ARC of Northern Essex County

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					                               Department of Mental Retardation
                 Office of Quality Management, Office of Quality Enhancement
                                   Licensure and Certification


                                                                             Report Date: March 27, 2007

Agency: ARC Of No. Essex County (The)

Review Dates: 2/22/2007 to 3/8/2007

Licensure: 3/26/2007 to 3/26/2009

Licensure Level: Two-Year License

Follow-Up Required: YES. “People’s rights are protected;” “People maintain good health;” “The
organization has systems in place to safeguard individuals”

Certification Performed By: DMR for Residential Supports

Certification Completed On: 3/26/2007

Certification Outcome: Certified with 6 out of 6 Quality of Life Areas Achieved

Survey Team: Joyce Herrmann (Team Leader)

Citizen Volunteer(s): none

Number of Individual Reviews Completed: [2]
                                                                                     [2] Residential Reviews
                                                                                     [ ] Work/Community Reviews
                                                                                     [ ] Respite Reviews (Not Rated)
                                                                                     [ ] Safeguard System Reviews
                                                                                          (Not Rated)

                                        EXECUTIVE SUMMARY

The ARC of Northern Essex (the ARC) is a small non-profit agency located in Haverhill, MA providing
services to individuals and their families in the Merrimack Valley area. The agency receives funding from the
Department of Mental Retardation (DMR), the United Way, and the private sector from fundraising efforts and
from families. The ARC provides support to individuals who may live at home with family, on their own or
with housemates. Individuals and their families are empowered by the ARC to design supports to meet their
needs and, if all parties agree, will provide the supports to meet the desires of that person. The agency’s focus is
to offer supports to people in their self development, which can be through advocacy work, home and vocational
supports, and leadership development. For the purpose of this survey, two individuals were selected and
participated in the agency’s first full survey and certification process. Three individuals receiving Individual
Support Services (ISS) were also surveyed and the results of that review are outlined in another report.

In July 2006, a Safeguard System Review was conducted to evaluate the agency’s newly developed placement
services. Since that time, the agency has committed organizational resources to meet the requirements and
                                                                                                                       1
regulations of DMR. A procedures manual and agency policies and protocols have been developed and these
are currently awaiting the agency’s Advisory Board approval. The responsiveness and philosophy of the ARC
and its dedicated employees to meet these requirements was impressive.

The current survey has identified many improvements in the safeguard areas. These include: the affiliation with
another agency’s human rights committee; full involvement with the requirements and responsibilities of that
committee; and the appointment and training of a human rights officer. Each residence has an approved safety
plan and search plan; required mandated trainings of home care providers have been completed; and emergency
fact sheets and basic information for individuals was updated and accurate. These are all improvements that are
to the agency’s credit and represent a firm foundation in regulatory safeguards for this agency’s relatively newly
established residential services.

The ARC of Northern Essex County demonstrates a commitment to support individuals and their families in a
creative, individualized and non-traditional manner. The enthusiasm of the agency’s staff was both encouraging
and exciting. The ARC describes itself as a “grass-roots, family-focused, advocacy and community building
agency.” An “open door” policy is not only talked about but demonstrated in the office’s open and welcoming
floor plan. A sense of pride, professionalism and a commitment to help facilitate individualized support for
people was clearly evident and commendable.

The ARC’s placement services have developed to support people in home settings that best suit their comfort
and needs. It was evident that the agency’s ability to be both flexible and adaptable in supporting people in the
most beneficial ways was the key factor in the arrangement of services. Although the residential service,
provided through a shared living model, is a relatively new program, it is clear that the agency works intensively
in the planning stages to ensure that individuals’ choices are heard and acted upon, resulting in supports that are
uniquely tailored.

Interviews, discussions and historical pictures show that this agency has moved, in the last few years, from a
small office in the basement of the Haverhill City Hall into an attractive, expansive office in a renovated
building in downtown Haverhill. The new location provides easy access for many ARC families and people
supported by walking or bus service. Pieces of art work, many created by individuals who receive supports, are
displayed. Pictures of days gone by and the people, activities, and events that brought this agency to where it is
today are displayed as well.

While the Arc of Northern Essex has done an excellent job of creating policies, procedures and protocols to
guide the administration of the agency, the organization needs to refine some of its safeguard guidelines in order
to be in better alignment with DMR regulations. Attention to some technical aspects of the organizational
safeguards with regard to medication administration, rights protection, and delegated funds management is
needed.

As a result of the current survey, the ARC of Northern Essex received a Two Year License and is certified with
six out of six Quality of Life Areas being rated as Achieved. This agency is one that is dedicated to its mission
and commitment to maintaining an active and positive role within the Haverhill community.




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Provider Scoring Summary



Licensure Review
                                                 Work/
  Quality of Life         Residential          Community                 Respite           Overall Provider
      Area                 Supports             Supports                Supports               Rating

Rights & Dignity       Achieved                                                                Achieved
Personal Well-
Being                  Achieved                                                                 Achieved
Organizational Outcomes: The organization has systems in place to safeguard people.        Partially Achieved



Certification Review
                                                 Work/
  Quality of Life         Residential          Community                 Respite           Overall Provider
      Area                 Supports             Supports                Supports               Rating

Individual Control     Achieved                                                                Achieved
Community and
Social Connections     Achieved                                                                Achieved
Personal Growth &
Accomplishments        Achieved                                                                Achieved
Organizational Outcomes: Staff have the skills and knowledge to support the quality            Achieved
                          of life of people.
Organizational Outcome: The organization supports growth and change to continually             Achieved
                         improve its quality of supports



Organizational Combined Rating:
(Based on both the licensure organizational outcome and the two certification quality of       Achieved
life outcomes)




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              Department of Mental Retardation
Office of Quality Management, Office of Quality Enhancement
                  Licensure and Certification




                          Section I


                   Licensure Review
           Outcome of Individual Quality Reviews

                        Rights and Dignity
                       Personal Well-Being




                Outcomes for the Organization

        The agency has systems in place to safeguard people.




                                                               4
                                            QUALITY OF LIFE AREA
                                             RIGHTS AND DIGNITY
                                                Rating: Achieved
Principles: Support and affirmation of individual rights are safeguards for all people as citizens of the United
States. These rights are framed in the Constitution, Bill of Rights, and Federal and State statutes. They include
such freedoms as the rights to privacy, free speech and due process. The actualization of individual rights is
especially important to people with disabilities because they have not always been afforded these most basic of
guarantees and may need support to exercise their rights. In order to have their rights affirmed, individuals first
must be respected, valued and treated with positive regard.

                                    QUALITY OF LIFE SCORING SUMMARY

                                                                   Work &                            % of Indicators
                  Outcomes                          Residential                       Respite
                                                                  Community
                and Indicators                       Reviews                          Reviews        (Excluding Respite)
                                                                   Reviews
             People are valued:
                 Achieved                          Yes      No    Yes      No       Yes       No      Yes         No
A. Interactions are respectful of people.           2        0                                        100%         _

B. People are supported to identify themselves      2        0                                        100%         _
   as adults.
C. People are supported to take pride in            2        0                                        100%         _
   themselves and their surroundings.
D. People live and work in settings that are        2        0                                        100%         _
   typical of other members of the community.
      People’s rights are affirmed:
                Achieved                           Yes      No    Yes      No       Yes       No      Yes         No
A. People and/or those supporting them              2        0                                        100%         _
   understand individual rights.
B. People’s rights are exercised in their           2        0                                        100%         _
   everyday lives.
C. People receive the same treatment as other      N/A      N/A                                       N/A        N/A
   employees.
D. People receive comparable wages and             N/A      N/A                                       N/A        N/A
   benefits as other employees.
      People’s rights are protected.
           Partially Achieved                      Yes      No    Yes      No       Yes       No      Yes         No
A. All interventions are the least intrusive and    1        1                                        50%        50%
   are based upon people’s unique needs.
B. All interventions are included in a written      0        1                                          _       100%
   plan.                                           1N/A
C. People, or their guardians, knowingly and       2N/A    2N/A                                       N/A        N/A
   voluntarily give consent and have the
   opportunity to refuse or withdraw
   approval.
D. Safeguards ensure a thorough review and         2N/A    2N/A                                       N/A        N/A
   approval process when needed.
E. All interventions are safely, accurately and     0        1                                          _       100%
   consistently implemented.                       1N/A



                                                                                                                    5
                                           QUALITY OF LIFE AREA
                                           PERSONAL WELL-BEING
                                               Rating: Achieved
Principles: Being safe, secure and healthy provides a foundation that enables people to have a truly fulfilling
life and do the things that are important to them. As with rights, certain universal things contribute to the well-
being of everyone in society, regardless of who they are and their personal circumstance. These universals
include having routine physical examinations, wearing seat belt, or installing smoke detectors. Beyond the
universal safeguards, personal well-being is supported by a recognition of people’s skills and needs as balanced
against their lifestyle choices. Services are designed to assist people to be secure, achieve and/or maintain good
health, to make decisions that keep them out of harm’s way, and to ensure a prompt response when people’s
safety, security or health are compromised.



                                    QUALITY OF LIFE SCORING SUMMARY

                                                                   Work &                            % of Indicators
                 Outcomes                          Residential                        Respite
                                                                  Community
               and Indicators                       Reviews                           Reviews        (Excluding Respite)
                                                                   Reviews
   People are safe at home and work:
                Achieved                           Yes     No     Yes      No       Yes       No      Yes          No
A. People’s home and work place are safe,           2       0                                         100%     _
   secure, and in good repair.
B. People and their supporters know what to         2       0                                         100%     _
   do in an emergency.
C. People can safely evacuate from their home       2       0                                         100%     _
   or work place in an emergency.
D. There are adequate supports for people to        2       0                                         100%     _
   be safe in their home and work.
E. People use materials and equipment safely.      N/A     N/A                                        N/A      N/A
       People are free from harm:
                Achieved                           Yes     No     Yes      No       Yes       No      Yes          No
A. Supports are in place if people make            N/A     N/A                                        N/A      N/A
   decisions that put them at risk.
B. Immediate actions are taken to ensure           N/A     N/A                                        N/A      N/A
   people’s safety.
C. Actions are taken to correct the situation      N/A     N/A                                        N/A      N/A
   when people have been mistreated.
D. Steps are taken to prevent the situation        N/A     N/A                                        N/A      N/A
   from occurring again.
E. People know how or have support to report        2       0                                         100%     _
   a situation where they feel they are being or
   have been mistreated or harmed.




                                                                                                                    6
                                PERSONAL WELL BEING: - Continued

                                                                        Work &                            % of Indicators
                 Outcomes                          Residential                              Respite
                                                                       Community
               and Indicators                       Reviews                                 Reviews       (Excluding Respite)
                                                                        Reviews
      People maintain good health:
           Partially Achieved                     Yes        No       Yes       No        Yes       No        Yes        No
A. People are supported to have a health            2         0                                           100%       _
   lifestyle.
B. People are supported to be active                2         0                                           100%       _
   participants in their health care.
C. People have needed routine and specialized       1         1                                           50%        50%
   health care services.
D. Supporters are knowledgeable about               2         0                                           100%       _
   people’s health care needs.
E. People’s medications are given properly          1         1                                           50%        50%
   and as prescribed by the practitioner.
    People’s funds are safeguarded:
               Achieved                           Yes        No       Yes       No        Yes       No        Yes        No
A. People receive the support and/or                2         0                                           100%       _
   education they need in managing their
   financial resources.
B. People’s funds are managed properly and          2         0                                           100%       _
   with their consent.


                      OUTCOMES FOR THE ORGANIZATION

Principles: Positive outcomes for individuals are the result of many factors, not the least of which is a strong,
coherent organizational structure. For positive outcomes for individuals to be sustained over time, across all
settings and by all staff, agencies need to create an infrastructure and culture that supports quality and
safeguards individuals.

                                                SCORING SUMMARY

                                    Outcome and Indicators                                                Agency
                                                                                                          Totals
           The organization has systems in place to safeguard individuals:                                        % of
                                 Partially Achieved                                                 Finding     Indicators
                                                                                                                 Present
A. The organization has strategies that proactively ensure that essential safeguards are in place   No
   across settings and over time.
B. The organization has systems in place to affirm and protect the rights and dignity of            Yes        66%
   individuals.
C. The agency implements procedures that minimize unnecessary risk to individuals.                  Yes




                                                                                                                          7
                  Department of Mental Retardation
    Office of Quality Management, Office of Quality Enhancement
                      Licensure and Certification




                             Section II


                     Certification Review

              Outcome of Individual Quality Reviews

                           Individual Control
                   Community and Social Connections
                  Personal Growth and Accomplishment



                    Outcome for the Organization
Staff have the skills and knowledge to support the quality of life of people.
     The organization improves services as a result of these analyses.




                                                                                8
                                          QUALITY OF LIFE AREA
                                          INDIVIDUAL CONTROL
                                             Rating: Achieved

Principles: Being able to direct the course of one’s life is something for which all people strive. Self-
determination is expressed in all aspects of people’s lives, both in little, everyday things such as deciding when
to get up as well as in major life decisions that may have a deep, long lasting effect such as deciding on a certain
career or moving to a new community. The type and amount of support people need to take charge of their lives
varies greatly. For some, even making everyday choices is a new experience and they need much guidance in
learning how to make both everyday and major choices. For others, periodic check-ins and discussions are
needed to keep them on course and to make sure they have an understanding of their options and of the
consequences of their decisions. What is important is that people have all the information they need to make
decisions, that they are empowered and supported to take action, and that they understand how their decisions
affect their lives.

                                   QUALITY OF LIFE SCORING SUMMARY
                                                                   Work &                             % of Indicators
                 Outcomes                       Residential                            Respite
                                                                  Community
               and Indicators                    Reviews                               Reviews        (Excluding Respite)
                                                                   Reviews
         People are understood:
                Achieved                        Yes      No       Yes       No       Yes      No       Yes          No
A. Supporters understand what people are         2        0                                           100%      _
   expressing.
B. Supporters use people’s primary means of      2        0                                           100%      _
   communication.
C. Supporters assist people to communicate       2        0                                           100%      _
   with and be understood by others.
          People make choices in
           their everyday lives:                Yes      No       Yes       No       Yes      No       Yes          No
                 Achieved
A. People make choices about their routines      2        0                                           100%      _
   and schedules.
B. People make choices about the work and        2        0                                           100%      _
   household tasks for which they are
   responsible.
C. People spend their leisure time in            2        0                                           100%      _
   personally satisfying ways.
    People are the primary decision-
         makers in their lives:                 Yes      No       Yes       No       Yes      No       Yes          No
           Partially Achieved
A. People develop their personal goals.          1        1                                           50%       50%

B. People influence who provides their           2        0                                           100%      _
   supports.
C. People control important decisions about      2        0                                           100%      _
   their home and home life.
D. People choose where they work or, if they    N/A      N/A                                          N/A       N/A
   choose not to work, people have options
   that are meaningful to them.



                                                                                                                     9
                                 QUALITY OF LIFE AREA
                            COMMUNITY AND SOCIAL CONNECTIONS
                                     Rating: Achieved
Principles: Membership in community life supports people’s sense of belonging and provides opportunities for
citizenship, friendship and valued roles in society. Everyone has unique, identifiable ways that he or she is
connected to the community and to other people who are important to them. Being a part of community life
means that people are using all the resources and amenities that others use. Being connected also means that
people have other people in their lives who are important to them, who are there for them when needed and with
whom they can share their thoughts and concerns. It also includes having a place in society, a place that other
people recognize and value. It may mean helping out neighbors and friends when needed or having talents and
gifts that are recognized and shared with other people.

                                 QUALITY OF LIFE SCORING SUMMARY

                                                                 Work &                          % of Indicators
                Outcomes                        Residential                        Respite
                                                                Community
              and Indicators                     Reviews                           Reviews       (Excluding Respite)
                                                                 Reviews
        People are integrated into
           their community:                     Yes     No     Yes       No      Yes      No       Yes          No
                 Achieved
A. People live and work in communities with      2     0                                         100%       _
   the resources they want and need.
B. People use the same community resources       2     0                                         100%      _
   as others on a frequent and ongoing basis.
       People are connected with
           their community:                     Yes     No     Yes       No      Yes      No       Yes          No
                 Achieved
A. People are supported to explore their         2         0                                     100%      _
   personal interests and options for
   community involvement.
B. People are involved in activities that        2         0                                     100%      _
   connect them to other people in the
   community.
       People have relationships:
                 Achieved                       Yes     No     Yes       No      Yes      No       Yes          No
A. People are supported to maintain and          2         0                                     100%      _
   enhance relationships with family, friends
   and co-workers.
B. People are supported to develop new           2         0                                     100%      _
   friendships.
C. People are supported to explore, define,      2         0                                     100%      _
   and express their need for intimacy.




                                                                                                                10
                                 QUALITY OF LIFE AREA
                         PERSONAL GROWTH AND ACCOMPLISHMENT
                                     Rating: Achieved
Principles: While developing one’s own goals is a critical first step in making decisions about one’s life,
achieving personal goals and developing the skills to be as independent as possible give individuals a sense of
purpose, direction and self-fulfillment in their lives. The strategies and support used in assisting people to reach
their goals takes on many forms and should be tailored to people’s unique skills, needs, preferences and style of
learning. It includes helping people to learn from both planned as well as unanticipated events in their lives.
While there is much to be proud of in acquiring the skills to do things independently, it does not mean that
people are independent in everything they do. There is the joy that people feel in accomplishing things together
and the feeling of self-worth that comes with completing something as independently as possible.

                                   QUALITY OF LIFE SCORING SUMMARY

                                                                   Work &                             % of Indicators
                 Outcomes                         Residential                          Respite
                                                                  Community
               and Indicators                      Reviews                             Reviews        (Excluding Respite)
                                                                   Reviews
     People accomplish their goals:
           Partially Achieved                     Yes     No      Yes       No       Yes      No       Yes          No
A. People’s goals are the basis of actions and     1       1                                          50%       50%
   supports.
B. There is a match between what people are        1       1                                          50%       50%
   doing now and what they want to do in the
   future.
C. People have access to needed resources in       2       0                                          100%      _
   order to accomplish their goals.
D. There are supports to get a job that people    N/A     N/A                                         N/A       N/A
   like.
E. There are supports to succeed at the job.      N/A     N/A                                         N/A       N/A
F. People are supported to advance in their       N/A     N/A                                         N/A       N/A
   job.
         People have autonomy:
                Achieved                          Yes     No      Yes       No       Yes      No       Yes          No
A. People complete day-to-day activities, tasks    2       0                                          100%      _
   and chores as independently as possible.
B. People have access within their home and        2       0                                          100%      _
   workplace.
        People grow through their
            life experiences:                     Yes     No      Yes       No       Yes      No       Yes          No
                 Achieved
A. Supporters are sensitive and attuned to         2       0                                          100%      _
   both small and large events in people’s
   lives.
B. People are encouraged to understand             2       0                                          100%      _
   experiences in their lives.
C. People are supported to grow from events        2       0                                          100%      _
   in their lives that affect them.




                                                                                                                    11
                                Department of Mental Retardation
                  Office of Quality Management, Office of Quality Enhancement
                                    Licensure and Certification



                            OUTCOME FOR THE ORGANIZATION

Principles: Positive outcomes for individuals are the result of many factors, not the least of which is a strong,
coherent organizational structure. For positive outcomes for individuals to be sustained over time, across all
settings and by all staff, agencies need to create an infrastructure and culture that supports quality and
safeguards individuals.

                                                SCORING SUMMARY
                      Staff have the skills and knowledge to support                                     % of
                             the quality of life of individuals:                            Finding    Indicators
                                                                                                        Present
                                          Achieved
A. The agency recruits and maintains a competent work force.                                  Yes        100%

B. The agency has ways to support staff knowledge, effectiveness and creativity.              Yes


             The organization supports growth and change to continually                                  % of
                        improve its supports to individuals:                                Finding    Indicators
                                                                                                        Present
                                      Achieved
A. The organization has processes to evaluate the quality of its supports.                    Yes
                                                                                                         100%
B. The organization improves services as a result of these analyses.                          Yes




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