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	

	
7/13/2015 - 7/16/2015	

	

	

	

	
Service Enhancement 
Meeting Date	

	
7/24/2015	

	

	

	

	

	

	
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) 7 audit (s) 	
Full Review	
51 / 53 2 Year License 07/24/2015 - 07/24/2017	

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

Full Review	
10 / 12 Certified	

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

Full Review	
15 / 18 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	
6/6 Certified	

	

		
EXECUTIVE SUMMARY :	

		
PLUS (People Learning Useful Skills) Company, Inc. is a non-profit organization headquartered in Nashua, NH  providing a wide array of supports including employment/vocational day services and residential/home care services to individuals with Developmental Disabilities.  In Massachusetts, the agency provides day services at two locations, a new Lawrence site provides a more attractive and functional environment for the Community Based Day Services (CBDS) and an Employment site in Tewksbury. The agency serves 90 individuals in employment/ day services in the two sites.

For the purpose of this survey, a full licensing and certification review of the agency's DDS funded CBDS and Employment Services was conducted.   The  agency has a number of ways that individuals can learn and explore job interests and gain employment skills. They continued to support individuals to engage in temporary unpaid internships  at Lowell General Hospital and Marshall's Corporation as a mechanism to gain job experience. Both sites were visited during the survey and the individuals took great pride in explaining their job function and the skills they were learning.  Since the last review, PLUS Company has added a new internship program InCOME (Insurance, Career Opportunities, Mentoring and Education) Program based out of UMASS Lowell.  Ten participants per year begin the process with classroom instruction for six weeks and finish with 12 weeks of unpaid internships. InCOME is designed to teach and navigate administrative skills such as: Microsoft Office, event planning, e-mail invites, scheduling, and making packets for meetings. PLUS Company has created a new, paid, work opportunity for individuals with an 'On Demand Temporary Service' which offers temp job services to companies in the area. For the Employment division, since the last survey conducted in 2013: The agency has placed 42 individuals in competitive jobs in the community and has shown individual wages were increased from $8.35/hr to $9.14/hr.
 
or the Employment division, since the last survey conducted in 2013: The agency has shown individual wages increased from $8.35/hr to $9.14/hr.  averaged 20.6 individual employment placements who worked an average of 10.5 hours per week earning an average wage ( $8.38 in  2013, $8.67 in 2014 and $9.14 in 2015) of $8.72 per hour  . 

Another new area of accomplishment is that the agency had developed their own Human Rights Committee currently meeting all regulatory components including full membership, by laws and effective minutes describing the committee's efforts. However, in the area of human rights it was identified that the agency needs to provide more detailed information to guardians regarding the reporting of possible abuse and neglect in addition to the phone number and contact information.

 Plus Company`s mission is to 'Empower Individuals, Maximize Independence'. The emphasis continues to focus on each person and assisting them toward independence. The agency's mission is actualized by providing daily and meaningful choices from a range of work, volunteer, opportunities and activity options to individuals who were on the employment track and those for whom employment was not an option/ interest such as people of retirement age. People receiving CBDS services in Lawrence were presented with from 5 to 10 choices of different in-house and community options to choose from daily. These included activities that promote people's health and well-being (e.g. Swimming at the Y, manicures/facials, nutrition and classes in healthy cooking) and provided opportunities for people to have a positive affirming presence in the community through volunteerism. Volunteer opportunities were plentiful and included such items as watering gardens; keeping Lawrence parks clean through ground work, Neighbors in Need, Lowell Wish Foundation and Salvation Army.  Although the agency had been effective in providing people with a meaningful busy day, there needs to be an increased focus and/or program orientation toward work for those who are interested and of employment age.

People receiving agency Employment Supports were also offered a range of skill building classes and support (e.g. hygiene class, transportation planning, money skills, interviewing and job club) and vocational opportunities to explore including volunteer options, job tours, temp work placements, and competitive employment.   Staff was creative and flexible in developing and supporting work opportunities for people through, for example, job-sharing and providing transportation outside of their normal work hours which included nights and weekends.

 In both support models assessments and support strategies were submitted within the regulatory timeframes. However, for five out of the seven individuals surveyed services/ support strategies that were identified in the ISP were not being consistently implemented. The agency needs to ensure that  agreed upon strategies are being carried out. 

The training review indicated that the agency had created a best practice in regards to ensuring that staff received required training.  Annually they selected a day which was set aside specifically for the purpose of obtaining a variety of training, for example:  First Aid and CPR, as well as specific individual protocols and generic health related information.

Another PLUS Company notable practice was its efforts to ensure that all individuals were capable of evacuating their buildings as identified in the evacuation plan. Given the fact that people's active schedules caused them to be frequently out of the building, the agency took great pains to conduct a multitude of drills across both settings, as well as job sites in the community to ensure that everyone participated and evacuated safely during fire drills. 

As a result of this licensing and certification survey, PLUS Company Inc. met 96% of the licensing indicators reviewed, 10 out of 12 certification indicators were met for CBDS and 15 out of 18 certification indicators were met for employment.  Due to this very positive outcome, the agency received a two year license for its employment/ day services and will complete its own follow-up of the ten licensing indicators that were not met.	

	

	

LICENSURE FINDINGS	

	

	

	

	
	
Met / Rated	
Not Met / Rated	
% Met	

Organizational	
8/8	
0/8	

Employment and Day Supports	
43/45	
2/45	

    Community Based Day Services
    Employment Support Services

	

Critical Indicators	
8/8	
0/8	

Total	
51/53	
2/53	
96%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
2	

	

	

	

	

	
Organizational Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 L76	
The agency has and utilizes a system to track required trainings.	
The  agency is recognized for having a notable practice to ensure that all staff received mandated trainings.  Every year they set aside one day when staff receives all mandated trainings such as First Aid, CPR, Human Rights and DPPC. PLUS Company offers an extensive list of additional trainings which directly supports the people they serve such as: Health Issues, Teaching Techniques, Wheelchair Van and Lift Use, Human Services Worker Safety and ISP workshops. Individual health and nursing protocols were listed by need and the corresponding individual to the protocol were listed. 	

		

	

	
Employment/Day Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 L7	
Fire drills are conducted as required.	
 The agency had a notable practice of making sure that individuals across two settings, with a myriad of schedules were present at some point throughout the year. This effort required many more than the required two fire drills per year.	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L1	
Individuals and guardians are trained in how to report alleged abuse/ neglect.	
Although guardians received the telephone number for DPPC they did not receive information and training on the procedures for reporting alleged abuse and neglect as required. 	

 L88	
Services and support strategies identified and agreed upon in the ISP for which the provider has designated responsibility are being implemented.	
For some of the individuals staff was not working on the most current ISP objectives. For others,  objectives were not being met and support strategies had not been modified in the ISP. The agency needs to ensure that effective strategies are utilized and implemented and/or the ISP is modified to ensure that the individual is accomplishing his/her identified objective.	

			

		

	

CERTIFICATION FINDINGS	

	

	

	
Met / Rated	
Not Met / Rated	

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

Employment and Day Supports	

Employment Support Services	
15/18	
3/18	

Community Based Day Services	
10/12	
2/12	

	

	
Community Based Day 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. 	
The agency needs to develop a policy/procedure providing people with the opportunity to give feedback on the staff that support them.

	
 C39	
There is a plan developed to identify job goals and support needs that would lead to movement into supported employment.	
Although involved in a number of groups and activities that could be considered preparatory to employment, including volunteerism, an employment plan had not been developed for one individual.  Though many supports were in place to ensure success, there was a lack of orientation toward employment. The agency needs to support this individual to identify his/her job goals and develop an employment plan based on his/her individual's interests, strengths and support needs.	

	

	
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. 	
The agency needs to develop a policy/procedure providing people with the opportunity to give feedback on the staff that support them.

	
 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.	
The agency had supported some people to utilize a Social Security Online resource. However they had not made a benefit analysis regarding the impact of employment on individual's specific disability benefits. The agency needs to assist individuals and/or guardians to understand the relationship between employment and benefits.	

 C35	
Individuals are given feedback on job performance by their employer.	
For two out of the four individuals there was no evidence that staff were aware of the performance or evaluation processes at their places of employment. The agency needs to ensure that they are knowledgeable about this process in order to ensure that performance evaluations are being conducted on a regular basis and that when performance is good, raises are received just like other employees. 	

	

	

	

					
	MASTER SCORE SHEET LICENSURE	

					
	Organizational: PLUS COMPANY	

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

O	
 L2	
Abuse/neglect reporting	
3/3	
Met	

 L3	
Immediate Action	
3/3	
Met	

 L4	
Action taken	
3/3	
Met	

 L48	
HRC	
1/1	
Met	

 L74	
Screen employees	
3/3	
Met	

 L75	
Qualified staff	
1/1	
Met	

 L76	
Track trainings	
4/4	
Met	

 L83	
HR training	
4/4	
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	
0/4	
	
1/3	
1/7	
Not Met
(14.29 %)	

 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	
	
3/3	
7/7	
Met	

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

 L10	
Reduce risk interventions	
I	

1/1	
1/1	
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	
	
2/2	
6/6	
Met	

 L32	
Verbal & written	
I	
4/4	
	
2/2	
6/6	
Met	

 L37	
Prompt treatment	
I	
3/3	
	
3/3	
6/6	
Met	

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

 L39	
Dietary requirements	
I	

1/1	
1/1	
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	
	
2/2	
6/6	
Met	

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

 L51	
Possessions	
I	
4/4	
	
3/3	
7/7	
Met	

 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	
4/4	
	
3/3	
7/7	
Met	

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

 L87	
Support strategies	
I	
3/4	
	
3/3	
6/7	
Met
(85.71 %)	

 L88	
Strategies implemented	
I	
2/4	
	
0/3	
2/7	
Not Met
(28.57 %)	

#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 Reviewed By -DDS	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff performance	
0/3	
Not Met (0 %)	

 C8	
Family/guardian communication	
3/3	
Met	

 C13	
Skills to maximize independence 	
3/3	
Met	

 C37	
Interpersonal skills for work	
2/2	
Met	

 C38	
Habilitative & behavioral goals	
1/1	
Met	

 C39	
Support needs for employment	
0/1	
Not Met (0 %)	

 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	
1/1	
Met	

 C45	
Revisit decisions	
3/3	
Met	

Employment Support Services Reviewed By -DDS	

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	
4/4	
Met	

 C23	
Assess skills & training needs	
4/4	
Met	

 C24	
Job goals & support needs plan	
3/3	
Met	

 C25	
Skill development	
4/4	
Met	

 C26	
Benefits analysis	
1/4	
Not Met (25.00 %)	

 C27	
Job benefit education	
4/4	
Met	

 C28	
Relationships w/businesses	
1/1	
Met	

 C29	
Support to obtain employment	
4/4	
Met	

 C30	
Work in integrated settings	
4/4	
Met	

 C31	
Job accommodations	
4/4	
Met	

 C32	
At least minimum wages earned	
1/1	
Met	

 C33	
Employee benefits explained	
4/4	
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	
4/4	
Met	

 C37	
Interpersonal skills for work	
4/4	
Met