PROVIDER REPORT FOR	

	

	

	

	

	

	

	

	

	
	
FRIENDSHIP HOME INC
458 Main St.
 Norwell, MA 02061    	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

Version	

	

	

	

	

	

	

	

	
Provider Web Report
May 17, 2017	

	

	

	

	

	

	

	
Prepared by the Department of Developmental Services
OFFICE OF QUALITY ENHANCEMENT	

	

	

	

	

	

	

				
	SUMMARY OF OVERALL FINDINGS	

				

	

	

Provider	

	
FRIENDSHIP HOME INC	

	

	

	

	
Review Dates	

	
4/14/2017 - 4/20/2017	

	

	

	

	
Service Enhancement 
Meeting Date	

	
5/4/2017	

	

	

	

	

	

	
Survey Team	

	
Barbara Mazzella	

Tina Napolitan (TL)	

	

	

	

	

	

	
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	
1 location(s) 2 audit (s) 	
Full Review	
50 / 56 2 Year License 05/04/2017 -  05/04/2019	
	
 No Review Conducted    	

Respite Services	

	
No Review	
No Review	

Planning and Quality Management (For all service groupings)	

	
Full Review	
2 / 6	

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	
46 / 52 2 Year License 05/04/2017 -  05/04/2019	
	
30 / 42 Certified with Progress Report 05/04/2017 -  05/04/2019	

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

Full Review	
12 / 14	

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

Full Review	
16 / 22	

Planning and Quality Management (For all service groupings)	

	
Full Review	
2 / 6	

	

	

			
EXECUTIVE SUMMARY :	

			
Friendship Home, Inc. was founded in 1999 by a grassroots advocacy group for families with children with developmental and intellectual disabilities.  The agency formed a recreational/social club (Friendship Club) to ensure social and recreational opportunities for family members as well as opportunities for individuals with developmental disabilities to share similar interests. The agency has expanded its services to include programs for adults with intellectual disabilities including its Bridges to Work program which consists of both Community Based Day Services (CBDS) and Employment Support Services, a Respite program offering four weeklong respite opportunities for families and individuals as well as weekend respite overnight care. Since 2010, the agency is also an Agency with Choice. The Bridges to Work program supports 54 individuals and the respite program can accommodate up to 5 people in each of two respite homes.  The agency also continues to provide services to approximately 200 individuals and families through its Friendship Club.
   
A full Licensure review was conducted on the agency's residential (respite) and employment/ day service groups and included indicators which were new or revised as of 8/29/2016. This review focused on services to adults with developmental disabilities receiving Respite, CBDS and Employment Supports and included all applicable indicators in areas such as personal safety, human rights, communication and goal development and accomplishment. In addition, the Certification review of the agency's CBDS and Employment Support services entailed an evaluation of indicators in areas such as opportunities for communication, skill development for job attainment and success and development of appropriate work-related interpersonal relationships. 

The findings of the survey team revealed a number of positive outcomes relating to a variety of domains.  The agency's respite program was found to be safe and well maintained. Individuals were provided opportunities to strengthen and or improve their cooking skills in the open kitchen areas and menus were tailored to the unique preferences of individuals as shopping was done with individuals after they arrived. Bedrooms afforded guests privacy for storing personal belongings and the ability to lock their doors during their overnight and weeklong visits. Staff providing respite supports were aware of guests' preferred activities and ensured that individual choices were solicited and considered when planning activities during their stay. During the review, one guest commented that he was excited to be staying as staff are aware of his favorite activities and usually accommodated his requests.. 

The survey team also noted several strengths within the CBDS and employment programs. A variety of activities and opportunities to access community based supports were provided throughout the day. Communication with individuals and families within both the CBDS and employment programs was noteworthy as interactions were mutually respectful, timely and informative. For example, the morning meetings offered individuals opportunities to showcase significant events in their personal lives by providing a venue to increase appropriate social skills development as well as opportunities to learn how to speak publically. Within the environmental domain, the CBDS program offered opportunities to practice and enhance independent living skills such as cooking, laundry, and prevocational training. The location was clean, well maintained and accessible. Individuals within the CBDS program were offered an opportunity to host a weekly cooking event (Café) in which they prepare, serve and clean up. Individuals were excited to share their culinary talents with members of the community at large. 

Within the Employment program all individuals were working competitively in integrated jobs and were proud of their accomplishments in these settings. The agency ensured that individuals were integrated within valued community settings, individuals were supported to be as independent as possible, and supports were faded when no longer necessary. For example, one individual was excited to share that she has her own office within her work setting where she coordinates stocking office supplies. Another individual was pleased to relay that he has been able to reduce the amount of staffing supports at his employment site as he can now independently perform these tasks. Staff also provided supports for several individuals so that they can independently take public transportation further enhancing independence. 

Since the last survey, a new executive director has been hired who focused on ensuring that all staff were in positions that met the needs of individuals. A review of training indicated that all staff met the required trainings and systems were in place to track and monitor renewals or expirations of trainings and certifications.  

As the new Executive Director moves forward, the agency could benefit from additional focus in a few discrete areas. Within organizational areas related to certification, the agency needs to develop a process to collect, analyze and utilize data to measure service improvement efforts.  As the agency continues to refine its strategic planning efforts, greater emphasis should be placed on developing oversight systems and monitoring mechanisms that ensure program goals are actualized. 
Recently as a result of being unable to meet Human Rights Committee requirements, the agency joined another provider's Human Rights Committee to effectively address issues that potentially impact the human rights of individuals they support.

The agency needs to further refine their process for securing consent to share photo images and individualize any necessary implementation of restrictive practives.  Within the health care domain, staff also needs to strenghten its implementaton and oversight when individuals require specialized diets.  

Based on the findings of this report, Friendship Home, Inc. has earned two Two-Year Licenses for Residential and Employment/Day Supports, with 89% of the licensing indicators rated Met for Residential Supports and 88% of the licensing indicators rated Met for Employment/Day Supports.  Within 60 days, the DDS office of Quality Enhancement will conduct a follow up review for any licensing indicators that were rated Not Met within the Residential and Employment/Day Supports. The agency is certified with a progress report in the Employment/Day Supports with 71% of the certification indicators receiving a rating of Met. The agency will have one year to address the certification findings and prepare its progress report of the certification indicators that were rated Not Met.	

	

	

LICENSURE FINDINGS	

	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
5/6	
1/6	

Residential and Individual Home Supports	
45/50	
5/50	

    Respite Services

	

Critical Indicators	
7/7	
0/7	

Total	
50/56	
6/56	
89%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
6	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
5/6	
1/6	

Employment and Day Supports	
41/46	
5/46	

    Community Based Day Services
    Employment Support Services

	

Critical Indicators	
6/6	
0/6	

Total	
46/52	
6/52	
88%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
6	

	

	

	

	

	

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.	
In December, the agency had joined a Human Rights Committee (HRC), as a result of a number of areas that the agency needed to strengthen in order to improve its effectiveness. The agency needs to ensure that its new HRC serves as an effective safeguard for all individuals.  	

		

	

	
Residential 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 was tested and exceeded allowable limits.  The agency needs to ensure that water temperatures register betweem 110 and 120 degrees.  	

 L39	
Special dietary requirements are followed. 	
Special dietary requirements were reviewed for two individuals. Staff were not providing support to assist one person to follow her dietary restrictions as prescribed by her physician. The agency needs to ensure that staff are knowledgeable about special dietary restrictions that are in place for individuals and provide support to ensure that strategies are present to implement requirements as designed.  	

 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 agency's Consent for Release and/or Obtainment of Confidential Information form was reviewed for two individuals. Of these, one information form should be amended so that it is specific regarding what documents would be released.  The agency needs to ensure that the form contains all necessary information for which consent is being requested	

 L61	
Supports and health related protections are included in ISP assessments and the continued need is outlined.	
Supportive and health related protections were reviewed for two individuals. In both of these instances, the procedures for use and frequency of safety checks were not included.  The agency needs to ensure that all required components are included in health related protections or supports	

 L62	
Supports and health related protections are reviewed by the required groups.	
Supportive and health related protections were reviewed for two individuals.  These were not reviewed by the Human Rights Committee as required.  The agency needs to ensure that supportive and health related supports are reviewed by the Human Rights Committee.   	

	

	

	
Employment/Day Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 L50	
Written and oral communication with and about individuals is respectful.	
The agency is commended for its oral and written communication with and about individuals.  Staff demonstrated practices which acknowledged the inherent values of each person and encouraged individuals to respectfully interact and communicate with their peers.  	

	

	
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 was tested and exceeded allowable limits.  The agency needs to ensure that water temperatures register between 110 and 120 degrees.  	

 L39	
Special dietary requirements are followed. 	
Special dietary requirements were reviewed for four individuals.  In three of these instances,  staff were not implementing strategies to ensure that specialized dietary requirements were being implemented as prescribed by practitioners.  The agency needs to ensure that specialized dietary requirements are being implemented as designed.   	

 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 agency's electronic consent for the use of photographs/media release was reviewed for seven individuals.  The electronic Consent for Photo Release did not contain the right to withdraw consent, and specify what media outlets would be utilized.   The agency needs to ensure that the electronic photo/media release contains all required components.  	

 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.	
The agency implemented a practice of securing all the knives within the day service location.  The agency needs to ensure that there is an individual compelling need for this restriction, that this rationale for restrictions are current, and in writing, that the restriction has  been reviewed annually  and that there are practices in place to mitigate the impact the restriction has on those who do not require it.  Alternatively, if there is no individual compelling need for this restriction, the agency needs to discontinue the practice of locking up the knives.  	

 L87	
Support strategies necessary to assist an individual to meet their goals and objectives are completed and submitted as part of the ISP.	
Support strategies were reviewed for seven individuals.  The agency did not submit support strategies within 15 days prior to the ISP as required.  The agency needs to ensure that ISP timelines are followed.	

			

		

	

	

CERTIFICATION FINDINGS	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

Certification - Planning and Quality Management	
2/6	
4/6	

Residential and Individual Home Supports	
0/0	
0/0	

TOTAL	

	

No Review Conducted	

	

	
	
Met / Rated	
Not Met / Rated	
% Met	

Certification - Planning and Quality Management	
2/6	
4/6	

Employment and Day Supports	
28/36	
8/36	

Community Based Day Services	
12/14	
2/14	

Employment Support Services	
16/22	
6/22	

TOTAL	
30/42	
12/42	
71%	

Certified with Progress Report	

	

	

	

	

	

	
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.	
The agency has not initiated a process to collect data for each service type regarding program quality.  The agency needs to develop a process to collect and aggregate data regarding program quality including utilization of HCSIS management reports and any internal quality measurements.  	

 C2	
The provider analyzes information gathered from all sources and identifies patterns and trends.	
 The agency has not initiated a process to analyze information to identify patterns or trends within each service type and for the organization as a whole.  The agency needs to have a mechanism to identify patterns and trends for service improvements from information gathered through consumer and family surveys, feedback from state agencies, and other sources.  	

 C5	
The provider has a process to measure progress towards achieving service improvement goals.	
While the agency had accomplished some short-term goals, such as securing a permanent Executive Director, longer term more comprehensive goals relating to service quality were less well formulated, e.g. mechanisms to measure progress were not yet fully developed.  The agency needs to develop mechanisms to measure progress towards meeting service improvement goals.  	

 C6	
The provider has mechanisms to plan for future directions in service delivery and implements strategies to actualize these plans.	
The agency identified that they do not have a current strategic plan as the short term strategies developed in June 2016 focused on ensuring a successful transition for a new executive director to ensure the continued success of current programs. A strategic plan needs to be developed to address overall service improvement, including strategies to actualize service improvement goals. The agency needs to ensure that mechanisms are in place to plan for future service delivery and strategies are in place to actualize the plans.  	

	

	

	

	
Community Based Day 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 its ongoing and multiple strategies to communicate with family members and guardians.  Communication occurred regularly in the form of phone calls, emails, on-line family newsletters and hosting of a weekly luncheon event where individual prepare and serve lunch to families, guardians and other key stakeholders.  	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 C7	
Individuals have opportunities to provide feedback at the time of hire and on an ongoing basis on the performance of staff that support them.	
Three individuals were reviewed regarding their opportunity to provide feedback.  The agency has not established a process to solicit feedback from individuals at the time of hire and needs to ensure that there is a process in place to assure that the opinions of individuals are included.      	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
Three individuals were reviewed.  Of these, none had been assessed to determine how/if assistive technology or modifications such as the use of pictures, timers, or computers/tablets can be used to increase independence.  The agency needs to ensure that all individuals have the modifications they need to maximize independence.	

	

	
Employment Support 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 its ongoing and multiple strategies to communicate with family members and guardians.  Communication occurred regularly in the form of phone calls, emails, and on-line family newsletters which illustrated successful business opportunities.  	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 C7	
Individuals have opportunities to provide feedback at the time of hire and on an ongoing basis on the performance of staff that support them.	
Four individuals were reviewed regarding their opportunities to provide feedback.  The agency has not established a process to solicit feedback from individuals at the time of hire and needs to ensure that there is a process in place to assure that the opinions of individuals are included.      	

 C23	
Staff utilize a variety of methods to assess an individual's skills, interests, career goals and training and support needs in employment.	
For two of four people surveyed, the agency had not assessed the employment related skills, interests and training needs.  Assessments should address the individual's strengths and abilities, as well as settings that would further promote learning and skill development.  The agency needs to expand and refine the tools for assessing individual's employment related skills, interests and training needs.  	

 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.	
For four individuals in the employment program, an analysis was not performed of how entitlements are impacted by their wages to encourage people to work.  The agency needs to ensure that individuals/guardians are provided with an analysis of how an individual's benefits/entitlements can be managed to ensure that individuals work successfully in integrated settings.  	

 C33	
Employee benefits and rights are clearly explained to the individual.	
The employment supports for four individuals who each had part time competitive paying jobs in the community were reviewed and individuals had not had their benefits explained to them.  The agency needs to work with the community employers to ensure that each individual is supported to understand their employment rights and benefits at their job(s).    	

 C35	
Individuals are given feedback on job performance by their employer.	
Three out of four individuals did not receive feedback from their employers on a regular basis.  The agency needs to advocate for individuals to receive performance evaluations on at least an annual basis, and/or the frequency in accordance to their employers policies/procedures.  	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
Four individuals were reviewed.  Of these, none were assessed to determine any assistive technology needs.  The agency needs to assess each individual to determine how/if assistive technology or modifications such as the use of pictures, timers, or computers/tablets can be used to increase independence in the work setting.  	

	

	

		

					
	MASTER SCORE SHEET LICENSURE	

					
	Organizational: FRIENDSHIP HOME INC	

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

O	
 L2	
Abuse/neglect reporting	
3/3	
Met	

 L3	
Immediate Action	
1/1	
Met	

 L48	
HRC	
0/1	
Not Met(0 % )	

 L74	
Screen employees	
1/1	
Met	

 L76	
Track trainings	
3/3	
Met	

 L83	
HR training	
3/3	
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	

	
2/2	

2/2	
Met	

 L5	
Safety Plan	
L	

	
1/1	

1/1	
Met	

O	
 L6	
Evacuation	
L	

	
1/1	

1/1	
Met	

 L8	
Emergency Fact Sheets	
I	

	
2/2	

2/2	
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	

 L18	
Above grade egress	
L	

	
1/1	

1/1	
Met	

 L19	
Bedroom location	
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	

 L23	
Egress door locks	
L	

	
1/1	

1/1	
Met	

 L24	
Locked door access	
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	

	
2/2	

2/2	
Met	

 L32	
Verbal & written	
I	

	
2/2	

2/2	
Met	

 L37	
Prompt treatment	
I	

	
2/2	

2/2	
Met	

O	
 L38	
Physician's orders	
I	

	
2/2	

2/2	
Met	

 L39	
Dietary requirements	
I	

	
1/2	

1/2	
Not Met
(50.0 %)	

 L40	
Nutritional food	
L	

	
1/1	

1/1	
Met	

 L41	
Healthy diet	
L	

	
1/1	

1/1	
Met	

 L44	
MAP registration	
L	

	
1/1	

1/1	
Met	

 L45	
Medication storage	
L	

	
1/1	

1/1	
Met	

 L49	
Informed of human rights	
I	

	
2/2	

2/2	
Met	

 L50	
Respectful Comm.	
L	

	
1/1	

1/1	
Met	

 L51	
Possessions	
I	

	
2/2	

2/2	
Met	

 L52	
Phone calls	
I	

	
2/2	

2/2	
Met	

 L53	
Visitation	
I	

	
2/2	

2/2	
Met	

 L54	
Privacy	
L	

	
1/1	

1/1	
Met	

 L55	
Informed consent	
I	

	
1/2	

1/2	
Not Met
(50.0 %)	

 L61	
Health protection in ISP	
I	

	
0/2	

0/2	
Not Met
(0 %)	

 L62	
Health protection review	
I	

	
0/1	

0/1	
Not Met
(0 %)	

 L77	
Unique needs training	
I	

	
2/2	

2/2	
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	

 L84	
Health protect. Training	
I	

	
2/2	

2/2	
Met	

 L85	
Supervision 	
L	

	
1/1	

1/1	
Met	

#Std. Met/# 50 Indicator	

	

	

45/50	

	
Total Score	

	

	

50/56	

	

	

	

	
89.29%	

		
							
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	
4/4	
	
3/3	
7/7	
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	
3/4	
	
3/3	
6/7	
Met
(85.71 %)	

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

 L18	
Above grade egress	
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	
	
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	

O	
 L38	
Physician's orders	
I	
1/1	
	
3/3	
4/4	
Met	

 L39	
Dietary requirements	
I	
0/1	
	
1/3	
1/4	
Not Met
(25.00 %)	

 L49	
Informed of human rights	
I	
4/4	
	
3/3	
7/7	
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	
0/4	
	
0/3	
0/7	
Not Met
(0 %)	

 L56	
Restrictive practices	
I	

0/3	
0/3	
Not Met
(0 %)	

 L57	
Written behavior plans	
I	

1/1	
1/1	
Met	

 L58	
Behavior plan component	
I	

1/1	
1/1	
Met	

 L59	
Behavior plan review	
I	

1/1	
1/1	
Met	

 L60	
Data maintenance	
I	

1/1	
1/1	
Met	

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

 L79	
Restraint training	
L	
1/1	
	
1/1	
2/2	
Met	

 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	
1/1	
	
1/1	
2/2	
Met	

 L86	
Required assessments	
I	
3/4	
	
3/3	
6/7	
Met
(85.71 %)	

 L87	
Support strategies	
I	
2/4	
	
1/3	
3/7	
Not Met
(42.86 %)	

 L88	
Strategies implemented	
I	
4/4	
	
3/3	
7/7	
Met	

#Std. Met/# 46 Indicator	

	

41/46	

	
Total Score	

	

46/52	

	

	

	
88.46%	

		
							
	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	
1/1	
Met	

 C4	
Utilizes input from stakeholders	
1/1	
Met	

 C5	
Measure progress	
0/1	
Not Met (0 %)	

 C6	
Future directions planning	
0/1	
Not Met (0 %)	

	

	

							
Community Based Day Services	

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	
3/3	
Met	

 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	
3/3	
Met	

 C45	
Revisit decisions	
3/3	
Met	

 C46	
Use of generic resources	
3/3	
Met	

 C47	
Transportation to/ from community	
3/3	
Met	

 C51	
Ongoing satisfaction with services/ supports	
3/3	
Met	

 C54	
Assistive technology	
0/3	
Not Met (0 %)	

Employment Support Services	

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	
2/4	
Not Met (50.0 %)	

 C24	
Job goals & support needs plan	
3/4	
Met	

 C25	
Skill development	
4/4	
Met	

 C26	
Benefits analysis	
0/4	
Not Met (0 %)	

 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	
4/4	
Met	

 C33	
Employee benefits explained	
0/4	
Not Met (0 %)	

 C34	
Support to promote success	
4/4	
Met	

 C35	
Feedback on job performance	
1/4	
Not Met (25.00 %)	

 C36	
Supports to enhance retention	
4/4	
Met	

 C37	
Interpersonal skills for work	
4/4	
Met	

 C47	
Transportation to/ from community	
4/4	
Met	

 C50	
Involvement/ part of the Workplace culture	
4/4	
Met	

 C51	
Ongoing satisfaction with services/ supports	
4/4	
Met	

 C54	
Assistive technology	
0/4	
Not Met (0 %)