Reach by jey14242

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



                                                                              Report Date: December 4, 2008


Provider: REACH, Inc.
Review Dates: October 30, 2008 to November 10, 2008
Licensure: November 24, 2008 to November 24, 2010
Licensure Level: TWO-YEAR LICENSE
Follow-Up Required: No
Certification Performed By: DMR for Residential and Day Supports
Certification Completed On: June 16, 2006
Certification Outcome: CERTIFIED WITH DISTINCTION
Survey Team: Barbara Eshbaugh-Nyhan (Team Leader), Stephen Abreu and Dawne Doyle
Number of Individual Reviews Completed: [ 14 ]
                                                         [ 3 ] Day
                                                         [ 11 ] Residential
                                                         [ 3 ] Safeguard System Reviews    (Not Rated)


                                            EXECUTIVE SUMMARY

Reach, Inc., which was founded in 1987, provides day and residential supports to people with disabilities who
live in the greater Plymouth area. The agency’s mission includes the key components of the fostering and
encouragement of self-determination, the preservation of human rights, the pursuit of a positive and gratifying
life, optimal fulfillment of ones civic and vocational responsibilities, and the development of respect and dignity.
The agency provides people with a variety of support options, which encompass both twenty-four hour and less
than twenty-four hour residential supports, community based day supports, which are delivered through the
agency’s Meaningful Day Services (MDS) in downtown Plymouth, and recreational supports.

Resulting from the agency’s success during its last review (June 2006), in which it attained a status of
“Certification with Distinction,” it was subject to Licensure Only review during this cycle. For the purpose of
this review, the supports for five individuals who were receiving twenty-four hour supports and six individuals
receiving less that twenty-four hours were evaluated for residential supports, and three individuals who were
receiving community based day supports were evaluated. In addition to the people involved in the Licensure
Review, three homes that provided twenty-four hour supports was visited in order to conduct a safeguard system
review. The remaining homes providing residential supports were not visited.

Since the previous review, the agency continued its focus on improving its core services. The agency had
completed renovations on its office space to include the grand opening of its retail store “Oh My Gallery.” This
fully integrated store sold artwork of those people served at the agency’s meaningful day program as well as
items created by other local artisans. In addition to the gallery, these renovations included increased office space
and meeting space for staff and those receiving supports. An outcome of this increased space provided for
                                       REACH, Inc. - Provider Report - 12/4/08

program managers to have enhanced access to agency resources, provided networking opportunities among
peers, and a private forum for supervision or confidential meetings. Resources were also directed towards staff
improvement and oversight in other ways. For example, residential programs were restructured so that there was
more onsite supervision, employee evaluations were enhanced to include more measurable goals, and the
orientation curriculum for new employees was expanded to include more training topics. Additionally, the
agency secured a grant to purchase resource information on supporting an aging population with developmental
disabilities. The agency also enhanced its ability to further support people’s health and well being by expanding
the nursing position from part time to full time.

Promoting people’s self-esteem continues to be a fundamental component and a hallmark of the agency’s
supports. This was evident across both residential and day program settings in the way supports were provided.
This emphasis accomplished the dual objective of ensuring an array of positive outcomes for people were
attained as well as reinforcing individuals’ value staff’s attention to this core goal was seen in many ways. First
and foremost, supporters’ interactions were observed to be respectful and acknowledged the inherent value of
each person. Other examples ranged from the conscious efforts to position individuals to have valued roles in
their community, to seeking permission before providing assistance, the latter which helped ensure that
individuals recognized that they held the primary and valued role. Another way in which the agency helped to
support people to see themselves as valued was its consistent approach towards affirming individuals’ rights.
The agency continued to educate people through a video focusing on human rights issues. People were also
assisted to register to vote and to be actively involved in political causes, again supporting their active
participation as an active and valued citizen.

Yet another example in how the agency supported individual’s self-esteem was seen in the area of health and
well-being. Staff presented information and options to people that helped them lose weight, explore and enjoy
food choices of which they had been previously unaware and live a generally healthier lifestyle. The agency
used some of the money raised through their fundraising avenues to purchase supplies for the agency’s Healthy
Lifestyle group. This group met at the MDS program location and provided assistance for people in making
decisions for improving general health such as healthy food options and exercise groups. Besides the obvious
health benefits, individuals felt better about themselves.

The agency’s day supports were located at a historic building in downtown Plymouth that provided a bright,
spacious, and attractive setting. The MDS is contracted as Community Based Day Supports that provided a mix
of employment supports and personal enrichment activities based on their interests and preferences both within
the community as well as on-site. The employment practices were found to affirm people’s rights. For example,
the agency did not seek department of labor certification to pay sub-minimum wage. All people were paid
according to minimum hourly wages. Additionally, the benefit of paid time was afforded to these individuals so
that they would not lose out on pay due to issues beyond their control such as inclement weather or medical
appointments. With the opening of the store, those receiving supports through MDS were afforded the
opportunity to pursue other skills. Going forward, the agency may want to review prevailing wages in the retail
environment to ensure that those individuals working in this area receive wages equal to those with the same skill
set as others working in similar retail environments.

The agency continued to focus on providing individuals with home supports that afforded maximum
independence while assuring safety. For example the agency supported many individual’s who had less than
twenty four hour supports. In several situations, these homes were adjacent to apartments where twenty-four
hour supports were provided. This structure had the effect of enhancing independence for those individuals who
had less than twenty-four hours of support, while ensuring that a needed safety net was present for them. The
agency continued to assist people in making these living situations affordable. This was evidenced by pursuit of
subsidies available based on people’s income such as food stamps, Section 8 Housing Vouchers, and heating
assistance.



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The agency had maintained an effective system in ensuring essential safeguards were in place across settings and
over time. Systems that had received increased focus since the last review included; increased nursing
availability and timely response to maintenance issues. The following are highlights of the agency’s successful
components if its systems:
 •   The agency also had an effective system to orient new staff as well as to monitor all staff training. A data
     base was maintained regarding training dates to ensure staff were current. Additionally, periodic trainings
     were offered so that staff had some options and flexibility in attending required training. The agency also
     enforced a progressive disciplinary system for those staff that did not maintain current status for required
     trainings.
 •   The agency’s core administration also acted as an important safeguard. Individuals supported by the
     agency were known to all members of the organization. This made it possible for any person within the
     agency’s support network, including staff to access information, assistance and direction from any
     member of the organizational team.
 •   Another important safeguard was present for the review of individual’s financial expenditures. Program
     Directors reviewed each person’s financial transactions on a monthly basis and would then bring a
     person’s information to the business office for further review.

While its overall system for affirming and protecting individuals’ rights was largely effective, the Human Rights
Committee (HRC) is one aspect that could benefit from further strengthening. As the agency moves forward an
increased focus on ensuring the HRC fulfills all expectations as well as increasing the information that is
contained in money management assessments will even further enhance its safeguard systems.

The agency is congratulated on maintaining a Two-Year License and Certification with Distinction. The
agency’s continued commitment to individuals served has been a key factor in its consistency in delivering
quality supports. REACH Inc. has succeeded in creating an organization that is committed to meet the changing
needs of the people that it serves. This sense of commitment has provided a strong framework for which to build
the future maintenance and enrichment of supports.




                                           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
      Outcome:                The organization has systems in place to safeguard people.         Achieved




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               REACH, Inc. - Provider Report - 12/4/08




              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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                                              REACH, Inc. - Provider Report - 12/4/08

                                                  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.       11       0         0        3     0    0     -       -      -    100%    --      N/A
     People are supported to identify them-
1.1B selves as adults.                            11       0         0        3     0    0     -       -      -    100%    --      N/A
     People are supported to take pride in
1.1C themselves and their surroundings            11       0         0        3     0    0     -       -      -    100%    --      N/A
     People live and work in settings that are
1.1D typical of other members of the              11       0         0        3     0    0     -       -      -    100%    --      N/A
     community.
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.                11       0         0        3     0    0     -       -      -    100%     --     N/A
     People’s rights are exercised in their
1.2B everyday lives.                              11       0         0        3     0    0     -       -      -    100%     --     N/A
     People receive the same treatment as
1.2C other employees.                             NA       0     11           3     0    0     -       -      -    100%     --     N/A
     People receive comparable wages and
1.2D benefits as other employees.                 NA       0     11           3     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
1.3A and are based upon people’s unique           11       0         0        3     0    0     -       -      -    100%     --     N/A
     needs.
     All interventions are included in a
1.3B written plan.                                 6       1         4        0     0    3     -       -      -    86%    14%      N/A
     People or their guardians knowingly
1.3C give consent and have the opportunity         7       0         4        0     0    3     -       -      -    100%     --     N/A
     to refuse or withdraw approval.
     Safeguards ensure a thorough review
1.3D and approval process when needed.             6        -        5        0     0    3     -       -      -    100%     --     N/A
     All interventions are safely, accurately,
1.3E and consistently implemented.                 6        -        5        0     0    3     -       -      -    100%     --     N/A




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                                            REACH, Inc. - Provider Report - 12/4/08

                                                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, secure,
5.1A and in good repair.                                  9       0         2    3     0    0         -         -       -   100%   --    N/A

     People and their supporters know what to do in
5.1B an emergency.                                       11       0         0    3     0    0         -         -       -   100%   --    N/A

     People can safely evacuate from their home and
5.1C workplace in an emergency.                          11       0         0    3     0    0         -         -       -   100%   --    N/A

     There are adequate supports for people to be
5.1D safe in their home and work.                        11       0         0    3     0    0         -         -       -   100%   --    N/A

5.1E People use materials and equipment safely.           0       0       11     2     0    1         -         -       -   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 decisions
5.2A that put them at risk.                               1       0       10     0     0    3         -         -       -   100%   --    N/A

     Immediate actions are taken to ensure people’s
5.2B safety.                                              1       0       10     0     0    3         -         -       -   100%   --    N/A

     Actions are taken to correct the situation when
5.2C people have been mistreated.                         0       0       11     0     0    3         -         -       -    NA    NA    N/A

     Steps are taken to prevent the situation from
5.2D occurring again.                                     0       0       11     0     0    3         -         -       -    NA    NA    N/A
     People know how or have support to report a
5.2E situation where they feel they are being mis-       11       0         0    3     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

5.3A People are supported to have a healthy lifestyle.   11       0         0    3     0    0         -         -       -   100%   --    N/A
     People are supported to be active participants in
5.3B their health care.                                  11       0         0    0    0-    3         -         -       -   100%   --    N/A

     People have needed routine and specialized
5.3C health care services.                               10       0         1    0     0    3         -         -       -   100%   --    N/A

     Supporters are knowledgeable about people’s
5.3D health care needs.                                  11       0         0    3     0    0         -         -       -   100%   --    N/A

     People’s medications are given properly and as
5.3E prescribed by the practitioner.                      4       1         6    0     0    3         -         -       -   80%    20%   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               11       0         0    0     0    3     -         -       -       100%   --    N/A
     resources.
     People’s funds are managed properly and with
5.4B their consent.                                       9       0         2    0     0    3     -         -       -       100%   --    N/A

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                                          REACH, Inc. - Provider Report - 12/4/08




                                       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.
                                                  Achieved                                                            Finding
        The organization has strategies that proactively ensure that essential safeguards are in place across
 7.1A   settings and over time.                                                                                        Yes

 7.1B   The organization has systems in place to affirm and protect the rights and dignity of individuals.             Yes
 7.1C   The organization has procedures that minimize unnecessary risk to individuals.                                 Yes
                                                                                            % Indicators Present       100%




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