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

Report Date:  11/10/2008
Agency:  CROTCHED MOUNTAIN FOUNDATION
Review Dates:  October 16, 2008 to October 23, 2008
Licensure:  November 4, 2008 to November 4, 2009
Licensure Level:  CONDITIONAL ONE-YEAR LICENSE

Follow-Up Required:  Yes
(Organizational Outcome: The organization has systems in place to safeguard people.)	
(Individual Outcome: People’s rights are affirmed.)	
(Individual Outcome: People’s rights are protected.)	
(Individual Outcome: People are safe at home and work.)	
(Individual Outcome: People are protected from harm.)	
(Individual Outcome: People maintain good health.)	
(Individual Outcome: People’s funds are safeguarded.)	
 
Certification Performed By:	DMR for Residential	
 
Certification Completed On:  November 4, 2008
Certification Outcome:  CERTIFIED: 1 of 6 Achieved
Survey Team:	Michelle Stomboly (Team Leader)	
 
Number of Individual Reviews Completed:  [ 2 ]
[ 2 ]	Residential		
 
[ 0 ]	Safeguard System Reviews	(Not Rated)	
EXECUTIVE SUMMARY
Crotched Mountain Foundation is a nonprofit charitable organization serving children and adults with disabilities and their families since 1953.  The organization’s main facility is located in New Hampshire on a 1,400-acre residential campus which includes a school, hospital, outpatient clinic, brain injury center, media center, an athletic complex.  Crotched Mountain provides a wide array of programs and services to 2,500 consumers annually in Greenfield, throughout New Hampshire, and in locations in New England and New York. 

For the purpose of this review, the services provided to two men in the organization’s only Massachusetts based residential home serving two individuals were reviewed.  Crotched Mountain has provided residential support to these two individuals in the Merrimack Valley area since 1984.   The current process was a full licensing and certification review, which encompasses all Quality of Life Areas included in the Quality Enhancement tool.

There were areas where the agency had made or maintained improvements since the last survey relative to the environmental safety of the home and staff longevity.  Some safeguard issues identified in the previous survey, such as home repairs to the outside of the home and porch had been addressed.  In general, the physical site review found the home to be safe, secure, and in good repair.  Safety features were in place and operational.  For example, fire extinguishers were inspected, interconnected smoke detectors were in working order, and flammable materials were not found in the home.  

In addition to home maintenance, the organization’s ability to maintain long-term direct care staff continues to be notable.  The staff providing care and support directly to the men in the home had been employed with the agency for many years.  They have worked with the men in this home for a long time and have established a trusting relationship with them.  The interactions of the staff with the residents were observed to be respectful and positive, and people were described in respectful, positive and affirming ways throughout the survey.  

The organization has encountered a number of changes and challenges since its last licensing review.  For example, since the last review, the turn-over of staff in the residential supervisor position continues to be an on-going challenge.  Many of the issues previously identified, and systems that had been developed or considered to address these concerns, were either not implemented or have not been maintained.  Consequently, the supports provided to the men in this home were affected, and a significant number of safeguard issues were identified throughout the survey.  The agency will need to take steps, both at the agency level and at the home location to ensure that all necessary safeguards across several Quality of Life areas, are in place

The agency needs to address issues identified in the quality of life area, Rights and Dignity.  For example, the occurrence of annual and on-going training for people and those supporting them to understand and exercise their rights was not fully evident.  The protection of people’s rights through proper due process had also not occurred.  The organization must adhere to the required regulatory requirements for administering behavior modifying medications. For example, specific criteria for the administration of the medication and its side effects, current and baseline data, and clinical indications for terminating the medication needs to be part of a medication plan.  The agency must ensure that all plans involving the use of behavior modifying medications have been reviewed by the Human Rights Committee.  The DMR’s policy and regulations relating to human rights should be the impetus towards addressing these issues.  

Follow-up is required in the quality of life area, Personal Well-Being, as many outcomes were not present relating to health, safety and security.  It was evident that staff did not always implement, nor were they always aware of, the required safeguards in the areas of fire safety, health care, medication, and finances.  For example, some information required by regulations was not kept current and accurate such as current medication listed on the EFS.  Regarding fire safety, staff had not received the required safety trainings; the agency’s plan for fire safety evacuation had expired, was not present in the home and staff had not been appropriately trained in this procedure; the required asleep fire drills had not occurred in the past two years.  Staff and individuals had not received training in DPPC and their personal responsibility as mandated reporters of potential abuse or neglect.  Regarding financial safeguards, regulatory requirements relating to the agency’s delegated responsibility for people’s funds was missing, including money management plans and information pertaining to charges for care.  

Crotched Mountain will require follow-up for the organizational safeguard outcome.  As identified in the previous survey, Crotched Mountain has yet to establish a functional Human Rights Committee responsible for the oversight of this home.  Additionally, the organization had not maintained a trained human rights officer in the home.  Furthermore, the organization needs to evaluate its current systems and develop additional mechanisms for safeguarding individuals, particularly in the area of rights protections and safety practices.  For example, the current curriculum used by the agency for physical interventions has not been approved, as required, by DMR.  The agency needs to ensure that it meets these regulatory requirements.

In addition to the areas requiring follow-up in the licensing outcomes, there were many obstacles and challenges identified during the review of the certification outcomes that impacted people’s achievement in several of these areas.  For example, while the accomplishment of some goals was evident, there was no input from individuals noted in the development of personal goals that reflected the individuals’ desires and aspirations, nor was there evidence of on-going guidance and support to explore and participate in leisure activities.  There was little support for people to integrate and connect with their community, and the development and maintenance of new relationships was not present.  Consequently, people’s life experiences were limited.  Crotched Mountain needs to organizationally attune itself to assure continual growth and improvement of the quality of its supports.  For example, the agency needs to insure that it solicits input regarding the quality of its services from all stakeholders, including the individuals being served.  This information could be used in the future planning, goal development and quality improvement of services, and planning should be program specific and identify oversight strategies.  Additionally, the organization needs to ensure that supervision includes sufficient monitoring to ensure that the program standards are being maintained.  

In summary, Crotched Mountain received a One Year Conditional License as result of having a Partially Achieved in the Quality of Life areas Rights and Dignity and Personal Well-Being, and a not achieved within the outcome Safeguards for the Organization. These outcomes will be the subject of follow-up within 60 days.  In addition, the agency received a Certification level of One out of Six Quality of Life areas Achieved, indicating a need to promote individual control and community involvement for the men served in this home.

Provider Scoring Summary

Licensure Review
Quality of Life
Area	Residential	Overall Provider Rating	
Rights and Dignity	Partially Achieved	Partially Achieved	
Personal Well Being	Partially Achieved	Partially Achieved	
Organizational Outcome:	The organization has systems in place to safeguard people.	Not Achieved	
 
Certification Review
Quality of Life
Area	Residential	Overall Provider Rating	
Individual Control	Partially Achieved	Partially Achieved	
Community and Social Connections	Partially Achieved	Partially Achieved	
Personal Growth and Accomplishments	Achieved	Achieved	
Organizational Outcome:	Staff have the skills and knowledge to support the quality of life of people.	Partially 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 organization has systems in place to safeguard people.	

 

QUALITY OF LIFE AREA
Rights and Dignity
Rating:  Partially 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	
People are valued.	Residential	Day	Respite	% of Indicators	
Achieved	Yes	No	NA	Yes	No	NA	Yes	No	NA	Yes	No	NA	
1.1A	Interactions are respectful of people.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
1.1B	People are supported to identify themselves as adults.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
1.1C	People are supported to take pride in themselves and their surroundings	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
1.1D	People live and work in settings that are typical of other members of the community.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
People’s rights are affirmed.	Residential	Day	Respite	% of Indicators	
Not  Achieved	Yes	No	NA	Yes	No	NA	Yes	No	NA	Yes	No	NA	
1.2A	People and/or those supporting them understand individual rights.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
1.2B	People’s rights are exercised in their everyday lives.	1	1	- 	- 	- 	- 	- 	- 	- 	50%	50%	N/A	
1.2C	People receive the same treatment as other employees.	- 	- 	2	- 	- 	- 	- 	- 	- 	NA	NA	N/A	
1.2D	People receive comparable wages and benefits as other employees.	- 	- 	2	- 	- 	- 	- 	- 	- 	NA	NA	N/A	
People’s rights are protected.	Residential	Day	Respite	% of Indicators	
Partially Achieved	Yes	No	NA	Yes	No	NA	Yes	No	NA	Yes	No	NA	
1.3A	All interventions are the least intrusive and are based upon people’s unique needs.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
1.3B	All interventions are included in a written plan.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
1.3C	People or their guardians knowingly give consent and have the opportunity to refuse or withdraw approval.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
1.3D	Safeguards ensure a thorough review and approval process when needed.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
1.3E	All interventions are safely, accurately, and consistently implemented.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	

	

QUALITY OF LIFE AREA
Personal Well Being
Rating:  Partially 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 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	
People are safe at home and work.	Residential	Day	Respite	% of Indicators	
Partially Achieved	Yes	No	NA	Yes	No	NA	Yes	No	NA	Yes	No	NA	
5.1A	People’s home and workplace are safe, secure, and in good repair.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
5.1B	People and their supporters know what to do in an emergency.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
5.1C	People can safely evacuate from their home and workplace in an emergency.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
5.1D	There are adequate supports for people to be safe in their home and work.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
5.1E	People use materials and equipment safely.	- 	- 	2	- 	- 	- 	- 	- 	- 	NA	NA	N/A	
People are protected from harm.	Residential	Day	Respite	% of Indicators	
Not  Achieved	Yes	No	NA	Yes	No	NA	Yes	No	NA	Yes	No	NA	
5.2A	Supports are in place if people make decisions that put them at risk.	- 	- 	2	- 	- 	- 	- 	- 	- 	NA	NA	N/A	
5.2B	Immediate actions are taken to ensure people's safety.	- 	- 	2	- 	- 	- 	- 	- 	- 	NA	NA	N/A	
5.2C	Actions are taken to correct the situation when people have been mistreated.	- 	- 	2	- 	- 	- 	- 	- 	- 	NA	NA	N/A	
5.2D	Steps are taken to prevent the situation from occurring again.	- 	- 	2	- 	- 	- 	- 	- 	- 	NA	NA	N/A	
5.2E	People know how or have support to report a situation where they feel they are being mistreated or have been mistreated or harmed.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
People maintain good health.	Residential	Day	Respite	% of Indicators	
Partially Achieved	Yes	No	NA	Yes	No	NA	Yes	No	NA	Yes	No	NA	
5.3A	People are supported to have a healthy lifestyle.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
5.3B	People are supported to be active participants in their health care.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
5.3C	People have needed routine and specialized health care services.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
5.3D	Supporters are knowledgeable about people’s health care needs.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
5.3E	People’s medications are given properly and as prescribed by the practitioner.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
People’s funds are safeguarded.	Residential	Day	Respite	% of Indicators	
Partially Achieved	Yes	No	NA	Yes	No	NA	Yes	No	NA	Yes	No	NA	
5.4A	People receive the support and/or education they need in managing their financial resources.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
5.4B	People’s funds are managed properly and with their consent.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	

	

	

	

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	Agency Totals	
The organization has systems in place to safeguard people.
Not Achieved	Finding	
7.1A	The organization has strategies that proactively ensure that essential safeguards are in place across settings and over time.	N	
7.1B	The organization has systems in place to affirm and protect the rights and dignity of individuals.	N	
7.1C	The organization has procedures that minimize unnecessary risk to individuals.	N	
% Indicators Present	0%	

	

	

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 Accomplishments	

Outcomes for the Organization	

Staff have the skills and knowledge to support the quality of life of people.	

The organization supports growth and change to continually improve its quality of supports.	

 

QUALITY OF LIFE AREA
Individual Control
Rating:  Partially 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 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	
People are understood.	Residential	Day	Respite	% of Indicators	
Achieved	Yes	No	NA	Yes	No	NA	Yes	No	NA	Yes	No	NA	
2.1A	Supporters understand what people are expressing.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
2.1B	Supporters use people’s primary means of communication.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
2.1C	Supporters assist people to communicate with and be understood by others.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
People make choices in their everyday lives.	Residential	Day	Respite	% of Indicators	
Partially Achieved	Yes	No	NA	Yes	No	NA	Yes	No	NA	Yes	No	NA	
2.2A	People make choices about their routines and schedules.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
2.2B	People make choices about the work and household tasks for which they are responsible.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
2.2C	People spend their leisure times in personally satisfying ways.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
People are the primary decision makers in their lives.	Residential	Day	Respite	% of Indicators	
Partially Achieved	Yes	No	NA	Yes	No	NA	Yes	No	NA	Yes	No	NA	
2.3A	People develop their personal goals.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
2.3B	People influence that provides their support.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
2.3C	People control important decisions about their home and home life.	1	1	- 	- 	- 	- 	- 	- 	- 	50%	50%	N/A	
2.3D	People choose where they work or, if they choose not to work, people have other options that are meaningful to them.	- 	- 	2	- 	- 	- 	- 	- 	- 	NA	NA	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	
People are integrated into their community	Residential	Day	Respite	% of Indicators	
Partially Achieved	Yes	No	NA	Yes	No	NA	Yes	No	NA	Yes	No	NA	
3.1A	People live and work in communities with the resources they want and need.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	
3.1B	People use the same community resources as others on a frequent and ongoing basis.	1	1	- 	- 	- 	- 	- 	- 	- 	50%	50%	N/A	
People are connected with their community.	Residential	Day	Respite	% of Indicators	
Not  Achieved	Yes	No	NA	Yes	No	NA	Yes	No	NA	Yes	No	NA	
3.2A	People are supported to explore their personal interests and options for community involvement.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
3.2B	People are involved in activities that connect them to other people in the community.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
People have relationships.	Residential	Day	Respite	% of Indicators	
Partially Achieved	Yes	No	NA	Yes	No	NA	Yes	No	NA	Yes	No	NA	
3.3A	People are supported to maintain and enhance relationships with family, friends, and co-workers.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
3.3B	People are supported to develop new friendships.	- 	2	- 	- 	- 	- 	- 	- 	- 	0%	100%	N/A	
3.3C	People are supported to explore, define, and express their need for intimacy.	2	- 	- 	- 	- 	- 	- 	- 	- 	100%	0%	N/A	

QUALITY OF LIFE AREA
Personal Growth and Accomplishments
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	

People accomplish their goals.	
Residential	
Day	
Respite	
% of Indicators	

Partially Achieved	
Yes	
No	
NA	
Yes	
No	
NA	
Yes	
No	
NA	
Yes	
No	
NA	

4.1A	
People’s goals are the basis for actions and supports.	
2	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
100%	
0%	
N/A	

4.1B	
There is a match between what people are doing now and what they want to do in the future.	
- 	
2	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
0%	
100%	
N/A	

4.1C	
People have access to needed resources in order to accomplish their goals.	
2	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
100%	
0%	
N/A	

4.1D	
There are supports to get a job that people like.	
- 	
- 	
2	
- 	
- 	
- 	
- 	
- 	
- 	
NA	
NA	
N/A	

4.1E	
There are supports to succeed at the job.	
- 	
- 	
2	
- 	
- 	
- 	
- 	
- 	
- 	
NA	
NA	
N/A	

4.1F	
People are supported to advance in their job.	
- 	
- 	
2	
- 	
- 	
- 	
- 	
- 	
- 	
NA	
NA	
N/A	

People have autonomy.	
Residential	
Day	
Respite	
% of Indicators	

Partially Achieved	
Yes	
No	
NA	
Yes	
No	
NA	
Yes	
No	
NA	
Yes	
No	
NA	

4.2A	
People complete day to day activities, tasks, and chores as independently as possible.	
1	
1	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
50%	
50%	
N/A	

4.2B	
People have access within their home and workplace.	
2	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
100%	
0%	
N/A	

People grow through their life experiences.	
Residential	
Day	
Respite	
% of Indicators	

Achieved	
Yes	
No	
NA	
Yes	
No	
NA	
Yes	
No	
NA	
Yes	
No	
NA	

4.3A	
Supporters are sensitive and attuned to both small and large events in people’s lives.	
2	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
100%	
0%	
N/A	

4.3B	
People are encouraged to understand experiences in their lives.	
2	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
100%	
0%	
N/A	

4.3C	
People are supported to grow from events in their lives that affect them.	
2	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
- 	
100%	
0%	
N/A	

	

	

	

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	

Outcomes	
Agency Totals	

Staff have the skills and knowledge to support the quality of life of people.
Partially Achieved	
Finding	

7.2A	
The organization recruits and maintains a competent work force.	
Y	

7.2B	
The organization has ways to support staff knowledge, effectiveness, and creativity.	
N	

% Indicators Present	
50%	

The organization supports growth and change to continually improve its quality of supports.
Partially Achieved	
Finding	

7.3A	
The organization has processes to evaluate the quality of its supports.	
N	

7.3B	
The organization improves services as a result of these analyses.	
N	

% Indicators Present	
0%