PROVIDER REPORT FOR	

	

	

	

	

	

	

	

	

	
	
PLUS COMPANY
19 Chestnut Street
 Nashua, NH 03060    	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

Version	

	

	

	

	

	

	

	

	
Provider Web Report	

	

	

	

	

	

	

	
Prepared by the Department of Developmental Services
OFFICE OF QUALITY ENHANCEMENT	

	

	

	

	

	

	

				
	SUMMARY OF OVERALL FINDINGS	

				

	

	

Provider	

	
PLUS COMPANY	

	

	

	

	
Review Dates	

	
8/2/2017 - 8/7/2017	

	

	

	

	
Service Enhancement 
Meeting Date	

	
8/18/2017	

	

	

	

	

	

	
Survey Team	

	
Sarah Flibotte (TL)	

Steve Goldberg	

	

	

	

	

	

	
Citizen Volunteers	

	

	

		

	

	
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) 8 audit (s) 	
Full Review	
52 / 54 2 Year License 08/18/2017 -  08/18/2019	
	
39 / 42 Certified 08/18/2017 -  08/18/2019	

Community Based Day Services	
1 location(s) 4 audit (s) 	

Full Review	
13 / 14	

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

Full Review	
20 / 22	

Planning and Quality Management	

	
Full Review	
6 / 6	

	

	

			
EXECUTIVE SUMMARY :	

			
PLUS (People Learning Useful Skills) Company, Inc. is a non-profit organization headquartered in Nashua, NH.  In New Hampshire, the agency provides a wide array of supports including employment and vocational day services and residential/home care services to individuals with intellectual disabilities and acquired brain injuries.  In Massachusetts, the agency provides day services to individuals with developmental disabilities at two locations; Community Based Day Services (CBDS) in Lawrence and Employment Supports in Tewksbury. The agency serves 107 individuals in employment/ day services at these two sites.

The scope of this survey conducted by the Office of Quality Enhancement (OQE) was a full review of all licensing and certification indicators for the agency's Massachusetts based CBDS and Employment programs funded through the Department of Developmental Disabilities.  The review was inclusive of indicators which were new or revised in August 2016. 

PLUS Co had begun a new strategic planning process that was fully inclusive of input from individuals served.  The agency hired an outside consultant to help with soliciting input through confidential result-orientated focus groups with individuals, support staff, board members and management to help develop certain components of the company's strategic plan.  A written strategic planning survey was utilized as a separate tool for those who could not attend the focus groups, enabling them to have a voice in the process. Supervisors were not present when speaking with individuals and staff to allow for honest comments, criticism and assessment of topics discussed. Based on the feedback from the different groups, new ideas and changes were incorporated into the Strategic Plan.

The agency put a strong emphasis on ensuring that individuals' schedules allowed for them to spend the majority of their day within the community.  Individuals were supported to have a voice in the selection of their daily schedules, which included choices for access to the community in a variety of meaningful ways that were fully integrated. For example, individuals attended classes at local libraries, community colleges and the Currier Arts Center. Individuals were provided opportunities to enhance computer skills, participate in community yoga classes, art therapy and music classes.  The agency purchased memberships for the local YMCA, and is utilized on a regular basis by individuals who wish to participate. In addition to accessing varied resources within the community, individuals were also afforded the opportunity to participate in a variety of volunteer opportunities that were integrated in the community with non-disabled people and afforded individuals an opportunity to gain skills and experience. 

Notable for individuals in the Employment program, the agency adheres to the philosophy that everyone may work with appropriate supports through the flexible process of Customized Employment. The agency's employment process is individualized and encompasses a rich resource of tools to fit the various needs of those seeking employment. For example, there is classroom training through the use of the Career Assessment Program (CAP), for those interested in job searches on-line, the agency utilizes the use of O*Net OnLine career exploration and job analysis in real time and may be done from any computer location which enables individuals the opportunity to complete assignments on their own time and pace if they choose. The agency also offers individuals who have identified an interest in pursuing careers in the healthcare/hospitality, retail and office support fields, the opportunity to participate in its Sector Based Training programs utilizing the Stride, Income and Internship Training programs. As a result of the various employment tools and exploration opportunities, PLUS has been able to support people in becoming successfully employed in jobs related to their career of choice. 

Since the last survey, the agency has made some gains in terms of individuals participating in the hiring and evaluating process of the staff that supports them. While the agency had solicited feedback from individuals during the hiring process via interviewing, the agency did not have a formal mechanism in place to ensure that individuals were able to contribute and provide feedback on the staff who support them and that the confidential information received may be shared with staff as part of an ongoing evaluation and training process.  Additionally, individuals who are employed should be receiving feedback on their job performance in a manner that is commensurate with other employees in the company in which they are working. Supporters awareness of when evaluations occur is crucial to assist individuals to improve or enhance job performance where needed.

Some additional areas requiring further attention were also identified during the survey. The agency needs to ensure that consents are specific to each image being used and that each explicitly outlines the scope and duration of the consent.  While media consent forms were present for some individuals, they were broad and did not include image or audience specific information. The agency should work to ensure that it develops a system to insure that ISP assessments and support strategies are completed and submitted to DDS within the required timeline. 

As a result of this review, PLUS Company Inc. Employment and Day Supports received a rating of met in 96% of licensing indicators with all critical indicators met. The agency met 93% of certification indicators reviewed. As a result, the agency will receive a Two Year License for Employment and Day Supports and is Certified. Follow-up on all not met licensing indicators will be conducted by PLUS Company within 60 days from the Service Enhancement Meeting.	

	

LICENSURE FINDINGS	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
9/9	
0/9	

Employment and Day Supports	
43/45	
2/45	

    Community Based Day Services
    Employment Support Services

	

Critical Indicators	
8/8	
0/8	

Total	
52/54	
2/54	
96%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
2	

	

	

			

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 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.	
For all individuals, informed consent forms for media did not include event specific information and was in many cases obtained for use when a picture/image had not yet been taken. The agency needs to ensure that consents are specific to each situation in which the individuals' picture or information is being shared and the duration of use.	

 L87	
Support strategies necessary to assist an individual to meet their goals and objectives are completed and submitted as part of the ISP.	
For 2 of 7 individuals, support strategies had not been submitted as required 15 days prior to the ISP meeting.  The agency needs to ensure support strategies are submitted to the area office in accordance with DDS regulatory requirements.	

	

		

	

	

CERTIFICATION FINDINGS	

	

	

	
	
Met / Rated	
Not Met / Rated	
% Met	

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

Employment and Day Supports	
33/36	
3/36	

Community Based Day Services	
13/14	
1/14	

Employment Support Services	
20/22	
2/22	

TOTAL	
39/42	
3/42	
93%	

Certified	

	

	

	

	

	
Community Based Day Services Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 C41	
Individuals participate in activities, including those in the community, that reflect their interests and preferences.	
Community activities were provided on a daily basis. Staff were knowledgeable about people's interests and there was an agency philosophy that emphasized pursuing identified interests in community settings. For example, people's interest in animals was met by accessing a service dog, and in reading by participation in a reading group, both occurring at a local library. The agency took full advantage of area events or resources of specific interest to the people supported, such as concerts for those with an interest in music, hiking in local parks or growing vegetables in a community garden, all of which promoted community involvement. The agency is commended for providing people with frequent opportunities to engage in preferred interests in community settings. 	

	

	
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 and on an ongoing basis on the performance of staff that support them.	
For all four individuals, there was no evidence that the opportunity to give feedback on the staff that supports them, thru the evaluation process in an ongoing manner had occurred.  The agency needs to ensure that individuals are afforded the opportunity to provide feedback on the staff who support them.	

	

	
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 and on an ongoing basis on the performance of staff that support them.	
For all four individuals, there was no evidence that the opportunity to give feedback on the staff that supports them, thru the evaluation process in an ongoing manner had occurred.  The agency needs to ensure that individuals are afforded the opportunity to provide feedback on the staff who support them.

	
 C35	
Individuals are given feedback on job performance by their employer.	
For two of the four individuals surveyed, feedback on their job performance had not occurred.  The agency needs to ensure that people are given feedback on their job performance by their employer and commensurate with other employees.	

	

	

		

					
	MASTER SCORE SHEET LICENSURE	

					
	Organizational: PLUS COMPANY	

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

O	
 L2	
Abuse/neglect reporting	
1/1	
Met	

 L3	
Immediate Action	
1/1	
Met	

 L4	
Action taken	
1/1	
Met	

 L48	
HRC	
1/1	
Met	

 L74	
Screen employees	
1/1	
Met	

 L75	
Qualified staff	
1/1	
Met	

 L76	
Track trainings	
4/4	
Met	

 L83	
HR training	
4/4	
Met	

 L83	
HR training	
6/6	
Met	

						
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	
4/4	
	
4/4	
8/8	
Met	

 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	
4/4	
	
4/4	
8/8	
Met	

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

 L10	
Reduce risk interventions	
I	
2/2	
	
2/2	
4/4	
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	

 L14	
Site in good repair	
L	
1/1	
	
1/1	
2/2	
Met	

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

 L16	
Accessibility	
L	
1/1	
	
1/1	
2/2	
Met	

 L17	
Egress at grade 	
L	
1/1	
	
1/1	
2/2	
Met	

 L18	
Above grade egress	
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	
Clean 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	
2/2	
Met	

 L30	
Protective railings	
L	
1/1	
	
1/1	
2/2	
Met	

 L31	
Communication method	
I	
4/4	
	
4/4	
8/8	
Met	

 L32	
Verbal & written	
I	
4/4	
	
4/4	
8/8	
Met	

 L37	
Prompt treatment	
I	
4/4	
	
4/4	
8/8	
Met	

O	
 L38	
Physician's orders	
I	
1/1	
	
2/2	
3/3	
Met	

 L39	
Dietary requirements	
I	
1/1	
	
3/3	
4/4	
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	

 L49	
Informed of human rights	
I	
4/4	
	
4/4	
8/8	
Met	

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

 L51	
Possessions	
I	
4/4	
	
4/4	
8/8	
Met	

 L52	
Phone calls	
I	
4/4	
	
4/4	
8/8	
Met	

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

 L55	
Informed consent	
I	
0/2	
	
0/3	
0/5	
Not Met
(0 %)	

 L77	
Unique needs training	
I	
4/4	
	
4/4	
8/8	
Met	

 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	
2/3	
	
4/4	
6/7	
Met
(85.71 %)	

 L87	
Support strategies	
I	
2/3	
	
3/4	
5/7	
Not Met
(71.43 %)	

 L88	
Strategies implemented	
I	
3/4	
	
4/4	
7/8	
Met
(87.50 %)	

#Std. Met/# 45 Indicator	

	

43/45	

	
Total Score	

	

51/53	

	

	

	
96.23%	

		
						
	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	
0/4	
Not Met (0 %)	

 C8	
Family/guardian communication	
4/4	
Met	

 C13	
Skills to maximize independence 	
4/4	
Met	

 C37	
Interpersonal skills for work	
4/4	
Met	

 C40	
Community involvement interest	
4/4	
Met	

 C41	
Activities participation	
4/4	
Met	

 C42	
Connection to others	
4/4	
Met	

 C43	
Maintain & enhance relationship	
4/4	
Met	

 C44	
Job exploration	
3/3	
Met	

 C45	
Revisit decisions	
4/4	
Met	

 C46	
Use of generic resources	
4/4	
Met	

 C47	
Transportation to/ from community	
4/4	
Met	

 C51	
Ongoing satisfaction with services/ supports	
4/4	
Met	

 C54	
Assistive technology	
4/4	
Met	

Employment Support Services	

Indicator #	
Indicator	
Met/Rated	
Rating	

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

 C8	
Family/guardian communication	
4/4	
Met	

 C22	
Explore job interests	
3/3	
Met	

 C23	
Assess skills & training needs	
4/4	
Met	

 C24	
Job goals & support needs plan	
3/3	
Met	

 C25	
Skill development	
3/3	
Met	

 C26	
Benefits analysis	
3/3	
Met	

 C27	
Job benefit education	
4/4	
Met	

 C28	
Relationships w/businesses	
1/1	
Met	

 C29	
Support to obtain employment	
3/3	
Met	

 C30	
Work in integrated settings	
4/4	
Met	

 C31	
Job accommodations	
3/3	
Met	

 C32	
At least minimum wages earned	
2/2	
Met	

 C33	
Employee benefits explained	
3/3	
Met	

 C34	
Support to promote success	
4/4	
Met	

 C35	
Feedback on job performance	
2/4	
Not Met (50.0 %)	

 C36	
Supports to enhance retention	
3/3	
Met	

 C37	
Interpersonal skills for work	
3/3	
Met	

 C47	
Transportation to/ from community	
4/4	
Met	

 C50	
Involvement/ part of the Workplace culture	
3/3	
Met	

 C51	
Ongoing satisfaction with services/ supports	
3/3	
Met	

 C54	
Assistive technology	
4/4	
Met