Department of Mental Retardation
Office of Quality Management, Office of Quality Enhancement 
Licensure and Certification

		Report Date:  March 27, 2007

Agency:  Cerebral Palsy Association of Eastern Massachusetts, Inc.

Review Dates: 2/28/2007   to 3/12/2007 

Licensure:  3/22/2007 to 3/22/2009  

Licensure Level:  Two-Year License

Follow-Up Required:  Yes.  The Organization has Systems in Place to Safeguard Individuals

Certification Performed By:   The Department of Mental Retardation for Residential Supports 

Certification Completed On:  3/22/2007

Certification Outcome:  Certified with 4 out of 6 Quality of Life Areas Achieved 

Survey Team: Sue Mullen (Team Leader)

Citizen Volunteer(s):  Alice Flynn

Number of Individual Reviews Completed:  [2 ]	
								[02] Residential Reviews
			 					[   ] Work/Community Reviews
								[   ] Respite Reviews (Not Rated)
						[   ] Safeguard System Reviews 
						       (Not Rated)

EXECUTIVE SUMMARY

Cerebral Palsy Association of Eastern Massachusetts, Inc. (CPEM) provides services to individuals with physical challenges and developmental disabilities.  It receives funding through the Department of Public Health, the Massachusetts Rehabilitation Commission, the Office of Child Care Services and the Department of Mental Retardation.  The majority of the agency’s services are provided to families and children through an early intervention program and a service to at-risk families of infants and young children.  The agency also provides employment related services funded via the Massachusetts Rehabilitation Commission and through an Independent Living program for adults for a much smaller group of people.  A residential service in a group home setting for four individuals is funded through the Department of Mental Retardation and is the subject of this review. 

For the purpose of this survey, two of four individuals living in a Department of Mental Retardation funded  home were selected and participated in the full survey and certification process.  It should be noted that all the individuals served in this home had major physical and/or health care challenges.  Since the current survey included a full licensure and certification process, safeguards in the areas of health, safety and human rights as well as quality of life areas such as choice-making, the development of relationships and social activities were reviewed.   

CPEM demonstrated a number of strengths including consistency and stability of staff who work with individuals, a house director who worked hand in hand with staff,  an open door policy for families, and a commitment by  the administration to work with local civic organizations to improve on the appearance of the home over time.   Long term staff who knew the individuals well contributed to the comfort level of both individuals living at the home and their family members.  Families were welcome to visit at all times and were included in events occurring at the home.  Staff were responsive to family members’ concerns.  One example of this was staff efforts to assist one family to obtain U.S. citizenship for their daughter.  With regard to the upkeep and appearance of the home, the agency had worked with Peabody Community Development and, through a grant, had recently installed a new kitchen and new windows in the home.  Staff had purchased professional photographs of the individuals which were nicely displayed in the living room and contributed to individuals’ sense of belonging and to a more valued appearance for their home.   

CPEM is in compliance with basic training requirements and processes for the evaluations of staff, including the input of the individuals served.  In the past year, specialized trainings occurred with the physical therapist at Hogan Regional Center providing staff with education and information relative to transferring individuals and preparing the home for adaptation for individuals.  In addition, the  DMR human rights specialist for the region had provided training to staff.   Staff were also encouraged to pursue additional training and a number of staff had received certificates or were currently enrolled in the direct support professional certificate program from the North Shore Community College.  In addition to encouragement, staff participating in this program were given paid time to pursue higher education in their field.  

Safeguards were in place at the Glenway residence.  The physical site review indicated that the home was safe, secure and in good repair.  Staff met basic training requirements in first aid, CPR, and fire safety.  They ensured that people were able to safely evacuate from their home in a timely manner.  The agency was also found to meet regulatory requirements relative to the review of restrictive interventions which included supportive protective devices and behavior modifying medications for the two individuals who participated in the survey.  Both of these restrictive practices were appropriately reviewed by the human rights committee utilized by the agency and documentation was present to address the requirements of the DMR regulations.  The agency had been responsive to issues identified during previous surveys in this area.  

Health care records were completed for individuals surveyed as required.  Staff supported individuals to obtain necessary health care by attending both regular and specialized doctor’s appointments with family members.  Medications were administered appropriately. The agency also accessed the orthopedic clinic at Hogan Regional Center for individuals.  On a monthly basis, VNA services were utilized to review medications and general health care needs of the individuals.  VNA nurses provided some technical assistance for the staff.

Although interviews indicated that individuals were supported to meet their goals, there were concerns regarding the assistance that individuals received toward meeting their goals.  Strategies were not fully developed or were not being addressed in the progress notes of the individuals, making it difficult to track people’s progress towards their goals.  The agency did not always keep data reflecting strategies identified in the ISP.  
 
There were issues that CPEM should address to further improve its services to individuals.  The results of this survey raised concerns regarding the frequency of individuals’ use of community resources and opportunities for involvement in their community, suggesting that the agency staff might benefit from additional consultation and training  relative to the value of community integration for all individuals.  The agency also needs to take a more active role in the human rights committee  where issues related to human rights of the individuals served at CPEM are presented. Also, given the fact that one individual has a chronic debilitating disease it is recommended that the agency provide or access additional clinical consultation to assist staff in caring for this individual.   

CPEM is encouraged to focus on ways to support growth and change to continually improve its supports to individuals.  CPEM’s mission statement: “to equip and enable individuals with cerebral palsy and others with severe disabilities to attain the fullest possible employment, productivity and participation in an integrated community,” is an inspiring one.  More specificity is needed, however, to further define agency goals for the home, develop implementation strategies, set timelines for achievement and identify persons responsible for meeting the targets set.  The agency also needs to expand its processes to solicit input from staff, DMR, family members, and individuals when developing long range plans for the organization. 

The results of the survey indicate that Cerebral Palsy Association of Eastern Massachusetts, Inc. is licensed for two years and is certified with four out of six quality of life areas achieved.  Agency strengths, including the provision of a home-like atmosphere and the presence of stable, caring long-term staff, as well as ongoing improvements in the physical environment in this home form a strong and valuable basis for continued service quality improvement.  The agency’s commitment to the four people served at the Glenway residence is clear, and administrators are encouraged to consider additional networking with other organizations that focus on best practice strategies in serving adult individuals with severe disabilities in order to share ideas and refine and strengthen its services.    

Provider Scoring Summary

Licensure Review 

Quality of Life
Area	
Residential
Supports	Work/
Community
Supports	
Respite
Supports	
Overall Provider
Rating	

Rights & Dignity	
Achieved		
	
Achieved	
Personal Well-
Being	
Achieved		
	
Achieved	
Organizational Outcomes:  The organization has systems in place to safeguard people.
	Partially Achieved	

Certification Review

Quality of Life
Area	
Residential
Supports	Work/
Community
Supports	
Respite
Supports	
Overall Provider
Rating	

Individual Control	
Achieved		
	
Achieved	
Community and
Social Connections	
Partially Achieved		
	
Partially Achieved	
Personal Growth &
Accomplishments	
Achieved		
	
Achieved	
Organizational Outcomes:  Staff have the skills and knowledge to support the quality  
                                               of life of people.	Achieved	
Organizational Outcome:  The organization supports growth and change to continually 
                                              improve its quality of supports	Partially Achieved	

Organizational Combined Rating:
(Based on both the licensure organizational outcome and the two certification quality of life outcomes)	

Partially Achieved	

Department of Mental Retardation
Office of Quality Management, Office of Quality Enhancement 
Licensure and Certification

Section I

Licensure Review 

Outcome of Individual Quality Reviews

Rights and Dignity
Personal Well-Being

Outcomes for the Organization

The agency has systems in place to safeguard people.

QUALITY OF LIFE AREA
RIGHTS AND DIGNITY
Rating:  Achieved

Principles:  Support and affirmation of individual rights are safeguards for all people as citizens of the United States.  These rights are framed in the Constitution, Bill of Rights, and Federal and State statutes.  They include such freedoms as the rights to privacy, free speech and due process.  The actualization of individual rights is especially important to people with disabilities because they have not always been afforded these most basic of guarantees and may need support to exercise their rights.  In order to have their rights affirmed, individuals first must be respected, valued and treated with positive regard.

QUALITY OF LIFE SCORING SUMMARY

Outcomes 
and Indicators	
Residential Reviews	Work &
Community
Reviews	
Respite
Reviews	
% of Indicators

(Excluding Respite) 	
People are valued:
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	Interactions are respectful of people.
	2	0					100%	-	
B.	People are supported to identify themselves as adults.	2	0					100%	-	
C.	People are supported to take pride in themselves and their surroundings.	2	0					100%	-	
D.	People live and work in settings that are typical of other members of the community.	2	0					100%	-	
People’s rights are affirmed:
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	People and/or those supporting them understand individual rights.	2	0					100%	-	
B.	People’s rights are exercised in their everyday lives.	2	0					100%	-	
C.	People receive the same treatment as other employees.	N/A	N/A					N/A	N/A	
D.	People receive comparable wages and benefits as other employees.	N/A	N/A					N/A	N/A	
People’s rights are protected.
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	All interventions are the least intrusive and are based upon people’s unique needs.	2	0					100%	-	
B.	All interventions are included in a written plan.	2	0					100%	-	
C.	People, or their guardians, knowingly and voluntarily give consent and have the opportunity to refuse or withdraw approval.	2	0					100%	-	
D.	Safeguards ensure a thorough review and approval process when needed.	2	0					100%	-	
E.	All interventions are safely, accurately and    consistently implemented.	2	0					100%	-	

                                                           QUALITY OF LIFE AREA
PERSONAL WELL-BEING
Rating:  Achieved

Principles:  Being safe, secure and healthy provides a foundation that enables people to have a truly fulfilling life and do the things that are important to them.  As with rights, certain universal things contribute to the well-being of everyone in society, regardless of who they are and their personal circumstance.  These universals include having routine physical examinations, wearing seat belt, or installing smoke detectors.  Beyond the universal safeguards, personal well-being is supported by a recognition of people’s skills and needs as balanced against their lifestyle choices.  Services are designed to assist people to be secure, achieve and/or maintain good health, to make decisions that keep them out of harm’s way, and to ensure a prompt response when people’s safety, security or health are compromised.

QUALITY OF LIFE SCORING SUMMARY

Outcomes 
and Indicators	
Residential Reviews	Work &
Community
Reviews	
Respite
Reviews	
% of Indicators

(Excluding Respite) 	
People are safe at home and work:
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	People’s home and work place are safe, secure, and in good repair.	2	0					  100%	    -	
B.	People and their supporters know what to do in an emergency.	2	0					  100%	    -	
C.	People can safely evacuate from their home or work place in an emergency.	2	0					  100%	    -	
D.	There are adequate supports for people to be safe in their home and work.	2	0					  100%	    -	
E.	People use materials and equipment safely.	N/A
	N/A
					  N/A	  N/A	
People are free from harm:
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	Supports are in place if people make decisions that put them at risk.	N/A	N/A					  N/A	  N/A	
B.	Immediate actions are taken to ensure people’s safety.	N/A	N/A					  N/A	  N/A	
C.	Actions are taken to correct the situation when people have been mistreated.	N/A	N/A					  N/A	  N/A	
D.	Steps are taken to prevent the situation from occurring again.	N/A	N/A					  N/A	  N/A	
E.	People know how or have support to report a situation where they feel they are being or have been mistreated or harmed.	2	0					   100%	    -	

PERSONAL WELL BEING: - Continued

Outcomes 
and Indicators	
Residential Reviews	Work &
Community
Reviews	
Respite
Reviews	
% of Indicators

(Excluding Respite) 	
People maintain good health:
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	People are supported to have a health lifestyle.	2	0					  100%	    -	
B.	People are supported to be active participants in their health care.	2	0					  100%	    -	
C.	People have needed routine and specialized health care services.	2	0					  100%	    -	
D.	Supporters are knowledgeable about people’s health care needs.	2	0					  100%	   -	
E.	People’s medications are given properly and as prescribed by the practitioner.	2	0					  100%	   -	
People’s funds are safeguarded:
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	People receive the support and/or education they need in managing their financial resources.	2	0					  100%	   -	
B.	People’s funds are managed properly and with their consent.	2	0					  100%	   -	

                                   OUTCOMES FOR THE ORGANIZATION

Principles:  Positive outcomes for individuals are the result of many factors, not the least of which is a strong, coherent organizational structure.  For positive outcomes for individuals to be sustained over time, across all settings and by all staff, agencies need to create an infrastructure and culture that supports quality and safeguards individuals.

SCORING SUMMARY

Outcome and Indicators	
Agency
Totals	
The organization has systems in place to safeguard individuals:
Partially Achieved	
Finding	% of IndicatorsPresent	
A.	The organization has strategies that proactively ensure that essential safeguards are in place       across settings and over time.	Yes	

   67 %	
B.	The organization has systems in place to affirm and protect the rights and dignity of individuals.	No		
C.	The agency implements procedures that minimize unnecessary risk to individuals.
	Yes		

Department of Mental Retardation
Office of Quality Management, Office of Quality Enhancement 
Licensure and Certification

Section II

Certification Review

Outcome of Individual Quality Reviews

Individual Control
Community and Social Connections
Personal Growth and Accomplishment

Outcome for the Organization

Staff have the skills and knowledge to support the quality of life of people.
The organization improves services as a result of these analyses.

	

QUALITY OF LIFE AREA
INDIVIDUAL CONTROL
Rating:  Achieved

Principles:  Being able to direct the course of one’s life is something for which all people strive.  Self-determination is expressed in all aspects of people’s lives, both in little, everyday things such as deciding when to get up as well as in major life decisions that may have a deep, long lasting effect such as deciding on a certain career or moving to a new community.  The type and amount of support people need to take charge of their lives varies greatly.  For some, even making everyday choices is a new experience and they need much guidance in learning how to make both everyday and major choices.  For others, periodic check-ins and discussions are needed to keep them on course and to make sure they have an understanding of their options and of the consequences of their decisions.  What is important is that people have all the information they need to make decisions, that they are empowered and supported to take action, and that they understand how their decisions affect their lives.
QUALITY OF LIFE SCORING SUMMARY

Outcomes 
And Indicators	
Residential Reviews	Work &
Community
Reviews	
Respite
Reviews	
% of Indicators

(Excluding Respite) 	
People are understood: 
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	Supporters understand what people are expressing.	2	0					100%	   -	
B.	Supporters use people’s primary means of communication.	2	0					100%	   -	
C.	Supporters assist people to communicate with and be understood by others.	2	0					100%	   -	
People make choices in
their everyday lives:
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	People make choices about their routines and schedules.	2	0					 100%	   -	
B.	People make choices about the work and household tasks for which they are responsible.	2	0					 100%	   -	
C.	People spend their leisure time in personally satisfying ways.	2	0					  100% 	   -	
People are the primary decision- 
makers in their lives:
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	People develop their personal goals.
	2	0					  100%	   -	
B.	People influence who provides their supports.	2	0					  100%	   -	
C.	People control important decisions about their home and home life.	2	0					  100%	   -	
D.  People choose where they work or, if they choose not to work, people have options that are meaningful to them.	N/A	N/A					   N/A	  N/A	

                                                           QUALITY OF LIFE AREA
COMMUNITY AND SOCIAL CONNECTIONS
Rating:  Partially Achieved

Principles:  Membership in community life supports people’s sense of belonging and provides opportunities for citizenship, friendship and valued roles in society.  Everyone has unique, identifiable ways that he or she is connected to the community and to other people who are important to them.  Being a part of community life means that people are using all the resources and amenities that others use.  Being connected also means that people have other people in their lives who are important to them, who are there for them when needed and with whom they can share their thoughts and concerns.  It also includes having a place in society, a place that other people recognize and value.  It may mean helping out neighbors and friends when needed or having talents and gifts that are recognized and shared with other people.

QUALITY OF LIFE SCORING SUMMARY

Outcomes 
and Indicators	
Residential Reviews	Work &
Community
Reviews	
Respite
Reviews	
% of Indicators

(Excluding Respite) 	
People are integrated into 
their community:
Partially Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	People live and work in communities with the resources they want and need.	2	   0					  100%	   -	
B.	People use the same community resources as others on a frequent and ongoing basis.	0	   2					     -	  100%	
People are connected with 
their community:
Partially Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	People are supported to explore their personal interests and options for community involvement.	0	2					     -	  100%	
B.	People are involved in activities that connect them to other people in the community.	2	0					  100%	    -	
People have relationships:
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	People are supported to maintain and enhance relationships with family, friends and co-workers.	2	0					  100%	    -	
B.	People are supported to develop new friendships.	2	0					  100%	    -	
C.	People are supported to explore, define, and express their need for intimacy.	2	0					  100%	    -	

                                                          QUALITY OF LIFE AREA
PERSONAL GROWTH AND ACCOMPLISHMENT
Rating:  Achieved

Principles:  While developing one’s own goals is a critical first step in making decisions about one’s life, achieving personal goals and developing the skills to be as independent as possible give individuals a sense of purpose, direction and self-fulfillment in their lives.  The strategies and support used in assisting people to reach their goals takes on many forms and should be tailored to people’s unique skills, needs, preferences and style of learning.  It includes helping people to learn from both planned as well as unanticipated events in their lives.  While there is much to be proud of in acquiring the skills to do things independently, it does not mean that people are independent in everything they do.  There is the joy that people feel in accomplishing things together and the feeling of self-worth that comes with completing something as independently as possible.

QUALITY OF LIFE SCORING SUMMARY

Outcomes 
and Indicators	
Residential Reviews	Work &
Community
Reviews	
Respite
Reviews	
% of Indicators

(Excluding Respite) 	
People accomplish their goals:
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	People’s goals are the basis of actions and supports.	1	1					   50 %	   50%	
B.	There is a match between what people are doing now and what they want to do in the future.	2	0					  100%	     -	
C.	People have access to needed resources in order to accomplish their goals.	2	0					  100%	     -	
D.	There are supports to get a job that people like.	N/A	N/A					   N/A	    N/A	
E.	There are supports to succeed at the job.	N/A	N/A					    N/A	   N/A 	
F.	People are supported to advance in their job.	N/A	N/A					    N/A	   N/A	
People have autonomy:
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	People complete day-to-day activities, tasks and chores as independently as possible.	2	0					  100%	    -	
B.	People have access within their home and workplace.	2	0					  100%	    -	
People grow through their 
life experiences:
Achieved	
Yes	
No	
Yes	
No	
Yes	
No	
Yes	
No	
A.	Supporters are sensitive and attuned to both small and large events in people’s lives.	2	0					  100%	    -	
B.	People are encouraged to understand experiences in their lives.	2	0					  100%	    -	
C.	People are supported to grow from events in their lives that affect them.	2	0					  100%	    -	

Department of Mental Retardation
Office of Quality Management, Office of Quality Enhancement 
Licensure and Certification

OUTCOME FOR THE ORGANIZATION

Principles:  Positive outcomes for individuals are the result of many factors, not the least of which is a strong, coherent organizational structure.  For positive outcomes for individuals to be sustained over time, across all settings and by all staff, agencies need to create an infrastructure and culture that supports quality and safeguards individuals.

SCORING SUMMARY
Staff have the skills and knowledge to support 
the quality of life of individuals:
Achieved	
Finding	% of IndicatorsPresent	
A.	The agency recruits and maintains a competent work force.
	Yes	
100%
	
B.	The agency has ways to support staff knowledge, effectiveness and creativity.
	Yes		
The organization supports growth and change to continually
improve its supports to individuals:
Partially Achieved	
Finding	% of IndicatorsPresent	
A.	The organization has processes to evaluate the quality of its supports.
	Yes	

50%	
B.	The organization improves services as a result of these analyses.
	No