PROVIDER REPORT FOR	

	

	

	

	

	

	

	

	

	
	
DDS SOUTHEAST STATE OP
151 Campanelli Drive
B Middleboro, MA 02346    	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

Version	

	

	

	

	

	

	

	

	
Provider Web Report
June 9, 2017	

	

	

	

	

	

	

	
Prepared by the Department of Developmental Services
OFFICE OF QUALITY ENHANCEMENT	

	

	

	

	

	

	

				
	SUMMARY OF OVERALL FINDINGS	

				

	

	

Provider	

	
DDS SOUTHEAST STATE OP	

	

	

	

	
Review Dates	

	
5/10/2017 - 5/16/2017	

	

	

	

	
Service Enhancement 
Meeting Date	

	
5/31/2017	

	

	

	

	

	

	
Survey Team	

	
Margareth Larrieux	

Michael Marchese	

Tina Napolitan	

Scott Nolan	

Laura O'Connor	

Ed Sutka (TL)	

Barbara Mazzella (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	
15 location(s) 16 audit (s) 	
Full Review	
80 / 86 2 Year License 05/31/2017 -  05/31/2019	
	
21 / 28 Certified with Progress Report 05/31/2017 -  05/31/2019	

Residential Services	
14 location(s) 14 audit (s) 	

Full Review	
15 / 22	

Respite Services	
1 location(s) 2 audit (s) 	

No Review	
No Review	

Planning and Quality Management (For all service groupings)	

	
Full Review	
6 / 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) 4 audit (s) 	
Full Review	
53 / 53 2 Year License 05/31/2017 -  05/31/2019	
	
23 / 28 Certified 05/31/2017 -  05/31/2019	

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

Full Review	
17 / 22	

Planning and Quality Management (For all service groupings)	

	
Full Review	
6 / 6	

	

	

			
EXECUTIVE SUMMARY :	

			
Southeastern Residential Services (SRS) is a state operated agency that provides residential supports to 215 people who live at 55 homes throughout southeastern Massachusetts, as well as employment supports to 55 people who work at bottle and can redemption centers in Dighton and Mansfield.  Within the agency's network of residential services is a medically oriented respite home.  A major focus of SRS is to provide assistance to people who require a high level of support, including complex medical needs, a variety of clinical needs, and issues related to aging.  This review by the Department of Developmental Services (DDS) survey team included visits to 15 homes as well as a review of the supports provided to 4 people who received employment supports at either the Dighton or Mansfield redemption centers.   

The current review included all licensing and certification indicators in the DDS survey tool, which as of August 2016 had been modified by the addition of new indicators and the strengthening of many of the existing ones.  In addition to the indicators pertaining to day and residential services, the survey team also reviewed a number of indicators that were specifically relevant to the agency's organizational systems.  For instance, the agency's three Human Rights Committees were reviewed as well as indicators that measured the agency's' on-going efforts to collect and utilize data as part of continuous quality improvement efforts.  

The review of the agency's residential services identified a number of positive practices, especially in those indicators related to licensing.  For instance, a major area of strength continues to be seen in the agency's efforts to ensure that people are receiving comprehensive health care, particularly for people who had complex medical needs.  All staff at the agency's respite home were LPN's, and this home filled a large need for many families who have cared for their sons and daughters at home, often going for extended periods of time without any relief due to the limited availability of respite alternatives.  The presence of effective systems was noted in other licensing areas as well.  For instance, the agency diligently exercised its responsibility as representative payee for many people, money management plans were in place, and systems to track people's expenditures were present.  The agency also received a rating of Met in all ten organizational indicators, e.g., required trainings were found to be place, including a large number of specialized trainings to address people's unique needs.  

Within the certification areas, an area of particular success was seen in the on-going efforts made to help people to connect or re-connect with family members.  Staff recognized the importance of family connectedness and persisted in efforts toward supporting these relationships, including the provision of transportation. Staff recognized that for various reasons some families were more responsive than others and individualized their efforts over time in encouraging contact.  

The need to develop additional strategies and approaches was seen in relation to some of the residential certification indicators.  For instance, the agency needs to increase support for individuals to have access and be integrated within the community, including promoting the use of generic resources and placing additional focus on building neighborhood connections.  Additionally, further strategies need to be developed to more effectively help people explore community activities that match their interests.    

The focus of the agency's employment supports continues to be the successful operation of two bottle and can redemption centers located in Dighton and Mansfield, which are open to the public.  Since January 1, 2017 all individuals have been paid minimum wage for the hours that they worked at the redemption centers or at their one off-site enclave location.  Another improvement pertained to the relocation of the Dighton redemption center to a more attractive setting.  Each individual received performance evaluations towards identifying their strengths and any areas where they could improve their existing work skills.  Three of the four people whose employment supports were evaluated were elected by their peers to be members of the Worker's Council, which served as an advisory group to the agency; this council successfully advocated for soundproofing to reduce workplace noise at the Mansfield redemption center.  Members of the Worker's Council also recently had the opportunity to participate in providing feedback as part of staff performance evaluations.  During times when people were not performing paid work, staff offered activities focused on building skills that are needed for successful employment, such using the "Skills to Pay the Bills " curriculum, practicing relaxation/coping techniques, and various situational interpersonal skills. 

All four of the individuals who participated in the survey expressed interest in working competitively at jobs that matched their career goals, and toward that end the agency the agency had identified the need for a job developer whose focus would be more individualized job development.  While improvements pertaining to employment services had been made, the agency needs to continue and expand its efforts to support individuals who have other employment interests to develop opportunities and plans towards securing competitive jobs in the community based on their interests, skills, and aptitudes.  The agency also needs to conduct assistive technology evaluations with each individual to determine which modifications or adaptive devices could help them to be as independent as possible at work.

Based on the findings of this report, the agency has earned Two-Year Licenses for both its Employment/Day and Residential/Individual Home Supports services.  Licensing indicators were 93% Met for Residential/Individual Home Supports and 100% Met for Employment/Day supports.  The agency will conduct its own follow-up for any licensing indicators rated Not Met and submit the results to the DDS Office of Quality Enhancement within 60 days.  The agency is Certified with a Progress Report in Residential/IHS supports with 75% 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 on the certification indicators that were rated Not Met. The Employment/Day supports are Certified with 82% of the certification indicators receiving a rating of Met.	

	

	

LICENSURE FINDINGS	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
10/10	
0/10	

Residential and Individual Home Supports	
70/76	
6/76	

    Residential Services
    Respite Services

	

Critical Indicators	
8/8	
0/8	

Total	
80/86	
6/86	
93%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
6	

	

Met / Rated	
Not Met / Rated	
% Met	

Organizational	
10/10	
0/10	

Employment and Day Supports	
43/43	
0/43	

    Employment Support Services

	

Critical Indicators	
8/8	
0/8	

Total	
53/53	
0/53	
100%	

2 Year License	

	

# indicators for 60 Day Follow-up	
	
0	

	

	

			

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 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 standard form for the Authorization for Release of Information, which was used agency-wide, combined all relevant medical providers and release of particular need to know information on a single form on which approvals were pre-populated.  The form also stated that "withholding or withdrawing consent may result with SRS being unable to continue to safely provide services."  Consents need to be individualized, sought in a more discrete manner, should not be pre-populated, should include the right to withdraw consent without penalty, and the statement about the possibility of SRS being unable to continue to safely provide services should be eliminated.	

 L62	
Supports and health related protections are reviewed by the required groups.	
For three of the fourteen individuals surveyed, the required reviews and authorizations were not in place.  The agency needs to ensure that reviews or approvals, as appropriate, from the ISP team and the Human Rights Committee are in place.  	

 L64	
Medication treatment plans are reviewed by the required groups.	
Five out of fourteen Medication Treatment Plans had not been reviewed by the ISP team. The agency needs to ensure that medication treatment plans are reviewed by the required groups. 	

 L86	
Required assessments concerning individual needs and abilities are completed in preparation for the ISP.	
The agency did not meet the DDS time-lines for three of the eleven of the individuals where assessments had been requested in a timely fashion.  The agency needs to ensure that assessments are submitted at least 15 days prior to the ISP.  	

 L87	
Support strategies necessary to assist an individual to meet their goals and objectives are completed and submitted as part of the ISP.	
The agency did not submit support strategies within 15 days prior to the ISP as required for four of the twelve individuals for whom this was reviewed. The agency needs to ensure that ISP time-lines for the submission of support strategies are followed.	

 L88	
Services and support strategies identified and agreed upon in the ISP for which the provider has designated responsibility are being implemented.	
For three of the fourteen individuals for which this was reviewed, strategies agreed upon in the ISP were not being implemented by staff. The agency needs to ensure that support strategies agreed upon in the ISP are being implemented.  	

	

		

	

	

CERTIFICATION FINDINGS	

	

	

	

Met / Rated	
Not Met / Rated	
% Met	

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

Residential and Individual Home Supports	
15/22	
7/22	

Residential Services	
15/22	
7/22	

TOTAL	
21/28	
7/28	
75%	

Certified with Progress Report	

	

	
	
Met / Rated	
Not Met / Rated	
% Met	

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

Employment and Day Supports	
17/22	
5/22	

Employment Support Services	
17/22	
5/22	

TOTAL	
23/28	
5/28	
82%	

Certified	

	

	

	

	

	
Residential Services Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 C11	
Staff (Home Providers) support individuals to get together with families and friends.	
Staff consistently worked to help people connect and re-connect with their families, including the provision of transportation and efforts to make contact with family members at significant times of the year, such as holidays.  The agency is commended for its commitment to support people to maintain and strengthen relationships with their families.  	

	

	
Residential 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.	
Although efforts were made to include input from individuals in the hiring process, for 11 out of 14 individuals, efforts to include input into the hiring or the on-going evaluation of staff were not effective.  The agency needs to strengthen the processes through which individuals can provide feedback on their staff.	

 C9	
Staff (Home Providers) act as bridge builders and provide opportunities to develop, and/or increase personal relationships and social contacts.	
For five of the fourteen individuals, there was a lack of evidence that sufficient opportunities were provided to develop personal relationships and social contacts. The agency needs to ensure that staff more effectively foster opportunities for individuals to explore and develop relationships.	

 C12	
Individuals are supported to explore, define, and express their need for intimacy and companionship.	
For eleven individuals, evidence was lacking that education has been provided to staff to support individuals in the area of sexuality and intimacy. In addition, there were no formal or informal assessments of individuals' need for intimacy and companionship based on their unique learning styles. The agency needs to further assess individuals and provide training to 
staff to support individuals to explore, define and express their need for intimacy and companionship. 	

 C16	
Staff (Home Providers) support individuals to explore, discover and connect with their interests for cultural, social, recreational and spiritual activities.	
For seven individuals, exploration of interests regarding cultural, social, recreational and spiritual activities had not taken place on a consistent basis. The agency needs to support individuals to explore, discover and encourage participation in integrated cultural, social recreational and spiritual activities on a more regular basis. 	

 C17	
Community activities are based on the individual's preferences and interests.	
Four of the fourteen individuals whose supports were reviewed were not provided with regular opportunities to participate in community activities that matched their interests.   The agency needs to ensure that individuals are provided with on-going opportunities to participate in activities that reflect their preferences.  	

 C46	
Staff (Home Providers) support individuals to learn about and use generic community resources.	
For seven of fourteen people surveyed, opportunities for individual to learn about and use generic resources were infrequent.  The agency needs to ensure that individuals are supported to access and use generic community resources on a more regular basis.  	

 C48	
Individuals are a part of the neighborhood.	
For three out of fourteen people whose supports were reviewed, connections with neighbors were limited and infrequent.  Additional efforts need to be made to support people to enjoy increased connectedness with their neighbors.	

	

	
Employment Support Services Commendations on Standards Met:	

Indicator #	
Indicator	
Commendations	

 C51	
Staff (Home Providers) are knowledgeable about individuals' satisfaction with services and supports and support individuals to make changes as desired.	
A group of individuals have been elected by their peers to serve on the Worker's Council, which serves as an advisory group to the agency's employment services. Three of the four individuals who participated in the survey served as members of this Council, and they indicated that the agency listened to their input.  Morning meetings were also held at both redemption center locations, which served as another forum for individuals to express their opinions.  The agency is commended for supporting individuals who receive employment services to have meaningful ways to express their satisfaction and make changes regarding their schedules and existing supports, as desired.	

	

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

Indicator #	
Indicator	
Area Needing Improvement	

 C24	
There is a plan developed to identify job goals and support needs.	
Four of the people whose supports were reviewed expressed a desire to work competitively in other settings; however, there were no plans in place to identify competitive jobs which aligned with their career goals.  The agency needs to ensure that each individual is supported to establish a plan towards accomplishing their unique job goals, including a description of their support 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.	
While the agency had recently offered a training opportunity for parents and guardians regarding the Beneplan Program, three of the four individuals had not yet received an analysis of how future earnings could impact entitlements.  The agency needs to support each individual and their family/guardians to receive and understand this type of analysis.	

 C29	
Individuals are supported to obtain employment that matches their skills and interests.	
Four individuals expressed an interest in working competitively, but efforts to support these individuals to obtain employment which matches their skills and interest was not present. The agency needs to ensure that individuals are supported to be competitively employed in areas that match their skills and interests. 	

 C30	
Individuals are supported to work in integrated job settings.	
While the agency operated redemption centers were located amongst other community based businesses and customers interacted with individuals, these were not integrated work settings. Individuals that wanted competitive jobs in the community did not have immediate plans toward working in integrated settings. The agency needs to consistently provide opportunities for individuals to work in integrated settings.	

 C54	
Individuals have the assistive technology and/or modifications to maximize independence. 	
The agency needs to conduct assistive technology evaluations with each individual to determine which modifications or adaptive devices could help them to be as independent as possible at their jobs.	

	

	

		

					
	MASTER SCORE SHEET LICENSURE	

					
	Organizational: DDS SOUTHEAST STATE OP	

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

O	
 L2	
Abuse/neglect reporting	
17/17	
Met	

 L3	
Immediate Action	
15/15	
Met	

 L4	
Action taken	
15/15	
Met	

 L48	
HRC	
3/3	
Met	

 L65	
Restraint report submit	
16/17	
Met(94.12 % )	

 L66	
HRC restraint review	
16/16	
Met	

 L74	
Screen employees	
10/10	
Met	

 L75	
Qualified staff	
14/14	
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	
14/14	

2/2	

16/16	
Met	

 L5	
Safety Plan	
L	
14/14	

1/1	

15/15	
Met	

O	
 L6	
Evacuation	
L	
14/14	

1/1	

15/15	
Met	

 L7	
Fire Drills	
L	
14/14	

	

14/14	
Met	

 L8	
Emergency Fact Sheets	
I	
13/14	

2/2	

15/16	
Met
(93.75 %)	

 L9	
Safe use of equipment	
L	
14/14	

1/1	

15/15	
Met	

 L10	
Reduce risk interventions	
I	
1/1	

	

1/1	
Met	

O	
 L11	
Required inspections	
L	
14/14	

1/1	

15/15	
Met	

O	
 L12	
Smoke detectors	
L	
13/14	

1/1	

14/15	
Met
(93.33 %)	

O	
 L13	
Clean location	
L	
14/14	

1/1	

15/15	
Met	

 L14	
Site in good repair	
L	
7/7	

	

7/7	
Met	

 L15	
Hot water	
L	
12/14	

0/1	

12/15	
Met
(80.0 %)	

 L16	
Accessibility	
L	
14/14	

1/1	

15/15	
Met	

 L17	
Egress at grade 	
L	
14/14	

1/1	

15/15	
Met	

 L19	
Bedroom location	
L	
14/14	

1/1	

15/15	
Met	

 L20	
Exit doors	
L	
14/14	

1/1	

15/15	
Met	

 L21	
Safe electrical equipment	
L	
14/14	

1/1	

15/15	
Met	

 L22	
Clean appliances	
L	
14/14	

1/1	

15/15	
Met	

 L23	
Egress door locks	
L	
12/13	

1/1	

13/14	
Met
(92.86 %)	

 L24	
Locked door access	
L	
14/14	

1/1	

15/15	
Met	

 L25	
Dangerous substances	
L	
14/14	

1/1	

15/15	
Met	

 L26	
Walkway safety	
L	
13/14	

1/1	

14/15	
Met
(93.33 %)	

 L28	
Flammables	
L	
13/14	

1/1	

14/15	
Met
(93.33 %)	

 L29	
Rubbish/combustibles	
L	
13/14	

1/1	

14/15	
Met
(93.33 %)	

 L30	
Protective railings	
L	
9/9	

	

9/9	
Met	

 L31	
Communication method	
I	
14/14	

2/2	

16/16	
Met	

 L32	
Verbal & written	
I	
14/14	

2/2	

16/16	
Met	

 L33	
Physical exam	
I	
14/14	

	

14/14	
Met	

 L34	
Dental exam	
I	
14/14	

	

14/14	
Met	

 L35	
Preventive screenings	
I	
14/14	

	

14/14	
Met	

 L36	
Recommended tests	
I	
14/14	

	

14/14	
Met	

 L37	
Prompt treatment	
I	
14/14	

	

14/14	
Met	

O	
 L38	
Physician's orders	
I	
12/12	

2/2	

14/14	
Met	

 L39	
Dietary requirements	
I	
12/14	

1/1	

13/15	
Met
(86.67 %)	

 L40	
Nutritional food	
L	
14/14	

1/1	

15/15	
Met	

 L41	
Healthy diet	
L	
14/14	

1/1	

15/15	
Met	

 L42	
Physical activity	
L	
13/14	

	

13/14	
Met
(92.86 %)	

 L43	
Health Care Record	
I	
13/14	

	

13/14	
Met
(92.86 %)	

 L44	
MAP registration	
L	
14/14	

1/1	

15/15	
Met	

 L45	
Medication storage	
L	
14/14	

1/1	

15/15	
Met	

O	
 L46	
Med. Administration	
I	
13/14	

2/2	

15/16	
Met
(93.75 %)	

 L47	
Self medication	
I	
14/14	

	

14/14	
Met	

 L49	
Informed of human rights	
I	
14/14	

2/2	

16/16	
Met	

 L50	
Respectful Comm.	
L	
14/14	

1/1	

15/15	
Met	

 L51	
Possessions	
I	
14/14	

2/2	

16/16	
Met	

 L52	
Phone calls	
I	
14/14	

2/2	

16/16	
Met	

 L53	
Visitation	
I	
14/14	

2/2	

16/16	
Met	

 L54	
Privacy	
L	
13/14	

1/1	

14/15	
Met
(93.33 %)	

 L55	
Informed consent	
I	
0/12	

0/2	

0/14	
Not Met
(0 %)	

 L56	
Restrictive practices	
I	
5/5	

	

5/5	
Met	

 L57	
Written behavior plans	
I	
8/8	

	

8/8	
Met	

 L58	
Behavior plan component	
I	
7/8	

	

7/8	
Met
(87.50 %)	

 L59	
Behavior plan review	
I	
8/8	

	

8/8	
Met	

 L60	
Data maintenance	
I	
7/8	

	

7/8	
Met
(87.50 %)	

 L61	
Health protection in ISP	
I	
14/14	

2/2	

16/16	
Met	

 L62	
Health protection review	
I	
11/14	

	

11/14	
Not Met
(78.57 %)	

 L63	
Med. treatment plan form	
I	
13/14	

	

13/14	
Met
(92.86 %)	

 L64	
Med. treatment plan rev.	
I	
9/14	

	

9/14	
Not Met
(64.29 %)	

 L65	
Restraint report submit	
L	
1/1	

	

1/1	
Met	

 L67	
Money mgmt. plan	
I	
14/14	

	

14/14	
Met	

 L68	
Funds expenditure	
I	
14/14	

2/2	

16/16	
Met	

 L69	
Expenditure tracking	
I	
13/14	

2/2	

15/16	
Met
(93.75 %)	

 L70	
Charges for care calc.	
I	
14/14	

	

14/14	
Met	

 L71	
Charges for care appeal	
I	
14/14	

	

14/14	
Met	

 L77	
Unique needs training	
I	
14/14	

2/2	

16/16	
Met	

 L78	
Restrictive Int. Training	
L	
5/5	

	

5/5	
Met	

 L79	
Restraint training	
L	
1/1	

	

1/1	
Met	

 L80	
Symptoms of illness	
L	
14/14	

1/1	

15/15	
Met	

 L81	
Medical emergency	
L	
14/14	

1/1	

15/15	
Met	

O	
 L82	
Medication admin.	
L	
14/14	

1/1	

15/15	
Met	

 L84	
Health protect. Training	
I	
13/14	

2/2	

15/16	
Met
(93.75 %)	

 L85	
Supervision 	
L	
14/14	

1/1	

15/15	
Met	

 L86	
Required assessments	
I	
8/11	

	

8/11	
Not Met
(72.73 %)	

 L87	
Support strategies	
I	
8/12	

	

8/12	
Not Met
(66.67 %)	

 L88	
Strategies implemented	
I	
11/14	

	

11/14	
Not Met
(78.57 %)	

 L90	
Personal space/ bedroom privacy	
I	
14/14	

	

14/14	
Met	

#Std. Met/# 76 Indicator	

	

	

70/76	

	
Total Score	

	

	

80/86	

	

	

	

	
93.02%	

		
							
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	

4/4	
Met	

 L5	
Safety Plan	
L	
2/2	

2/2	
Met	

O	
 L6	
Evacuation	
L	
2/2	

2/2	
Met	

 L7	
Fire Drills	
L	
2/2	

2/2	
Met	

 L8	
Emergency Fact Sheets	
I	
4/4	

4/4	
Met	

 L9	
Safe use of equipment	
L	
2/2	

2/2	
Met	

O	
 L11	
Required inspections	
L	
2/2	

2/2	
Met	

O	
 L12	
Smoke detectors	
L	
2/2	

2/2	
Met	

O	
 L13	
Clean location	
L	
2/2	

2/2	
Met	

 L14	
Site in good repair	
L	
2/2	

2/2	
Met	

 L15	
Hot water	
L	
2/2	

2/2	
Met	

 L16	
Accessibility	
L	
2/2	

2/2	
Met	

 L17	
Egress at grade 	
L	
2/2	

2/2	
Met	

 L18	
Above grade egress	
L	
1/1	

1/1	
Met	

 L20	
Exit doors	
L	
2/2	

2/2	
Met	

 L21	
Safe electrical equipment	
L	
2/2	

2/2	
Met	

 L22	
Clean appliances	
L	
2/2	

2/2	
Met	

 L25	
Dangerous substances	
L	
2/2	

2/2	
Met	

 L26	
Walkway safety	
L	
2/2	

2/2	
Met	

 L28	
Flammables	
L	
2/2	

2/2	
Met	

 L29	
Rubbish/combustibles	
L	
2/2	

2/2	
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	
3/3	

3/3	
Met	

 L44	
MAP registration	
L	
2/2	

2/2	
Met	

 L45	
Medication storage	
L	
2/2	

2/2	
Met	

O	
 L46	
Med. Administration	
I	
1/1	

1/1	
Met	

 L49	
Informed of human rights	
I	
4/4	

4/4	
Met	

 L50	
Respectful Comm.	
L	
2/2	

2/2	
Met	

 L51	
Possessions	
I	
4/4	

4/4	
Met	

 L52	
Phone calls	
I	
4/4	

4/4	
Met	

 L54	
Privacy	
L	
2/2	

2/2	
Met	

 L77	
Unique needs training	
I	
4/4	

4/4	
Met	

 L79	
Restraint training	
L	
2/2	

2/2	
Met	

 L80	
Symptoms of illness	
L	
2/2	

2/2	
Met	

 L81	
Medical emergency	
L	
2/2	

2/2	
Met	

O	
 L82	
Medication admin.	
L	
2/2	

2/2	
Met	

 L85	
Supervision 	
L	
2/2	

2/2	
Met	

 L86	
Required assessments	
I	
4/4	

4/4	
Met	

 L87	
Support strategies	
I	
4/4	

4/4	
Met	

 L88	
Strategies implemented	
I	
4/4	

4/4	
Met	

#Std. Met/# 43 Indicator	

	

43/43	

	
Total Score	

	

53/53	

	

	

	
100%	

		
							
	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	

	

	

							
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	
4/4	
Met	

 C23	
Assess skills & training needs	
4/4	
Met	

 C24	
Job goals & support needs plan	
0/4	
Not Met (0 %)	

 C25	
Skill development	
4/4	
Met	

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

 C27	
Job benefit education	
4/4	
Met	

 C28	
Relationships w/businesses	
2/2	
Met	

 C29	
Support to obtain employment	
0/4	
Not Met (0 %)	

 C30	
Work in integrated settings	
0/4	
Not Met (0 %)	

 C31	
Job accommodations	
4/4	
Met	

 C32	
At least minimum wages earned	
4/4	
Met	

 C33	
Employee benefits explained	
4/4	
Met	

 C34	
Support to promote success	
4/4	
Met	

 C35	
Feedback on job performance	
4/4	
Met	

 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 %)	

Residential Services	

Indicator #	
Indicator	
Met/Rated	
Rating	

 C7	
Feedback on staff performance	
3/14	
Not Met (21.43 %)	

 C8	
Family/guardian communication	
14/14	
Met	

 C9	
Personal relationships	
9/14	
Not Met (64.29 %)	

 C10	
Social skill development	
14/14	
Met	

 C11	
Get together w/family & friends	
14/14	
Met	

 C12	
Intimacy	
3/14	
Not Met (21.43 %)	

 C13	
Skills to maximize independence 	
12/14	
Met (85.71 %)	

 C14	
Choices in routines & schedules	
13/14	
Met (92.86 %)	

 C15	
Personalize living space	
14/14	
Met	

 C16	
Explore interests	
7/14	
Not Met (50.0 %)	

 C17	
Community activities	
10/14	
Not Met (71.43 %)	

 C18	
Purchase personal belongings	
12/14	
Met (85.71 %)	

 C19	
Knowledgeable decisions	
14/14	
Met	

 C20	
Emergency back-up plans	
14/14	
Met	

 C46	
Use of generic resources	
7/14	
Not Met (50.0 %)	

 C47	
Transportation to/ from community	
14/14	
Met	

 C48	
Neighborhood connections	
11/14	
Not Met (78.57 %)	

 C49	
Physical setting is consistent 	
14/14	
Met	

 C51	
Ongoing satisfaction with services/ supports	
14/14	
Met	

 C52	
Leisure activities and free-time choices /control	
14/14	
Met	

 C53	
Food/ dining choices	
14/14	
Met	

 C54	
Assistive technology	
12/14	
Met (85.71 %)