Beta Community Services ISS by jey14242

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									                               Department of Mental Retardation
                 Office of Quality Management, Office of Quality Enhancement
                              Individual Support Services Review


                                                                            Report Date: December 7, 2007


Provider Name: Beta Community Services
ISS Team Members: Edward Sutka and Scott F. Nolan
ISS Certification Dates: October 24, 2007 to October 24, 2009
ISS Certification Outcome: Certified


                        Provider Description of Individual Support Services
Beta Community Services is a non-profit organization that has provided a range of residential supports to
people with disabilities in the greater Attleboro area since 1973. The agency’s Individual Support Services
(ISS), which are designed for people not receiving more than fifteen hours of support per week, comprised the
focus of the current review. This review was conducted concurrently with a Licensure and Certification review
for people receiving more than fifteen hours of residential support per week. Findings of that review are
included in a separate report. In general, the organizational structure of ISS paralleled that found in the agency
as a whole with administrative authority exercised by the same personnel for both components
The survey sample for this review was comprised of three of the ten people who received ISS from the agency.
Each of the three survey participants lived in an apartment in Attleboro either alone or with one housemate.
Supports provided by the agency were targeted to areas where assistance was instrumental to helping people to
continue to live successfully in the community. Some of the support areas addressed by staff included
assistance with finances, transportation, recreation, health management, and landlord issues.


                                            Overview of Findings
While general expectations were in place in regard to what supports would be provided, staff understood that
taking a fluid approach to service delivery was often needed to best meet people’s needs and preferences. As
people’s needs changed, staff were skillful in adjusting the focus of supports and number of support hours.
Agency staff persons were aware that some people were resistant to accepting certain aspects of supports and
tailored their approach to maximize people’s comfort level with accepting what was offered to them. In some
instances staff’s relationships with people had extended over many years, and a feeling of friendship had
developed between people and their staff. Staff’s knowledge of people was an important factor in
individualizing people’s supports rather than limiting what was offered to a fixed menu of offerings. Each of
the three people whose supports were reviewed participated in the Individual Support Plan (ISP) process, and
people’s ISP’s reflected an individualized approach to goal development.

Beta staff were aware of the importance of helping people become informed decision-makers, respected the fact
that people might make decisions with which staff disagreed, and made efforts to help people explore
alternative options. For instance, one survey participant had expressed over time the wish to terminate her
services from the agency. This person also made decisions which put her at risk and which were clearly
contrary to staff’s advice. Despite the difficulties this created, staff continued to offer options and to explain the
                         Beta Community Services - Individual Support Services Review - 12/7/07

possible consequences that might ensue from any given decision or set of actions and to follow the
recommendations set forth in this person’s DMR Risk Management Plan. These efforts had ensured that at least
basic supports remained in place for this person. Staff also honored people’s choices to receive support from
people in their lives other than staff, such as family and friends, and realized the importance of the supports that
were provided through these means. People were encouraged to give input in regard to which staff with whom
they preferred to work, and efforts were made to match staff with those people with whom they worked most
effectively. On-going support of people’s choices was one of the main ways in which staff supported people to
exercise their rights, and staff also provided people with human rights information and encouraged them to self-
advocate.

Another way in which staff responded to people’s needs was their ability to help people make linkages to
resources. For instance, people were assisted to access or to more effectively use benefit programs, such as
subsidized housing and food stamps. Examples where staff advocacy had been helpful included ensuring that
hospitals delivered thorough medical care and persuading the Social Security Administration to allow people to
receive their checks without having a representative payee, where this was appropriate. People’s resource use
was also enhanced by staff’s efforts to maintain contact with people’s day supports and to help people to access
social and recreational opportunities of their choosing. When needed, staff also worked cooperatively with
agencies involved with legal enforcement, such as the local police department and the court system. The
agency also worked with the DMR system on an on-going basis to resolve any particularly difficult issues.

The agency had a variety of systems in place to ensure people’s health, safety, and general well-being. For
instance, people were given assistance to make sure that they could access help in an emergency, and safety
skills assessments within their neighborhoods and apartments, and to address maintenance issues at the
apartments themselves. Staff’s longevity and their commitment to people also acted as a less tangible, but
important safeguard. For instance, when people’s health needs increased or they were otherwise in crisis, staff
were responsive in accommodating their changing support needs.

While many of the agency’s systems to assess and ensure people’s health, safety, and financial integrity
generally worked well, some aspects of how the agency had designed and implemented these systems could
have been refined or improved. Examples or areas where this was indicated included ensuring the completion
of all required items on Emergency Fact Sheets and adhering to Medication Administration Program (MAP)
standards when people did not meet the criteria for self-medication. In some instances when the agency
exercised shared or delegated money management responsibilities, further efforts were needed to meet all
relevant requirements. For instance, money management plans did not necessarily include full information in
regard to such issues as how any money from trust funds would be accessed and how much money a person
could safely handle independently, to determine the threshold for documenting financial transaction records.

The agency has acknowledged that a present and future challenge will be the fact that many of the people who
have been part of the ISS component for many years were to showing signs of aging. This was evident for two
of the three survey participants in the current sample. The agency remained committed to assisting people to
maintain their highest possible degree of independence for as long as possible. As part of an effort to address
this issue, the agency may want to explore housing options where a person receiving ISS could live adjacent to
people living in a more heavily staffed living situation.

People supported by the agency through ISS had benefited from the agency’s commitment to normalization and
the positive relationships that people had developed with their staff over a number of years. As an area for
future emphasis, it is recommended that the agency strengthen those areas of its safeguard systems where
further efforts are still needed to fully meet DMR requirements. Efforts of this nature coupled with the existing
base of strength that the agency has established for this component should provide a solid foundation for further
development.
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                         Beta Community Services - Individual Support Services Review - 12/7/07




                     PART I: INDIVIDUAL SERVICE QUALITY REVIEW

                              AREA #1 - RESPONSIVENESS / FLEXIBILITY

                    Outcome/Indicator                                       Indicator Response Summary
                                                                 # Rated     Yes     No    % of Indicators Present
A. Provider has a mechanism to determine what the                   3         3       0            100%
   individual’s needs are.
B. Provider is aware of the degree to which the individual          3          3        0           100%
  will accept supports.
C. Provider is offering supports in areas identified and            3          3        0           100%
   consistent with individual’s willingness to engage.
D. Provider has the flexibility to modify supports when             3          3        0           100%
    needed by the individual.




                 AREA #2 - CHOICE / CONTROL / INFORMED DECISION MAKING

                    Outcome/Indicator                                       Indicator Response Summary
                                                                 # Rated     Yes     No    % of Indicators Present
A. Staff assists individuals to understand their rights and         3         3       0            100%
   responsibilities.
B. Staff have an understanding of the individual’s                  3          3        0           100%
   capability to make informed decisions.
C. Individuals are given support to make informed                   3          1        2           33%
  decisions about where they live, work, recreate, spend
   money with whom they have relationships and other
   significant lifestyle choices.
D. Individuals have opportunities to participate in the             3          3        0           100%
   selection and evaluation of staff.




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                         Beta Community Services - Individual Support Services Review - 12/7/07



              AREA #3 - SAFETY / EMERGENCY RESPONSE CAPABILITY
                    Outcome/Indicator                                       Indicator Response Summary
                                                                 # Rated     Yes     No    % of Indicators Present
A. Staff offers information and support to assist an                2         2       1             67%
   individual to be safe in his/her home.
B. Staff offers information and supports to assist an               3          3        0           100%
   individual to recognize danger and take action in their
   home, work place and neighborhood.
C. Staff educates the individual about what to do and who           3          3        0           100%
   to call in the event of an emergency.
D. Staff has supports in place if individuals make                  3          3        0           100%
   decisions that put them at risk.
E. Staff responds effectively when an individual’s                  2          2        0           100%
   decisions impact on the rights and safety of others.
F. Staff collaborates with others if there is a risk                2          2        0           100%
   management plan in place.
G. Staff are aware of mechanisms to report a situation              3          3        0           100%
   when an individual has been mistreated or harmed and
   take appropriate action.



                               AREA #4 – OUTREACH / ADVOCACY
                    Outcome/Indicator                                        Indicator Response Summary
People accomplish their goals.                                    # Rated     Yes     No    % of Indicators Present
A. Staff engages in outreach efforts to other agencies,              3         3       0            100%
   groups, community resources and natural supports in
   order to support an individual.
B. Staff effectively coordinates the efforts of an array of             3      3        0           100%
   community resources where appropriate.
C. Staff assist the individual to get the services they need.           3      3        0           100%




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                         Beta Community Services - Individual Support Services Review - 12/7/07



                          PART II - OUTCOMES FOR ORGANIZATION

                       Outcome/Indicator                                           Indicator Summary
The organization has effective systems in place to safeguard            Outcome        % of Indicators Present
individuals.
The organization has strategies that proactively ensure that               No
essential safeguards are in place.
The agency has systems in place to affirm and protect the rights           No                       33%
and dignity of individuals.
The agency implements procedures that minimize unnecessary                 Yes
risk to individuals.
Staff have the skills and knowledge to support the quality of           Outcome            % of Indicators Present
life of individuals.
The agency recruits and maintains a competent workforce.                   Yes
                                                                                                   100%
The agency has ways to support staff knowledge, effectiveness,             Yes
and creativity.
The organization supports growth and change to continually              Outcome            % of Indicators Present
improve its supports to individuals.
The organization has processes to evaluate the quality of its              Yes
supports.                                                                                          100%
The organization improves services as a result of these analyses.          Yes




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