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

 

INDIVIDUAL SUPPORT SERVICES REVIEW

Community Partnerships, Inc.
90 New State Highway (Rt. 44)
Raynham, MA 02767

March 6, 2009	

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

Report Date:  March 6, 2009

Provider Name:  Community Partnerships, Inc.
ISS Team Member:  Scott F. Nolan
ISS Certification Dates:  February 12, 2009 to February 12, 2011
ISS Certification Outcome:  CERTIFIED

Description of Individual Support Services
Community Partnerships, Inc. is a non-profit organization that provides a variety of services to approximately forty individuals living in Taunton and the surrounding community.  The services offered by the agency include residential and individual supports, case management, guardianship and an extensive Representative Payee program.  In addition, the agency also provides information, education, and guidance to access community resources that may be beneficial to individuals regarding issues such as: affordable housing, transportation, alcohol and substance abuse, legal and advocacy supports, and emergency or crisis services.  

The mission of the organization is, “to help people with disabilities live rewarding lives as participating, valued and included members of the communities."  The Individual Support Services (ISS) delivered by the agency are rooted in its commitment and passion to following an Independent Living model with respect for individuals’ lifestyle choices.  Individuals served through the agency’s ISS program received less than fifteen hours of staffing per week.  Many individuals either lived alone, or shared their home with one other person.  Services were based on individuals’ unique needs and interests included, but were not limited to the following areas: budgeting, Representative Payee services, money management, grocery shopping, healthcare, and community membership.  Some individuals supported by the agency required and benefited from the combination of Department of Mental Retardation (DMR) funded staff and the use of Medicaid funded Personal Care Attendants (PCA’s), which assisted the agency to tailor supports to the individual’s unique needs and lifestyle. These collaborative services were coordinated and monitored by agency management.

Since the agency’s last certification review, which took place in 2006, the agency had adapted its supports to respond to changes being experienced by those supported.  Some of the new challenges people faced included increased medical issues associated with an aging population, changes in employment/day program options that allow individuals to stay home during the day, and other life situations that challenged individuals to maintain their independence within their home and communities (e.g., increasing financial costs with limited income, accessing community nursing services).  These challenges have required the agency to be even more creative to access and/or provide different supports to accommodate each individual’s unique needs.  

At the time of the survey, the agency was providing ISS services, consisting of fifteen hours of staffing or less, to twenty-three individuals.  The ISS supports provided to four individuals were evaluated, as part of this certification review.  The focus of Individual Support is to assist individuals to live independently in the communities of their choice.  While the ISS were reviewed concurrently with the Licensure and Certification review, the findings pertaining to the residential services for individuals receiving residential supports are presented in a separate Licensure and Certification Report.

Overview of Findings

A continued strength of the agency is its flexibility and responsiveness in serving the twenty-three individuals who receive Individual Support Services.  Several supporters have known individuals for many years. Individuals shared mutually respectful relationships with their supporters, which were based on trust and open communication.  Staff at all levels of the organization worked collaboratively with individuals and one another to design supports that accommodated each individual’s needs and lifestyle preferences.  The four individuals who participated in this review were justifiably proud of their many accomplishments and were supported, as needed, to maximize their independence.  Three of the individuals who participated in the survey enjoyed living in their own homes.  Supporters made ongoing efforts to assist individuals, as needed, to access a variety of resources and services to allow them to remain living in their homes.  For example, creative efforts were made to enable one man to remember to take a medication several times per day.  Another woman was supported to attend frequent medical appointments, which helped her to stay healthy enough to continue living independently.   

The agency recognized and promoted individuals as the driver of their supports.  Each individual’s supports were customized, varied, and flexible, based on their current needs and preferences.  Examples of supports included: providing transportation to visit family members, shopping and to access local resources, as well as providing assistance to attend medical appointments.  Supporters also provided transportation for one individual to visit his father who lived on Cape Cod, while another woman was supported to visit her husband who was ill.  Although the focus of each individual’s supports was defined, the actual services provided often were expanded to accommodate their current needs or preferences.  For example, supporters who typically assisted one woman to manage her medical provided compassionate assistance to enable her to effectively plan the funeral and make other arrangements when her spouse passed away.  Another gentleman, whose supports focused around helping him to manage his funds, attend to his medical needs, and to go shopping, was driven to various community locations when he wanted to go fishing or participate in other leisure pursuits.

Supporters were sensitive to understand when it was best to offer information and guidance when individuals discussed personal matters, and to know when listening was the best option.  When individuals had a need, staff provided assistance and oversight of their medical care and assisted them to seek specialized medical support when needed to resolve concerns.  Staff attended medical appointments with individuals if this was requested, assisted them to access services such as counseling, to seek second opinions if necessary, and acted as patient advocates for those who preferred or needed this type of support.  

Supporters throughout the agency were very responsive and maintained flexible schedules to accommodate individuals’ changing needs.  Another positive attribute of the agency is the staff’s desire and compassion to understand why some individual’s are reluctant to accept supports while trying to provide supports in a manner that is more easily acceptable.  This included persistence in offering their support, and sharing personal experiences that they had in common with individuals as well as making periodic contact to check in with people.  When individuals expressed concern about something in their lives, supporters listened and responded in neutral tones to what was said, which assisted individuals to explore their options and to remain confident in their decisions.  These long-term and ongoing efforts helped individuals to understand that supporters were making efforts to be non-judgmental, and to offer flexible supports that were responsive to their unique needs.  

Individuals were supported, as needed, to become knowledgeable of their rights and to understand their options so they could make informed decisions.  Ongoing efforts were also made to support individuals to understand their responsibilities and the potential consequences of their choices.  For example, one woman, who struggled with obesity, was supported to plan healthy food purchases and to continue her involvement in an organization which met regularly and provided her with extensive moral and motivational supports in this area.  Another individual discussed a dilemma that he was experiencing with a friend, whom he has known since childhood.  This individual was seeking and received guidance and reassurance from his supporter regarding the best way to deal with situations when he and his friend experienced conflicts.  Supporters throughout the agency are commended for respectfully presenting individuals with a wide array of information in a neutral manner, which helped them to understand the potential positive/negative outcome of their decisions.  These ongoing efforts enabled individuals to assert their rights to exercise choice and control over their lives.

The agency has several formal and informal mechanisms in place toward promoting individuals’ safety in their homes and communities.  These mechanisms included: the ongoing presence of key management personnel, frequent communications amongst supporters and with individuals served, an on-call system, monthly external reviews of banking records for Representative Payee accounts, a database to effectively track staff training, and regularly conducted staff meetings/supervision.  The agency’s positive presence and relationships within the local community also served as a safeguard for individuals.  

As an extension of the agency’s own, internal safeguarding mechanisms, individuals were supported, as needed, to establish relationships with their neighbors, co-workers, friends and families, which provided them with natural supports.  Supporters and individuals maintained open communications, without compromising their confidentiality, which promoted opportunities for people to feel comfortable notifying the agency when issues arose.  These natural supports and ongoing communications with others often assisted the agency to proactively assist individuals to address potential issues before a crisis occurred. 

Supporters shared mutually respectful relationships with individuals that were based on trust, communication, and a commitment to honoring each individual’s independence.  Supporters used a variety of formal and informal ways to assess each individual’s skills and abilities in a variety of areas including: fire safety, emergency responsiveness, and their abilities to self-administer medications.  Supporters also reviewed and discussed various community based safety skills with individuals in areas such as: street crossing, interacting with strangers, how to prevent being taken advantage of, and how to protect/assert themselves.  Individuals were provided with the cellular phone numbers of their support staff, and called them on a regular and as needed basis.  Individuals also had access to various community based emergency telephone numbers and had demonstrated their ability to effectively use these numbers.  In addition, agency personnel could be accesses by individuals twenty-four hours per day by utilizing the emergency on-call system.

Oversight and guidance was also provided, as needed, to encourage individuals to proactively monitor their health issues, follow specialized diets, and take their medications as prescribed.  The longevity of the relation-ships that individuals and supporters shared, knowledge of their unique lifestyle preferences, and of their willingness to accept information or feedback contrary to their own opinions, were key elements of the informal assessment processes.  This approach was effective in getting individuals to become more invested or “buy into” the design or acceptance of their supports.  

The agency has a strong presence and several supporters are actively involved in contributing to the local and statewide communities in a variety of areas.  The Executive Director is a member of the Governor’s Commission on Mental Retardation and has served as a member of the Disabled Persons Protective Commission’s Advisory Committee for some time.  Several support staff from the agency are involved in various task forces and committees in the area, which helps to network and stay abreast of various issues and resources that might be helpful to the individuals served.  The agency also works collaboratively with the local police department regarding various issues and trainings.  These partnerships have promoted the agency’s active presence in the community and fostered community awareness of the needs of those with disabilities in assisting individuals to access services typical of other community members.  The agency is commended for its consistent efforts to support individuals to explore their options, coordinate, and utilize an array of resources, which enabled them to maintain their independence.

Promoting people’s independence and individuality continue to be the primary focus of Individual Supports.  Agency personnel provide support in a respectful manner that promotes the equality of those they serve.  The ongoing commitment and sustained involvement of supporters have made meaningful differences to the quality of life of the individuals served.  The findings of this ISS review confirm that the agency provides high quality, flexible, and individualized supports.

PART I:  INDIVIDUAL SERVICE QUALITY REVIEW

Area #1 - Responsiveness / Flexibility
Outcome/Indicator	Indicator Response Summary	
		# Rated	Yes	No	% of Indicators Present	
1 A	Provider has a mechanism to determine what the individual's needs are.	4	4	0	100%	
1 B	Provider is aware of the degree to which the individual will accept supports.	4	4	0	100%	
1 C	Provider is offering supports in areas identified and consistent with the individual's willingness to engage.	4	4	0	100%	
1 D	Provider has the flexibility to modify supports when needed by the individual.	4	4	0	100%	
 
Commendation:
An ongoing strength of the agency, its unwavering commitment to providing supports to meet each individual’s lifestyle needs (e.g., relationships, health, daily living), especially during times of distress or crisis.  The agency is commended for its ability to respond to the changing needs of individuals by utilizing its staff and a variety of other resources that were responsive and flexible to adapt to individuals changing needs.

Area #2 - Choice / Control / Informed Decision-Making
Outcome/Indicator	Indicator Response Summary	
		# Rated	Yes	No	% of Indicators Present	
2 A	Staff assists individuals to understand their rights and responsibilities.	4	4	0	100%	
2 B	Staff have an understanding of the individual’s capability to make informed decisions.	4	4	0	100%	
2 C	Individuals are given support to make informed decisions about where they live, work, recreate, spend money, with whom they have relationships and other significant lifestyle choices.	4	4	0	100%	
2 D	Individuals have opportunities to participate in the selection and evaluation of staff.	4	4	0	100%	
 
Commendation:
Supporters throughout the agency are commended for respectfully presenting individuals with a wide array of information in a neutral manner, which helped them to understand the potential positive/negative outcome of their decisions.  These ongoing efforts enabled individuals to assert their rights to exercise choice and control over their lives.

Area #3 - Safety / Emergency Response Capability
Outcome/Indicator	Indicator Response Summary	
		# Rated	Yes	No	% of Indicators Present	
3 A	Staff offers information and support to assist an individual to be safe in their home.	3	3	0	100%	
3 B	Staff offers information and supports to assist an individual to recognize danger and take action in their home, work place and neighborhood.	4	4	0	100%	
3 C	Staff educates the individual about what to do and who to call in the event of an emergency.	4	4	0	100%	
3 D	Staff has supports in place if individuals make decisions that put them at risk.	4	4	0	100%	
3 E	Staff responds effectively when an individual’s decisions impact on the rights and safety of others.	0	0	0	- 	
3 F	Staff collaborates with others if there is a risk management plan in place.	1	1	0	100%	
3 G	Staff are aware of mechanisms to report a situation when an individual has been mistreated or harmed and take appropriate action.	4	4	0	100%	

No Areas Needing Improvement, Suggestions for Service Enhancement, nor Commendations in this area.

Area #4 - Outreach / Advocacy
Outcome/Indicator	Indicator Response Summary	
		# Rated	Yes	No	% of Indicators Present	
4 A	Staff engages in outreach efforts to other agencies, groups, community resources and natural supports in order to support an individual.	4	4	0	100%	
4 B	Staff effectively coordinates the efforts of an array of community resources where appropriate.	4	4	0	100%	
4 C	Staff assist the individual to get the services they need.	4	4	0	100%	
 
Commendation:
Supporters throughout the agency were actively involved in a variety of community-based committees and task forces, which facilitated networking with other agencies and community members.  The agency is commended for it’s commitment to maintaining a strong, contributing presence in the community, which promotes opportunities for individuals to become aware of, and benefit from, a variety of different resources within their communities, which helped them to maintain their independence.

PART II:  OUTCOMES FOR ORGANIZATION
Outcomes and Indicators	Agency Totals	
The organization has systems in place to safeguard people.
Achieved	Finding	
7.1A	The organization has strategies that proactively ensure that essential safeguards are in place across settings and over time.	Yes	
7.1B	The organization has systems in place to affirm and protect the rights and dignity of individuals.	Yes	
7.1C	The organization has procedures that minimize unnecessary risk to individuals.	Yes	
% Indicators Present	100%	
Staff have the skills and knowledge to support the quality of life of people.
Achieved	Finding	
7.2A	The organization recruits and maintains a competent work force.	Yes	
7.2B	The organization has ways to support staff knowledge, effectiveness, and creativity.	Yes	
% Indicators Present	100%	
The organization supports growth and change to continually improve its quality of supports.
Achieved	Finding	
7.3A	The organization has processes to evaluate the quality of its supports.	Yes	
7.3B	The organization improves services as a result of these analyses.	Yes	
% Indicators Present	100%	
 
Comment:
There were no significant differences noted between the Individual Supports Review and the concurrent License and Certification review.  Please see Organizational Outcomes under the Provider’s Licensure Report.  A full description of the findings will be described in detail within that report.