SUMMARY OF OVERALL FINDINGS

Provider:  Cardinal Cushing Centers, Inc.

Review Dates:  May 2 – 8, 2012

Service Enhancement Meeting Date:  May 22, 2012

Survey Team:  Steve Abreu (TL) and Jennifer Petersen

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 Locations  8 Audits 	Full Review	78 / 83       Two- Year License 05/21/2012 - 05/21/2014	 

 	 

 	
Residential Services	3 Locations  7 Audits 	 

 	 

 	Full Review	13 / 14 Certified - with partial indicators std. met.	
Placement Services	1 Location    1 Audit 	 

 
 	Full Review	14 / 14 Certified - with all indicators std. met.	
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	3 Locations  7 Audits	Full Review	55 / 57       Two-Year License 05/21/2012 - 05/21/2014	 

 	 

 	
Employment Support Services	2 Locations    4 Audits 	 

 	 

 	Full Review	11 / 18 Certified - with partial indicators std. met.	
Center-Based Employment	1 Location    3 Audits 	 

 	 

 	Full Review	10 / 14 Certified - with partial indicators std. met.	

EXECUTIVE SUMMARY

The Cardinal Cushing Centers of Massachusetts is a private, nonprofit agency that provides supports to school aged children and adults with developmental disabilities.  

This Licensure and Certification review focused on the Cardinal Cushing Adult Services Program which consists of residential and vocational services for adults with disabilities over the age of twenty-two living throughout Southeastern Massachusetts.   

Survey findings were based on a total of fourteen (14) audits.  The sample included five (5) audits of twenty-four hour residential supports, one (1) audit of less than 24 hour residential supports and one (1) audit of placement supports. In the vocational support component of Cardinal Cushing Centers four (4) audits were conducted in employments supports and three (3) audits in the center-based work component. 
	
The agency's residential services continued to provide strong support for people to take pride in their homes.  A continued focus of the agency was to provide homes that reflect a valued presence within their neighborhood and reflect individual's personal tastes and preferences.  This was particularly evident in people's bedrooms.  Pictures of family members, special events and awards won were proudly displayed. Wall colors and themes reflected people's interests.  These ongoing efforts by the agency fostered homes that were personally meaningful and valued.  Additionally, people were well supported to remain active in various areas of physical fitness based on their interests.  Activities such as weight training, yoga, and mountain biking were just some of the activities people participated in. 

South Shore Industries is the vocational component of the agency, which offers employment options such as competitive employment, community-based work crews, center-based employment, and volunteer opportunities.  Since the last review period, the agency determined that the completion of piece work was no longer a viable work option and had not sought to renew the Department of Labor certificate to pay below minimum wage for piece rate work.  The emphasis remained on obtaining and/or maintaining competitive employment, off site work crews, volunteer sites and development of skills threw the agency's "attainment center."  South Shore Industries was successful in the outcomes measured in the License portion of the review.  However, more emphasis in needed in the Certification outcomes of the process.  Particularly those outcomes related to the development of individualized assessment of job/career interests and skills.  Following these assessments, individuals would benefit from the development of goals and strategies to meet those areas of interests; in particular, assisting people to increase their marketable skills.  Additionally, access to training for the enhancement of staff knowledge in the relationship between employment pay and benefits/entitlements could also serve as an effective resource for those receiving employment support as well as their guardians.  To foster the overall improvement of employment services, the development of a broader vision and incorporating actualization strategies into the organization’s long-term planning process should be a focus for the agency.

Cardinal Cushing Centers had maintained a strong and effective Human Rights Committee (HRC).  The HRC met on a quarterly basis and regular attendance by all members with the required expertise was noted.  Meeting minutes indicated a review of incident reports, behavioral interventions, investigations, and review of annual site visits by members.  Individuals and staff were trained in human rights with weekly meetings being held within each home to discuss different human rights issues in more depth. 

Based on the results of this review, Cardinal Cushing Centers will receive a Two-Year License of its Residential and Employment services respectively.  The agency is congratulated on this success.

LICENSURE FINDINGS

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
9/10	
1/10	

Residential and Individual Home
  Supports	
69/73	
4/73	

 	

  Residential Services
  Placement Services	

 

 	

Critical Indicators	
8/8	
0/8	

Total	
78/83	
5/83	
94%	

Two-Year License	

 	

# Indicators for 60 Day Follow-up.

 	
5	

	
	
Met / Rated	
Not Met / Rated	
% Met	

Organizational	
9/10	
1/10	

Employment and  Day Supports	
46/47	
1/47	

  Employment
      Support Services
  Center-Based  
      Employment	

 

 

 

 	

Critical Indicators	
8/8	
0/8	

Total	
55/57	
2/57	
96%	

Two-Year License	

 	

# Indicators for 60 Day Follow-up.	

2	

	

 	Organizational Area Needing Improvement on Standard Not Met/Follow-up to Occur:	
 	Indicator #	Indicator	Area Needing Improvement	

 	 L65	Restraint reports are submitted within required timelines.	The agency needs to ensure that the time line for the Manages review of Physical restraint reports occurs within five days.

 
 	Residential Commendation on Standard Met:	
 
 	Indicator #	Indicator	Commendations	

 
 	 L42	Individuals are supported to engage in physical activity. 	The agency is commended for assisting people to explore their individual interests for physical activity to promote optimal health.  Activities that people enjoyed included Yoga, weight and cardio training and bicycle riding.

 	Residential Areas Needing Improvement on Standards Not Met/Follow-up to Occur:	
 
 	Indicator #	Indicator	Area Needing Improvement	

 	 L47	Individuals are supported to become self medicating when appropriate. 	The agency needs consider the extent to which individuals may be capable of becoming self-medicating.  Each person should play an active role in their medication regime and be supported to acquire the optimal level of independence.	

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

 
 	 L58	All behavior plans contain the required components.	The agency needs to ensure that positive only supports plans are explored prior to the implementation of a contingency based plan.  This is essential in the assurance that the plan developed is the least restrictive.

 
 
 	 L60	Data are consistently maintained and used to determine the efficacy of behavioral interventions.	The agency needs to ensure that data collection is monitored to ensure that support plans are implemented as written. 	

 
 
 	 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 needs to ensure that an individualized plan is developed regarding assisting people to maximize their financial management skills.	

 	Employment/Day Area Needing Improvement on Standard Not Met/Follow-up to Occur:	
 
 	Indicator #	Indicator	Area Needing Improvement	

 
 	 L58	All behavior plans contain the required components.	The agency needs to ensure that positive only supports plans are explored prior to the implementation of a contingency based plan.  This is essential in the assurance that the plan developed is the least restrictive.	

 
CERTIFICATION FINDINGS

 	
Met / Rated	
Not Met / Rated	

Certification - Planning and Quality Management	
5/6	
1/6	

Residential and      Individual Home Supports 	

 

    Residential Services
    Placement Services	
13/14 14/14 	
1/14 0/14 

	

 
 	
Met / Rated	
Not Met / Rated	

Certification - Planning and Quality Management	
5/6	
1/6	

Employment and             Day Supports 	

  Employment Support  
     Services
  Center-Based Employment	
11/18 

10/14 	
7/18 

4/14 

	

 	Planning and Quality Management Area Needing Improvement on Standard 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 enhance it planning processes to include mechanisms for improvement in service delivery.  An area of particular focus is broadening the options for career exploration and skill development for people supported by the organization.  	

 	Residential Services Commendations on Standards Met:	
 	Indicator #	Indicator	Commendations	

  

 	 C8	There are opportunities for communication between guardians, family members, and staff on a regular and timely basis. 	The agency is commended for it use of a variety of methods to foster communication between guardians, family members and staff.  These included bi-annual meetings with a social event, regular contact via email and telephone conversations and inviting family and friend to people's homes.

 

 
 	 C15	Staff (Home Providers) support individuals to personalize and decorate their rooms/homes according to their tastes and preferences. 	Each person had been actively involved in the personalization of their home particularly their bedrooms.  For each person, there was individualized decor, unique room colors, and personalization with photographs of family, friends and events.	

  	Residential Services- Area Needing Improvement on Standard Not Met:	
 	Indicator #	Indicator	Area Needing Improvement	

 

 	 C12	Individuals are supported to explore, define, and express their need for intimacy.  	The agency should explore options for staff to become more knowledgeable in providing guidance, support and/or education on matters related to recognizing and preventing sexual abuse, gender identity, health, safety, self-expression, physical and romantic relationships, and appropriate boundaries.

 	Placement Services Commendations on Standards Met:	
 	Indicator #	Indicator	Commendations	

 

 	 C8	There are opportunities for communication between guardians, family members, and staff on a regular and timely basis. 	 The agency is commended for it use of a variety of methods to foster communication between guardians, family members and staff.  These included bi-annual meetings with a social event, regular contact via email and telephone conversations and inviting family and friend to people's homes.
	
	Placement Services Commendations on Standards Met, cont.	
 	Indicator #	Indicator	Commendations	

 

 
 	 C15	Staff (Home Providers) support individuals to personalize and decorate their rooms/homes according to their tastes and preferences. 	Each person had been actively involved in the personalization of their home.  For each person, there was individualized bedroom decor, unique bedroom room color, and personalization within the home of photographs of family, friends and events.	

 	Employment Support Services Commendation on Standard Met:	
 	Indicator #	Indicator	Commendations	

 

 	 C8	There are opportunities for communication between guardians, family members, and staff on a regular and timely basis. 	 The agency is commended for it use of a variety of methods to foster communication between guardians, family members and staff.  These included bi-annual meetings with a social event, regular contact via email and telephone conversations and open door policy at the day support location.

 
  	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.	The agency needs to regularly assess individual job interests and provide opportunities to explore jobs related to such interests.  This assessment process should include job trial, situational assessments, and work culture preferences.	

 
 
 	 C23	Staff utilize a variety of methods to assess an individual's skills, interests, career goals and training and support needs in employment.	The agency needs to develop an assessment tool that identifies skill interests across a wide variety of career and employment support needs, not just those currently offered.	

 

 	 C24	There is a plan developed to identify job goals and support needs.	Of the four people in the survey, two people were not able to identify job goals or support needs due to the lack of interest and skill inventory.  The agency needs to review how each person’s interests and skills regarding job opportunities are developed.	

 
 
	 C25	Staff assist individuals to work on skill development for job attainment and success.	Although the agency offered an array of work related trainings such as work place ethics, recognizing abuse, and topics related to self help.  A greater emphasis should be placed on supporting people with skill acquisition relating to unique job interests. 
	
  	Employment Support Services- Areas Needing Improvement on Standards Not Met, cont.	
 	Indicator #	Indicator	Area Needing Improvement	

 
 	 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 would benefit accessing resources that increase their understanding of the impact of employ-ment on disability benefits.	

 
  	 C29	Individuals are supported to obtain employment that matches their skills and interests.	Since an individualized assessment on skills and supports toward employment was lacking, two people’s daily options for work were limited as there was little interests or skill in these areas. 

 
 	 C30	Individuals are supported to work in integrated job settings.	Two people in the survey had limited or no opportunities to work in integrated job settings.	

   	Center-Based Employment Commendation on Standard Met:	
 	Indicator #	Indicator	Commendation	

 

 	 C8	There are opportunities for communication between guardians, family members, and staff on a regular and timely basis. 	 The agency is commended for it use of a variety of methods to foster communication between guardians, family members and staff.  These included bi-annual meetings with a social event, regular contact via email and telephone conversations and open door policy at the day support location.

 	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.	The agency needs to regularly assess individual job interests and provide opportunities to explore jobs related to such interests.  This assessment process should include job trial, situational assessments, and work culture preferences.

 
 
 	 C23	Staff utilize a variety of methods to assess an individual's skills, interests, career goals and training and support needs in employment.	The agency needs to develop an assessment tool that identifies skill interests across a wide variety of career and employment support needs, not just those currently offered.

 

 	 C25	Staff assist individuals to work on skill development for job attainment and success.	Although the agency offered an array of work related trainings such as work place ethics, recognizing abuse and topics related to self help.  A greater emphasis should be placed on supporting people with skill acquisition relating to unique job interests. 

 
  	 C38	Specific habilitative and behavioral goals necessary to prepare individuals for work are identified.	An assessment of people's obstacles to employment needs to be completed to effectively develop strategies to assist people to overcome barriers.

MASTER SCORE SHEET LICENSURE
Organizational: 

	Indicator #	Indicator	Met/Rated	Rating
(Met, Not Met, Not Rated)	
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	
 	 L65	Restraint report submit	0/1	Not Met (0% )	
 	 L66	HRC restraint review	1/1	Met	
 	 L74	Screen employees	1/1	Met	
 	 L75	Qualified staff	1/1	Met	
 	 L76	Track trainings	7/7	Met	
 	 L83	HR training	7/7	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	6/6	  
 	1/1	  
 	7/7	Met	
 
 	 L5	Safety Plan	L	2/3	 
 	1/1	 
 	3/4	Met	
O	 L6	Evacuation	L	3/3	 
	1/1	 	4/4	Met	
 	 L7	Fire Drills	L	3/3	 
	 	 	3/3	Met	
  
 	 L8	Emergency Fact Sheets	I	5/6	  
 	1/1	  
 	6/7	Met
(85.71%)	
 
 	 L9	Safe use of equipment	L	3/3				3/3	Met	
O	 L11	Required inspections	L	3/3		1/1		4/4	Met	
O	 L12	Smoke detectors	L	3/3		1/1		4/4	Met	
O	 L13	Clean location	L	3/3	 
 	1/1	 
 	4/4	Met	
 
 	 L14	Site in good repair	L	2/2	 
  	1/1	  
 	3/3	Met	
 	 L15	Hot water	L	3/3	 	1/1	 
	4/4	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	
 
 	 L16	Accessibility	L	3/3	 
 	1/1	 
 	4/4	Met	
 
 	 L17	Egress at grade 	L	3/3	 
 	1/1	 
 	4/4	Met	
  
 	 L18	Above grade egress	L	3/3				3/3	Met	
 
 	 L19	Bedroom location	L	1/1	 

 	1/1	Met	
 	 L20
	Exit doors	L	3/3	 	 	 	3/3	Met	
  
 	 L21	Safe electrical equipment	L	3/3	 
  	1/1	  
 	4/4	Met	
 
 	 L22	Clean appliances	L	3/3	 
 	1/1	 
 	4/4	Met	
 
 	 L23	Egress door locks	L	3/3	 

 	3/3	Met	
  
 	 L24	Locked door access	L	2/2	 

 	2/2	Met	
  
 	 L25	Dangerous substances	L	3/3				3/3	Met	
 
 	 L26	Walkway safety	L	3/3	 
 	1/1	 
 	4/4	Met	

 	 L27	Swimming pools	L	 
 	 
 	1/1	 
 	1/1	Met	
 
 	 L28	Flammables	L	3/3	 
 	1/1	 
 	4/4	Met	
  
 	 L29	Rubbish/
Combustibles	L	3/3	  
 	1/1		4/4	Met	
 
 	 L30	Protective railings	L	3/3	 
 	1/1		4/4	Met	
 
 	 L31	Communica-tion method	I	6/6		1/1		7/7	Met	
 
 	 L32	Verbal & written	I	6/6		1/1		7/7	Met	
 
 	 L33	Physical exam	I	6/6		1/1		7/7	Met	
 
 	 L34	Dental exam	I	6/6		1/1		7/7	Met	
 
 	 L35	Preventive screenings	I	6/6		1/1		7/7	Met	
 
 	 L36	Recommended tests	I	6/6		1/1		7/7	Met	
 
 	 L37	Prompt treatment	I	6/6		1/1		7/7	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	
O	 L38	Physician's orders	I	2/2		 
 		2/2	Met	
  
 	 L39	Dietary requirements	I	4/4		 
  		4/4	Met	
 
 	 L40	Nutritional food	L	3/3		1/1	 
 	4/4	Met	
 
 	 L41	Healthy diet	L	3/3		1/1	 
 	4/4	Met	
 
 	 L42	Physical activity	L	3/3		1/1	 
 	4/4	Met	
  
 	 L43	Health Care Record	I	6/6		1/1	  
 	7/7	Met	
 
 	 L44	MAP registration	L	2/2	 

 	2/2	Met	
 
 	 L45	Medication storage	L	3/3	 

 	3/3	Met	
O	 L46	Medication Administration	I	3/3	  
 	1/1	  
 	4/4	Met	
 
 	 L47	Self- medication	I	4/6	 

 	4/6	Not Met
(66.67%)	
  
 	 L49	Informed of human rights	I	6/6	  
 	1/1	 
  	7/7	Met	

 	 L50	Respectful Comm.	L	3/3	 
 	1/1	 
 	4/4	Met	
 
 	 L51	Possessions	I	6/6	 
 	1/1	 
 	7/7	Met	
 
 	 L52	Phone calls	I	6/6	 
 	1/1	 
 	7/7	Met	
 	 L53	Visitation	I	6/6	 
	1/1	 	7/7	Met	
 	 L54	Privacy	L	3/3	 
	1/1	 	4/4	Met	
 
 	 L55	Informed consent	I	1/1	 
 	1/1	 
 	2/2	Met	
  
 	 L57	Written behavior plans	I	1/1				1/1	Met	
  
 	 L58	Behavior plan component	I	0/1				0/1	Not Met
(0%)	
  
 	 L59	Behavior plan review	I	1/1				1/1	Met	
  
 	 L60	Data maintenance	I	0/1				0/1	Not Met
(0 %)	
  
 	 L61	Health protection in ISP	I	1/1				1/1	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	
  
 	 L62	Health protection review	I	1/1				1/1	Met	
  
 	 L63	Med. treatment plan form	I	2/2				2/2	Met	
  
 	 L64	Med. treatment plan rev.	I	2/2				2/2	Met	
 
 	 L67	Money mgmt. plan	I	3/6	 
 	1/1	 
 	4/7	Not Met
(57.14%)	
 
  	 L68	Funds expenditure	I	6/6	 
  	1/1	 
  	7/7	Met	
 
 	 L69	Expenditure tracking	I	6/6	 
 	1/1	 
 	7/7	Met	
  
 	 L70	Charges for care calc.	I	5/5	  
 	1/1	 
  	6/6	Met	
 
  	 L71	Charges for care appeal	I	5/5	  
 	1/1	  
 	6/6	Met	
  
 	 L77	Unique needs training	I	6/6	  
 	1/1	  
 	7/7	Met	
 
 	 L79	Restraint training	L	2/2	  

 	2/2	Met	

 	 L80	Symptoms of illness	L	3/3	 
 	1/1	 
 	4/4	Met	
 
 	 L81	Medical emergency	L	3/3	 
 	1/1	 
 	4/4	Met	
O	 L82	Medication admin.	L	2/2	 

 	2/2	Met	
  
 	 L84	Health protect. Training	I	1/1	  

  	1/1	Met	
 
 	 L85	Supervision 	L	3/3	 
 	1/1	 
 	4/4	Met	
  
 	 L86	Required assessments	I	6/6	 
  	1/1	  
 	7/7	Met	
 
 	 L87	Support strategies	I	6/6	 
 	1/1	 
 	7/7	Met	
  
 	 L88	Strategies implemented	I	6/6	  
 	1/1	  
 	7/7	Met	
  
 	#Std. Met/ # 73 Indicators	  

 	  

 	69/73	 

 	Total Score	 

 	 

 	78/83	 

 	 

 	 

 	 
 	93.98%	 

Employment and Day Supports:

	
Indicator #	
Indicator	Location
or Individual Indicator	
Employment Support	
Center- Based Work	
Community- Based Day Support	
Total Met / Rated	
Rating	
 	 L1	Abuse/Neglect training	I	4/4	3/3	  	7/7	Met	
 	 L5	Safety Plan	L	2/2	1/1	 
	3/3	Met	
O	 L6	Evacuation	L	2/2	1/1	 
	3/3	Met	
 	 L7	Fire Drills	L	2/2	1/1	 
	3/3	Met	
 
 	 L8	Emergency Fact Sheets	I	4/4	3/3	 
 	7/7	Met	
 
 	 L9	Safe use of equipment	L	2/2	1/1	 
 	3/3	Met	
O	 L11	Required inspections	L	2/2	1/1	 
 	3/3	Met	
O	 L12	Smoke detectors	L	2/2	1/1	 
 	3/3	Met	
O	 L13	Clean location	L	2/2	1/1	 
	3/3	Met	
	 L15	Hot water	L
	2/2	1/1	 	3/3	Met	
 	 L16	Accessibility	L	2/2	1/1	 
	3/3	Met	
 
 	 L17	Egress at grade 	L	2/2	1/1	 
 	3/3	Met	
 	 L20	Exit doors	L	2/2	1/1	 
	3/3	Met	
 
 	 L21	Safe electrical equipment	L	2/2	1/1	 
 	3/3	Met	
 
 	 L22	Clean appliances	L	2/2	1/1	 
 	3/3	Met	
 
 	 L25	Dangerous substances	L	2/2	1/1	 
 	3/3	Met	
 
 	 L26	Walkway safety	L	2/2	1/1	 
 	3/3	Met	
 	 L28	Flammables	L	2/2	1/1	 
	3/3	Met	
 
 	 L29	Rubbish/
Combustibles	L	2/2	1/1	 
 	3/3	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	4/4	3/3	 
 	7/7	Met	
	 L38	Physician's orders	I	4/4	2/2	 
 	6/6	Met	

 	 L44	MAP registration	L	2/2	1/1	 
 	3/3	Met	
Employment and Day Supports, cont.

	
Indicator #	
Indicator	Location
or Individual Indicator	
Employment Support	
Center- Based Work	
Community- Based Day Support	
Total Met / Rated	
Rating	
 
 	 L45	Medication storage	L	2/2	1/1	 
 	3/3	Met	
O	 L46	Med. Administration	I	4/4	 
 	 
 	4/4	Met	
 
 	 L49	Informed of human rights	I	4/4	3/3	 
 	7/7	Met	
 
 	 L50	Respectful Comm.	L	2/2	1/1	 
 	3/3	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	2/2	1/1	 	3/3
	Met	
 
 	 L55	Informed consent	I	4/4	3/3	 
 	7/7	Met	
 
 	 L56	Restrictive practices	I	4/4	3/3	 
 	7/7	Met	
 
 	 L57	Written behavior plans	I	1/1	1/1	 
 	2/2	Met	
 
 	 L58	Behavior plan component	I	1/1	0/1	 
 	1/2	Not Met
(50%)	
 
 	 L59	Behavior plan review	I	1/1	1/1	 
 	2/2	Met	
 
 	 L60	Data maintenance	I	1/1	1/1	 
 	2/2	Met	
 
 	 L77	Unique needs training	I	4/4	3/3	 
 	7/7	Met	
 
 	 L78	Restrictive Int. Training	L	2/2	1/1	 
 	3/3	Met	
 
 	 L79	Restraint training	L	2/2	1/1	 
 	3/3	Met	
 
 	 L80	Symptoms of illness	L	2/2	1/1	 
 	3/3	Met	
 
 	 L81	Medical emergency	L	2/2	1/1	 
 	3/3	Met	
O	 L82	Medication admin.	L	2/2	1/1	 
 	3/3	Met	
 	 L85	Supervision 	L	2/2	1/1	 	3/3
	Met	
 
 	 L86	Required assessments	I	4/4	3/3	 
 	7/7	Met	

 	 L87	Support strategies	I	4/4	3/3	 
 	7/7	Met	
 
 	 L88	Strategies implemented	I	4/4	3/3	 
 	7/7	Met	

Employment and Day Supports, cont.

	
Indicator #	
Indicator	Location
or Individual Indicator	
Employment Support	
Center- Based Work	
Community- Based Day Support	
Total Met / Rated	
Rating	
  
 	#Std. Met/ # 47 Indicators						46/47	 

 	Total Score	 

 	 
 	 
 	55/57	 
 	
 	 	 	 	 	 	 	96.49%	 

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	0/1	Not Met (0%)	

Center-Based Employment	
Indicator #	Indicator	Met/Rated	Rating	
 C7	Feedback on staff performance	3/3	Met	
 C8	Family/Guardian communication	3/3	Met	
 C22	Explore job interests	1/3	Not Met (33.33%)	
 C23	Assess skills & training needs	0/3	Not Met (0%)	
 C24	Job goals & support needs plan	3/3	Met	
 C25	Skill development	2/3	Not Met (66.67%)	
 C27	Job benefit education	3/3	Met	
 C31	Job accommodations	3/3	Met	
 C33	Employee benefits explained	3/3	Met	
 C34	Support to promote success	3/3	Met	
 C35	Feedback on job performance	3/3	Met	
 C37	Interpersonal skills for work	3/3	Met	
 C38	Habilitative & behavioral goals	2/3	Not Met (66.67%)	
 C39	Support needs for employment	3/3	Met	

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%)	
 C23	Assess skills & training needs	2/4	Not Met (50%)	
 C24	Job goals & support needs plan	2/4	Not Met (50%)	
 C25	Skill development	2/4	Not Met (50%)	
 C26	Benefits analysis	0/4	Not Met (0%)	
 C27	Job benefit education	4/4	Met	
 C28	Relationships w/businesses	2/2	Met	
 C29	Support to obtain employment	2/4	Not Met (50%)	
 C30	Work in integrated settings	2/4	Not Met (50%)	
 C31	Job accommodations	2/2	Met	
 C32	At least minimum wages earned	4/4	Met	
 C33	Employee benefits explained	3/3	Met	
 C34	Support to promote success	2/2	Met	
 C35	Feedback on job performance	2/2	Met	
 C36	Supports to enhance retention	2/2	Met	
 C37	Interpersonal skills for work	4/4	Met	

Placement 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	

Residential Services	
Indicator #	Indicator	Met/Rated	Rating	
 C7	Feedback on staff performance	6/6	Met	
 C8	Family/guardian communication	6/6	Met	
 C9	Personal relationships	6/6	Met	
 C10	Social skill development	6/6	Met	
 C11	Get together w/family & friends	6/6	Met	
 C12	Intimacy	4/6	Not Met (66.67%)	
 C13	Skills to maximize independence 	6/6	Met	
 C14	Choices in routines & schedules	6/6	Met	
 C15	Personalize living space	3/3	Met	
 C16	Explore interests	6/6	Met	
 C17	Community activities	6/6	Met	
 C18	Purchase personal belongings	6/6	Met	
 C19	Knowledgeable decisions	6/6	Met	
 C20	Emergency back-up plans	3/3	Met