PROVIDER REPORT FOR	

	

	

	

	

	

	

	

	

	
	
M.O. Life, Inc.
43 Daniel Street
 Fairhaven, MA 02719    	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

Version	

	

	

	

	

	

	

	

	
Provider Web Report
February 19, 2019	

	

	

	

	

	

	

	
Prepared by the Department of Developmental Services
OFFICE OF QUALITY ENHANCEMENT	

	

	

	

	

	

	

				
	SUMMARY OF OVERALL FINDINGS	

				

	

	

Provider	

	
M.O. Life, Inc.	

	

	

	

	
Review Dates	

	
1/29/2019 - 2/4/2019	

	

	

	

	
Service Enhancement 
Meeting Date	

	
2/19/2019	

	

	

	

	

	

	
Survey Team	

	
Michelle Boyd (TL)	

Jennifer Petersen	

	

	

	

	

	

	
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) 6 audit (s) 	
Full Review	
65 / 77 2 Year License 02/19/2019 -  02/19/2021	
	
45 / 51 Certified 02/19/2019 -  02/19/2021	

Residential Services	
1 location(s) 2 audit (s) 	

Full Review	
20 / 22	

Individual Home Supports	
4 location(s) 4 audit (s) 	

Full Review	
21 / 23	

Planning and Quality Management (For all service groupings)	

	
Full Review	
4 / 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) 5 audit (s) 	
Full Review	
45 / 54 2 Year License 02/19/2019 -  02/19/2021	
	
34 / 42 Certified 02/19/2019 -  02/19/2021	

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

Full Review	
12 / 14	

Employment Support Services	
1 location(s) 4 audit (s) 	

Full Review	
18 / 22	

Planning and Quality Management (For all service groupings)	

	
Full Review	
4 / 6	

	

	

EXECUTIVE SUMMARY :	

			
Murphy and Others Living Interdependently for Future Endeavors (M.O. L.I.F.E.)  is a non-profit human service agency founded in 1994 serving individuals with intellectual and developmental disabilities in the Greater New Bedford area. The main focus for the agency is to allow individuals with disabilities and their families to be treated with respect and be allowed the choice to decide their future endeavors. 

The scope of this survey conducted by the Office of Quality Enhancement (OQE)   included a full review of all licensing and certification indicators for 24 hour Residential Supports, Individual Home Supports (IHS), Community Based Day Service (CBDS) and Employment Supports. In addition to the services that comprised this review, the agency also offers medical transportation services, and pre-employment transition services.  In 2000, the agency opened a food pantry that supports 300-500 people in need each month in the Greater New Bedford area.

A strength identified across the agency was how individuals were supported to have meaningful and quality lives through inclusion into their community, while assisting individuals to connect with others with similar social and recreational interests. Options for community involvement were based on people's preferences and in close proximity to where people lived.   The agency also organized events such as a trip to Six Flags, cruise to the Caribbean and sporting events in Boston. Across all settings, staff were observed being respectful when interacting with and when discussing individuals.
 
In residential services, individuals who received assistance with health care coordination where provided assistance to receive routine and preventive health screenings. Individuals were supported to attend follow-up appointments and recommended tests.   Staff were trained in identifying signs and symptoms of illness and were aware of what to do in a medical emergency.  

Individuals were supported and encouraged to regularly visit with friends and family, which an area of strength in residential services.  Supports were provided to assist people to make plans and get together with friends and family both at home and in the community.  In one instance, an individual who struggled with anxiety was supported to visit with his friend and her dog, which helped him cope with some of his anxiety. 

Within community based day supports, individuals were supported to access their community that matched their interest. The agency promoted a person centered approach, which was evident through staff supporting individuals to make frequent and ongoing changes to their daily schedules to allow for preferences regarding options of activities and the staff that supported them. 

Individuals' receiving employment services were supported to successfully maintain jobs in integrated community settings that matched their interests. One individual emphasized the importance to find a job that would work around school vacations so she could spend time with her son. Staff regularly checked in with individuals to enhance retention and advancement in their jobs. 

The review also identified areas which need strengthening. Within residential supports, the agency needs to strengthen its practices to support individuals that have dietary requirements. Practices need to be revised to ensure the individual is consuming the proper food and fluid intake. Efforts should be made to strengthen Medication Treatment Plans (MTP) to include all the required components and ensure they have received the required reviews. Within day supports, the agency needs to ensure they have agreement from guardians for their money management plans. Another area to focus efforts is ensuring support strategies and assessments are submitted according to required timelines. 

Across all services, there are several areas requiring focus to enhance essential safeguards in place and the overall quality of services.  The agency needs to ensure that all staff receive the mandated reporter training.  Monitoring and guidance needs to be enhanced to ensure staff are aware of what constitutes a reportable incident and the required timelines for reporting.   Additionally, it was identified that the agency had a mechanism to inform individuals and their guardians of their human rights; however the agency needs to develop a process for which individuals and their guardians can file a grievance.  Staff need additional training to better support individuals to assess, identify and utilize assistive technology to maximize their independence.   Lastly, efforts should be made to support individuals to provide feedback on staff performance. 

Within twenty-four residential services, the agency needs to provide education and training to staff to help support individuals to explore and define their needs for intimacy and companionship.  

Based on the findings of this report, M.O. L.I.F.E. has earned a Two-Year License and Certified for both the Residential Supports and Employment and Day Supports group. Residential scores were 84% in licensing and 88% in certification; Employment/ Day Support scores were 83% in licensing and 81% in certification. The DDS will be conducting follow-up in 60 days on the licensure indicators not met in residential supports and day/employment supports.	

	

	

LICENSURE FINDINGS	

	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
5/7	
2/7	

Residential and Individual Home Supports	
60/70	
10/70	

    Residential Services
    Individual Home Supports

	

Critical Indicators	
8/8	
0/8	

Total	
65/77	
12/77	
84%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
12	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
5/7	
2/7	

Employment and Day Supports	
40/47	
7/47	

    Community Based Day Services
    Employment Support Services

	

Critical Indicators	
8/8	
0/8	

Total	
45/54	
9/54	
83%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
9	

	

	

	

	

	

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's Human Rights Committee met three times in the last year, which does not meet the requirement of meeting at least quarterly. The agency needs to ensure their Human Rights Committee meets the requirement of meeting at least quarterly. 	

 L83	
Support staff are trained in human rights.	
Agency staff were not trained in the mandated reporting requirements that were required by April 1, 2018. A Notice of Action was issued. The agency needs to ensure that all staff are trained in the most current mandated reporting training requirements. 	

		

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L39	
Special dietary requirements are followed. 	
One individual was prescribed a specialized diet.  As the individual's support needs change, the agency needs to develop a mechanism to track information that can be shared with all staff for consistency with her specialized diet.  	

 L47	
Individuals are supported to become self medicating when appropriate. 	
Two of the six individuals, who participated in the survey  had not been evaluated for their self-medicating skills.  This is essential to ensure that individuals identify any potential changes in skills and to identify any supports that many be needed to maintain independence.  The agency needs regularly reevaluate individuals self-medicating skills. 	

 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.	
In four instances, the agency obtained consent for photo use without identifying the image that would be used, the purpose or to whom the information would be released. The agency needs to ensure that when obtaining consent all required information is included. 	

 L61	
Supports and health related protections are included in ISP assessments and the continued need is outlined.	
For one of the two individuals supported with the use of supports and health related protections, all required information including a procedure for and frequency to ensure equipment is properly functioning was not in place. The agency needs to ensure that all required information is in place for proper utilization of supports. 	

 L62	
Supports and health related protections are reviewed by the required groups.	
For one of two individuals, the information regarding the use of supportive and health related protections was not reviewed by all the required groups. The agency needs to ensure all supportive and health related protections are reviewed by all of the required groups. 	

 L63	
Medication treatment plans are in written format with required components.	
Two medication treatment plans (MTP) did not include a description of the symptoms the medication is prescribed to address, all behavior modifying medication prescribed or method to track and convey information to prescribing clinicians in order to evaluate the effectiveness of the medication. 	

 L64	
Medication treatment plans are reviewed by the required groups.	
Two medication treatment plans (MTP) did not include all of the required components such as all of the medications a person is prescribed, therefore could not be sufficiently reviewed by the required groups. The agency needs to ensure medication treatment plans with all the required components are reviewed by the required groups. 	

 L86	
Required assessments concerning individual needs and abilities are completed in preparation for the ISP.	
Assessments were not submitted within the required time frames for three of the individuals. The agency needs to ensure that assessments are submitted to the DDS area office at least 15 days prior to the scheduled 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.	
Support strategies were not submitted within the required time frames for two of the individuals. The agency needs to ensure that support strategies are submitted to the DDS area office at least 15 days prior to the scheduled ISP meeting. 	

 L91	
Incidents are reported and reviewed as mandated by regulation.	
In one location, there were two incidents that were not reported. The agency needs to ensure that all staff are knowledgeable of the criteria for reportable incidents and that they are reported within the timelines. 	

	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L16	
The location is adapted and accessible to the needs of the individuals.  	
In one location, the kitchen area was not fully accessible or usable by all individuals who have limited mobility and use adaptive equipment. The agency needs to ensure the location is adapted and accessible to the needs of the individuals. 	

 L49	
Individuals and guardians have been informed of their human rights and know how to file a grievance or to whom they should talk if they have a concern.	
Two of the five individuals and/ or their guardian interviewed, did not know how to file a grievance or know whom they should talk to if they have a concern. The agency needs to ensure that on an annual basis, individuals and guardians are informed of the procedures to file a grievance and to whom they should contact with concerns.  	

 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.	
In two instances, the agency obtained consent without identifying the image that would be used, the purpose of use or to whom the information would be released. The agency needs to ensure that when obtaining media related consents that all required information is included. 	

 L67	
There is a written plan in place accompanied by a training plan when the agency has shared or delegated money management responsibility.	
For one person, for whom the agency has shared funds management responsibility, agreement of the money management support plan had not been obtained by the guardian. The agency needs to ensure that agreement to money management supports plans is obtained. 	

 L86	
Required assessments concerning individual needs and abilities are completed in preparation for the ISP.	
Assessments were not submitted within the required time frames for four of the individuals. The agency needs to ensure that assessments are submitted to the DDS area office at least 15 days prior to the scheduled 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.	
Support strategies were not submitted within the required time frames for four of the individuals. The agency needs to ensure that support strategies are submitted to the DDS area office at least 15 days prior to the scheduled ISP meeting. 	

 L91	
Incidents are reported and reviewed as mandated by regulation.	
In one location, there were incidents that were not reported and/ or finalized within the required timelines. The agency needs to ensure that all staff are knowledgeable of the criteria for reportable incidents and that they are reported within the timelines. 	

			

						
	CERTIFICATION FINDINGS	

						
		
Met / Rated	
Not Met / Rated	
% Met	

Certification - Planning and Quality Management	
4/6	
2/6	

Residential and Individual Home Supports	
41/45	
4/45	

Individual Home Supports	
21/23	
2/23	

Residential Services	
20/22	
2/22	

TOTAL	
45/51	
6/51	
88%	

Certified	

	

Met / Rated	
Not Met / Rated	
% Met	

Certification - Planning and Quality Management	
4/6	
2/6	

Employment and Day Supports	
30/36	
6/36	

Community Based Day Services	
12/14	
2/14	

Employment Support Services	
18/22	
4/22	

TOTAL	
34/42	
8/42	
81%	

Certified	

	

						
		
Planning and Quality Management Areas Needing Improvement on Standards not met:	

Indicator #	
Indicator	
Area Needing Improvement	

 C2	
The provider analyzes information gathered from all sources and identifies patterns and trends.	
The agency has not identified patterns and trends within each service which could be beneficial in developing appropriate actions and ongoing strategies to enhance service. The agency needs to utilize data/information gathered to systemically evaluate the quality of services and identify trends and patterns which could assist in identifying areas of additional oversight and monitoring. 	

 C5	
The provider has a process to measure progress towards achieving service improvement goals.	
The agency's growth and development plan does not measure service improvement goals across service types. The agency needs to ensure that it measures progress on an ongoing basis to continually enhance service delivery. 	

	

		

Individual Home Supports- Areas Needing Improvement on Standards not met:	

Indicator #	
Indicator	
Area Needing Improvement	

 C7	
Individuals have opportunities to provide feedback at the time of hire / time of the match and on an ongoing basis on the performance/actions of staff / care providers that support them.	
All individuals had not been offered opportunities to provide feedback on the performance of their staff. The agency needs to ensure that individuals have opportunities to provide feedback on the performance of their staff at the time of hire and on an ongoing basis. 	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
Assessments had not been completed for all individuals regarding their need for assistive technology. Assessments and Plans need to be developed that could help people to use assistive technology in ways that could enhance their independence at work. 	

	

	
Residential Services Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 C14	
Staff (Home Providers) support individuals to make choices regarding daily household routines and schedules.	
The agency is commended for supporting individuals to direct their daily routines and schedules. Staff listed to individuals and supported their choices. 	

	

	
Residential Services- Areas Needing Improvement on Standards not met:	

Indicator #	
Indicator	
Area Needing Improvement	

 C7	
Individuals have opportunities to provide feedback at the time of hire / time of the match and on an ongoing basis on the performance/actions of staff / care providers that support them.	
Two individuals had not been offered opportunities to provide feedback on the performance of their staff. The agency needs to ensure that individuals have opportunities to provide feedback on the performance of their staff at the time of hire and on an ongoing basis. 	

 C12	
Individuals are supported to explore, define, and express their need for intimacy and companionship.	
For one of two individuals, the agency needs to continue its efforts to assess, educate, and support the individual in the areas of intimacy and companionship. The agency needs to assess individuals and provide training to staff to support individuals to explore, define and express their need for intimacy and companionship. 	

	

	
Community Based Day Services Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 C45	
Individual's decisions of what to do during the day are revisited on a regular basis.	
The agency is commended for supporting individuals to direct their daily routines and and revisit decisions. The agency dedicated resources for a designated staff to assist people with making changes in real time to their daily schedules and the staff that worked with them.  	

 C51	
Staff (Home Providers) are knowledgeable about individuals' satisfaction with services and supports and support individuals to make changes as desired.	
The agency staff is commended for their demonstrated knowledge about individuals' satisfaction with services and supports and the variety of support individuals receive to makes changes as desired.  Staff provide effective avenues for individuals and guardians to express dissatisfaction with services, and respond in a reasonable period of time. 	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 C7	
Individuals have opportunities to provide feedback at the time of hire / time of the match and on an ongoing basis on the performance/actions of staff / care providers that support them.	
One individual had not been offered the opportunity to provide feedback on the performance of their staff. The agency needs to ensure that individuals have opportunities to provide feedback on the performance of their staff at the time of hire and on an ongoing basis. 	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
Assessments had not been completed for all individuals regarding their need for assistive technology. Assessments and Plans need to be developed that could help people to use assistive technology in ways that could enhance their independence. 	

	

	
Employment Support Services Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 C29	
Individuals are supported to obtain employment that matches their skills and interests.	
The agency is commended for supporting individuals to obtain and sustain employment that is meaningful to them and matches their skills.  Individuals were supported to learn new tasks within their places of employment and be a valued member of the workforce.  	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 C7	
Individuals have opportunities to provide feedback at the time of hire / time of the match and on an ongoing basis on the performance/actions of staff / care providers that support them.	
Three individuals had not been offered opportunities to provide feedback on the performance of their staff. The agency needs to ensure that individuals have opportunities to provide feedback on the performance of their staff at the time of hire and on an ongoing basis. 	

 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.	
For one individual, additional support was needed to assist the person with understanding how the effect future earnings may have on her entitlements.   The agency needs to ensure all individuals are support to complete an analysis of how a person's entitlements can be managed in a way that allows them to work successfully in the community.	

 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 and that individuals are receiving the benefits to which they are entitled. 	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
Assessments had not been completed for all individuals regarding their need for assistive technology. Assessments and plans need to be developed that could help people to use assistive technology in ways that could enhance their independence at work. 	

	

		

					
	MASTER SCORE SHEET LICENSURE	

					
	Organizational: M.O. Life, Inc.	

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

O	
 L2	
Abuse/neglect reporting	
7/7	
Met	

 L3	
Immediate Action	
2/2	
Met	

 L48	
HRC	
0/1	
Not Met(0 % )	

 L74	
Screen employees	
6/6	
Met	

 L75	
Qualified staff	
1/1	
Met	

 L76	
Track trainings	
6/6	
Met	

 L83	
HR training	
0/6	
Not Met(0 % )	

	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	
2/2	
3/4	

	
	
5/6	
Met
(83.33 %)	

 L5	
Safety Plan	
L	
1/1	
3/4	

	
	
4/5	
Met
(80.0 %)	

O	
 L6	
Evacuation	
L	
1/1	
3/4	

	
	
4/5	
Met
(80.0 %)	

 L7	
Fire Drills	
L	
1/1	

	

1/1	
Met	

 L8	
Emergency Fact Sheets	
I	
1/2	
4/4	

	
	
5/6	
Met
(83.33 %)	

 L9	
Safe use of equipment	
L	
1/1	
4/4	

	
	
5/5	
Met	

 L10	
Reduce risk interventions	
I	
2/2	
2/2	

	
	
4/4	
Met	

O	
 L11	
Required inspections	
L	
1/1	

	

1/1	
Met	

O	
 L12	
Smoke detectors	
L	
1/1	
2/2	

	
	
3/3	
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	
2/2	

	
	
3/3	
Met	

 L17	
Egress at grade 	
L	
1/1	
2/2	

	
	
3/3	
Met	

 L18	
Above grade egress	
L	
	
1/1	

	
	
1/1	
Met	

 L19	
Bedroom location	
L	
1/1	
1/1	

	
	
2/2	
Met	

 L20	
Exit doors	
L	
1/1	
2/2	

	
	
3/3	
Met	

 L21	
Safe electrical equipment	
L	
1/1	

	

1/1	
Met	

 L22	
Well-maintained appliances	
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	
2/2	
4/4	

	
	
6/6	
Met	

 L32	
Verbal & written	
I	
2/2	
4/4	

	
	
6/6	
Met	

 L33	
Physical exam	
I	
2/2	
3/3	

	
	
5/5	
Met	

 L34	
Dental exam	
I	
2/2	
3/3	

	
	
5/5	
Met	

 L35	
Preventive screenings	
I	
2/2	
3/3	

	
	
5/5	
Met	

 L36	
Recommended tests	
I	
2/2	
3/3	

	
	
5/5	
Met	

 L37	
Prompt treatment	
I	
2/2	
3/3	

	
	
5/5	
Met	

O	
 L38	
Physician's orders	
I	
2/2	
1/1	

	
	
3/3	
Met	

 L39	
Dietary requirements	
I	
	
0/1	

	
	
0/1	
Not Met
(0 %)	

 L40	
Nutritional food	
L	
1/1	
3/3	

	
	
4/4	
Met	

 L41	
Healthy diet	
L	
1/1	
4/4	

	
	
5/5	
Met	

 L42	
Physical activity	
L	
1/1	
4/4	

	
	
5/5	
Met	

 L43	
Health Care Record	
I	
2/2	
3/3	

	
	
5/5	
Met	

 L44	
MAP registration	
L	
1/1	

	

1/1	
Met	

 L45	
Medication storage	
L	
1/1	

	

1/1	
Met	

O	
 L46	
Med. Administration	
I	
1/1	

	

1/1	
Met	

 L47	
Self medication	
I	
2/2	
2/4	

	
	
4/6	
Not Met
(66.67 %)	

 L49	
Informed of human rights	
I	
2/2	
3/4	

	
	
5/6	
Met
(83.33 %)	

 L50	
Respectful Comm.	
L	
1/1	
4/4	

	
	
5/5	
Met	

 L51	
Possessions	
I	
2/2	
4/4	

	
	
6/6	
Met	

 L52	
Phone calls	
I	
2/2	
4/4	

	
	
6/6	
Met	

 L53	
Visitation	
I	
2/2	
4/4	

	
	
6/6	
Met	

 L54	
Privacy	
L	
0/1	
4/4	

	
	
4/5	
Met
(80.0 %)	

 L55	
Informed consent	
I	
0/2	
0/2	

	
	
0/4	
Not Met
(0 %)	

 L61	
Health protection in ISP	
I	
1/1	
0/1	

	
	
1/2	
Not Met
(50.0 %)	

 L62	
Health protection review	
I	
1/1	
0/1	

	
	
1/2	
Not Met
(50.0 %)	

 L63	
Med. treatment plan form	
I	
0/1	
0/1	

	
	
0/2	
Not Met
(0 %)	

 L64	
Med. treatment plan rev.	
I	
0/1	
0/1	

	
	
0/2	
Not Met
(0 %)	

 L67	
Money mgmt. plan	
I	
1/1	
1/1	

	
	
2/2	
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	
2/2	

	

2/2	
Met	

 L71	
Charges for care appeal	
I	
2/2	

	

2/2	
Met	

 L77	
Unique needs training	
I	
2/2	
3/4	

	
	
5/6	
Met
(83.33 %)	

 L78	
Restrictive Int. Training	
L	
	
1/1	

	
	
1/1	
Met	

 L80	
Symptoms of illness	
L	
1/1	
4/4	

	
	
5/5	
Met	

 L81	
Medical emergency	
L	
1/1	
4/4	

	
	
5/5	
Met	

O	
 L82	
Medication admin.	
L	
1/1	

	

1/1	
Met	

 L84	
Health protect. Training	
I	
1/1	
1/1	

	
	
2/2	
Met	

 L85	
Supervision 	
L	
1/1	
4/4	

	
	
5/5	
Met	

 L86	
Required assessments	
I	
2/2	
1/4	

	
	
3/6	
Not Met
(50.0 %)	

 L87	
Support strategies	
I	
2/2	
2/4	

	
	
4/6	
Not Met
(66.67 %)	

 L88	
Strategies implemented	
I	
2/2	
4/4	

	
	
6/6	
Met	

 L90	
Personal space/ bedroom privacy	
I	
2/2	
4/4	

	
	
6/6	
Met	

 L91	
Incident management	
L	
1/1	
1/2	

	
	
2/3	
Not Met
(66.67 %)	

#Std. Met/# 70 Indicator	

	

	

60/70	

	
Total Score	

	

	

65/77	

	

	

	

	
84.42%	

		
							
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	
3/4	
	
1/1	
4/5	
Met
(80.0 %)	

 L5	
Safety Plan	
L	
1/1	
	
1/1	
2/2	
Met	

O	
 L6	
Evacuation	
L	
1/1	
	
1/1	
2/2	
Met	

 L7	
Fire Drills	
L	
1/1	
	
1/1	
2/2	
Met	

 L8	
Emergency Fact Sheets	
I	
2/2	
	
1/1	
3/3	
Met	

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

 L10	
Reduce risk interventions	
I	

1/1	
1/1	
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	

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

 L16	
Accessibility	
L	
1/1	
	
0/1	
1/2	
Not Met
(50.0 %)	

 L17	
Egress at grade 	
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	
Well-maintained 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	
Met	

 L30	
Protective railings	
L	

1/1	
1/1	
Met	

 L31	
Communication method	
I	
4/4	
	
1/1	
5/5	
Met	

 L32	
Verbal & written	
I	
4/4	
	
1/1	
5/5	
Met	

 L37	
Prompt treatment	
I	
3/3	

3/3	
Met	

O	
 L38	
Physician's orders	
I	

1/1	
1/1	
Met	

 L39	
Dietary requirements	
I	

1/1	
1/1	
Met	

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

 L45	
Medication storage	
L	

1/1	
1/1	
Met	

O	
 L46	
Med. Administration	
I	

1/1	
1/1	
Met	

 L49	
Informed of human rights	
I	
2/4	
	
1/1	
3/5	
Not Met
(60.0 %)	

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

 L51	
Possessions	
I	
4/4	
	
1/1	
5/5	
Met	

 L52	
Phone calls	
I	
4/4	
	
1/1	
5/5	
Met	

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

 L55	
Informed consent	
I	
0/2	

0/2	
Not Met
(0 %)	

 L67	
Money mgmt. plan	
I	

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

 L68	
Funds expenditure	
I	

1/1	
1/1	
Met	

 L69	
Expenditure tracking	
I	

1/1	
1/1	
Met	

 L77	
Unique needs training	
I	
3/4	
	
1/1	
4/5	
Met
(80.0 %)	

 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	
Met	

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

 L86	
Required assessments	
I	
0/4	
	
1/1	
1/5	
Not Met
(20.0 %)	

 L87	
Support strategies	
I	
0/4	
	
1/1	
1/5	
Not Met
(20.0 %)	

 L88	
Strategies implemented	
I	
4/4	
	
1/1	
5/5	
Met	

 L91	
Incident management	
L	
1/1	
	
0/1	
1/2	
Not Met
(50.0 %)	

#Std. Met/# 47 Indicator	

	

40/47	

	
Total Score	

	

45/54	

	

	

	
83.33%	

		
							
	MASTER SCORE SHEET CERTIFICATION	

							
	
Certification - Planning and Quality Management	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C1	
Provider data collection	
1/1	
Met	

 C2	
Data analysis	
0/1	
Not Met (0 %)	

 C3	
Service satisfaction	
1/1	
Met	

 C4	
Utilizes input from stakeholders	
1/1	
Met	

 C5	
Measure progress	
0/1	
Not Met (0 %)	

 C6	
Future directions planning	
1/1	
Met	

	

	

							
Community Based Day Services	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff / care provider performance	
0/1	
Not Met (0 %)	

 C8	
Family/guardian communication	
1/1	
Met	

 C13	
Skills to maximize independence 	
1/1	
Met	

 C37	
Interpersonal skills for work	
1/1	
Met	

 C40	
Community involvement interest	
1/1	
Met	

 C41	
Activities participation	
1/1	
Met	

 C42	
Connection to others	
1/1	
Met	

 C43	
Maintain & enhance relationship	
1/1	
Met	

 C44	
Job exploration	
1/1	
Met	

 C45	
Revisit decisions	
1/1	
Met	

 C46	
Use of generic resources	
1/1	
Met	

 C47	
Transportation to/ from community	
1/1	
Met	

 C51	
Ongoing satisfaction with services/ supports	
1/1	
Met	

 C54	
Assistive technology	
0/1	
Not Met (0 %)	

Employment Support Services	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff / care provider performance	
1/4	
Not Met (25.00 %)	

 C8	
Family/guardian communication	
4/4	
Met	

 C22	
Explore job interests	
3/3	
Met	

 C23	
Assess skills & training needs	
3/3	
Met	

 C24	
Job goals & support needs plan	
3/3	
Met	

 C25	
Skill development	
4/4	
Met	

 C26	
Benefits analysis	
2/3	
Not Met (66.67 %)	

 C27	
Job benefit education	
2/2	
Met	

 C28	
Relationships w/businesses	
1/1	
Met	

 C29	
Support to obtain employment	
4/4	
Met	

 C30	
Work in integrated settings	
4/4	
Met	

 C31	
Job accommodations	
4/4	
Met	

 C32	
At least minimum wages earned	
2/2	
Met	

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

 C34	
Support to promote success	
4/4	
Met	

 C35	
Feedback on job performance	
3/4	
Met	

 C36	
Supports to enhance retention	
4/4	
Met	

 C37	
Interpersonal skills for work	
4/4	
Met	

 C47	
Transportation to/ from community	
4/4	
Met	

 C50	
Involvement/ part of the Workplace culture	
4/4	
Met	

 C51	
Ongoing satisfaction with services/ supports	
4/4	
Met	

 C54	
Assistive technology	
0/4	
Not Met (0 %)	

Individual Home Supports	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff / care provider performance	
0/4	
Not Met (0 %)	

 C8	
Family/guardian communication	
4/4	
Met	

 C9	
Personal relationships	
4/4	
Met	

 C10	
Social skill development	
4/4	
Met	

 C11	
Get together w/family & friends	
4/4	
Met	

 C12	
Intimacy	
4/4	
Met	

 C13	
Skills to maximize independence 	
4/4	
Met	

 C14	
Choices in routines & schedules	
4/4	
Met	

 C15	
Personalize living space	
4/4	
Met	

 C16	
Explore interests	
4/4	
Met	

 C17	
Community activities	
4/4	
Met	

 C18	
Purchase personal belongings	
4/4	
Met	

 C19	
Knowledgeable decisions	
4/4	
Met	

 C20	
Emergency back-up plans	
4/4	
Met	

 C21	
Coordinate outreach	
4/4	
Met	

 C46	
Use of generic resources	
4/4	
Met	

 C47	
Transportation to/ from community	
4/4	
Met	

 C48	
Neighborhood connections	
4/4	
Met	

 C49	
Physical setting is consistent 	
2/2	
Met	

 C51	
Ongoing satisfaction with services/ supports	
4/4	
Met	

 C52	
Leisure activities and free-time choices /control	
4/4	
Met	

 C53	
Food/ dining choices	
4/4	
Met	

 C54	
Assistive technology	
1/4	
Not Met (25.00 %)	

Residential Services	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff / care provider performance	
0/2	
Not Met (0 %)	

 C8	
Family/guardian communication	
2/2	
Met	

 C9	
Personal relationships	
2/2	
Met	

 C10	
Social skill development	
2/2	
Met	

 C11	
Get together w/family & friends	
2/2	
Met	

 C12	
Intimacy	
1/2	
Not Met (50.0 %)	

 C13	
Skills to maximize independence 	
2/2	
Met	

 C14	
Choices in routines & schedules	
2/2	
Met	

 C15	
Personalize living space	
1/1	
Met	

 C16	
Explore interests	
2/2	
Met	

 C17	
Community activities	
2/2	
Met	

 C18	
Purchase personal belongings	
2/2	
Met	

 C19	
Knowledgeable decisions	
2/2	
Met	

 C20	
Emergency back-up plans	
1/1	
Met	

 C46	
Use of generic resources	
2/2	
Met	

 C47	
Transportation to/ from community	
2/2	
Met	

 C48	
Neighborhood connections	
2/2	
Met	

 C49	
Physical setting is consistent 	
1/1	
Met	

 C51	
Ongoing satisfaction with services/ supports	
2/2	
Met	

 C52	
Leisure activities and free-time choices /control	
2/2	
Met	

 C53	
Food/ dining choices	
2/2	
Met	

 C54	
Assistive technology	
2/2	
Met