Provider:       New England Villages, Inc.					Address:       664 School Street, Pembroke, MA	

Name of Person Completing Form:    Ginger Sullivan			Dates of Review:     September 19 – 22, 2011		

Follow-up Scope and Results:
Service 
Grouping	Licensure Level 
and Duration	# Indicators Std. Met / 
Std. Rated at Follow-up	
Residential and 
Individual Home Supports	Two-Year License	     5	 / 5	

Summary of Ratings:

Residential Areas Needing Improvement on Standards Not Met:	
Indicator #	
L8	

Indicator	
Emergency Fact Sheets.	

Area Need Improvement	
All Emergency Fact Sheets (EFS) need to include all required information such as medical issues, medications, and identifying information.  The agency needs to ensure that all EFS are accurate and up-to-date.	

Process utilized to correct and review indicator.	
Emergency Fact Sheets are on-site and have been revised to include all required information. Random audit of records conducted 45 days after review.	

Status at follow-up.	
The EFS have been revised as needed in all homes.  19 of the 19 EFS randomly audited included all pertinent information.	

Rating	
Met	

Residential Areas Needing Improvement on Standards Not Met, cont.
Indicator #	
L59	

Indicator	
Behavior Plan review.	

Area Need Improvement	
Behavioral interventions need to be reviewed by the Individual Support Plan team.	

Process utilized to 
correct and review indicator.	
Behavioral intervention plans have received the proper review buy ISP team either at annual meeting or by request of and ISP modification.

Status at follow-up. 	
Behavioral intervention plans have been reviewed as required. There is evidence of ISP team review in ISP.

Rating	
Met	

Indicator #	
L55	

Indicator	
Informed consent.	

Area Need Improvement	
Consent for photos needs to be specific to the event or the material used.  Release of information forms need to be specific as to what information is being released and to whom it is being released.

Process utilized to correct and review indicator.	
Photo consent form revised to include language as follows; authorization can be rescinded at any time through written notification to NEV’s Department of Marketing and Development.  Party will be contacted for permission on a case by case basis for purposes that include placement of photographs in media outlets.  Consent for release of information is obtained on an as needed basis only.  Practice of obtaining in advance has been ceased.

Status at follow-up.	
Advanced completion of Release of Information document has been ceased and blank forms have been purged. The approach for consent for photos has been revised.

Rating	
Met	

Residential Areas Needing Improvement on Standards Not Met, cont.
Indicator #	
L67	

Indicator	
Money Management Plans.	

Area Need Improvement	
The agency needs to ensure that agreement is obtained including the monetary value to be paid toward cable for each person.

Process utilized to correct and review indicator.	
Written plans in place are inclusive of a training plan component.  Agreement or shared expense is obtained through consent form which includes monetary values of specified expense.

Status at follow-up.	
All plans for shared and delegated responsibilities now include this information.

Rating	
Met	

	

	
Indicator #	
L84	

Indicator	
Health protection training.	

Area Need Improvement	
All those providing support need to receive training on the proper utilization and application of health-related protections.

Process utilized to 
correct and review indicator.	
All staff providing support have been trained in the proper utilization and maintenance of all health-related protections.  NEV reviewed the records of individuals supported with these devices to assess the presence of staff training.

Status at follow-up.	
Training has been completed in all homes where supports and health related protections are present.  Documentation of training is present.

Rating	
Met