SUMMARY OF OVERALL FINDINGS

Provider:  Associates for Human Services, Inc.
Review Dates:  November 15 – 21, 2011
Service Enhancement Meeting Date:  December 2, 2011
Survey Team:  Dawne Doyle (TL) and Laura K. O’Connor
Citizen Volunteers:  None

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	6 Locations 
6 Audits 	Full Review	70 / 80 
Deferred Licensure   	 

 
 	
Residential Services	3 Locations 
3 Audits	 

 
 	Full Review	14 / 14 Certified - with all indicators std. met.	
Individual Home Supports	3 Locations 
3 Audits 	 

 
 	Full Review	15 / 15 Certified - with all indicators std. met.	

EXECUTIVE SUMMARY

Associates For Human Services, Inc. (AHS) is a private, non-profit agency that provides an array of supports to children, adults, and families within the Greater Taunton Area.  The agency's over-all mission is to 'provide choice, opportunity and support to the individuals they serve, their families, and those people they employ to enhance the quality of life in their communities’.  The agency provides a diverse range of services, examples of these include: an Early Intervention Program, Head Start, a home-based Parent-Child Program, and WISE Elder Services, which is an adult day health program.  For the purposes of this licensing and certification review, residential and individual home support components of the agency’s services to adults with developmental disabilities were reviewed.

A number of changes have taken place within the agency's provision of services over the last two years.  A successful initiative included increased attention and success in the area of fundraising.  As a result of these efforts, additional money became available to supplement budgets which allow individuals who receive residential and IHS services to request and receive assistance to fund extracurricular things like vacations or special occasion expenses such as tickets to a show they might otherwise be unable to afford.  Fundraising efforts also allowed the continuance of the agency's Spring Fling, a favored formal event for many people in the organization.  Other changes within the organization were of note within the Individual Support Program model.  A van was purchased for people supported within this service model.  This resulted in people enjoying greater freedom and ability to attend needed appointments or expand upon their social network, even on weekends.  In addition, a supervisor was hired for this service model and provided additional staffing and oversight.

EXECUTIVE SUMMARY, CONT.

The agency continues to have a strongly networked, positive presence, in the Greater Taunton Area; which increased staff's knowledge regarding available resources and benefited the individuals served.  For example, individuals were supported to explore available resource options, to pro-actively apply for assistance with their food and fuel costs, as well as taking part in various local community activities and classes of interest.

Significant efforts have been made to attract and maintain quality staff through providing competitive benefits.  The Boston Globe has recognized the agency as one of the 'Top Places to Work', which was a repeat honor.  A number of changes had taken place over the last two years in the management of the agency's twenty four hour homes.  While some new managers had benefitted from mentorship by previous staff holding those positions, other managers came to the agency with differing experiences in the field.  As a result, varying levels of knowledge and skill were noted.  While the agency had a comprehensive orientation process in place for new staff and provided oversight, additional assistance support and guidance is needed to better assure a greater consistency in the level of knowledge across its managerial staff.   

The agency has made concerted efforts to incorporate feedback from the last review into modifying the structure and systems within its existing Residential and Individual Home Support services.  Changes have been made toward improving the quality of the tools used by agency staff to assess individuals' skills and unique needs in the areas of: functional abilities, self-medication, and home safety including the use of appliances, nutrition, and funds management.  Modifications have also been made to the agency's systems that are designed to monitor and track safeguards in the following areas: Individual Service Plan (ISP) paperwork submission, health appointments, home and vehicle safety, financial transaction records and “Charges for Care.”  These efforts toward improving the agency's safeguard systems were generally effective; however, some issues continued to be identified.  Additional emphasis is needed to ensure the agency’s systems are consistently implemented across settings, particularly in the areas of Emergency Fact Sheets and medical diagnoses, unique protocols, medication administration and monitoring behavioral support.  

 

LICENSURE FINDINGS

  	Met / Rated	Not Met / Rated	% Met	
Organizational	8/8	0/8	 	
Residential and Individual Home Supports	62/72	10/72	 

    Residential Services
    Individual Home 
       Supports	 

 

 	
Critical Indicators	5/8	2/8	 	
Total	70/80	10/80	88%	
Defer Licensure	 	 	 	
# Indicators for 60 day follow-up.	 
 	10	 

 

 	Residential 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.	Emergency Fact Sheets were reviewed for six individuals who participated in the audit process.  For three of these people, medical diagnoses were missing.  The agency needs to ensure that all required information including special medical needs are included on the Emergency 
Fact Sheets.
	
O	 L38	Physicians' orders and treatment protocols are followed (when agree-ment for treatment has been reached by the individual/guardian/ team). 	Two people who participated in the audit were supported by staff through implementation of treatment protocols.  
For these individuals, the protocols were either not being followed as ordered or staff were not informed regarding the origin of a protocol.  In the later instance, one person was experiencing increased difficulty in performing range 
of motion exercises.  The agency needs to ensure when protocols are implemented that they are done as outlined and if doing so is not longer possible, evaluation and/or consultation for its continuance occurs.
	
O	 L46	All prescription medications are administered according to the written order of a practitioner and are properly documented on a Medication Treatment Chart. 	Administration of medication for three people was reviewed as part of the audit process.  For one of these people, a prescribed over the counter medication had not been administered according to physician’s order.  The agency needs to ensure that all prescribed medication is administered in accordance with written practitioner orders.

 

 
 
 	 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.	Authorization to use or disclose protected health informa-tion forms did not identify who the information was requested from and who would use information.  Rather parts of the consent form were blank.  Consent forms need to be completed so the person offering consent has the knowledge as to where the information is coming from and how this information will be used.

 

  

	 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.	When restrictive practices are in place at a home intended for one or more people that impact all people living in that home, written provisions so as not to unduly restrict the rights of others needs to be in place.	

 

 	 L59	Behavior plans have received all the required reviews.	When interventions pose a potential restriction to individuals' rights, the HRC needs to review and approve of such a plan on an annual basis. The agency needs to ensure that behavioral support strategies are reviewed and approved by required groups.

	Residential Areas Needing Improvement on Standards Not Met/Follow-up to occur, cont.	
 
 	Indicator #	Indicator	Area Needing Improvement	

 
 
 	 L60	Data are consistently maintained and used to determine the efficacy of behavioral interventions.	Data maintained for two people had not been reviewed in over a year.  The agency needs to ensure oversight of behavioral data is reviewed on a routine basis and changes made as appropriate.	

 

 	 L78	Staff are trained to safely and consistently implement restrictive interventions.	Staff providing support to a person with potentially restrictive, behavioral strategies had not received training to successfully implement the plan.  For example, the plan called for the implementation of strategies outlined in NVMAB training.  All staff implementing this plan need to receive training in NVMAB 

 
 
 	 L84	Staff are trained in the correct utilization of health related protections per regulation.	The agency needs to ensure that all staff are trained in the correct utilization of health related protections.	

 
 	 L85	The agency provides on-going supervision and staff development	While a structure for supervision was in place, it was not effective in identifying areas in which staff needed additional support and direction.  In two of the six homes reviewed, ongoing issues related to the implementation of unique medical protocols and behavioral strategies and individuals paying for programmatic expenses were not recognized and addressed.

 
  
CERTIFICATION FINDINGS

  	Met / Rated	Not Met / Rated	
Certification - Planning and Quality Management

	6/6	0/6	
Residential and Individual Home Supports 

 	 
 	
    Residential Services
    Individual Home Supports	14/14 15/15 	0/14  
0/15 

 

 	Individual Home Supports Commendations on Standards Met:	
 	Indicator #	Indicator	Commendation	

 
 	 C8	There are opportunities for com-munication between guardians, family members, and staff on a regular and timely basis. 	Agency staff are commended for their ongoing efforts to assist individuals to communicate and coordinate efforts with their families and/or guardians, which enhanced the quality of their lives. 

 

 
 
 	 C9	Staff (Home Providers) provide opportunities to develop and/or increase personal relationships and social contacts.  	Since the last review, which occurred two years ago, the agency has made a concerted effort to increase opportunities for the people who often live alone and receive Individual Home Support Services, to participate in various recreational activities based on their interests.  The agency is commended for this effort, which has resulted in increased socialization, community integration, and relationships for several individuals.

 

 	 C11	Staff (Home Providers) support individuals to get together with families and friends when appropriate   	Staff throughout the agency recognized the importance of individuals’ relationships with their families and friends, and are commended for the creative, ongoing efforts to support and strengthen these relationships. 	

 

 

 

 
 	 C21	Staff helps to coordinate outreach efforts to other agencies, groups, community resources and natural supports when necessary to assist individuals to manage and maintain their independence.	Agency staff are commended for their ongoing commitment to supporting individuals to research their available options, network, and utilize other community based services, when this was wanted or needed.  For example, when one individual and his wife recently expressed a desire to move into a more accessible and affordable home, agency staff quickly began to assist them to take tours of different possible home locations and to complete a variety of financial/housing applications.  Creative efforts were also made to work with local transportation services and agency staff to increase the availability and flexibility of transporta-tion options for individuals, including on weekends. 	

 	
Residential Services Commendation on Standard Met:	
 	Indicator #	Indicator	Commendation	

 
 
 	 C11	Staff (Home Providers) support individuals to get together with families and friends when appropriate   	Staff throughout the agency recognized the importance of individuals’ relationships with their families and friends, and are commended for the creative, ongoing efforts to support and strengthen these relationships. 	

 

 

MASTER SCORE SHEET LICENSURE

Organizational:  Associates for Human Services, Inc.

	Indicator
#	Indicator	Met/Rated	Rating
(Met, Not Met, Not Rated)	
 	 L2	Abuse/Neglect reporting	7/7	Met	
 	 L3	Immediate Action	7/7	Met	
 	 L4	Action taken	2/2	Met	
 	 L48	HRC	1/1	Met	
 	 L74	Screen employees	4/4	Met	
 	 L75	Qualified staff	1/1	Met	
 	 L76	Track trainings	1/1	Met	
 	 L83	HR training	10/10	Met	

Residential and Individual Home Supports:

Indicator #	
Indicator	Location or Individual Indicator	
Residential Supports	Individual Home Support	
Placement Support	
Respite Support	
Total Met/Rated	
Rating	
  
 	 L1	Abuse/Neglect training	I	3/3	3/3			6/6	Met	
 
 	 L5	Safety Plan	L	3/3	 

 	3/3	Met	
O	 L6	Evacuation	L	2/3	2/2	 
 	 
 	4/5	Met
(80%)	
 	 L7	Fire Drills	L	3/3	 	 	 	3/3	Met

  	 L8	Emergency Fact Sheets	I	1/3	2/3			3/6	Not Met
(50%)	
 
  	 L9	Safe use of equipment	L	3/3	3/3			6/6	Met	
O	 L11	Required inspections	L	3/3	1/1			4/4	Met	
O	 L12	Smoke detectors	L	3/3	3/3			6/6	Met	
O	 L13	Clean 
location	L	3/3	1/1			4/4	Met	
  
 	 L14	Site in good repair	L	3/3	1/1			4/4	Met	
 	 L15	Hot water	L	3/3	2/2
			5/5	Met	
 
 	 L16	Accessibility	L	2/2	1/1			3/3	Met	
 
 	 L17	Egress at grade 	L	3/3	1/1			4/4	Met	
  
 	 L18	Above grade egress	L	1/1				1/1	Met	
 
 	 L19	Bedroom location	L	2/2				2/2	Met	

Residential and Individual Home Supports, cont.

Indicator #	
Indicator	Location or Individual Indicator	
Residential Supports	Individual Home Support	
Placement Support	
Respite Support	
Total Met/Rated	
Rating	
 	 L20	Exit doors	L	3/3	3/3
			6/6	Met	

 	 L21	Safe electrical equipment	L	3/3	3/3			6/6	Met	
 
 	 L22	Clean appliances	L	3/3	3/3			6/6	Met	
 
 	 L23	Egress door locks	L	2/2				2/2	Met	
  
 	 L24	Locked door access	L	1/1				1/1	Met	
  
 	 L25	Dangerous substances	L	3/3				3/3	Met	
 
 	 L26	Walkway safety	L	3/3	1/1			4/4	Met	
  
 	 L29	Rubbish/combustibles	L	3/3	1/1			4/4	Met	
 
 	 L30	Protective railings	L	2/2	2/2			4/4	Met	
  
 	 L31	Communication method	I	3/3	3/3			6/6	Met	
 
 	 L32	Verbal & written	I	3/3	3/3			6/6	Met	
 
 	 L33	Physical exam	I	3/3	3/3			6/6	Met	
 
 	 L34	Dental exam	I	3/3	3/3			6/6	Met	
 
 	 L35	Preventive screenings	I	3/3	3/3			6/6	Met	
 
 	 L36	Recommended tests	I	2/3	3/3			5/6	Met
(83.33%)	
 
 	 L37	Prompt treatment	I	3/3	2/2			5/5	Met	
O	 L38	Physician’s orders	I	0/2				0/2	Not Met
(0%)	
  
 	 L39	Dietary requirements	I	3/3				3/3	Met	
 
 	 L40	Nutritional food	L	3/3	3/3			6/6	Met	
 
 	 L41	Healthy diet	L	3/3	3/3			6/6	Met	
 
 	 L42	Physical activity	L	3/3	3/3			6/6	Met	
 
  	 L43	Health Care Record	I	3/3	2/3			5/6	Met
(83.33%)	
  	 L44	MAP registration	L	3/3	  			3/3	Met	
  	 L45	Medication storage	L	3/3	  			3/3	Met	
O	 L46	Med. Administration	I	2/3	  			2/3	Not Met
(66.67%)	
  	 L47	Self- medication	I	2/2	3/3			5/5	Met

Residential and Individual Home Supports, cont.

Indicator #	
Indicator	Location or Individual Indicator	
Residential Supports	Individual Home Support	
Placement Support	
Respite Support	
Total Met/Rated	
Rating	
  	 L49	Informed of human rights	I	3/3	2/2			5/5	Met	
  	 L50	Respectful communication	L	3/3	3/3			6/6	Met	
  	 L51	Possessions	I
	3/3	2/2			5/5	Met	

 	 L52	Phone calls	I
	3/3	3/3			6/6	Met	
 	 L53	Visitation
	I	3/3	3/3	 	 	6/6	Met	
 	 L54	Privacy
	L	3/3	3/3	 	 	6/6	Met	
  	 L55	Informed consent	I	1/3	2/3			3/6	Not Met
(50%)	
  	 L56	Restrictive practices	I	0/1				0/1	Not Met
(0%)	
  	 L57	Written behavior plans	I	2/2				2/2	Met	
  	 L58	Behavior plan component	I	2/2				2/2	Met	
  	 L59	Behavior plan review	I	1/2				1/2	Not Met
(50%)	
  	 L60	Data maintenance	I	0/2				0/2	Not Met
(0%)	
  	 L61	Health protection in ISP	I	2/2				2/2	Met	
	 L62	Health protection review	I	2/2				2/2	Met	
	 L63	Medication. Treatment Plan form	I	3/3				3/3	Met	
	 L64	Medication Treatment Plan review	I	3/3				3/3	Met	
	 L67	Money Mgmt. Plan	I	2/3	3/3			5/6	Met
(83.33%)	
   	 L68	Funds expenditure	I	2/3	3/3			5/6	Met
(83.33%)	
  	 L69	Expenditure tracking	I	3/3	3/3			6/6	Met	
 	 L70	“Charges for Care” calculations	I	3/3	   			3/3	Met	
 	 L71	“Charges for Care” appeal	I	3/3				3/3	Met	
   	 L77	Unique needs training	I	2/3	3/3			5/6	Met
(83.33%)	
   	 L78	Restrictive Int. Training	L	1/2				1/2	Not Met
(50%)	
  	 L80	Symptoms of illness	L	3/3	3/3			6/6	Met	

Residential and Individual Home Supports, cont.

Indicator #	
Indicator	Location or Individual Indicator	
Residential Supports	Individual Home Support	
Placement Support	
Respite Support	
Total Met/Rated	
Rating	
  	 L81	Medical emergency	L	3/3	3/3			6/6	Met	
O	 L82	Medication admin.	L	3/3	  			3/3	Met	
  
 	 L84	Health Protection Training	I	0/2	 			0/2	Not Met
(0%)	
  	 L85	Supervision 	L	1/3	3/3			4/6	Not Met
(66.67%)	
  	 L86	Required assessments	I	3/3	3/3			6/6	Met	
  	 L87	Support strategies	I	3/3	3/3	  	  	6/6	Met	
   	 L88	Strategies implemented	I	2/3	3/3			5/6	Met
(83.33%)	
	# Stds. Met 72 Indicators							62/72	  	
  	Total Score							70/80
	 	
  	  							87.50%

 
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	

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	2/2	Met	
 C10	Social skill development	2/2	Met	
 C11	Get together w/family & friends	3/3	Met	
 C12	Intimacy	3/3	Met	
 C13	Skills to maximize independence 	2/2	Met	

Individual Home Supports, cont.	
Indicator #	Indicator	Met/Rated	Rating	
 C14	Choices in routines & schedules	1/1	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	2/2	Met	
 C20	Emergency back-up plans	3/3	Met	
 C21	Coordinate outreach	3/3	Met	

Residential Services	
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	3/3	Met