PROVIDER REPORT FOR

VOCATIONAL ADVANCEMENT

115 Watertown St

Watertown, MA, MA 02472

February 13, 2015

Version

Provider Web Report

Prepared by the Department of Developmental Services

OFFICE OF QUALITY ENHANCEMENT

SUMMARY OF OVERALL FINDINGS

Provider

VOCATIONAL ADVANCEMENT

Review Dates

1/20/2015 - 1/22/2015

Service Enhancement

Meeting Date

1/30/2015

Survey Team

Leslie Hayes (TL)

Lisa MacPhail

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) 5 audit (s)

Full Review

31 / 42 Defer Licensure -

Community Based Day Services

1 location(s) 2 audit (s)

Full Review

4 / 12 Certified

Employment Support Services

0 location(s) 1 audit (s)

Full Review

14 / 17 Certified

Center Based Employment

1 location(s) 2 audit (s)

Full Review

6 / 14 Certified

Survey scope and findings for Planning and Quality Management

Service Group Type

Sample Size

Scope

Licensure Level

Certification Scope

Certification Level

Planning and Quality Management

N/A

N/A

N/A

Full Review

0/6 Certified

EXECUTIVE SUMMARY:

The Vocational Advancement Center (VAC) has provided vocational training and employment services for individuals with disabilities and others in need of support for over 50 years. For the purpose of this full Licensure and Certification Review, Community Based Day, Employment Supports and Center Based Employment Services were evaluated.

Since the last survey in 2013, which was a Provider Self-Assessment and DDS Targeted Review, the agency underwent a number of positive changes. After many years of providing services at a location in Brighton, VAC moved in October 2013 into a location in Watertown. The new building was completely renovated to suit the agency's needs offering a bright, airy atmosphere and good program space. There are also additional rooms for small groups and socializing. In regards to supports provided, the individuals receiving services were enthusiastic about their activities and eager to show the program to visitors. Staff was happy to discuss the services being provided including its new service, Community Based Day Supports. They noted that the individuals may be involved in 2 different tracks, one of which is work-focused. The agency is part of the Greater Boston Employment Collaborative which meets regularly for networking and to share information on employment opportunities. Under Employment and Center Based Work Supports, VAC has a long-standing relationship with Tufts University which provides employment and offers training opportunities in its cafeterias. Individuals may also take part in in-house work opportunities such as cleaning and clerical activities for which they receive minimum wage. The agency has one individual who works full-time and receives job-coaching. The second track, Community Based Day Supports (CBDS), is social/recreationally-based. Individuals on this track take part in community outings such as bowling, community parks and the local library and in-house activities such as cooking, arts and crafts and Chinese language lessons. Some in-house activities are facilitated through the use of Wii.

VAC was found to need improvement in a number of licensing expectations including ISP development and implementation, health care documentation and environmental safety, Human Rights Committee expectations and consent forms. With respect to ISPs, the agency should ensure that assessments and goals/objectives are submitted on time, that objectives are clearly defined from the goals and that progress notes reflect the goals/objectives and support strategies that are to be consistently addressed. Under Health care, emergency fact sheets need to be updated regarding current medications; and, under safety, cleaning supplies such as dish soap need to be stored separately from food items. Environmentally, the agency needs to ensure all required inspections are conducted annually and that hot water temperatures remain within required guidelines. Written informed consents need to be specific to each instance where the personal information or picture will be used, when it will be published and where. It also needs to clearly state that permission may be withdrawn at any time. VAC takes part in a Human Rights Committee that is shared with another agency. VAC needs to ensure it is properly represented at these meetings, that any appropriate issues are reviewed and that minutes are maintained. The agency stated that staff meetings are held regularly. The agency has only recently started documenting attendance at staff meetings and the content of what was discussed. Staff need ongoing training and supervision that includes a focus on the unique needs of the individuals served including, but not limited to medical and mental health issues as well as interests and service needs. While the administration and staff were able to speak knowledgeably about the program, the individuals attending and daily operations, required documentation was lacking. In many cases, the lack of documentation made it difficult to determine compliance with regulations. The agency needs to concentrate on developing and implementing systems for documenting compliance with licensing and quality indicators.

With regard to Certification expectations, the agency has several areas that are in need of improvement. The agency did well with adapting environments to the needs of individuals up to and including

relocation to its new and improved setting. It also did well communicating with families and guardians and promoting relationships. VAC connects individuals with Project Impact so they fully understand how employment may affect any public benefits they may receive. However, a system for the ongoing assessment of the individuals served was not consistently evident. Regardless of the type of employment/ day supports provided, individuals must be assessed on an ongoing and routine basis for needs, interests, and job and social skills; and, this information needs to be used in the implementation of programming for each individual.

The agency also needs to have a Strategic Plan in place towards agency service improvement with goals and a system to track progress towards those goals. In addition, the agency needs to regularly gather data from individuals, families, guardians and other stakeholders and use this information to work towards improving services.

The result of the DDS Licensing and Certification Survey was that indicators were met at 74 percent with 31/42 indicators met and one critical indicator (L 11: required inspections) not met. As a result of these findings, the agency is in deferred licensing status and sanctions are in place, meaning that the agency is prohibited from any new business until the critical indicator is met and the agency scores an 80 percent or higher during follow-up. Within sixty days of the service enhancement meeting, the Office of Quality Enhancement will conduct a follow-up review relative to the licensing indicators which were not met. If during follow-up, the agency is found to have corrected a sufficient number of not met indicators to score above 80 percent, the agency will be granted a Two-Year License with a Mid-Cycle Review and sanctions will be lifted.

LICENSURE FINDINGS

Met / Rated

Not Met / Rated

% Met

Organizational

4/5

1/5

Employment and Day Supports

27/37

10/37

Community Based Day Services

Employment Support Services

Center Based Employment

Critical Indicators

3/4

1/4

Total

31/42

11/42

74%

Defer Licensure

# indicators for 60 Day Follow-up

11

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.

While the agency has trained a new Human Rights Officer (HRO) and he has started to attend the HR meetings, going forward, the agency needs to continue to ensure regular attendance at the Human Rights Committee meetings, that minutes are regularly obtained after the meeting and that any appropriate issues are reviewed.

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

Indicator #

Indicator

Area Needing Improvement

L8

Emergency fact sheets are current and accurate and available on site.

While there was evidence that the agency was informed of current medications, in two instances, individuals' medications had not been updated on their emergency fact sheets. The agency needs to ensure that emergency fact sheets are kept up-to-date.



L11

All required annual inspections have been conducted.

The water heaters at the program had not been inspected. This was corrected by 1/23/15. The agency needs to ensure that inspections occur annually. (Corrected)

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

Indicator #

Indicator

Area Needing Improvement

L15

Hot water temperature tests between 110 and 130 degrees.

The water temperature measured over 124 degrees. The agency needs to ensure that the water temperature remains within the required limits. (Corrected)

L25

Potentially dangerous substances are stored separately from food and are in containers that are accurately labeled.

Food items were stored with soap under the sink in the program area. This was immediately corrected. The agency needs to continue to ensure that food is stored separately from cleaning items.

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.

The informed consent forms reviewed were not specific regarding how the information will be used, when it will be used and the time-limit, if applicable. Consent forms also need to include the individual/guardian's right to withdraw consent at any time. The agency needs to ensure that informed consents are specific to when and how the information will be used, are time-limited and that individuals/guardians are aware of their right to withdraw consent.

L77

The agency assures that staff are familiar with and trained to support the unique needs of individuals.

The agency needs to ensure that staff are trained to support the unique needs of the individuals they serve including medical and psychiatric diagnoses.

L85

The agency provides on-going supervision and staff development

There was no evidence of ongoing training and development to staff including trainings on the unique needs of the individuals they serve including, but not limited to medical and mental health diagnoses. The agency needs to ensure staff receive ongoing training and staff development.

L86

Required assessments concerning individual needs and abilities are completed in preparation for the ISP.

The ISP assessments reviewed were not submitted within the required timelines. The agency needs to ensure assessments are submitted to the DDS Service Coordinator (SC) within the required timelines.

L87

Support strategies necessary to assist an individual to meet their goals and objectives are completed and submitted as part of the ISP.

The ISP support strategies reviewed were not submitted within the required timelines. The agency needs to ensure goals and objectives are submitted to the DDS Service Coordinator (SC) within the required timelines.

L88

Services and support strategies identified and agreed upon in the ISP for which the provider has designated responsibility are being implemented.

In 4 of the 5 individuals reviewed, progress notes did not reflect concrete information on the progress towards the individual's goals. The agency needs to ensure that progress notes specifically address the support strategies outlined for each objective.

CERTIFICATION FINDINGS

Met / Rated

Not Met / Rated

Certification - Planning and Quality Management

0/6

6/6

Employment and Day Supports

Employment Support Services

14/17

3/17

Center Based Employment

6/14

8/14

Community Based Day Services

4/12

8/12

Planning and Quality Management Areas Needing Improvement on Standards not met:

Indicator #

Indicator

Area Needing Improvement

C1

The provider collects data regarding program quality including but not limited to incidents, investigations, restraints, and medcation occurrences.

There was no evidence that there is a system in place to track program quality. The agency needs to regularly collect data and use it to determine program quality.

C2

The provider analyzes information gathered from all sources and identifies patterns and trends.

There was no evidence that there is a system in place to identify patterns and trends in regards to program quality. The agency needs to regularly collect data so that through the analysis of information patterns and trends are identified.

C3

The provider actively solicits and utilizes input from the individuals and families regarding satisfaction with services.

There was no information available to evidence that the agency regularly solicits input. The agency needs to regularly solicit and utilize input from individuals, guardians and families.

C4

The provider receives and utilizes input received internally, from DDS and other stakeholders to inform service improvement efforts.

There was no documentation to evidence that the agency regularly solicits input from DDS and other stakeholders. The agency needs to solicit and utilize input from DDS and other stakeholders to inform service improvement efforts.

C5

The provider has a process to measure progress towards achieving service improvement goals.

The agency did not present a mechanism for establishing agency goals toward improvement of services and measuring progress towards achieving service immprovement goals.

Planning and Quality Management Areas Needing Improvement on Standards not met:

Indicator #

Indicator

Area Needing Improvement

C6

The provider has mechanisms to plan for future directions in service delivery and implements strategies to actualize these plans.

The agency needs to demonstrate it has a system for program planning and strategies to actualize these plans.

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

Indicator #

Indicator

Area Needing Improvement

C7

Individuals have opportunities to provide feedback on the performance of staff that supports them.

There is no evidence that the individual had the opportunity to provide feedback on the staff working with him. The agency needs to ensure the individual has the opportunity to offer feedback.

C34

The agency provides the optimal level of support to promote success with a specific plan for minimizing supports.

Although the job coach makes regular visits to the work location, no documentation is in place that matches the number of job coach contacts with the needs of the individual. The agency needs to determine the level of supervisory support needed for this individual

C36

Ongoing supports are provided to enhance job retention and advancement.

The agency identified additional tasks that the individual has the skills to perform, but the individual has expressed he is not interested in trying new tasks. The agency needs to work with the individual to introduce tasks that advance his longstanding duties.

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

Indicator #

Indicator

Area Needing Improvement

C13

Staff (Home Providers) provide support for individuals to develop skills to enable them to maximize independence and participation in typical activities and routines.

There is no evidence that the individuals are regularly assessed to determine current functioning and how to maximize support to increase independence and participation in typical activities and routines. The agency needs to ensure that regular assessments are conducted and the information is used to support the development of skills.

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

Indicator #

Indicator

Area Needing Improvement

C37

There is support to develop appropriate work related interpersonal skills.

Individuals need to be regularly assessed on their current level of interpersonal skills and specific needs for further skill development. The agency needs to ensure regular assessments are completed and the information is used to support the development of work-related interpersonal skills.

C38

Specific habilitative and behavioral goals necessary to prepare individuals for work are identified.

Individuals should be regularly assessed to determine need areas for specific habilitative and behavioral goals relating to employment. The agency needs to ensure regular assessments are completed and the information is used to identify specific habilitative and behavioral goals.

C39

There is a plan developed to identify job goals and support needs that would lead to movement into supported employment.

Individuals need to be regularly assessed to help identify job goals and needs that would help them to either achieve supported employment or progress within their current job. The agency needs to ensure regular assessments are completed and a plan developed to identify job goals and support needs that would lead to supported employment.

C40

Individuals are supported to explore their personal interest and options for community involvement, personal interest and hobbies.

Individuals need to be regularly assessed to ensure the program addresses their interests and abilities. The agency needs to ensure regular assessments are completed and the information is used to determine personal interests, options for community involvement and/or hobbies.

C41

Individuals participate in activities that reflect their interests.

Although the individuals were found to enjoy participating in a variety of activities, the connection between the activities offered and interest inventories could not be determined. Interest inventories need to be completed at least annually.

C44

Staff have effective methods to assist individuals to explore their job interests if appropriate.

The agency needs to ensure that individuals are provided with ongoing opportunities to explore potential interests.

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

Indicator #

Indicator

Area Needing Improvement

C45

Individual's decisions of what to do during the day are revisited on a regular basis.

Although a schedule is developed daily and new activities are introduced and encouraged, it was not possible to determine the connection between activities and individual choices.

Center Based Employment- 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.

There is no evidence that individuals are assessed to determine their job interests and abilities through job exploration. The agency needs to ensure that individuals are supported to explore job opportunities.

C23

Staff utilize a variety of methods to assess an individual's skills, interests, career goals and training and support needs in employment.

There is no evidence that individuals are assessed to determine their skills, interests, career goals and training and support needs. The agency needs to ensure that individuals are assessed.

C24

There is a plan developed to identify job goals and support needs.

There is no evidence that individuals have a plan to address their job goals and support needs. The agency needs to ensure that individuals are assessed and a plan is developed to ensure follow-through.

C25

Staff assist individuals to work on skill development for job attainment and success.

There is no evidence that staff work on specific individual skill development. and/or a plan is being carried out to improve skills towards employment.

C34

The agency provides the optimal level of support to promote success with a specific plan for minimizing supports.

There was no evidence that individuals are regularly assessed to determine their optimal level of support nor is there a plan to minimize needed supports. The agency needs to ensure that individuals are receiving the optimal level of support and that a plan is in place to minimize supports.

C35

Individuals are given feedback on job performance by their employer.

There is no documentation provided that the individuals have the opportunity to receive regular feedback on job performance from their employer. The agency should ensure individuals have the opportunity to receive regular feedback.

Center Based Employment- Areas Needing Improvement on Standards not met:

Indicator #

Indicator

Area Needing Improvement

C38

Specific habilitative and behavioral goals necessary to prepare individuals for work are identified.

There were no assessments or other documents to reflect the need for specific habilitative and behavioral goals relating to employment. The agency needs to ensure that individuals are assessed and a plan developed to ensure follow-through towards supported employment.

C39

There is a plan developed to identify job goals and support needs that would lead to movement into supported employment.

There were no plans available to identify job goals and support needs that would lead to movement into supported employment. The agency needs to ensure that individuals are assessed and a plan developed to ensure progress towards a supported employment goal.

MASTER SCORE SHEET LICENSURE

Organizational: VOCATIONAL ADVANCEMENT

Indicator #

Indicator

Met/Rated

Rating(Met,Not Met,NotRated)

L48

HRC

1/2

Not Met(50.0 % )

L74

Screen employees

3/3

Met

L75

Qualified staff

3/3

Met

L76

Track trainings

3/3

Met

L83

HR training

3/3

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

1/1

2/2

2/2

5/5

Met

L5

Safety Plan

L

1/1

1/1

2/2

Met



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

1/1

2/2

0/2

3/5

Not Met

(60.0 %)

L9

Safe use of equipment

L

1/1

1/1

2/2

Met



L11

Required inspections

L

0/1

0/1

0/2

Not Met

(0 %)



L12

Smoke detectors

L

1/1

1/1

2/2

Met



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

0/1

0/1

0/2

Not Met

(0 %)

L16

Accessibility

L

1/1

1/1

2/2

Met

L17

Egress at grade

L

1/1

1/1

2/2

Met

Ind. #

Ind.

Loc. or Indiv.

Emp. Sup.

Cent. Based Work

Com. Based Day

Total Met / Rated

Rating

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

0/1

0/1

0/2

Not Met

(0 %)

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

1/1

2/2

2/2

5/5

Met

L32

Verbal & written

I

1/1

2/2

2/2

5/5

Met

L49

Informed of human rights

I

1/1

2/2

2/2

5/5

Met

L50

Respectful Comm.

L

1/1

1/1

2/2

Met

L51

Possessions

I

1/1

2/2

2/2

5/5

Met

L52

Phone calls

I

1/1

2/2

2/2

5/5

Met

L54

Privacy

L

1/1

1/1

2/2

Met

L55

Informed consent

I

0/2

0/2

0/4

Not Met

(0 %)

L77

Unique needs training

I

1/1

0/2

0/2

1/5

Not Met

(20.0 %)

L80

Symptoms of illness

L

1/1

1/1

2/2

Met

L81

Medical emergency

L

1/1

1/1

2/2

Met

L85

Supervision

L

0/1

0/1

0/2

Not Met

(0 %)

L86

Required assessments

I

0/1

0/1

0/2

Not Met

(0 %)

Ind. #

Ind.

Loc. or Indiv.

Emp. Sup.

Cent. Based Work

Com. Based Day

Total Met / Rated

Rating

L87

Support strategies

I

0/1

0/1

0/2

Not Met

(0 %)

L88

Strategies implemented

I

0/1

0/2

1/2

1/5

Not Met

(20.0 %)

#Std. Met/# 37 Indicator

27/37

Total Score

31/42

73.81%

MASTER SCORE SHEET CERTIFICATION

Certification - Planning and Quality Management

Indicator #

Indicator

Met/Rated

Rating

C1

Provider data collection

0/1

Not Met (0 %)

C2

Data analysis

0/1

Not Met (0 %)

C3

Service satisfaction

0/1

Not Met (0 %)

C4

Utilizes input from stakeholders

0/1

Not Met (0 %)

C5

Measure progress

0/1

Not Met (0 %)

C6

Future directions planning

0/1

Not Met (0 %)

Center Based Employment Reviewed By -DDS

Indicator #

Indicator

Met/Rated

Rating

C7

Feedback on staff performance

2/2

Met

C8

Family/guardian communication

2/2

Met

C22

Explore job interests

0/2

Not Met (0 %)

C23

Assess skills & training needs

0/2

Not Met (0 %)

C24

Job goals & support needs plan

0/2

Not Met (0 %)

C25

Skill development

0/2

Not Met (0 %)

C27

Job benefit education

2/2

Met

C31

Job accommodations

2/2

Met

C33

Employee benefits explained

2/2

Met

C34

Support to promote success

0/2

Not Met (0 %)

Center Based Employment Reviewed By -DDS

Indicator #

Indicator

Met/Rated

Rating

C35

Feedback on job performance

0/2

Not Met (0 %)

C37

Interpersonal skills for work

2/2

Met

C38

Habilitative & behavioral goals

0/2

Not Met (0 %)

C39

Support needs for employment

0/2

Not Met (0 %)

Community Based Day Services Reviewed By -DDS

Indicator #

Indicator

Met/Rated

Rating

C7

Feedback on staff performance

2/2

Met

C8

Family/guardian communication

2/2

Met

C13

Skills to maximize independence

0/2

Not Met (0 %)

C37

Interpersonal skills for work

1/2

Not Met (50.0 %)

C38

Habilitative & behavioral goals

0/1

Not Met (0 %)

C39

Support needs for employment

0/1

Not Met (0 %)

C40

Community involvement interest

0/2

Not Met (0 %)

C41

Activities participation

0/2

Not Met (0 %)

C42

Connection to others

2/2

Met

C43

Maintain & enhance relationship

2/2

Met

C44

Job exploration

0/2

Not Met (0 %)

C45

Revisit decisions

0/2

Not Met (0 %)

Employment Support Services Reviewed By -DDS

Indicator #

Indicator

Met/Rated

Rating

C7

Feedback on staff performance

0/1

Not Met (0 %)

C8

Family/guardian communication

1/1

Met

C22

Explore job interests

1/1

Met

C23

Assess skills & training needs

1/1

Met

C24

Job goals & support needs plan

1/1

Met

C25

Skill development

1/1

Met

C26

Benefits analysis

1/1

Met

C27

Job benefit education

1/1

Met

C29

Support to obtain employment

1/1

Met

C30

Work in integrated settings

1/1

Met

C31

Job accommodations

1/1

Met

C32

At least minimum wages earned

1/1

Met

Employment Support Services Reviewed By -DDS

Indicator #

Indicator

Met/Rated

Rating

C33

Employee benefits explained

1/1

Met

C34

Support to promote success

0/1

Not Met (0 %)

C35

Feedback on job performance

1/1

Met

C36

Supports to enhance retention

0/1

Not Met (0 %)

C37

Interpersonal skills for work

1/1

Met