CapeAbilities ISS by jey14242


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

                                                                           Report Date: January 4, 2008

Provider Name: capeAbilities, Inc.
ISS Team Member: Scott F. Nolan
ISS Certification Dates: November 20, 2007 to November 20, 2009
ISS Certification Outcome: Certified

                       Provider Description of Individual Support Services
capeAbilities, Inc. is a non-profit organization that provides employment and day habilitation, residential,
transportation, and therapeutic services for Cape Codders with disabilities. Founded as Nauset Workshop in
1968 in Orleans, capeAbilities now serves people with disabilities from Bourne to Provincetown. The mission
of the organization is to serve individuals with disabilities by educating, counseling and providing residential,
therapeutic, and social and employment supports so as to empower them to achieve meaningful and valued roles
in society. This review represents the agency’s second participation in Certification of its Individual Support

Since the last review (July 2005) the agency’s Individual Support Services (ISS) program has gone through a
period of transition which included significant change in the provision of oversight systems for individuals who
received this type of support. This change came about as a result of hiring a new management team who
demonstrated a renewed focus to providing individualized supports. Additional changes included one
individual choosing to leave Individual Support Services to move into a shared living arrangement which better
suited his needs while two others sought services through ISS that accommodated their need for individualized
services. In addition to shared living and ISS, the agency is providing Adult Foster Care Services (AFCS) after
another organization no longer offered this service. The agency incorporated some of the positive practices of
AFCS by adding nursing support to ISS. The nursing support provided assistance with medical appointments,
consulting with specialists to develop a course of action when deemed necessary and monitoring health care.
Recently, the agency hired a part-time case manager to provide additional support to the ISS and AFCS
programs. This support will enable the agency to maintain the level of service being delivered to individuals
receiving less than fifteen hours of weekly support.

                                           Overview of Findings
A variety of supports were available to people served through the agency’s ISS program, including, but not
limited to: transportation, advocacy, medical care coordination, recreational and community outings. Each of
these individuals lives in their own apartment or home and receives supports that reflected their unique
preferences and needs, which changed and varied over time. These individuals also had active family members
who assisted them to advocate for supports that enhanced the quality of their lives such as increased
opportunities for community involvement. The staff worked with individuals to promote and enhance their
independence, while assisting them to understand and responsibly assert their rights in their homes, places of
employment, and community.
                            capeAbilities, Inc. - Individual Support Services Review - 1/4/08

The agency approached assessing individuals’ skills and abilities in a thorough and comprehensive manner
through the use of observation, consultation and written assessments. Outcomes from the assessment process
typically built the foundation of agency supports, sometimes forming goals and in other instances sparking a
more informal area of focus. Staff also sought input from those people who were active in the individual’s life
such as family members, service coordination, and agency personnel who shared long-term relationships. The
combination of assessing individual’ skills and gathering qualitative information provided a solid base for the
provision of individualized supports. For example, goals were holistic and focused on learning skills to foster
independence at home and in the community, using public transportation and increasing community involve-
ment. The two people who participated in the review benefited from this process as the agency tailored time
each week to reflect what was important to them and areas in which they could benefit from additional skill

Individuals were assisted to understand the responsibilities that came from making informed choices in all areas
of their lives (e.g., home, work, community). The agency accessed clinical supports to assist individuals to
learn positive social behaviors and develop strategies to cope with anger or frustration in various settings.
These interventions resulted in people experiencing enhanced social skills which led to increased participation
in community life (e.g., involvement in their place of worship). When necessary, staff also provided individuals
with the information they needed to make informed and important life decisions, while remaining respectful of
personal choices. Staff are commended for their efforts to enable individuals to learn and develop the necessary
skills to exercise control over their supports and other aspects of their lives.

A clear strength of the agency was the recent addition of nursing support. The ISS manager and nurse worked
collaboratively to ensure that people received routine or specialized medical attention as needed. Also, the
nurse played an integral role in advocating for health services during medical appointments. In one instance,
the doctor recommended a course of treatment that the nurse knew would not be suitable for the individual
based on his tolerance level; instead the nurse requested the doctor perform a simple procedure in the office
which alleviated the problem. Another example which highlighted the benefit of having an involved medical
professional was attending a specialized medical consultation with the individual and family member to rule out
the onset of Alzheimer’s disease. An additional recommendation to which the family agreed was to conduct
tests that would be useful in future diagnosis or preventative care. The agency is recognized for taking the
initiative to expand the range of health supports typically provided under this model and is encouraged to
continue its efforts to support individuals to maintain good health.

The agency had safeguard systems in place to ensure people’s safety at home and in the community. Although
not required, the agency had Emergency Evacuation Safety Plans (EESP) in place in the homes. Individual
safety and situational assessments were used to assess people’s skills while serving as a tool for additional skill
training when necessary. For example, one individual expressed concern that using public transportation from
work to his home resulted in coming home later than expected on occasion; staff have assisted this individual to
use a cell phone to notify family members and others when he is going to be late. In another instance, an
individual was supported by his family and the agency to live in a neighborhood setting surrounded by people
whom he and his family had established trusting relationships. This “extra set of eyes” provided an additional
safeguard that promoted this individual’s independence. The agency’s 24-hour emergency on-call system
provided ready access in the event of an emergency.

The agency supported a very active Human Rights Committee which provided oversight to individual’s
throughout the organization including those within the Individual Support Services. The Committee met
consistently and meeting minutes provided a detailed description of information reviewed as they pertain to
items within the purview of the Committee. The Committee did struggle in maintaining required membership
or in changing members over the last two years. During the course of this certification, the agency submitted a
waiver for to access the member with clinical expertise on a consultant basis.
                            capeAbilities, Inc. - Individual Support Services Review - 1/4/08

One area that would further strengthen rights protection was noted in the agency’s practices around the use of
behavior modifying medications. One of the two individuals participating in the review was administered this
type of medication. Although a medication treatment plan was in place and signed by the legal guardian,
medication treatment plans need to contain more detailed information regarding the unique signs and symptoms
of the medication and the data being collected. This will assist the agency in reporting the effectiveness of the
medication to the prescribing physician in evaluating the course of treatment.

The agency demonstrated its commitment to continually improve upon the supports provided to individuals. To
this end, it sought input from a variety of internal and external stakeholders. The agency conducted a review of
its supports through annual satisfaction surveys. A strength within the ISS model was the relationship that the
manager and nurse cultivated with individuals and their family members in a short period of time. The ongoing
communication and interactions between the ISS team and the individuals/family members provided a
mechanism for ongoing dialogue for the improvement of services at any point in time.

In summary, the agency’s Individual Support Services were highly customized and effectively responsive to
meet the needs and preferences of each individual at this point in time. Supporters throughout the agency, who
worked directly with and oversaw these services, were strongly committed to providing respectful and caring
assistance to help individuals maintain and strengthen their independence. As a result of the survey findings,
the agency’s Individual Support Services are “Certified” for the next two years.

                             AREA #1 - RESPONSIVENESS / FLEXIBILITY
                    Outcome/Indicator                                         Indicator Response Summary
                                                                  # Rated      Yes     No    % of Indicators Present
A. Provider has a mechanism to determine what the                    2          2       0            100%
   individuals’ needs are.
B. Provider is aware of the degree to which the individual           2          2         0           100%
   will accept supports.
C. Provider is offering supports in areas identified and             2          2         0           100%
   consistent with individual’s willingness to engage.
D. Provider has the flexibility to modify supports when              2          2         0           100%
    needed by the individual.

                             capeAbilities, Inc. - Individual Support Services Review - 1/4/08

                    Outcome/Indicator                                          Indicator Response Summary
                                                                   # Rated      Yes     No    % of Indicators Present
A. Staff assists individuals to understand their rights and           2          2       0            100%
B. Staff have an understanding of the individuals’                    2          2         0           100%
   Capability to make informed decisions.
C. Individuals are given support to make informed                     2          2         0           100%
  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               2          2         0           100%
   selection and evaluation of staff.

                    Outcome/Indicator                                          Indicator Response Summary
                                                                   # Rated      Yes     No    % of Indicators Present
A. Staff offers information and support to assist an                  2          2       0            100%
   individual to be safe in his/her home.
B. Staff offers information and supports to assist an                 2          2         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             2          2         0           100%
   to call in the event of an emergency.
D. Staff has supports in place if individuals make                    2          2         0           100%
   decisions that put them at risk.
E. Staff responds effectively when an individual’s                    1          1         0           100%
   decisions impact on the rights and safety of others.
F. Staff collaborates with others if there is a Risk                  0          0         0           N/A
   Management Plan in place.
G. Staff are aware of mechanisms to report a situation                2          2         0           100%
   when an individual has been mistreated or harmed and
   take appropriate action.

                              capeAbilities, Inc. - Individual Support Services Review - 1/4/08

                                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,                 2          2       0            100%
   groups, community resources and natural supports in
   order to support an individual.
B. Staff effectively coordinates the efforts of an array of              2           2      0                100%
   community resources where appropriate.
C. Staff assist the individual to get the services they need.            2           2      0                100%

                           PART II - OUTCOMES FOR ORGANIZATION

                          Outcome/Indicator                                              Indicator Summary
  The organization has effective systems in place to safeguard
                                                                             Outcome            % of Indicators Present
  The organization has strategies that proactively ensure that                 Yes
  essential safeguards are in place.
  The agency has systems in place to affirm and protect the rights             Yes                      100%
  and dignity of individuals.
  The agency implements procedures that minimize unnecessary                   Yes
  risk to individuals.


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