

	

	

	

	

	

	
Survey Team	

	
Steve Goldberg	

Sally Hajjar	

Ed Sutka (TL)	

Barbara Mazzella	

	

	

	

	

	

	
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	
5 location(s) 5 audit (s) 	
Full Review	
75 / 82 2 Year License 02/29/2016 - 02/28/2018	

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

Full Review	
9 / 14 Certified	

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) 6 audit (s) 	
Full Review	
69 / 71 2 Year License 02/29/2016 - 02/28/2018	

Community Based Day Services	
1 location(s) 3 audit (s) 	

Full Review	
5 / 12 Certified	

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

Full Review	
12 / 18 Certified	

	

	

	
Survey scope and findings for Planning and Quality Management	

Service Group Type	
Sample Size	
Scope	
Licensure Level	
Certification Scope	
Certification Level	

Planning and Quality Management	
N/A	
N/A	
N/A	
Full Review	
6/6 Certified	

	

		
EXECUTIVE SUMMARY :	

		
The Judge Rotenberg Center (JRC) is a private not-for-profit organization that provides both day and residential supports to children and adults who come from Massachusetts as well as from other states.  The agency specializes in supporting individuals with a history of severe behavioral challenges.  
JRC is also licensed by the Massachusetts Department of Elementary and Secondary Education rather than by the Department of Developmental Services (DDS) for services provided to individuals under the age of 18 and these services were therefore not part of this review.  At the time of this survey, the agency supported 116 adults, with 24 hour staffing provided to all whom the agency provided residential services.  

The current review by the DDS Office of Quality Enhancement,consisted of all licensure and certification indicators within the DDS survey tool.  The survey sample included residential services provided to ten people who resided at five of the agency's homes, six people who received Community Based Day Supports (CBDS), and three people who received employment supports.  The scope of the DDS licensure review is related to domains such as health care, medication administration, environmental safety, funds management and human rights.  The scope of the certification review included areas such as individual choice, community membership, employment options, the development of independent living skills 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.  

A variety of positive practices were seen across several of the domains that comprise the survey tool.  For instance, all locations visited by the survey team were found to be safe and in good repair.  People's health care was up-to-date, and, as evidenced by nursing notes and Human Rights Committee meeting minutes, agency medical personnel and clinicians worked together to review physical health in relation to people's behavioral issues.  The agency served as Representative Payee for many of the individuals whom it supported, and documentation of expenditures was in place that accounted for how people's funds had been spent.  The agency emphasized collecting and utilizing behavioral data as part of an effort to deliver appropriate services.  As well, the agency had also increased its involvement with a number of external and the DDS resources, such as the use of DDS hosted clinical services for periodic reviews of people's behavior modifying medication and collaboration with the Institute for Community Inclusion (ICI)and local Chamber of Commerce to enhance employment services.  The agency is encouraged to expand partnerships of this nature. 

While the agency's conscientious efforts are recognized, the survey team identified a number of areas where additional work was needed to fully meet DDS requirements, particularly to ensure that any restrictive procedures are individually based. Several individuals had Level 1 behavior plans that did not contain sufficient information on the individually based rationale for the intervention as the least restrictive alternative.  For instance, within one person's behavior plan, a behavioral consequence specified that community access was denied based on the occurrence of minor behaviors rather than used as a consequence in situations where there is an immediate safety concern to accessing the community and where behaviors that pose a danger of risk are present.  Along similar lines, audio/visual monitoring was in place for some people without an individually based rationale as to why this was needed, without review by the agency's Human Rights Committee, and without a plan to fade the intervention over time.  Another area where further refinements were needed to meet DDS requirements concerned consents for the use of photographic images.  While the agency had many consents in place to address a broad variety of areas, including the use of such images, the agency's photo consents did not contain the level of specificity currently required regarding how these images would be used. 

Within the agency's day supports, efforts were seen to provide people with activities or employment, as appropriate.  While the positive intent of these endeavors is acknowledged, in several instances further strategies needed to be developed to increase people's successes and sense of personal satisfaction.  For instance, while some information was known about the interests and preferences of those who participated in CBDS, additional strategies to encourage people to try new activities need to be considered in optimizing service planning, especially for those people who were not effective communicators about their preferences.  Although all three people in the survey sample who received employment supports worked for the agency and received the same benefits as all agency employees, efforts to help people find successful integrated work situations consistent with safety had been less successful.  For instance, to create additional options for people to experience success in their employment, the agency may want to further explore strategies to support individuals to gain employment with local businesses within the community and/or consider the development of operating an agency owned business within a community setting.  The product of this process of individualized exploration could then be incorporated into shaping the direction of people's goals.

Based on the findings of this report, the agency has earned Two-Year Licenses for both Employment/Day supports and for Residential/IHS supports with   licensure scores of 97% for the Employment/Day supports service grouping and 91% for the Residential/IHS Supports service grouping.  The agency was certified and received a rating of Met in 9 out of 14 indicators for residential supports, 5 out of 12 indicators for CBDS, and 12 out of 18 indicators for employment supports.   As the agency has earned licensure scores of at least 90% for both its day and residential components, within 60 days the agency will complete its own follow-up in regard to any licensing indicators rated Not Met, and forward the agency's follow-up report to the DDS Office of Quality Enhancement.	

	

	

LICENSURE FINDINGS	

	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
9/10	
1/10	

Residential and Individual Home Supports	
66/72	
6/72	

    Residential Services

	

Critical Indicators	
8/8	
0/8	

Total	
75/82	
7/82	
91%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
7	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
9/10	
1/10	

Employment and Day Supports	
60/61	
1/61	

    Community Based Day Services
    Employment Support Services

	

Critical Indicators	
8/8	
0/8	

Total	
69/71	
2/71	
97%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
2	

	

	

	

	

	

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 agency needs to ensure consistent attendance of HRC members with professional expertise, i.e., lawyer, clinician, nurse.  In some instances, additional detail in the HRC minutes would be helpful in clarifying what had been discussed and approved to ensure that members not in attendance are knowledgeable concerning the actions taken by the HRC.  	

		

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L15	
Hot water temperature tests between 110 and 130 degrees.	
Hot water tested below 100 degrees at two homes.  Hot water should measure between 110 and 120 degrees.	

 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.	
While an array of consents were in place, photo consents lacked the required level of specificity, e.g., the image to be used and the context of its use needs to be more fully described.	

 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.	
The use of audio and/or visual monitoring was utilized in three of five homes without an individualized rationale for use or review by the agency's Human Rights Committee.  The agency needs to ensure that when interventions and restrictive practices are used that these are the least intrusive alternatives, based on individuals' unique needs and include provisions to not unduly restrict the rights of others.	

 L63	
Medication treatment plans are in written format with required components.	
One out of three Medication Treatment Plans reviewed did not contain all required components including the unique behavioral symptoms targeted by each medication prescribed.  Additionally, not all medications prescribed for modifying behaviors were included in the plan.  The agency needs to ensure that Medication Treatment Plans include all required components.  	

 L86	
Required assessments concerning individual needs and abilities are completed in preparation for the ISP.	
Three records of individuals funded by the DDS were reviewed.  In one instance, not all assessments had been submitted within the required timelines.  The agency needs to ensure that all required assessments are submitted at least 15 days prior to 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.	
Three records of individuals funded by the DDS were reviewed.  In one instance, not all support strategies had been submitted within the required time lines.  The agency needs to ensure that all required assessments are submitted at least 15 days prior to the ISP meeting.	

	

	

	
Employment/Day 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.	
While an array of consents were in place, photo consents lacked the required level of specificity, e.g., the image to be used and the context of how photographic images are to be used needs to be more fully described.	

			

		

	

CERTIFICATION FINDINGS	

	

	

	
Met / Rated	
Not Met / Rated	

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

Residential and Individual Home Supports	

Residential Services	
9/14	
5/14	

	
	
Met / Rated	
Not Met / Rated	

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

Employment and Day Supports	

Employment Support Services	
12/18	
6/18	

Community Based Day Services	
5/12	
7/12	

	

	

	
Residential Services- Areas Needing Improvement on Standards not met:	

Indicator #	
Indicator	
Area Needing Improvement	

 C9	
Staff (Home Providers) provide opportunities to develop and/or increase personal relationships and social contacts.  	
People did not have the opportunity to regularly meet new people as a means to develop new relationships. Additional strategies are needed to assist people with building and sustaining relationships with others.  This should include supporting people to develop social contacts with others in addition to individuals with whom they lived. 	

 C12	
Individuals are supported to explore, define, and express their need for intimacy.  	
The agency needs to ensure that a formal or informal evaluation process is utilized to assess individuals' needs and desires and provide support which enables individuals to receive education that is geared toward their learning styles.	

 C16	
Staff (Home Providers) support individuals to explore their interests for cultural, social, recreational and spiritual activities.  	
The agency needs to increase individualized exploration of people's interests to allow them to explore community organizations and activities in which they might want to increase their participation. 	

 C17	
Community activities are provided and are based on the individual's preferences and interests. 	
For some individuals, access to community activities tended to be limited based on the behavior of others living in the home while for other people, the activities were not individualized.  The agency needs to support people to regularly participate in community activities based on individual preferences.	

 C18	
Staff (Home Providers) assist individual to purchase personal belongings. 	
For two of the five people who participated in the survey additional support was needed for them to purchase personal belongings.  This could include making small purchases such as personal care items.	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 C22	
Staff have effective methods to assist individuals to explore their job interests.	
For two individuals, there was limited evidence of staff support to assist them in exploring all options for employment. The agency needs to implement strategies to support people to explore a range of possible job opportunities which match their particular interests. 	

 C23	
Staff utilize a variety of methods to assess an individual's skills, interests, career goals and training and support needs in employment.	
Assessments for those receiving employment supports were limited.  The agency needs to develop a variety of means to assess people's skills and further explore their job interests and support needs in the workplace. 	

 C24	
There is a plan developed to identify job goals and support needs.	
The agency needs to develop job plans that reflect an individual's skills, interests and future 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 ensure that career planning includes an analysis of how an individual's benefits/entitlement impact employment.  	

 C30	
Individuals are supported to work in integrated job settings.	
All three people in the survey sample worked at the agency's administrative center in Canton.  While there were positive aspects to these placements, this did not provide an integrated setting.  The agency needs to expand people's opportunities to work at integrated settings consistent with safety and people's preferences.	

 C33	
Employee benefits and rights are clearly explained to the individual.	
The agency needs to ensure that employee benefits and rights are clearly explained to individuals supported by the agency who are also agency employees. This handbook was provided to two out of the three individuals who participated in the survey.  	

	

	
Community Based Day Services- Areas Needing Improvement on Standards not met:	

Indicator #	
Indicator	
Area Needing Improvement	

 C39	
There is a plan developed to identify job goals and support needs that would lead to movement into supported employment.	
For people who are involved and/or interested in paid work, a comprehensive plan needs to be developed that would lead to supported employment.	

 C40	
Individuals are supported to explore their personal interest and options for community involvement, personal interest and hobbies.	
Individuals' personal interests beyond what was available was not always known or acted upon.  In addition, the agency needs to expand individuals' opportunities to identify and explore their personal interests within the community.	

 C41	
Individuals participate in activities that reflect their interests.	
For one person activities did not necessarily reflect his individualized interests.  All individuals need to be supported to participate in a range of activities based on their preferences.	

 C42	
Individuals are involved in activities that connect them to other people in the community.	
As community trips were often conducted in large groups or not provided on a regular basis, opportunities to naturally interact with others in the community was limited.  Additional strategies need to be developed to foster community connections that people would find personally meaningful.	

 C43	
Staff support individuals to maintain and enhance relationships with others.	
One individual had not been provided with sufficient opportunities to build relationships.  The agency needs to ensure that all individuals have ample opportunity and support to maintain and enhance relationships.	

 C44	
Staff have effective methods to assist individuals to explore their job interests if appropriate.	
While over time, agency staff had gained familiarity with the individuals they supported, staff need to collect further information on individuals' job interests, e.g., through job trials and tours, and then assist individuals to explore these interests.  	

 C45	
Individual's decisions of what to do during the day are revisited on a regular basis.	
Additional means need to be developed to support people to make decisions regarding the activities at their day supports.  For instance, expanded opportunities to try various activities would be helpful, especially for those people whose ability to communicate effectively was limited.	

	

	

				
	MASTER SCORE SHEET LICENSURE	

				
	Organizational: THE JUDGE ROTENBERG EDUC CENTER 	

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

O	
 L2	
Abuse/neglect reporting	
7/7	
Met	

 L3	
Immediate Action	
15/15	
Met	

 L4	
Action taken	
12/12	
Met	

 L48	
HRC	
0/1	
Not Met(0 % )	

 L65	
Restraint report submit	
124/150	
Met(82.67 % )	

 L66	
HRC restraint review	
128/135	
Met(94.81 % )	

 L74	
Screen employees	
15/15	
Met	

 L75	
Qualified staff	
7/7	
Met	

 L76	
Track trainings	
20/20	
Met	

 L83	
HR training	
20/20	
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	
5/5	

	

5/5	
Met	

 L5	
Safety Plan	
L	
5/5	

	

5/5	
Met	

O	
 L6	
Evacuation	
L	
5/5	

	

5/5	
Met	

 L7	
Fire Drills	
L	
5/5	

	

5/5	
Met	

 L8	
Emergency Fact Sheets	
I	
5/5	

	

5/5	
Met	

 L9	
Safe use of equipment	
L	
5/5	

	

5/5	
Met	

 L10	
Reduce risk interventions	
I	
5/5	

	

5/5	
Met	

O	
 L11	
Required inspections	
L	
4/4	

	

4/4	
Met	

O	
 L12	
Smoke detectors	
L	
5/5	

	

5/5	
Met	

O	
 L13	
Clean location	
L	
5/5	

	

5/5	
Met	

 L14	
Site in good repair	
L	
5/5	

	

5/5	
Met	

 L15	
Hot water	
L	
3/5	

	

3/5	
Not Met
(60.0 %)	

 L16	
Accessibility	
L	
4/4	

	

4/4	
Met	

 L17	
Egress at grade 	
L	
5/5	

	

5/5	
Met	

 L18	
Above grade egress	
L	
5/5	

	

5/5	
Met	

 L19	
Bedroom location	
L	
1/1	

	

1/1	
Met	

 L20	
Exit doors	
L	
5/5	

	

5/5	
Met	

 L21	
Safe electrical equipment	
L	
5/5	

	

5/5	
Met	

 L22	
Clean appliances	
L	
5/5	

	

5/5	
Met	

 L23	
Egress door locks	
L	
1/1	

	

1/1	
Met	

 L24	
Locked door access	
L	
5/5	

	

5/5	
Met	

 L25	
Dangerous substances	
L	
5/5	

	

5/5	
Met	

 L26	
Walkway safety	
L	
5/5	

	

5/5	
Met	

 L28	
Flammables	
L	
5/5	

	

5/5	
Met	

 L29	
Rubbish/combustibles	
L	
5/5	

	

5/5	
Met	

 L30	
Protective railings	
L	
3/3	

	

3/3	
Met	

 L31	
Communication method	
I	
5/5	

	

5/5	
Met	

 L32	
Verbal & written	
I	
5/5	

	

5/5	
Met	

 L33	
Physical exam	
I	
5/5	

	

5/5	
Met	

 L34	
Dental exam	
I	
5/5	

	

5/5	
Met	

 L35	
Preventive screenings	
I	
5/5	

	

5/5	
Met	

 L36	
Recommended tests	
I	
5/5	

	

5/5	
Met	

 L37	
Prompt treatment	
I	
5/5	

	

5/5	
Met	

O	
 L38	
Physician's orders	
I	
5/5	

	

5/5	
Met	

 L39	
Dietary requirements	
I	
2/2	

	

2/2	
Met	

 L40	
Nutritional food	
L	
5/5	

	

5/5	
Met	

 L41	
Healthy diet	
L	
5/5	

	

5/5	
Met	

 L42	
Physical activity	
L	
5/5	

	

5/5	
Met	

 L43	
Health Care Record	
I	
5/5	

	

5/5	
Met	

 L44	
MAP registration	
L	
5/5	

	

5/5	
Met	

 L45	
Medication storage	
L	
5/5	

	

5/5	
Met	

O	
 L46	
Med. Administration	
I	
5/5	

	

5/5	
Met	

 L47	
Self medication	
I	
5/5	

	

5/5	
Met	

 L49	
Informed of human rights	
I	
5/5	

	

5/5	
Met	

 L50	
Respectful Comm.	
L	
5/5	

	

5/5	
Met	

 L51	
Possessions	
I	
5/5	

	

5/5	
Met	

 L52	
Phone calls	
I	
5/5	

	

5/5	
Met	

 L53	
Visitation	
I	
5/5	

	

5/5	
Met	

 L54	
Privacy	
L	
5/5	

	

5/5	
Met	

 L55	
Informed consent	
I	
3/5	

	

3/5	
Not Met
(60.0 %)	

 L56	
Restrictive practices	
I	
2/5	

	

2/5	
Not Met
(40.0 %)	

 L57	
Written behavior plans	
I	
5/5	

	

5/5	
Met	

 L58	
Behavior plan component	
I	
4/5	

	

4/5	
Met
(80.0 %)	

 L59	
Behavior plan review	
I	
5/5	

	

5/5	
Met	

 L60	
Data maintenance	
I	
5/5	

	

5/5	
Met	

 L63	
Med. treatment plan form	
I	
2/3	

	

2/3	
Not Met
(66.67 %)	

 L64	
Med. treatment plan rev.	
I	
3/3	

	

3/3	
Met	

 L67	
Money mgmt. plan	
I	
5/5	

	

5/5	
Met	

 L68	
Funds expenditure	
I	
5/5	

	

5/5	
Met	

 L69	
Expenditure tracking	
I	
5/5	

	

5/5	
Met	

 L70	
Charges for care calc.	
I	
5/5	

	

5/5	
Met	

 L71	
Charges for care appeal	
I	
5/5	

	

5/5	
Met	

 L77	
Unique needs training	
I	
4/5	

	

4/5	
Met
(80.0 %)	

 L78	
Restrictive Int. Training	
L	
5/5	

	

5/5	
Met	

 L79	
Restraint training	
L	
5/5	

	

5/5	
Met	

 L80	
Symptoms of illness	
L	
5/5	

	

5/5	
Met	

 L81	
Medical emergency	
L	
5/5	

	

5/5	
Met	

O	
 L82	
Medication admin.	
L	
5/5	

	

5/5	
Met	

 L85	
Supervision 	
L	
5/5	

	

5/5	
Met	

 L86	
Required assessments	
I	
2/3	

	

2/3	
Not Met
(66.67 %)	

 L87	
Support strategies	
I	
2/3	

	

2/3	
Not Met
(66.67 %)	

 L88	
Strategies implemented	
I	
5/5	

	

5/5	
Met	

#Std. Met/# 72 Indicator	

	

	

66/72	

	
Total Score	

	

	

75/82	

	

	

	

	
91.46%	

		
							
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	
3/3	
	
3/3	
6/6	
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	
3/3	
	
3/3	
6/6	
Met	

 L9	
Safe use of equipment	
L	
1/1	
	
1/1	
2/2	
Met	

 L10	
Reduce risk interventions	
I	
3/3	
	
3/3	
6/6	
Met	

O	
 L11	
Required inspections	
L	
1/1	
	
1/1	
2/2	
Met	

O	
 L12	
Smoke detectors	
L	
1/1	
	
1/1	
2/2	
Met	

O	
 L13	
Clean location	
L	
1/1	
	
1/1	
2/2	
Met	

 L14	
Site in good repair	
L	
1/1	
	
1/1	
2/2	
Met	

 L15	
Hot water	
L	
1/1	
	
1/1	
2/2	
Met	

 L16	
Accessibility	
L	
1/1	
	
1/1	
2/2	
Met	

 L17	
Egress at grade 	
L	
1/1	
	
1/1	
2/2	
Met	

 L18	
Above grade egress	
L	
1/1	
	
1/1	
2/2	
Met	

 L20	
Exit doors	
L	
1/1	
	
1/1	
2/2	
Met	

 L21	
Safe electrical equipment	
L	
1/1	
	
1/1	
2/2	
Met	

 L22	
Clean appliances	
L	
1/1	
	
1/1	
2/2	
Met	

 L25	
Dangerous substances	
L	
1/1	
	
1/1	
2/2	
Met	

 L26	
Walkway safety	
L	
1/1	
	
1/1	
2/2	
Met	

 L28	
Flammables	
L	
1/1	
	
1/1	
2/2	
Met	

 L29	
Rubbish/combustibles	
L	
1/1	
	
1/1	
2/2	
Met	

 L30	
Protective railings	
L	

1/1	
1/1	
Met	

 L31	
Communication method	
I	
3/3	
	
3/3	
6/6	
Met	

 L32	
Verbal & written	
I	
3/3	
	
3/3	
6/6	
Met	

 L37	
Prompt treatment	
I	
3/3	
	
3/3	
6/6	
Met	

O	
 L38	
Physician's orders	
I	
2/2	
	
3/3	
5/5	
Met	

 L39	
Dietary requirements	
I	
2/2	
	
2/2	
4/4	
Met	

 L44	
MAP registration	
L	
1/1	
	
1/1	
2/2	
Met	

 L45	
Medication storage	
L	
1/1	
	
1/1	
2/2	
Met	

O	
 L46	
Med. Administration	
I	
2/2	
	
2/2	
4/4	
Met	

 L49	
Informed of human rights	
I	
3/3	
	
3/3	
6/6	
Met	

 L50	
Respectful Comm.	
L	
1/1	
	
1/1	
2/2	
Met	

 L51	
Possessions	
I	
3/3	
	
3/3	
6/6	
Met	

 L52	
Phone calls	
I	
3/3	
	
3/3	
6/6	
Met	

 L54	
Privacy	
L	
1/1	
	
1/1	
2/2	
Met	

 L55	
Informed consent	
I	
1/3	
	
2/3	
3/6	
Not Met
(50.0 %)	

 L56	
Restrictive practices	
I	
3/3	
	
3/3	
6/6	
Met	

 L57	
Written behavior plans	
I	
3/3	
	
3/3	
6/6	
Met	

 L58	
Behavior plan component	
I	
3/3	
	
3/3	
6/6	
Met	

 L59	
Behavior plan review	
I	
3/3	
	
3/3	
6/6	
Met	

 L60	
Data maintenance	
I	
3/3	
	
3/3	
6/6	
Met	

 L61	
Health protection in ISP	
I	

1/1	
1/1	
Met	

 L62	
Health protection review	
I	

1/1	
1/1	
Met	

 L63	
Med. treatment plan form	
I	

2/2	
2/2	
Met	

 L64	
Med. treatment plan rev.	
I	

2/2	
2/2	
Met	

 L67	
Money mgmt. plan	
I	
2/2	
	
2/2	
4/4	
Met	

 L68	
Funds expenditure	
I	
1/1	
	
1/1	
2/2	
Met	

 L69	
Expenditure tracking	
I	
1/1	
	
1/1	
2/2	
Met	

 L73	
DOL certificate	
L	

1/1	
1/1	
Met	

 L77	
Unique needs training	
I	
3/3	
	
3/3	
6/6	
Met	

 L78	
Restrictive Int. Training	
L	
1/1	
	
1/1	
2/2	
Met	

 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 admin.	
L	
1/1	
	
1/1	
2/2	
Met	

 L84	
Health protect. Training	
I	

1/1	
1/1	
Met	

 L85	
Supervision 	
L	
1/1	
	
1/1	
2/2	
Met	

 L86	
Required assessments	
I	

1/1	
1/1	
Met	

 L87	
Support strategies	
I	

1/1	
1/1	
Met	

 L88	
Strategies implemented	
I	
2/3	
	
3/3	
5/6	
Met
(83.33 %)	

#Std. Met/# 61 Indicator	

	

60/61	

	
Total Score	

	

69/71	

	

	

	
97.18%	

		
							
	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	

 C37	
Interpersonal skills for work	
3/3	
Met	

 C38	
Habilitative & behavioral goals	
1/1	
Met	

 C39	
Support needs for employment	
0/1	
Not Met (0 %)	

 C40	
Community involvement interest	
0/3	
Not Met (0 %)	

 C41	
Activities participation	
2/3	
Not Met (66.67 %)	

 C42	
Connection to others	
0/3	
Not Met (0 %)	

 C43	
Maintain & enhance relationship	
2/3	
Not Met (66.67 %)	

 C44	
Job exploration	
0/2	
Not Met (0 %)	

 C45	
Revisit decisions	
1/3	
Not Met (33.33 %)	

Employment Support Services Reviewed By -DDS	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff performance	
3/3	
Met	

 C8	
Family/guardian communication	
3/3	
Met	

 C22	
Explore job interests	
1/3	
Not Met (33.33 %)	

 C23	
Assess skills & training needs	
1/3	
Not Met (33.33 %)	

 C24	
Job goals & support needs plan	
1/3	
Not Met (33.33 %)	

 C25	
Skill development	
3/3	
Met	

 C26	
Benefits analysis	
1/3	
Not Met (33.33 %)	

 C27	
Job benefit education	
3/3	
Met	

 C28	
Relationships w/businesses	
1/1	
Met	

 C29	
Support to obtain employment	
3/3	
Met	

 C30	
Work in integrated settings	
0/3	
Not Met (0 %)	

 C31	
Job accommodations	
3/3	
Met	

 C32	
At least minimum wages earned	
3/3	
Met	

 C33	
Employee benefits explained	
2/3	
Not Met (66.67 %)	

 C34	
Support to promote success	
3/3	
Met	

 C35	
Feedback on job performance	
3/3	
Met	

 C36	
Supports to enhance retention	
3/3	
Met	

 C37	
Interpersonal skills for work	
3/3	
Met	

Residential Services Reviewed By -DDS	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff performance	
5/5	
Met	

 C8	
Family/guardian communication	
5/5	
Met	

 C9	
Personal relationships	
3/5	
Not Met (60.0 %)	

 C10	
Social skill development	
5/5	
Met	

 C11	
Get together w/family & friends	
5/5	
Met	

 C12	
Intimacy	
2/5	
Not Met (40.0 %)	

 C13	
Skills to maximize independence 	
5/5	
Met	

 C14	
Choices in routines & schedules	
5/5	
Met	

 C15	
Personalize living space	
5/5	
Met	

 C16	
Explore interests	
2/5	
Not Met (40.0 %)	

 C17	
Community activities	
3/5	
Not Met (60.0 %)	

 C18	
Purchase personal belongings	
3/5	
Not Met (60.0 %)	

 C19	
Knowledgeable decisions	
5/5	
Met	

 C20	
Emergency back-up plans	
5/5	
Met