PROVIDER REPORT FOR	

	

	

	

	

	

	

	

	

	
	
Melmark New England
461 River Rd.
 Andover, MA 01810    	

	

	

	

	

	

	

	

July 28, 2016	

	

	

	

	

	

	

	

	

Version	

	

	

	

	

	

	

	

	
Provider Web Report	

	

	

	

	

	

	

	
Prepared by the Department of Developmental Services
OFFICE OF QUALITY ENHANCEMENT	

	

	

	

	

	

	

				
	SUMMARY OF OVERALL FINDINGS	

				

	

	

Provider	

	
Melmark New England	

	

	

	

	
Review Dates	

	
5/17/2016 - 5/20/2016	

	

	

	

	
Service Enhancement 
Meeting Date	

	
6/7/2016	

	

	

	

	

	

	
Survey Team	

	
Sarah Flibotte (TL)	

Patty McCarthy	

	

	

	

	

	

	
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	
1 location(s) 3 audit (s) 	
Full Review	
74 / 81 2 Year License 06/07/2016 -  06/07/2018	
	
20 / 20 Certified 06/07/2016 -  06/07/2018	

Residential Services	
1 location(s) 3 audit (s) 	

Full Review	
14 / 14	

Planning and Quality Management (For all service groupings)	

	
Full 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	
1 location(s) 2 audit (s) 	
Full Review	
59 / 61 2 Year License 06/07/2016 -  06/07/2018	
	
16 / 16 Certified 06/07/2016 -  06/07/2018	

Community Based Day Services	
1 location(s) 2 audit (s) 	

Full Review	
10 / 10	

Planning and Quality Management (For all service groupings)	

	
Full Review	
6 / 6	

	

	

			
EXECUTIVE SUMMARY :	

			
Melmark New England (Melmark NE) is a nonprofit agency founded in 1988 as a new service division of Melmark, Inc., a Pennsylvania based organization that specializes in services to children and adults with developmental disabilities. In addition to its residential supports, Melmark provides educational, rehabilitative, vocational and residential needs to children and adults that have complex and challenging needs such as; autism spectrum disorders, acquired brain injury, neurodevelopmental, intellectual disorders, dual diagnosis and challenging behaviors. In July of 2015, Melmark began providing Community Based Day Services (CBDS) to young adults transitioning from school to adult services.  It has been in its current location at the Riverwalk in Lawrence, MA since November 2015. 

For the purposes of this full Licensing and Certification review, a total of five audits were completed. This was inclusive of three audits of six individuals living in 24-hour group living situations, and two audits of four individuals receiving Community Based Day Supports (CBDS). 

The survey team noted during the review, the long term knowledge that direct support staff had of the individuals served; many of whom they had supported through the children's services and then transitioned into the adult services program. Staff had long term knowledge of the individuals and had worked with most across both residential and day services.  Many of the individuals supported across both settings had significant complex medical and behavioral challenges. It was demonstrated through individualized plans that the agency empowers continuing education, skill development, promoting relationships, increased self-sufficiency, volunteerism and community integration. 

The review identified a number of accomplishments on the part of the agency which resulted in positive individual outcomes across both settings.  One area of strength was noted in the Health Care domain. The agency has a thoughtful Wellness Policy which balances health, nutrition and exercise into an individually choice based program. The agency encourages individuals to maintain optimal health as well as recognizing the importance of proper nutrition, exercise and dietary guidelines to foster healthy lifestyles. Survey visits revealed that individuals had been assessed by a nutritionist, and were personally involved in healthy meal planning. Specialized recipe cards were developed to meet the unique needs of assisting individuals to maintain focus, safety and attention while learning to cook. Each individual had a detailed exercise/physical activity plan from choices they had made for day and at home to assist in further promoting a healthy lifestyle across all settings.  The agency also encourages employees to maintain a healthy lifestyle to support the overall objective of a healthy community.

The agency has a strong, thorough and fully comprised Human Rights Committee (HRC).  Through interview and review of HRC meeting minutes it was affirmed that criteria of Committee By-Laws and procedures had been met. Through documentation, Committee members had received training in a myriad of topics specific to rights of people with disabilities. Further review of Committee minutes revealed that the agency has a unique style of Behavior Support Plan (BSP)  presentation to the Committee. Staff presents the BSP, any new behavioral challenges, medication changes or less restrictive practices which are then graphed. Staff role play the implementation of the plan, any active resistance which may occur and the potential response or responses of the individual. Committee members are interactive with the approval or denial process of BSP's. 

The agency takes pride in providing clinical supports to individuals with significant behavioral challenges and its commitment to using Positive Behavioral Supports (PBS). Each individual has a  (BSP) which is written by a Board Certified Behavior Analyst (BCBA).  Changes are made as directed by an individual's response or changes in the environment.  Staff is continuously trained in the changes in the plan to ensure and evaluate the direct link of accurate data collection to evidence based outcomes.  The agency has been able to successfully modify three Level II plans down to one Level I plan.
  The survey team was able to review the agency's process for assessing people's interests and skills which resulted in the development of an individualized support plan for each individual, incorporating a preference summary, activity choice graph and a vocational interest profile summary.  Notes of learning style were included, how the individual will plan their day, future goals and community outing logs that correlated to individual's choices were included as direct evidence of how an individual might chose to spend their day. Currently, four of the nine individuals in the CBDS program have external volunteer or internship employment, all in areas related to their interests as identified in the assessment process.  Additionally, individuals were observed engaging in individual activities, and activities that would lead to potential employment opportunities.  Individuals were engaged in meaningful and purposeful activities of their choice based on individual preference and the assessment process.  
While the agency has had many positive accomplishments, a need for further strengthening was identified in relation to Melmark meeting DDS timeframes specific to submission of restraints, ISP assessments and support strategies. Another theme which occurred residentially and requires further review by the agency was its use of restrictive practices without individualized written rationales and without the required review and approvals.
As a result of this survey, Melmark New England met 53/54 of licensing indicators for Employment and Day Supports and received a score of 97%. Residential Supports met 68/74 licensing indicators with a score of 91%.  Melmark is congratulated for earning a two-year license for both its Day and Employment Services and its Residential Services. The agency's employment services are certified having met 10/10 certification indicators and the residential services is certified having earning 14/14 certification indicators. The agency met all of the critical indicators within the scope of the survey. Since the licensing scores for both services were over 90%, the agency will do its own follow-up on those indicators that received a "not met" rating, and report the results to the Office of Quality Enhancement within 60 days of the Service Enhancement Meeting. The agency is congratulated for its continued commitment to provide quality services for persons with disabilities.	

	

	

LICENSURE FINDINGS	

	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
6/7	
1/7	

Residential and Individual Home Supports	
68/74	
6/74	

    Residential Services

	

Critical Indicators	
7/7	
0/7	

Total	
74/81	
7/81	
91%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
7	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
6/7	
1/7	

Employment and Day Supports	
53/54	
1/54	

    Community Based Day Services

	

Critical Indicators	
7/7	
0/7	

Total	
59/61	
2/61	
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	

 L65	
Restraint reports are submitted within required timelines.	
Of the nine restraint reports created over the previous 13 months, seven of the restraint reports had not been reviewed and finalized by the agency restraint manager within the required five days of the restraint event. The agency needs to ensure restraint reports are created and reviewed within five days of the restraint event in accordance with DDS regulatory requirements.	

		

	

	
Residential Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 L85	
The agency provides on-going supervision and staff development	
Comprehensive tools were in place to support the growth and learning of staff through supervision; modeling and supervisor/manager feedback.  The Feedback Tools were data evidence driven and utilized to address a number of functions for which staff was responsible.  The Feedback Tools included:  INDIVIDUAL COMMUNICATION MODALITY; INTERACTION FEEDBACK; BEHAVIOR MANAGEMENT; SUPERVISED ACTIVITY and TASK ANALYSIS FEEDBACK. During weekly 10 minute sessions on all functions noted, staff were positively recognized for the functions they performed well and given constructive demonstrative feedback on areas to strengthen. Feedback tools are scored and the results are incorporated into the annual appraisal. The agency is commended for the ways in which it supported staff to develop and maintain a high level of performance while keeping the commitment to the quality of life for the individuals served of paramount concern.	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L20	
Exit doors are easily operable by hand from inside without the use of keys.	
One residential home reviewed had a hotel style (hasp and ball) lock placed high above on the two exit doors.  Draw bolts, chain latches, and hooks and eye locks may not be used on exit doors. The agency needs to ensure that all exit doors are free of inside locks that require keys or other mechanisms and are easily operable. (Corrected)	

 L47	
Individuals are supported to become self medicating when appropriate. 	
Self-medication assessments were not in place for three individuals surveyed.  The agency needs to ensure that individuals are assessed and supported to self-medicate whenever possible. (Corrected)	

 L54	
Individuals have privacy when taking care of personal needs and discussing personal matters. 	
For the one residential site surveyed, staff were conducting 15 minute bed checks for all individuals in the home.  This practice did not include specific written rationales, were not reviewed as required and/or did not have provisions developed which would not interfere with the privacy of the individuals while they were sleeping.  The agency needs to ensure that individuals are given privacy while in their bedrooms sleeping.  If bed checks are required, they should be based on individual needs, based on needs, and go through the required review and approval process.	

 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 home had door chimes on all exit doors.  There was no rational identifying the need for these alarms. The agency needs to ensure that all restrictive practices have a written rationale for their need, are reviewed by required groups and include provisions for those whom the restrictive practice does not apply so as to not unduly restrict their rights.  	

 L86	
Required assessments concerning individual needs and abilities are completed in preparation for the ISP.	
For one of two individuals surveyed, assessments were not submitted to the area office at least 15 days prior to the ISP. The agency needs to ensure that assessments are submitted in accordance with DDS regulatory requirements.	

 L87	
Support strategies necessary to assist an individual to meet their goals and objectives are completed and submitted as part of the ISP.	
For one of two individuals surveyed, Support Strategies were not submitted to the area office at least 15 days prior to the ISP.  The agency needs to ensure that Support Strategies are submitted in accordance with DDS regulatory requirements.	

	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L25	
Potentially dangerous substances are stored separately from food and are in containers that are accurately labeled. 	
While all cleaning supplies were stored away from food, there was unidentified cleaning spray bottles located in the cleaning closet.  The agency needs to ensure that all containers of potentially dangerous substances are clearly and accurately labeled and stored appropriately. (Corrected)	

			

		

	

	

CERTIFICATION FINDINGS	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

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

Residential and Individual Home Supports	
14/14	
0/14	

Residential Services	
14/14	
0/14	

TOTAL	
20/20	
0/20	
100%	

Certified	

	

	
	
Met / Rated	
Not Met / Rated	
% Met	

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

Employment and Day Supports	
10/10	
0/10	

Community Based Day Services	
10/10	
0/10	

TOTAL	
16/16	
0/16	
100%	

Certified	

	

	

	

	

	
Residential Services Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 C13	
Staff (Home Providers) provide support for individuals to develop skills to enable them to maximize independence and participation in typical activities and routines. 	
Verbal prompting around household routines was an evident part of observed shifts, for example, staff prompted one individual to write up his daily schedule and another individual to complete his afternoon snack preparation. Activities and routines were broken down in writing using task analysis, for example, many household chores such as how to load the dishwasher were available in step by step written instructions making it easy for individuals to learn and easy for direct support staff to teach each chore in a consistent manner.
One individual was noted to be independent in showering, cleaning his room and completing laundry. This individual also helps with the dishwasher and cooking meals.
Another individual (who requires support around his gait while walking) routinely brings his dinner items from the table to the kitchen counter, brings his basket to the laundry machine, makes his bed and cleans his room with support.
The agency is commended for the way in which it provides support for individuals to develop skills to enable them to maximize independence and participation in typical activities and routines. 	

	

	

		

	

						
	MASTER SCORE SHEET LICENSURE	

						
	Organizational: Melmark New England	

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

 L48	
HRC	
1/1	
Met	

 L65	
Restraint report submit	
2/9	
Not Met(22.22 % )	

 L66	
HRC restraint review	
2/2	
Met	

 L74	
Screen employees	
1/1	
Met	

 L75	
Qualified staff	
1/1	
Met	

 L76	
Track trainings	
5/5	
Met	

 L83	
HR training	
5/5	
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	
3/3	

	

3/3	
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	
Met	

 L9	
Safe use of equipment	
L	
1/1	

	

1/1	
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	

 L14	
Site in good repair	
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	

 L18	
Above grade egress	
L	
1/1	

	

1/1	
Met	

 L19	
Bedroom location	
L	
1/1	

	

1/1	
Met	

 L20	
Exit doors	
L	
0/1	

	

0/1	
Not Met
(0 %)	

 L21	
Safe electrical equipment	
L	
1/1	

	

1/1	
Met	

 L22	
Clean appliances	
L	
1/1	

	

1/1	
Met	

 L23	
Egress door locks	
L	
1/1	

	

1/1	
Met	

 L24	
Locked door access	
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/combustibles	
L	
1/1	

	

1/1	
Met	

 L30	
Protective railings	
L	
1/1	

	

1/1	
Met	

 L31	
Communication method	
I	
3/3	

	

3/3	
Met	

 L32	
Verbal & written	
I	
3/3	

	

3/3	
Met	

 L33	
Physical exam	
I	
3/3	

	

3/3	
Met	

 L34	
Dental exam	
I	
3/3	

	

3/3	
Met	

 L35	
Preventive screenings	
I	
3/3	

	

3/3	
Met	

 L36	
Recommended tests	
I	
3/3	

	

3/3	
Met	

 L37	
Prompt treatment	
I	
2/2	

	

2/2	
Met	

O	
 L38	
Physician's orders	
I	
2/2	

	

2/2	
Met	

 L39	
Dietary requirements	
I	
1/1	

	

1/1	
Met	

 L40	
Nutritional food	
L	
1/1	

	

1/1	
Met	

 L41	
Healthy diet	
L	
1/1	

	

1/1	
Met	

 L42	
Physical activity	
L	
1/1	

	

1/1	
Met	

 L43	
Health Care Record	
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	
Med. Administration	
I	
3/3	

	

3/3	
Met	

 L47	
Self medication	
I	
0/3	

	

0/3	
Not Met
(0 %)	

 L49	
Informed of human rights	
I	
3/3	

	

3/3	
Met	

 L50	
Respectful Comm.	
L	
1/1	

	

1/1	
Met	

 L51	
Possessions	
I	
3/3	

	

3/3	
Met	

 L52	
Phone calls	
I	
3/3	

	

3/3	
Met	

 L53	
Visitation	
I	
3/3	

	

3/3	
Met	

 L54	
Privacy	
L	
0/1	

	

0/1	
Not Met
(0 %)	

 L55	
Informed consent	
I	
2/2	

	

2/2	
Met	

 L56	
Restrictive practices	
I	
0/3	

	

0/3	
Not Met
(0 %)	

 L57	
Written behavior plans	
I	
3/3	

	

3/3	
Met	

 L58	
Behavior plan component	
I	
3/3	

	

3/3	
Met	

 L59	
Behavior plan review	
I	
3/3	

	

3/3	
Met	

 L60	
Data maintenance	
I	
3/3	

	

3/3	
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	
3/3	

	

3/3	
Met	

 L68	
Funds expenditure	
I	
3/3	

	

3/3	
Met	

 L69	
Expenditure tracking	
I	
3/3	

	

3/3	
Met	

 L70	
Charges for care calc.	
I	
3/3	

	

3/3	
Met	

 L71	
Charges for care appeal	
I	
3/3	

	

3/3	
Met	

 L77	
Unique needs training	
I	
3/3	

	

3/3	
Met	

 L78	
Restrictive Int. Training	
L	
1/1	

	

1/1	
Met	

 L79	
Restraint training	
L	
1/1	

	

1/1	
Met	

 L80	
Symptoms of illness	
L	
1/1	

	

1/1	
Met	

 L81	
Medical emergency	
L	
1/1	

	

1/1	
Met	

O	
 L82	
Medication admin.	
L	
1/1	

	

1/1	
Met	

 L84	
Health protect. Training	
I	
1/1	

	

1/1	
Met	

 L85	
Supervision 	
L	
1/1	

	

1/1	
Met	

 L86	
Required assessments	
I	
1/2	

	

1/2	
Not Met
(50.0 %)	

 L87	
Support strategies	
I	
1/2	

	

1/2	
Not Met
(50.0 %)	

 L88	
Strategies implemented	
I	
3/3	

	

3/3	
Met	

#Std. Met/# 74 Indicator	

	

	

68/74	

	
Total Score	

	

	

74/81	

	

	

	

	
91.36%	

		
							
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	

2/2	
2/2	
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	

2/2	
2/2	
Met	

 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	

 L14	
Site in good repair	
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	

0/1	
0/1	
Not Met
(0 %)	

 L26	
Walkway safety	
L	

1/1	
1/1	
Met	

 L28	
Flammables	
L	

1/1	
1/1	
Met	

 L29	
Rubbish/combustibles	
L	

1/1	
1/1	
Met	

 L31	
Communication method	
I	

2/2	
2/2	
Met	

 L32	
Verbal & written	
I	

2/2	
2/2	
Met	

 L37	
Prompt treatment	
I	

2/2	
2/2	
Met	

O	
 L38	
Physician's orders	
I	

2/2	
2/2	
Met	

 L39	
Dietary requirements	
I	

2/2	
2/2	
Met	

 L44	
MAP registration	
L	

1/1	
1/1	
Met	

 L45	
Medication storage	
L	

1/1	
1/1	
Met	

O	
 L46	
Med. Administration	
I	

2/2	
2/2	
Met	

 L49	
Informed of human rights	
I	

2/2	
2/2	
Met	

 L50	
Respectful Comm.	
L	

1/1	
1/1	
Met	

 L51	
Possessions	
I	

2/2	
2/2	
Met	

 L52	
Phone calls	
I	

2/2	
2/2	
Met	

 L54	
Privacy	
L	

1/1	
1/1	
Met	

 L55	
Informed consent	
I	

2/2	
2/2	
Met	

 L57	
Written behavior plans	
I	

2/2	
2/2	
Met	

 L58	
Behavior plan component	
I	

2/2	
2/2	
Met	

 L59	
Behavior plan review	
I	

2/2	
2/2	
Met	

 L60	
Data maintenance	
I	

2/2	
2/2	
Met	

 L61	
Health protection in ISP	
I	

2/2	
2/2	
Met	

 L62	
Health protection review	
I	

2/2	
2/2	
Met	

 L63	
Med. treatment plan form	
I	

2/2	
2/2	
Met	

 L64	
Med. treatment plan rev.	
I	

2/2	
2/2	
Met	

 L77	
Unique needs training	
I	

2/2	
2/2	
Met	

 L78	
Restrictive Int. Training	
L	

1/1	
1/1	
Met	

 L79	
Restraint training	
L	

1/1	
1/1	
Met	

 L80	
Symptoms of illness	
L	

1/1	
1/1	
Met	

 L81	
Medical emergency	
L	

1/1	
1/1	
Met	

O	
 L82	
Medication admin.	
L	

1/1	
1/1	
Met	

 L84	
Health protect. Training	
I	

2/2	
2/2	
Met	

 L85	
Supervision 	
L	

1/1	
1/1	
Met	

 L86	
Required assessments	
I	

1/1	
1/1	
Met	

 L87	
Support strategies	
I	

1/1	
1/1	
Met	

 L88	
Strategies implemented	
I	

2/2	
2/2	
Met	

#Std. Met/# 54 Indicator	

	

53/54	

	
Total Score	

	

59/61	

	

	

	
96.72%	

		
							
	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	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff performance	
2/2	
Met	

 C8	
Family/guardian communication	
2/2	
Met	

 C13	
Skills to maximize independence 	
1/1	
Met	

 C37	
Interpersonal skills for work	
2/2	
Met	

 C40	
Community involvement interest	
2/2	
Met	

 C41	
Activities participation	
2/2	
Met	

 C42	
Connection to others	
2/2	
Met	

 C43	
Maintain & enhance relationship	
2/2	
Met	

 C44	
Job exploration	
2/2	
Met	

 C45	
Revisit decisions	
2/2	
Met	

Residential Services	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff performance	
3/3	
Met	

 C8	
Family/guardian communication	
3/3	
Met	

 C9	
Personal relationships	
3/3	
Met	

 C10	
Social skill development	
3/3	
Met	

 C11	
Get together w/family & friends	
3/3	
Met	

 C12	
Intimacy	
3/3	
Met	

 C13	
Skills to maximize independence 	
3/3	
Met	

 C14	
Choices in routines & schedules	
3/3	
Met	

 C15	
Personalize living space	
1/1	
Met	

 C16	
Explore interests	
3/3	
Met	

 C17	
Community activities	
3/3	
Met	

 C18	
Purchase personal belongings	
3/3	
Met	

 C19	
Knowledgeable decisions	
3/3	
Met	

 C20	
Emergency back-up plans	
1/1	
Met