PROVIDER REPORT FOR	

	

	

	

	

	

	

	

	

	
	
Southeastern Massachusetts Educational Collaborative
25 Russells Mills Rd. 
 Dartmouth, MA 02748    	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

Version	

	

	

	

	

	

	

	

	
Provider Web Report
May 12, 2017	

	

	

	

	

	

	

	
Prepared by the Department of Developmental Services
OFFICE OF QUALITY ENHANCEMENT	

	

	

	

	

	

	

				
	SUMMARY OF OVERALL FINDINGS	

				

	

	

Provider	

	
Southeastern Massachusetts Educational Collaborative	

	

	

	

	
Review Dates	

	
3/22/2017 - 3/28/2017	

	

	

	

	
Service Enhancement 
Meeting Date	

	
4/20/2017	

	

	

	

	

	

	
Survey Team	

	
Tina Napolitan	

Laura O'Connor (TL)	

	

	

	

	

	

	
Citizen Volunteers	

	

	

		

	

	
Survey scope and findings for Residential and Individual Home Supports	

Service Group Type	
Sample Size	
Licensure Scope	
Licensure Level	
Certification Scope	
Certification Level	

Residential and Individual Home Supports	
4 location(s) 4 audit (s) 	
Full Review	
58 / 63 2 Year License 04/20/2017 -  04/20/2019	
	
49 / 51 Certified 04/20/2017 -  04/20/2019	

Residential Services	
1 location(s) 1 audit (s) 	

Full Review	
21 / 22	

Individual Home Supports	
3 location(s) 3 audit (s) 	

Full Review	
22 / 23	

Planning and Quality Management (For all service groupings)	

	
Full Review	
6 / 6	

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) 7 audit (s) 	
Full Review	
52 / 57 2 Year License 04/20/2017 -  04/20/2019	
	
31 / 42 Certified with Progress Report 04/20/2017 -  04/20/2019	

Community Based Day Services	
1 location(s) 3 audit (s) 	

Full Review	
12 / 14	

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

Full Review	
13 / 22	

Planning and Quality Management (For all service groupings)	

	
Full Review	
6 / 6	

	

	

			
EXECUTIVE SUMMARY :	

			
Southeastern Massachusetts Educational Collaborative (SMEC) was established in 1975 as a public collaborative to address demands for special education services.  SMEC accepts students ages 3-21 for enrollment in its programs from school systems throughout Southeastern Massachusetts public school districts. These services include: Early Childhood, Primary Language, Integrated Services, Alternative Learning Classrooms I & II, and Transitional Services. Through its Supporting Adults for Inclusive Living (SAIL) program, SMEC offers a variety of services for adults with intellectual disabilities who live throughout Southeastern Massachusetts including 24 hour residential, employment, Community Based Day Supports (CBDS) and Individualized Home Supports (IHS). Since the last survey, the agency moved into brand new buildings, located in Dartmouth MA.  The agency also expanded its services to include Medicare funded Adult Day Health Services, which included nursing staff.  

A full licensure and certification review was conducted of the agency's residential, IHS; employment and  Community Based Day (CBDS) services and included indicators which were new or revised as of 8/29/16.  

Organizationally, the agency experienced several successes.  An effective tracking system was developed to ensure a competent and skilled workforce.  Staff training records verified that all staff had been screened prior to hire and attended the required trainings. The agency developed effective systems to monitor and submit ISP assessments and objectives within DDS required time lines. All individuals who participated in the survey indicated that they liked the services that they received from the agency and that staff treated them respectfully, and satisfaction surveys were conducted on an annual basis to solicit feedback from individuals and their families/guardians. In June 2016, the agency changed their staff performance evaluations to include written input from the individuals whom they supported.  Overall improvement was also noted in the domain of health, specifically in the areas of physician orders and treatment protocols and medication administration. 

The agency's residential services also demonstrated success in meeting most licensure and certification outcomes.  Residential services ranged from supporting individuals to live in their own homes with minimal services to supporting individuals who lived in 24 hour supervised living situations, all of which were personalized and enabled individuals to actively engage in their communities.  Each home was located near community resources such as grocery stores, public transportation and banks. Individuals and/or their families owned or leased their own homes. The individuals were supported to live healthy lifestyles including learning to eat in a healthy manner making more appropriate food choices and exercising more frequently.    

There were numerous positive findings revealed in the Employment and Community Based Day Services.  A commendable feature of the CBDS services included the support to individuals during evening hours, focusing on individualized skill building and recreational/social activities.  Another practice, which is unique to the agency, is many individuals who received employment services are supported by agency staff to work whenever their employers needed them, which included nights and weekend hours. This flexible structure regarding how and when supports are provided offered individuals and families more ways to schedule their supports, fulfilling their identified needs.  In addition a component of the CBDS program featured hands on training regarding a variety of independent living skills, such as laundry, house cleaning, and cooking, both at the agency's apartment and in the CBDS kitchen area.

The agency's employment services were committed to finding jobs for individuals that were in integrated settings.  All four of the individuals who participated in the survey, had part time jobs at businesses in the community, earning at least minimum wage.  The agency has developed relationships with many local community businesses, which often led to jobs for individuals.  Agency staff assisted individuals to become part of the culture of their workplaces and to develop relationships with their co-workers and supervisors. The four individuals each had one to one job coaching staff that provided transportation to and from work as well as supports during the majority of the hours that they worked.   

While the agency has demonstrated success in a variety of areas and has made notable progress since the last survey, there are a few licensure areas for future concentration. The agency should continue efforts to ensure that the Human Rights Committee (HRC) is fully constituted to include a member with required legal expertise, and supporting the HRC to understand their roles/responsibilities. The agency's  consumer handbook was distributed to CBDS participants when they started the program and contained valuable information, however key pieces such as the 'complaint' policy and the cell phone policy would benefit from revision and re-review by the individuals and the Human Rights Committee on an annual basis. Residentially, the agency could benefit from further ensuring that medication treatment plans and any restrictive intervention plans get developed and approved by the appropriate parties.  In addition when individuals have been identified as having behaviors that pose potential risk, the agency needs to actively develop individualized written protocols to ensure that all staff are familiar with how to prevent and address behaviors which pose a risk.

Regarding the certification indicators, there are also a few areas for future concentration.  In particular, the certification domains of Career Planning, Career Development, and Employment Success could use strengthening as the agency moves forward.  Several individuals liked having a job and getting paid, however they were not fully supported to work toward or in their field of interest.  As mentioned above, individuals are all working in community positions being paid minimum wage or better.  However, the agency could benefit from increased planning to support the individuals to become more autonomous, independent, and successful at work.  For example, job coaches were present for the entire duration that the individual works, often at the request of the employer, and performed certain components of the job that the individual may have been able to perform, if assessed and properly trained.  All individuals could benefit from assessments to determine if assistive technology or modifications can help increase their independence at home and/or work.  

Based on the findings of this report, the agency has earned a Two Year License for Residential and Individual Home Supports with 92% of the licensure indicators rated as Met.  For the residential licensing indicators rated Not Met, the agency will conduct its own follow up review, within sixty days. The agency is also Certified in Residential / I H S supports with 96% of certification indicators rated as Met. The agency has earned a Two Year License for its Employment and Community Based Day Supports with 91% of the licensure indicators rated as Met. The agency will conduct its own follow up on the licensure ratings Not Met in the Employment and Day Supports program. The agency is also Certified with a progress report for their Employment / Day Supports, achieving a score of Met for 74% of the certification indicators. The agency will have one year to address the certification findings and prepare its progress report on the certification indicators that were rated Not Met.	

	

	

LICENSURE FINDINGS	

	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
6/7	
1/7	

Residential and Individual Home Supports	
52/56	
4/56	

    Residential Services
    Individual Home Supports

	

Critical Indicators	
8/8	
0/8	

Total	
58/63	
5/63	
92%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
5	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
6/7	
1/7	

Employment and Day Supports	
46/50	
4/50	

    Community Based Day Services
    Employment Support Services

	

Critical Indicators	
8/8	
0/8	

Total	
52/57	
5/57	
91%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
5	

	

	

	

	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L48	
The agency has an effective Human Rights Committee.	
There were a number of areas that the agency needs to strengthen in order to improve the effectiveness of its Human Rights Committee.  The agency needs to ensure that the HRC meets mandated composition and fulfills all responsibilities such as reviewing policies and any practices that potentially restrict individuals' rights on an annual basis or as changes occur. For example, key pieces such as the complaint and cell phone policies would benefit from revision and re-review by the individuals and the Human Rights Committee on an annual basis.	

		

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L36	
Recommended tests and appointments with specialists are made and kept. 	
For one of three individuals, recommended follow up appointments did not occur.  The agency needs to ensure that additional tests and appointments are made and kept within the time frame recommended by the physician.  	

 L56	
Restrictive practices intended for one individual that affect all individuals served at a location need to have a written rationale that is reviewed as required and have provisions so as not to unduly restrict the rights of others.	
A restrictive practice (door alarm) was in place for one individual living in a home with others.   There was no written rationale for this restriction.  The agency needs to ensure that all required components are in place including: a written rationale, that this restriction is the least restrictive option or alternatively determine if this can be eliminated.  This plan needs to be reviewed and approved, and provisions so as not to unduly restrict others, put into place.	

 L63	
Medication treatment plans are in written format with required components.	
The agency needs to ensure that the medication treatment plan contains all the required components including observable behavioral symptoms for which data should be collected..	

 L64	
Medication treatment plans are reviewed by the required groups.	
The Medication Treatment Plan needs to be reviewed by all the required groups.  It is not included in the ISP.  	

	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L10	
The provider implements interventions to reduce risk for individuals whose behaviors may pose a risk to themselves or others.  	
Although the agency and DDS Area Office met regularly to review the risk management needs for two individuals, the risks persist.  The agency needs to collaborate with the ISP teams to develop protocols and train staff to clearly describe what staff are supposed to do if the behaviors which pose risk occur.  	

 L50	
Written and oral communication with and about individuals is respectful.	
The signs that stated "Consumers Only" and "Staff Only" on the refrigerator and the single stall accessible bathroom located at the CBDS program did not promote people first language.  These signs were removed when identified by surveyors. (Corrected)	

 L51	
Individuals can access and keep their own possessions. 	
Seven individuals were reviewed regarding the ability to access and keep their own possessions.  Of these, three individuals in the CBDS program were asked to agree to a cell phone policy which included potential removal of the cell phone.   The agency needs to review the use of its cell phone policy, which includes potential collection of individuals' personal property, to ensure that this is the least restrictive option. If this policy continues to be used, it must be: based on individual need, and have a written plan in place that has been reviewed and approved per regulatory requirements.  	

 L67	
There is a written plan in place accompanied by a training plan when the agency has shared or delegated money management responsibility.	
The agency had shared or delegated funds management responsibility for three individuals. The existing financial management plans need to include further information regarding each individual's capacity to manage money and develop training plans to increase their independence in this area.	

			

		

	

	

CERTIFICATION FINDINGS	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

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

Residential and Individual Home Supports	
43/45	
2/45	

Individual Home Supports	
22/23	
1/23	

Residential Services	
21/22	
1/22	

TOTAL	
49/51	
2/51	
96%	

Certified	

	

	
	
Met / Rated	
Not Met / Rated	
% Met	

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

Employment and Day Supports	
25/36	
11/36	

Community Based Day Services	
12/14	
2/14	

Employment Support Services	
13/22	
9/22	

TOTAL	
31/42	
11/42	
74%	

Certified with Progress Report	

	

	

	

	

	
Individual Home Supports- Areas Needing Improvement on Standards not met:	

Indicator #	
Indicator	
Area Needing Improvement	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
Three individuals were reviewed.  Of these, none had participated in an assistive technology assessment.  The agency needs to assess each individual to determine how/if assistive technology or modifications such as pictorial cues, peer mentoring, automated reminders, or computers/tablets can be used to increase their independence.  	

	

	
Residential Services Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 C48	
Individuals are a part of the neighborhood.	
 The residential supports for four individuals were reviewed and all four individuals were supported to take part in events and activities that connected them to their neighbors, both with and without disabilities. Two individuals introduced the surveyor to their neighbors.  Staff are commended for supporting and encouraging individuals to be active members of their communities.	

	

	
Residential Services- Areas Needing Improvement on Standards not met:	

Indicator #	
Indicator	
Area Needing Improvement	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
The agency needs to assess each individual to determine how/if assistive technology or modifications such as pictorial cues, automated reminders, or computers/tablets can be used to increase their independence.  	

	

	
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.	
The agency is commended for offering its unique service of CBDS supports that were available and provided during evening hours. These services focused on individualized skill building, recreational and social activities, and successfully filled the needs expressed by many individuals and families.	

	

	
Community Based Day Services- Areas Needing Improvement on Standards not met:	

Indicator #	
Indicator	
Area Needing Improvement	

 C44	
Staff have effective methods to assist individuals to explore their job interests if appropriate.	
For one of the three individuals surveyed, the agency needs to more effectively implement ways to assess their job interests on a regular basis and provide supports to explore expressed interests.	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
The supports for three individuals were reviewed.  Of these, none had participated in an assistive technology assessment.  The agency needs to assess each individual to determine how/if assistive technology or modifications such as pictorial cues,  automated reminders, or computers/tablets can be used to increase their independence.  	

	

	
Employment Support Services- Areas Needing Improvement on Standards not met:	

Indicator #	
Indicator	
Area Needing Improvement	

 C22	
Staff have effective methods to assist individuals to explore their job interests.	
While some employment staff were aware of individuals job interests, these interests were not explored with individuals. The agency needs to support individuals to explore and learn more about their unique job interests and career goals.	

 C23	
Staff utilize a variety of methods to assess an individual's skills, interests, career goals and training and support needs in employment.	
While the agency had completed vocational assessments for individuals that contained some information pertaining to more generalized employment areas such as their physical capacities and learning styles, individuals were not sufficiently assessed  in their skills or training needs relevant to their specific career goals or fields of interest.  The agency needs to expand existing assessment tools to focus more on what the individual wants to do for employment, their career goals, and their unique training / support needs.	

 C26	
Career planning includes an analysis of how an individual's entitlements can be managed in a way that allows them to work successfully in the community.	
Agency staff indicated that there was a resource person they could call for benefits and entitlement type questions, but none of the four individuals who received employment supports had been assisted to understand how their entitlements and wages could impact each other if they worked various amounts of hours.  The agency needs to support all individuals who receive employment supports to receive an analysis and information so to better understand how entitlements can be managed to promote further employment in the community.	

 C29	
Individuals are supported to obtain employment that matches their skills and interests.	
Two individuals surveyed expressed their career preferences.  While these two individuals are competitively employed, the agency has not pursued securing employment that matches the expressed areas of interests.  	

 C31	
 Accommodations and adjustments are made to enable an individual to perform his/her job functions.	
Two people had jobs at the Olive Garden restaurant, where they were not allowed to complete the job of baking the bread, as the agency reports that the Olive Garden will only allow the job coach to perform this duty.  The agency needs to conduct assessments and work with the restaurant to provide safety equipment /accommodations and training to determine whether these two people's may be able to perform these job functions with accommodations.	

 C33	
Employee benefits and rights are clearly explained to the individual.	
The employment supports for four individuals who each had part time competitively paying jobs in the community were reviewed. The agency needs to ensure that each individual is supported to understand their employment rights and benefits.  	

 C34	
The agency provides the optimal level of support to promote success with a specific plan for minimizing supports.	
In some circumstances, the job coaches were performing job duties as requested by the employment site.  The agency needs to perform assessments routinely with a discussion of how to promote further success and fade supports.  	

 C35	
Individuals are given feedback on job performance by their employer.	
While individuals and agency staff indicated that informal feedback was provided from their employers on a regular basis, those individuals who had been at their jobs for more than one year did not have performance evaluations. The agency needs to advocate to ensure that individuals receive performance evaluations on at least an annual basis, and/or the frequency in accordance to their employer's policies/procedures.	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
The supports for four individuals were reviewed.  The agency has not conducted assessments for assistive technology.  The agency needs to assess each individual to determine how/if assistive technology or modifications such as pictorial cues, heat resistant oven mitts, automated reminders, or computers/tablets can be used to increase their independence.  	

	

	

		

					
	MASTER SCORE SHEET LICENSURE	

					
	Organizational: Southeastern Massachusetts Educational Collaborative	

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

O	
 L2	
Abuse/neglect reporting	
5/5	
Met	

 L3	
Immediate Action	
2/2	
Met	

 L4	
Action taken	
2/2	
Met	

 L48	
HRC	
0/1	
Not Met(0 % )	

 L74	
Screen employees	
4/4	
Met	

 L76	
Track trainings	
20/20	
Met	

 L83	
HR training	
20/20	
Met	

							
	Residential and Individual Home Supports:	

							
	
Ind. #	
Ind.	
Loc. or Indiv.	
Res. Sup.	
Ind. Home Sup.	
Place.	
Resp.	
ABI-MFP Res. Sup.	
ABI-MFP Place.	
Total Met/Rated	
Rating	

 L1	
Abuse/neglect training	
I	
1/1	
3/3	

	
	
4/4	
Met	

 L5	
Safety Plan	
L	
1/1	
2/3	

	
	
3/4	
Met	

O	
 L6	
Evacuation	
L	
1/1	
3/3	

	
	
4/4	
Met	

 L7	
Fire Drills	
L	
1/1	

	

1/1	
Met	

 L8	
Emergency Fact Sheets	
I	
0/1	
3/3	

	
	
3/4	
Met	

 L9	
Safe use of equipment	
L	
1/1	
3/3	

	
	
4/4	
Met	

O	
 L11	
Required inspections	
L	
1/1	

	

1/1	
Met	

O	
 L12	
Smoke detectors	
L	
1/1	
3/3	

	
	
4/4	
Met	

O	
 L13	
Clean location	
L	
1/1	

	

1/1	
Met	

 L14	
Site in good repair	
L	
1/1	

	

1/1	
Met	

 L15	
Hot water	
L	
1/1	

	

1/1	
Met	

 L16	
Accessibility	
L	
1/1	

	

1/1	
Met	

 L20	
Exit doors	
L	
1/1	

	

1/1	
Met	

 L21	
Safe electrical equipment	
L	
1/1	

	

1/1	
Met	

 L22	
Clean appliances	
L	
1/1	

	

1/1	
Met	

 L25	
Dangerous substances	
L	
1/1	

	

1/1	
Met	

 L26	
Walkway safety	
L	
1/1	

	

1/1	
Met	

 L29	
Rubbish/combustibles	
L	
1/1	

	

1/1	
Met	

 L30	
Protective railings	
L	
1/1	

	

1/1	
Met	

 L31	
Communication method	
I	
1/1	
3/3	

	
	
4/4	
Met	

 L32	
Verbal & written	
I	
1/1	
3/3	

	
	
4/4	
Met	

 L33	
Physical exam	
I	
1/1	
2/2	

	
	
3/3	
Met	

 L34	
Dental exam	
I	
1/1	
2/2	

	
	
3/3	
Met	

 L35	
Preventive screenings	
I	
1/1	
2/2	

	
	
3/3	
Met	

 L36	
Recommended tests	
I	
0/1	
2/2	

	
	
2/3	
Not Met
(66.67 %)	

 L37	
Prompt treatment	
I	
1/1	
2/2	

	
	
3/3	
Met	

O	
 L38	
Physician's orders	
I	
1/1	

	

1/1	
Met	

 L39	
Dietary requirements	
I	
1/1	
1/1	

	
	
2/2	
Met	

 L40	
Nutritional food	
L	
1/1	
2/2	

	
	
3/3	
Met	

 L41	
Healthy diet	
L	
1/1	
3/3	

	
	
4/4	
Met	

 L42	
Physical activity	
L	
1/1	
3/3	

	
	
4/4	
Met	

 L43	
Health Care Record	
I	
1/1	
2/2	

	
	
3/3	
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	

 L47	
Self medication	
I	
1/1	
2/3	

	
	
3/4	
Met	

 L49	
Informed of human rights	
I	
1/1	
3/3	

	
	
4/4	
Met	

 L50	
Respectful Comm.	
L	
1/1	
3/3	

	
	
4/4	
Met	

 L51	
Possessions	
I	
1/1	
3/3	

	
	
4/4	
Met	

 L52	
Phone calls	
I	
1/1	
3/3	

	
	
4/4	
Met	

 L53	
Visitation	
I	
1/1	
3/3	

	
	
4/4	
Met	

 L54	
Privacy	
L	
1/1	
3/3	

	
	
4/4	
Met	

 L55	
Informed consent	
I	
	
1/1	

	
	
1/1	
Met	

 L56	
Restrictive practices	
I	
0/1	

	

0/1	
Not Met
(0 %)	

 L63	
Med. treatment plan form	
I	
0/1	

	

0/1	
Not Met
(0 %)	

 L64	
Med. treatment plan rev.	
I	
0/1	

	

0/1	
Not Met
(0 %)	

 L67	
Money mgmt. plan	
I	
1/1	

	

1/1	
Met	

 L68	
Funds expenditure	
I	
1/1	

	

1/1	
Met	

 L69	
Expenditure tracking	
I	
1/1	

	

1/1	
Met	

 L80	
Symptoms of illness	
L	
1/1	
3/3	

	
	
4/4	
Met	

 L81	
Medical emergency	
L	
1/1	
3/3	

	
	
4/4	
Met	

O	
 L82	
Medication admin.	
L	
1/1	

	

1/1	
Met	

 L85	
Supervision 	
L	
1/1	
3/3	

	
	
4/4	
Met	

 L86	
Required assessments	
I	
1/1	
3/3	

	
	
4/4	
Met	

 L87	
Support strategies	
I	
1/1	
3/3	

	
	
4/4	
Met	

 L88	
Strategies implemented	
I	
1/1	
3/3	

	
	
4/4	
Met	

#Std. Met/# 56 Indicator	

	

	

52/56	

	
Total Score	

	

	

58/63	

	

	

	

	
92.06%	

		
							
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	
	
3/3	
7/7	
Met	

 L5	
Safety Plan	
L	

1/1	
1/1	
Met	

O	
 L6	
Evacuation	
L	

1/1	
1/1	
Met	

 L7	
Fire Drills	
L	

1/1	
1/1	
Met	

 L8	
Emergency Fact Sheets	
I	
4/4	
	
3/3	
7/7	
Met	

 L9	
Safe use of equipment	
L	

1/1	
1/1	
Met	

 L10	
Reduce risk interventions	
I	
0/1	
	
0/1	
0/2	
Not Met
(0 %)	

O	
 L11	
Required inspections	
L	

1/1	
1/1	
Met	

O	
 L12	
Smoke detectors	
L	

1/1	
1/1	
Met	

O	
 L13	
Clean location	
L	

1/1	
1/1	
Met	

 L15	
Hot water	
L	

1/1	
1/1	
Met	

 L16	
Accessibility	
L	

1/1	
1/1	
Met	

 L17	
Egress at grade 	
L	

1/1	
1/1	
Met	

 L18	
Above grade egress	
L	

1/1	
1/1	
Met	

 L20	
Exit doors	
L	

1/1	
1/1	
Met	

 L21	
Safe electrical equipment	
L	

1/1	
1/1	
Met	

 L22	
Clean appliances	
L	

1/1	
1/1	
Met	

 L25	
Dangerous substances	
L	

1/1	
1/1	
Met	

 L26	
Walkway safety	
L	

1/1	
1/1	
Met	

 L28	
Flammables	
L	

1/1	
1/1	
Met	

 L29	
Rubbish/combustibles	
L	

1/1	
1/1	
Met	

 L31	
Communication method	
I	
4/4	
	
3/3	
7/7	
Met	

 L32	
Verbal & written	
I	
4/4	
	
3/3	
7/7	
Met	

 L37	
Prompt treatment	
I	
2/2	
	
3/3	
5/5	
Met	

O	
 L38	
Physician's orders	
I	

3/3	
3/3	
Met	

 L39	
Dietary requirements	
I	

2/2	
2/2	
Met	

 L44	
MAP registration	
L	

1/1	
1/1	
Met	

 L45	
Medication storage	
L	

1/1	
1/1	
Met	

O	
 L46	
Med. Administration	
I	

2/2	
2/2	
Met	

 L49	
Informed of human rights	
I	
4/4	
	
3/3	
7/7	
Met	

 L50	
Respectful Comm.	
L	
1/1	
	
0/1	
1/2	
Not Met
(50.0 %)	

 L51	
Possessions	
I	
4/4	
	
0/3	
4/7	
Not Met
(57.14 %)	

 L52	
Phone calls	
I	
4/4	
	
3/3	
7/7	
Met	

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

 L55	
Informed consent	
I	
3/3	
	
1/1	
4/4	
Met	

 L61	
Health protection in ISP	
I	

1/1	
1/1	
Met	

 L62	
Health protection review	
I	

1/1	
1/1	
Met	

 L67	
Money mgmt. plan	
I	

0/3	
0/3	
Not Met
(0 %)	

 L68	
Funds expenditure	
I	

3/3	
3/3	
Met	

 L69	
Expenditure tracking	
I	

3/3	
3/3	
Met	

 L77	
Unique needs training	
I	
4/4	
	
3/3	
7/7	
Met	

 L79	
Restraint training	
L	
1/1	
	
1/1	
2/2	
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	

 L84	
Health protect. Training	
I	

1/1	
1/1	
Met	

 L85	
Supervision 	
L	
1/1	
	
1/1	
2/2	
Met	

 L86	
Required assessments	
I	
3/3	
	
2/2	
5/5	
Met	

 L87	
Support strategies	
I	
3/3	
	
2/2	
5/5	
Met	

 L88	
Strategies implemented	
I	
4/4	
	
3/3	
7/7	
Met	

#Std. Met/# 50 Indicator	

	

46/50	

	
Total Score	

	

52/57	

	

	

	
91.23%	

		
							
	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	
3/3	
Met	

 C8	
Family/guardian communication	
2/2	
Met	

 C13	
Skills to maximize independence 	
3/3	
Met	

 C37	
Interpersonal skills for work	
3/3	
Met	

 C40	
Community involvement interest	
3/3	
Met	

 C41	
Activities participation	
3/3	
Met	

 C42	
Connection to others	
3/3	
Met	

 C43	
Maintain & enhance relationship	
3/3	
Met	

 C44	
Job exploration	
1/3	
Not Met (33.33 %)	

 C45	
Revisit decisions	
3/3	
Met	

 C46	
Use of generic resources	
3/3	
Met	

 C47	
Transportation to/ from community	
3/3	
Met	

 C51	
Ongoing satisfaction with services/ supports	
3/3	
Met	

 C54	
Assistive technology	
0/3	
Not Met (0 %)	

Employment Support Services	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff performance	
4/4	
Met	

 C8	
Family/guardian communication	
4/4	
Met	

 C22	
Explore job interests	
2/4	
Not Met (50.0 %)	

 C23	
Assess skills & training needs	
1/4	
Not Met (25.00 %)	

 C24	
Job goals & support needs plan	
4/4	
Met	

 C25	
Skill development	
4/4	
Met	

 C26	
Benefits analysis	
0/4	
Not Met (0 %)	

 C27	
Job benefit education	
4/4	
Met	

 C28	
Relationships w/businesses	
1/1	
Met	

 C29	
Support to obtain employment	
2/3	
Not Met (66.67 %)	

 C30	
Work in integrated settings	
4/4	
Met	

 C31	
Job accommodations	
2/4	
Not Met (50.0 %)	

 C32	
At least minimum wages earned	
4/4	
Met	

 C33	
Employee benefits explained	
0/4	
Not Met (0 %)	

 C34	
Support to promote success	
2/4	
Not Met (50.0 %)	

 C35	
Feedback on job performance	
1/3	
Not Met (33.33 %)	

 C36	
Supports to enhance retention	
4/4	
Met	

 C37	
Interpersonal skills for work	
4/4	
Met	

 C47	
Transportation to/ from community	
4/4	
Met	

 C50	
Involvement/ part of the Workplace culture	
4/4	
Met	

 C51	
Ongoing satisfaction with services/ supports	
4/4	
Met	

 C54	
Assistive technology	
0/4	
Not Met (0 %)	

Individual Home Supports	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff performance	
3/3	
Met	

 C8	
Family/guardian communication	
3/3	
Met	

 C9	
Personal relationships	
3/3	
Met	

 C10	
Social skill development	
3/3	
Met	

 C11	
Get together w/family & friends	
3/3	
Met	

 C12	
Intimacy	
3/3	
Met	

 C13	
Skills to maximize independence 	
3/3	
Met	

 C14	
Choices in routines & schedules	
3/3	
Met	

 C15	
Personalize living space	
3/3	
Met	

 C16	
Explore interests	
3/3	
Met	

 C17	
Community activities	
3/3	
Met	

 C18	
Purchase personal belongings	
3/3	
Met	

 C19	
Knowledgeable decisions	
3/3	
Met	

 C20	
Emergency back-up plans	
2/2	
Met	

 C21	
Coordinate outreach	
3/3	
Met	

 C46	
Use of generic resources	
3/3	
Met	

 C47	
Transportation to/ from community	
3/3	
Met	

 C48	
Neighborhood connections	
3/3	
Met	

 C49	
Physical setting is consistent 	
3/3	
Met	

 C51	
Ongoing satisfaction with services/ supports	
3/3	
Met	

 C52	
Leisure activities and free-time choices /control	
3/3	
Met	

 C53	
Food/ dining choices	
3/3	
Met	

 C54	
Assistive technology	
0/3	
Not Met (0 %)	

Residential Services	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff performance	
1/1	
Met	

 C8	
Family/guardian communication	
1/1	
Met	

 C9	
Personal relationships	
1/1	
Met	

 C10	
Social skill development	
1/1	
Met	

 C11	
Get together w/family & friends	
1/1	
Met	

 C12	
Intimacy	
1/1	
Met	

 C13	
Skills to maximize independence 	
1/1	
Met	

 C14	
Choices in routines & schedules	
1/1	
Met	

 C15	
Personalize living space	
1/1	
Met	

 C16	
Explore interests	
1/1	
Met	

 C17	
Community activities	
1/1	
Met	

 C18	
Purchase personal belongings	
1/1	
Met	

 C19	
Knowledgeable decisions	
1/1	
Met	

 C20	
Emergency back-up plans	
1/1	
Met	

 C46	
Use of generic resources	
1/1	
Met	

 C47	
Transportation to/ from community	
1/1	
Met	

 C48	
Neighborhood connections	
1/1	
Met	

 C49	
Physical setting is consistent 	
1/1	
Met	

 C51	
Ongoing satisfaction with services/ supports	
1/1	
Met	

 C52	
Leisure activities and free-time choices /control	
1/1	
Met	

 C53	
Food/ dining choices	
1/1	
Met	

 C54	
Assistive technology	
0/1	
Not Met (0 %)