PROVIDER REPORT FOR	

	

	

	

	

	

	

	

	

	
	
AMEGO
33 Perry Avenue
 Attleboro, MA 02703    	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

Version	

	

	

	

	

	

	

	

	
Provider Web Report
December 9,2015	

	

	

	

	

	

	

	
Prepared by the Department of Developmental Services
OFFICE OF QUALITY ENHANCEMENT	

	

	

	

	

	

	

				
	SUMMARY OF OVERALL FINDINGS	

				

	

	

Provider	

	
AMEGO	

	

	

	

	
Review Dates	

	
11/12/2015 - 11/18/2015	

	

	

	

	
Service Enhancement 
Meeting Date	

	
12/2/2015	

	

	

	

	

	

	
Survey Team	

	
Sally Hajjar	

Michael Marchese	

Scott Nolan (TL)	

Laura O'Connor	

Ed Sutka	

	

	

	

	

	

	
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	
8 location(s) 8 audit (s) 	
Full Review	
81 / 85 2 Year License 12/02/2015 - 12/02/2017	

Residential Services	
8 location(s) 8 audit (s) 	

Full Review	
0 / 0 Certified	

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	
1 location(s) 4 audit (s) 	
Full Review	
52 / 55 2 Year License 12/02/2015 - 12/02/2017	

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

Deemed	

	

	

	
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 :	

		
Amego, Inc., founded in 1971 is a non-profit human service agency that provides community based residential and day services to children and adults with diagnoses of Autism Spectrum Disorder and other developmental disabilities.  The Agency specializes in supporting people with a history of significant behavior challenges. An aspect of the agency's mission is "to strive toward excellence in service to provide the highest level of behavioral services, education, and habilitation. We collaborate with our staff, other agencies, families, and external professionals to optimize supports to the people we serve." Through the agency's adult services, supports were provided to 150 adults, which included residential supports provided in 30 homes and community based day supports at one location. 

The current review, conducted by the Department of Developmental Services (DDS) included all licensure and certification indicators for residential services.  A full Licensing review of community based day services was completed, with certification deemed through CARF accreditation.  The scope of the DDS licensure review addressed a range of indicators which either impacted people directly or which related to the agency's organizational systems.  Licensing indicators related to domains such as health care, medication administration, environmental safety, funds management, and human rights.  The certification review was conducted for residential services only. The range of certification indicators included areas such as individual choice, community membership, the development of independent living skills, and the collection and analysis of data regarding the quality of services provided by the agency. 

The review of residential services identified a number of accomplishments which enhanced supports to individuals.  In the environmental and choice domain, homes were well maintained, reflected the personal preferences and interests of individuals, and blended into their local communities.  Individuals that participated in the survey were assisted to access a variety of community resources such as outdoor concerts, libraries, and local fitness centers for swimming and exercise.  In some instances, individuals were regulars at the local restaurant where wait staff knew their names and favorite dishes.  Staff were observed to encourage individuals to make choices or engage in activities. For example, some individuals were assisted by staff to cook a variety of foods such as a spaghetti dinner, corn bread and chicken stir fry. Another individual was supported to go rollerblading on a regular basis when he chose to do so. 

An additional strength of the agency was the efforts made by staff to support individuals to maintain relationships with their family.  An example of this is when staff took the initiative to bring a woman to Connecticut so she could visit with her mother who could no longer make the long drive. In another instance, staff assisted an individual to host a birthday party with his family at his home.

The licensing indicators pertaining to community based day supports were reviewed at the agency's northern location.  The agency plans to move this program to a new location in the Spring 2016. The licensing domains included: environmental review, health and safety, human rights, and goal accomplishment.  The agency met 43 out of 45 licensing indicators.  A potential human rights issue was identified pertaining to privacy when using the bathrooms.   The agency needs to ensure that the level of support and restrictions put in place are tailored based on each individual's unique needs.  

An ongoing strength of the agency was its commitment to ensure all direct support staff focused on each individual's positive attributes.  All staff were trained in Applied Behavior Analysis and implemented these techniques to assist people to develop and use positive behavior to maximize success. Clinical supervision, data collection analysis, and ongoing staff training across settings resulted in a steady decrease in contingency plans that included restrictive practices. The development and implementation of Universal Support Plans focused on interactional guidelines designed to address the unique support needs and preferences of the individuals. It is recommended the agency strengthen the Functional Communication Techniques section of these plans to include:  specific strategies, techniques and staff approaches to be implemented towards supporting each individual to maximize his/her communication skills. 
In addition to positive behavior supports, some individuals were supported with behavior modifying medication.  For six people, Medication Treatment Plans were developed that identified behaviors to be addressed through the use of behavior modifying medication.  Data was collected, analyzed and evaluated based on observations of staff providing residential and day services.  Issues were identified in the area of medication treatment planning for two of the eight individuals for whom these supports were needed. One individual who took behavior modifying medication for sleep needed a medication treatment plan developed. While another individual's plan did not include a description of the observable symptoms/behavior for which behavior modifying medication was prescribed.

The agency's management team was committed to promoting a workplace culture that sought the opinions and fostered respect for staff at all levels of the organization. This lead to positive outcomes for individuals in residential services.  Interactions observed between direct support staff and individuals was mutually respectful. The relationships developed between the individuals and long-term staff continued to be strength of the agency.  Staff at all levels; direct care and senior administrators had many years of service within the organization and provided a rich history and long standing relationship with those receiving support. This knowledge of individuals' preferences helped to identify and develop new staff that would be the most compatible and successful in working with them.  

In the Certification areas of Planning and Quality Management, the agency developed a strategic plan, which began in 2009. This plan identified areas of need to be addressed such as improving staff training, maintaining a motivated and satisfied workforce, and developing objective measures to evaluate the quality of services.   The agency used a monthly checklist which includes onsite review of residential services to ensure increased effectiveness and monitoring of areas relating to overall program quality.  It is recommended that the agency expand the standards reviewed to include restrictive interventions, supportive and health related protections and physician ordered treatment protocols. In addition, the agency should strengthen its systems to follow-up that issues identified through these monitoring practices are resolved within a timely manner.  The agency should also implement its plan to further identify trends and patterns across the agency to enhance the quality of services provided to individuals.  It would also be beneficial to include a system to track when maintenance repair requests will be completed.

As a result of the current licensing and certification review, Amego will receive a Two-Year License for both residential and employment/day service groups.  Amego will follow-up on all licensing standards that were not met during the course of the survey for both service groups. The results of the follow-up will be reported by the agency to OQE within sixty days. Additionally, the outcome of the certification review of the residential service group was 100% met.	

	

	

LICENSURE FINDINGS	

	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
9/10	
1/10	

Residential and Individual Home Supports	
72/75	
3/75	

    Residential Services

	

Critical Indicators	
8/8	
0/8	

Total	
81/85	
4/85	
95%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
4	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
9/10	
1/10	

Employment and Day Supports	
43/45	
2/45	

    Community Based Day Services

	

Critical Indicators	
8/8	
0/8	

Total	
52/55	
3/55	
95%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
3	

	

	

	

	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L65	
Restraint reports are submitted within required timelines.	
Out of seventy restraint reports submitted, forty one did not meet either the three day submission or the five-day managerial review timeline. The agency needs to ensure the restraint reports are submitted within the established timelines.	

		

	

	
Residential Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 L85	
The agency provides on-going supervision and staff development	
The agency is commended for its commitment to hiring, developing and retaining staff who are competent to support individuals to increase their skills and abilities at both home and in the community. This was accomplished through comprehensive screening, orientation, and ongoing training systems.  Supervision and observation, which was provided to staff on a regular basis from both clinical and management teams, focused towards professional development.  This lead to positive outcomes for individuals across all settings. 	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 L30	
Every porch, balcony, deck or roof used as a porch or deck has a wall or protective railing in good repair.	
Two out of eight locations visited had either a loose railing or were lacking hand rails, posing a potential safety risk.  The agency needs to ensure that all porches and decks have railings and hand rails in place, and that they are in good repair. 	

 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.	
Issues were identified for five out of seven locations where restrictive practices were implemented. These included the use of alarms on egress doors to individual's bedroom doors and locked cabinets without a specific need, written rationale or strategies to mitigate the impact on others who do not need the restrictive practice.  	

 L63	
Medication treatment plans are in written format with required components.	
Eight people were supported with the use of behavior modifying medication.  In two instances, either the medication treatment plan did not have the required components or medication plan was not developed when needed.  The agency needs to ensure that medication treatment plans, with required components, are developed for individuals supported with the use of behavior modifying medication.	

	

	

	
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 hot water at the day program tested at 96 degrees. The agency needs to ensure that the water temperature is between 110 and 120 degrees.	

 L54	
Individuals have privacy when taking care of personal needs and discussing personal matters. 	
One bathroom designated for staff was able to be locked from the inside to ensure privacy; the inside locks for the three bathrooms used by individuals served were removed.  Staff were observed to stand by the door and checked in on each individual while he/she used the bathroom. When the surveyor asked about this practice, staff indicated that only some of the individuals needed assistance or supervision to use the bathroom safely.  The agency needs to ensure that the level of support and restrictions put in place are tailored to each individual's unique needs.	

			

		

	

CERTIFICATION FINDINGS	

	

	

	
Met / Rated	
Not Met / Rated	

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

Residential and Individual Home Supports	

Residential Services	
0/0	
0/0	

	
	
Met / Rated	
Not Met / Rated	

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

Employment and Day Supports	

	

	

	

	
Residential Services Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 C11	
Staff (Home Providers) support individuals to get together with families and friends when appropriate   	
The agency is commended for supporting individuals to strengthen and maintain their relationships with family and/or guardians through ongoing communication and visits. An example of this is when staff took the initiative to bring a woman to Connecticut so she could visit with her ailing mother. Families and guardians were encouraged and welcomed to call or visit at any time.	

 C16	
Staff (Home Providers) support individuals to explore their interests for cultural, social, recreational and spiritual activities.  	
All of the individuals who participated in the survey were supported to participate in a variety of social and recreational activities including local parks, concerts, and libraries.  Some individuals have benefited from being supported to explore cultural and spiritual activities as well. For example, one woman who enjoyed religious music was supported to attend her church and other religious concerts with a staff person who shared this interest.  	

	

	

	

					
	MASTER SCORE SHEET LICENSURE	

					
	Organizational: AMEGO	

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

O	
 L2	
Abuse/neglect reporting	
8/9	
Met(88.89 % )	

 L3	
Immediate Action	
11/11	
Met	

 L4	
Action taken	
15/15	
Met	

 L48	
HRC	
2/2	
Met	

 L65	
Restraint report submit	
29/70	
Not Met(41.43 % )	

 L66	
HRC restraint review	
65/65	
Met	

 L74	
Screen employees	
5/5	
Met	

 L75	
Qualified staff	
3/3	
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	
8/8	

	

8/8	
Met	

 L4	
Action taken	
L	
1/1	

	

1/1	
Met	

 L5	
Safety Plan	
L	
8/8	

	

8/8	
Met	

O	
 L6	
Evacuation	
L	
8/8	

	

8/8	
Met	

 L7	
Fire Drills	
L	
8/8	

	

8/8	
Met	

 L8	
Emergency Fact Sheets	
I	
8/8	

	

8/8	
Met	

 L9	
Safe use of equipment	
L	
8/8	

	

8/8	
Met	

 L10	
Reduce risk interventions	
I	
4/4	

	

4/4	
Met	

O	
 L11	
Required inspections	
L	
8/8	

	

8/8	
Met	

O	
 L12	
Smoke detectors	
L	
8/8	

	

8/8	
Met	

O	
 L13	
Clean location	
L	
8/8	

	

8/8	
Met	

 L14	
Site in good repair	
L	
7/8	

	

7/8	
Met
(87.50 %)	

 L15	
Hot water	
L	
7/8	

	

7/8	
Met
(87.50 %)	

 L16	
Accessibility	
L	
8/8	

	

8/8	
Met	

 L17	
Egress at grade 	
L	
8/8	

	

8/8	
Met	

 L18	
Above grade egress	
L	
4/4	

	

4/4	
Met	

 L19	
Bedroom location	
L	
4/4	

	

4/4	
Met	

 L20	
Exit doors	
L	
8/8	

	

8/8	
Met	

 L21	
Safe electrical equipment	
L	
8/8	

	

8/8	
Met	

 L22	
Clean appliances	
L	
8/8	

	

8/8	
Met	

 L23	
Egress door locks	
L	
5/5	

	

5/5	
Met	

 L24	
Locked door access	
L	
6/6	

	

6/6	
Met	

 L25	
Dangerous substances	
L	
8/8	

	

8/8	
Met	

 L26	
Walkway safety	
L	
8/8	

	

8/8	
Met	

 L28	
Flammables	
L	
8/8	

	

8/8	
Met	

 L29	
Rubbish/combustibles	
L	
8/8	

	

8/8	
Met	

 L30	
Protective railings	
L	
6/8	

	

6/8	
Not Met
(75.00 %)	

 L31	
Communication method	
I	
8/8	

	

8/8	
Met	

 L32	
Verbal & written	
I	
8/8	

	

8/8	
Met	

 L33	
Physical exam	
I	
8/8	

	

8/8	
Met	

 L34	
Dental exam	
I	
8/8	

	

8/8	
Met	

 L35	
Preventive screenings	
I	
8/8	

	

8/8	
Met	

 L36	
Recommended tests	
I	
8/8	

	

8/8	
Met	

 L37	
Prompt treatment	
I	
8/8	

	

8/8	
Met	

O	
 L38	
Physician's orders	
I	
8/8	

	

8/8	
Met	

 L39	
Dietary requirements	
I	
7/7	

	

7/7	
Met	

 L40	
Nutritional food	
L	
8/8	

	

8/8	
Met	

 L41	
Healthy diet	
L	
8/8	

	

8/8	
Met	

 L42	
Physical activity	
L	
8/8	

	

8/8	
Met	

 L43	
Health Care Record	
I	
8/8	

	

8/8	
Met	

 L44	
MAP registration	
L	
8/8	

	

8/8	
Met	

 L45	
Medication storage	
L	
8/8	

	

8/8	
Met	

O	
 L46	
Med. Administration	
I	
8/8	

	

8/8	
Met	

 L47	
Self medication	
I	
4/4	

	

4/4	
Met	

 L49	
Informed of human rights	
I	
8/8	

	

8/8	
Met	

 L50	
Respectful Comm.	
L	
8/8	

	

8/8	
Met	

 L51	
Possessions	
I	
8/8	

	

8/8	
Met	

 L52	
Phone calls	
I	
8/8	

	

8/8	
Met	

 L53	
Visitation	
I	
8/8	

	

8/8	
Met	

 L54	
Privacy	
L	
8/8	

	

8/8	
Met	

 L56	
Restrictive practices	
I	
2/7	

	

2/7	
Not Met
(28.57 %)	

 L57	
Written behavior plans	
I	
6/6	

	

6/6	
Met	

 L58	
Behavior plan component	
I	
6/6	

	

6/6	
Met	

 L59	
Behavior plan review	
I	
6/6	

	

6/6	
Met	

 L60	
Data maintenance	
I	
6/6	

	

6/6	
Met	

 L61	
Health protection in ISP	
I	
2/2	

	

2/2	
Met	

 L62	
Health protection review	
I	
2/2	

	

2/2	
Met	

 L63	
Med. treatment plan form	
I	
5/7	

	

5/7	
Not Met
(71.43 %)	

 L64	
Med. treatment plan rev.	
I	
6/7	

	

6/7	
Met
(85.71 %)	

 L67	
Money mgmt. plan	
I	
8/8	

	

8/8	
Met	

 L68	
Funds expenditure	
I	
8/8	

	

8/8	
Met	

 L69	
Expenditure tracking	
I	
8/8	

	

8/8	
Met	

 L70	
Charges for care calc.	
I	
8/8	

	

8/8	
Met	

 L71	
Charges for care appeal	
I	
8/8	

	

8/8	
Met	

 L77	
Unique needs training	
I	
8/8	

	

8/8	
Met	

 L78	
Restrictive Int. Training	
L	
8/8	

	

8/8	
Met	

 L79	
Restraint training	
L	
8/8	

	

8/8	
Met	

 L80	
Symptoms of illness	
L	
8/8	

	

8/8	
Met	

 L81	
Medical emergency	
L	
8/8	

	

8/8	
Met	

O	
 L82	
Medication admin.	
L	
8/8	

	

8/8	
Met	

 L84	
Health protect. Training	
I	
2/2	

	

2/2	
Met	

 L85	
Supervision 	
L	
8/8	

	

8/8	
Met	

 L86	
Required assessments	
I	
4/5	

	

4/5	
Met
(80.0 %)	

 L87	
Support strategies	
I	
4/5	

	

4/5	
Met
(80.0 %)	

 L88	
Strategies implemented	
I	
8/8	

	

8/8	
Met	

#Std. Met/# 75 Indicator	

	

	

72/75	

	
Total Score	

	

	

81/85	

	

	

	

	
95.29%	

		
							
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	

3/3	
3/3	
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	
4/4	
Met	

 L9	
Safe use of equipment	
L	

1/1	
1/1	
Met	

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	

 L14	
Site in good repair	
L	

1/1	
1/1	
Met	

 L15	
Hot water	
L	

0/1	
0/1	
Not Met
(0 %)	

 L16	
Accessibility	
L	

1/1	
1/1	
Met	

 L17	
Egress at grade 	
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	

 L30	
Protective railings	
L	

1/1	
1/1	
Met	

 L31	
Communication method	
I	

4/4	
4/4	
Met	

 L32	
Verbal & written	
I	

4/4	
4/4	
Met	

 L37	
Prompt treatment	
I	

4/4	
4/4	
Met	

O	
 L38	
Physician's orders	
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	

4/4	
4/4	
Met	

 L49	
Informed of human rights	
I	

4/4	
4/4	
Met	

 L50	
Respectful Comm.	
L	

1/1	
1/1	
Met	

 L51	
Possessions	
I	

4/4	
4/4	
Met	

 L52	
Phone calls	
I	

4/4	
4/4	
Met	

 L54	
Privacy	
L	

0/1	
0/1	
Not Met
(0 %)	

 L56	
Restrictive practices	
I	

3/3	
3/3	
Met	

 L73	
DOL certificate	
L	

1/1	
1/1	
Met	

 L77	
Unique needs training	
I	

4/4	
4/4	
Met	

 L78	
Restrictive Int. Training	
L	

1/1	
1/1	
Met	

 L79	
Restraint training	
L	

1/1	
1/1	
Met	

 L80	
Symptoms of illness	
L	

1/1	
1/1	
Met	

 L81	
Medical emergency	
L	

1/1	
1/1	
Met	

O	
 L82	
Medication admin.	
L	

1/1	
1/1	
Met	

 L85	
Supervision 	
L	

1/1	
1/1	
Met	

 L86	
Required assessments	
I	

2/2	
2/2	
Met	

 L87	
Support strategies	
I	

2/2	
2/2	
Met	

 L88	
Strategies implemented	
I	

3/3	
3/3	
Met	

#Std. Met/# 45 Indicator	

	

43/45	

	
Total Score	

	

52/55	

	

	

	
94.55%	

		
							
	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	

	

	

							
Residential Services Reviewed By -DDS	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff performance	
7/8	
Met (87.50 %)	

 C8	
Family/guardian communication	
8/8	
Met	

 C9	
Personal relationships	
8/8	
Met	

 C10	
Social skill development	
8/8	
Met	

 C11	
Get together w/family & friends	
8/8	
Met	

 C12	
Intimacy	
8/8	
Met	

 C13	
Skills to maximize independence 	
8/8	
Met	

 C14	
Choices in routines & schedules	
8/8	
Met	

 C15	
Personalize living space	
8/8	
Met	

 C16	
Explore interests	
8/8	
Met	

 C17	
Community activities	
8/8	
Met	

 C18	
Purchase personal belongings	
8/8	
Met	

 C19	
Knowledgeable decisions	
8/8	
Met	

 C20	
Emergency back-up plans	
8/8	
Met