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Department of Mental Retardation
Office of Quality Management, Office of Quality Enhancement
Licensure and Certification
Report Date: June 29, 2009
Agency: Better Community Living, Inc.
Review Dates: May 27, 2009 to June 4, 2009
Licensure: June 17, 2009 to June 17, 2011
Licensure Level: Two-Year License
Follow-Up Required: Yes, “The organization has systems in place to safeguard people.”
Certification Performed By: DMR for Residential & Day Supports
Certification Completed On: June 17, 2009
Certification Outcome: CERTIFIED: 6 of 6 Quality of Life Areas “Achieved”
Survey Team: Laura K. O’Connor (Team Leader), Stephen Abreu, Dawne Doyle, and
Jennifer Petersen
Citizen Volunteer: Elizabeth Walters
Number of Individual Reviews Completed: [ 11 ]
[ 2 ] Day
[ 9 ] Residential
[ 5 ] Safeguard System Reviews (Not Rated)
EXECUTIVE SUMMARY
Better Community Living, Inc. (BCL) has been providing residential, employment, individual, shared living,
and family supports to children and adults with disabilities and their families living in and around New
Bedford, since 1988. The mission of the organization states that, “Better Community Living, Inc. is a team
dedicated to creating quality supports and services to enhance the lives of individuals we serve as they strive
for greater independence in the community.” The agency’s goals focused on helping individuals to enhance
their independence, become productive members of their communities, establish friendships, and develop
natural supports. The agency’s continued commitment to respecting individuals’ choices and involving them
in the design of their supports, based on their needs and preferences, helped individuals to experience success
towards succeeding at these goals.
For the purposes of this licensure and certification review, the residential services provided for nine people
including one person receiving shared living supports, and the employment supports provided for two people,
were reviewed. The Individual Support Services (ISS) for three individuals were also concurrently reviewed.
The ISS findings are presented in a separate report entitled “Individual Support Services Review.”
Better Community Living, Inc. - Provider Report - 6/29/09
The agency offered twenty-four hour a day, shared living, and less than twenty-four hour a day residential
supports. Individuals were supported to live by themselves, or with up to three housemates. Residential
supports were varied, in accordance to each individual’s needs and preferences.
The agency’s employment supports were provided through a new site, which was located near a variety of
New Bedford businesses and retailers. The agency is commended for its commitment to provide an
employment location and supports that enabled individuals to utilize a variety of community resources on a
frequent and ongoing basis. Efforts were made to help individuals served through employment services to
secure competitive, community based employment or to perform various jobs for the agency, for which they
received at least minimum wages.
At the time of the survey, the agency was considering developing and offering day habilitation supports in an
effort to provide services for those whose primary focus is neither employment nor retirement. Pursuing such
avenues might create a way for the agency to continue its efforts to individually tailor the supports it provides
for people. As part of this planning process, it is suggested that the agency evaluate how individuals whose
focus is employment and/or do not meet the medical guidelines for day habilitation will be effectively
supported.
Continued efforts have been made by the agency to have a positive presence in the Greater New Bedford
area, which helped to strengthen natural supports and networking opportunities for individuals served. The
agency also owned a “Del’s Lemonade” franchise and ran a lawn care business called “Grassroots,” which
provided opportunities for individuals to earn competitive wages, and to meet and get to know others from
their community. The agency also continued to sponsor the “Bridges to Faith” program which provided an
avenue for people to be connected with others within their community that shared their religious beliefs and
preferences for worship.
The culture of the agency continued to promote individualized supports. Many staff advocated strongly and
successfully to design supports that were flexible and focused on meeting each individual’s changing needs.
Ongoing communications between the agency’s employment and residential supports promoted cohesiveness
and continuity for individuals across settings. The agency supported several individuals, who experienced
significant behavioral challenges; which posed some obstacles towards maximum independence. The agency
had achieved a large measure of accomplishment in helping these people to maintain stability and to reduce
or overcome obstacles.
Many individuals had very involved family members, who also advocated on their behalf. Agency staff made
ongoing efforts to involve, communicate with, and respond to any concerns that family members expressed,
within a timely manner. However, in one instance, the agency honored a family member’s request to
implement an intervention that posed rights limitations, without ensuring that safeguards pertaining to
regulatory requirements were in place. The agency must make efforts to balance its regulatory and family
responsiveness responsibilities.
The area of supporting individuals to understand and grow through the varied experiences in their lives
continues to be one of the agency’s greatest strengths. Many staff, worked for the agency for several years
and established strong, mutual relationships with each other, and the individuals they support. The longevity
of many directors, coordinators, and direct support staff helped to proactively recognize when additional
supports were needed and to reallocate resources to meet changing needs. Staff throughout the agency, were
caring and supportive to assist individuals to understand and grow through various issues and events in their
lives. For example, one man was helped to live with fewer people and with whom he felt more compatible.
Another man was assisted to adjust to changes due to major health challenges. Individuals were also
encouraged and supported, as needed, to grieve the losses of loved ones, as well as to participate in
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Better Community Living, Inc. - Provider Report - 6/29/09
celebrations or other events with their friends and families. The agency is commended for its commitment to
providing sensitive and caring supports that enable individuals to understand and grow from the varied
experiences in their lives.
Since the last survey which took place in 2007, the agency has expanded its quality assurance practices to
include reviews of individuals’ confidential, financial transaction, and medication administration records.
The agency has hired part time consultants in the areas of: clinical, nursing, and quality assurance. In
addition to these consultants, many staff have worked for the agency for a long time and/or have developed
expertise in certain areas or systems, such as behavioral supports, goal development and accomplishment,
medication, or money systems. This has resulted in noted improvement across several of the areas where
concerns had been noted previously. To further enhance its quality assurance practices, it is suggested that
the agency develop a mentoring component where internal staff that have experienced success in specific
areas, provide support to assist others who might benefit from additional guidance or professional
development in those specific area(s).
Although there have been some improvements since the last survey, the agency needs to continue its
emphasis on strengthening the oversight and monitoring of essential safeguards and systems to ensure that
these are consistently implemented and effective across the various locations. Issues were identified
pertaining to safeguards to individuals the areas of: practices that were restrictive or posed potential rights
limitations, medication administration, home maintenance, funds management, and Emergency Evacuation
Safety Plans (EESP)/fire drill procedures. Consultation with the DMR Area Office clinical staff and/or the
DMR Human Rights Specialist should help the agency to strengthen its systems to ensure that any
interventions in place are the least restrictive and meet regulatory requirements. The agency needs to
continue to strengthen its’ systems to more effectively monitor and address the issues identified in the Areas
Needing Improvement noted within the Quality of Life Areas: “Rights and Dignity” and “Personal Well-
Being,” as well as location-specific “Safeguard Summaries,” and “Safeguard System Reviews.” The agency
also needs to develop and implement systems to identify other locations or individuals, where similar issues
might occur, and to prevent recurrence of such issues, across settings and over time.
In summary, the agency is congratulated for receiving a Two-Year License, which was accomplished by
achieving all of the individually based outcomes within the Quality of Life Areas of licensure. Follow-up
will occur through the Office of Quality Management regarding the organizational outcome: “The
organization has systems in place to safeguard people.” To strengthen the consistency of safeguards, the
agency should continue to expand its internal and external quality assurance systems to address the identified
issues and develop strategies to prevent recurrence. Many supporters, who have worked for Better
Community Living for a significant number of years and have provided stability for a number of individuals,
should also be a valuable resource in the agency’s endeavor to continually improve its quality of services.
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Better Community Living, Inc. - Provider Report - 6/29/09
Provider Scoring Summary
Licensure Review
Quality of Life Overall Provider
Area Residential Day Rating
Rights and Dignity Achieved Achieved Achieved
Personal Well Being Achieved Achieved Achieved
Organizational
The organization has systems in place to safeguard people. Partially Achieved
Outcome:
Certification Review
Quality of Life Overall Provider
Area Residential Day Rating
Individual Control Achieved Achieved Achieved
Community and
Achieved Achieved Achieved
Social Connections
Personal Growth and
Achieved Achieved Achieved
Accomplishments
Organizational Staff have the skills and knowledge to support the quality of life of
Achieved
Outcome: people.
Organizational The organization supports growth and change to continually
Achieved
Outcome: improve its quality of supports.
Organizational Combined Rating:
(Based on both the licensure organizational outcome and the two certification Achieved
quality of life outcomes.)
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Better Community Living, Inc. - Provider Report - 6/29/09
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 organization has systems in place to safeguard people.
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Better Community Living, Inc. - Provider Report - 6/29/09
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
People are valued. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
1.1A Interactions are respectful of people. 9 0 0 2 0 0 - - - 100% -- N/A
People are supported to identify themselves
1.1B as adults. 9 0 0 2 0 0 - - - 100% -- N/A
People are supported to take pride in
1.1C themselves and their surroundings 9 0 0 2 0 0 - - - 100% -- N/A
People live and work in settings that are
1.1D typical of other members of the community. 9 0 0 2 0 0 - - - 100% -- N/A
People’s rights are affirmed. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
People and/or those supporting them
1.2A understand individual rights. 9 0 0 2 0 0 - - - 100% -- N/A
People’s rights are exercised in their
1.2B everyday lives. 9 0 0 2 0 0 - - - 100% -- N/A
People receive the same treatment as other
1.2C employees. 0 0 9 2 0 0 - - - 100% -- N/A
People receive comparable wages and
1.2D benefits as other employees. 0 0 9 2 0 0 - - - 100% -- N/A
People’s rights are protected. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
All interventions are the least intrusive and
1.3A are based upon people’s unique needs. 7 2 0 2 0 0 - - - 82% 18% N/A
All interventions are included in a written
1.3B plan. 5 2 2 0 0 2 - - - 71% 29% N/A
People or their guardians knowingly give
1.3C consent and have the opportunity to refuse 6 1 2 0 0 2 - - - 86% 14% N/A
or withdraw approval.
Safeguards ensure a thorough review and
1.3D approval process when needed. 5 2 2 0 0 2 - - - 71% 29% N/A
All interventions are safely, accurately, and
1.3E consistently implemented. 7 0 2 0 0 2 - - - 100% -- N/A
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Better Community Living, Inc. - Provider Report - 6/29/09
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 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
People are safe at home and work. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
People’s home and workplace are safe,
5.1A secure, and in good repair. 9 0 0 2 0 0 - - - 100% -- N/A
People and their supporters know what to do
5.1B in an emergency. 6 3 0 2 0 0 - - - 73% 27% N/A
People can safely evacuate from their home
5.1C and workplace in an emergency. 8 1 0 2 0 0 - - - 91% 9% N/A
There are adequate supports for people to be
5.1D safe in their home and work. 9 0 0 2 0 0 - - - 100% -- N/A
5.1E People use materials and equipment safely. 0 0 9 2 0 0 - - - 100% -- N/A
People are protected from harm. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
Supports are in place if people make
5.2A decisions that put them at risk. 1 0 8 0 0 2 - - - 100% -- N/A
Immediate actions are taken to ensure
5.2B people's safety. 1 0 8 0 0 2 - - - 100% -- N/A
Actions are taken to correct the situation when
5.2C people have been mistreated. 2 0 7 0 0 2 - - - 100% -- N/A
Steps are taken to prevent the situation from
5.2D occurring again. 2 0 7 0 0 2 - - - 100% -- N/A
People know how or have support to report a
5.2E situation where they feel they are being mis- 9 0 0 2 0 0 - - - 100% -- N/A
treated or have been mistreated or harmed.
People maintain good health. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
People are supported to have a healthy
5.3A lifestyle. 9 0 0 2 0 0 - - - 100% -- N/A
People are supported to be active participants
5.3B in their health care. 9 0 0 0 0 2 - - - 100% -- N/A
People have needed routine and specialized
5.3C health care services. 9 0 0 0 0 2 - - - 100% -- N/A
Supporters are knowledgeable about people’s
5.3D health care needs. 9 0 0 2 0 0 - - - 100% -- N/A
People’s medications are given properly and
5.3E as prescribed by the practitioner. 6 2 1 0 0 2 - - - 75% 25% N/A
People’s funds are safeguarded. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
People receive the support and/or education
5.4A they need in managing their financial 8 1 0 1 0 1 - - - 90% 10% N/A
resources.
People’s funds are managed properly and
5.4B with their consent. 9 0 0 0 1 1 - - - 90% 10% N/A
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Better Community Living, Inc. - Provider Report - 6/29/09
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 Agency Totals
The organization has systems in place to safeguard people.
Partially Achieved Finding
The organization has strategies that proactively ensure that essential safeguards are in place across
7.1A settings and over time. No
7.1B The organization has systems in place to affirm and protect the rights and dignity of individuals. No
7.1C The organization has procedures that minimize unnecessary risk to individuals. Yes
% Indicators Present 33%
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 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
People are understood. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
Supporters understand what people are
2.1A expressing. 9 0 0 2 0 0 - - - 100% -- N/A
Supporters use people’s primary means of
2.1B communication. 9 0 0 2 0 0 - - - 100% -- N/A
Supporters assist people to communicate with
2.1C and be understood by others. 9 0 0 2 0 0 - - - 100% -- N/A
People make choices in their everyday lives. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
People make choices about their routines and
2.2A schedules. 9 0 0 2 0 0 - - - 100% -- N/A
People make choices about the work and
2.2B household tasks for which they are responsible. 9 0 0 2 0 0 - - - 100% -- N/A
People spend their leisure times in personally
2.2C satisfying ways. 9 0 0 - 0 2 - - - 100% -- N/A
People are the primary decision makers in their lives. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
2.3A People develop their personal goals. 8 1 0 2 0 0 - - - 91% 9% N/A
2.3B People influence that provides their support. 9 0 0 2 0 0 - - - 100% -- N/A
People control important decisions about their
2.3C home and home life. 9 0 0 0 0 2 - - - 100% -- N/A
People choose where they work or, if they choose
2.3D not to work, people have other options that are 0 0 9 2 0 0 - - - 100% -- N/A
meaningful to them.
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Better Community Living, Inc. - Provider Report - 6/29/09
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
People are integrated into their community Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
People live and work in communities with
3.1A the resources they want and need. 9 0 0 2 0 0 - - - 100% -- N/A
People use the same community resources
3.1B as others on a frequent and ongoing basis. 8 1 0 2 0 0 - - - 91% 9% N/A
People are connected with their community. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
People are supported to explore their
3.2A personal interests and options for 8 1 0 0 0 2 - - - 89% 11% N/A
community involvement.
People are involved in activities that
3.2B connect them to other people in the 8 1 0 0 0 2 - - - 89% 11% N/A
community.
People have relationships. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
People are supported to maintain and
3.3A enhance relationships with family, friends, 9 0 0 2 0 0 - - - 100% -- N/A
and co-workers.
People are supported to develop new
3.3B friendships. 8 1 0 0 - 2 - - - 89% 11% N/A
People are supported to explore, define,
3.3C and express their need for intimacy. 9 0 0 0 0 2 - - - 100% -- N/A
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Better Community Living, Inc. - Provider Report - 6/29/09
QUALITY OF LIFE AREA
Personal Growth and Accomplishments
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
People accomplish their goals. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
People’s goals are the basis for actions and
4.1A supports. 9 0 0 2 0 0 - - - 100% -- N/A
There is a match between what people are
4.1B doing now and what they want to do in the 9 0 0 2 0 0 - - - 100% -- N/A
future.
People have access to needed resources in
4.1C order to accomplish their goals. 9 0 0 1 1 0 - - - 91% 9% N/A
There are supports to get a job that people
4.1D like. 0 0 9 2 0 0 - - - 100% -- N/A
4.1E There are supports to succeed at the job. 0 0 9 2 0 0 - - - 100% -- N/A
People are supported to advance in their
4.1F job. 0 0 9 2 0 0 - - - 100% -- N/A
People have autonomy. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
People complete day to day activities, tasks,
4.2A and chores as independently as possible. 9 0 0 2 0 0 - - - 100% -- N/A
People have access within their home and
4.2B workplace. 9 0 0 2 0 0 - - - 100% -- N/A
People grow through their life experiences. Residential Day Respite % of Indicators
Achieved Yes No NA Yes No NA Yes No NA Yes No NA
Supporters are sensitive and attuned to
4.3A both small and large events in people’s 9 0 0 2 0 0 - - - 100% -- N/A
lives.
People are encouraged to understand
4.3B experiences in their lives. 9 0 0 2 0 0 - - - 100% -- N/A
People are supported to grow from events
4.3C in their lives that affect them. 9 0 0 2 0 0 - - - 100% -- N/A
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Better Community Living, Inc. - Provider Report - 6/29/09
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
Agency
Outcomes Totals
Staff have the skills and knowledge to support the quality of life of people.
Achieved Finding
7.2A The organization recruits and maintains a competent work force. Yes
7.2B The organization has ways to support staff knowledge, effectiveness, and creativity. Yes
% Indicators Present 100%
The organization supports growth and change to continually improve its quality of supports.
Achieved Finding
7.3A The organization has processes to evaluate the quality of its supports. Yes
7.3B The organization improves services as a result of these analyses. Yes
% Indicators Present 100%
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