1. 2005 Community Practice Review Northwest Region DRAFT Findings 2005 Community Practice Review Northwest Region DRAFT Findings Presented: August 15, 2005 NW Review held July 11-15, 2005

2. 2005 Community Practice Review DRAFT Northwest Region Class Members: 29 Number in Sample: 12 (41%) Three Independent Case Management Agencies in Sample Excel 6 in sample Innovative Health at Home 5 in sample Peak 1 in sample 2

3. 2005 Community Practice Review DRAFT Northwest Region Day and Residential Agencies and number in sample Day Residential Day Residential Disability Services, Inc. 1 1 High Desert 1 2 Mosaic 3 3 PMS/Shield 2_ ResCare 2 3 ZEE 2 2 Ramah Care Services 11 3

4. 2005 Community Practice Review DRAFT Northwest Region Individuals Needing Immediate Attention: None Individuals Needing Special Attention: 2 People 17% of sample Individuals for whom health, safety, environment and/or abuse or neglect issues were identified during the review. Issues were identified that may, if not addressed, effect the person’s health safety and welfare. In 2004, three people required Immediate Attention (23%) and four people required Special Attention (30.7%). (13 people in the sample) Class Members with Immediate or Special Needs 4

5. 2005 Community Practice Review DRAFT Northwest Region Identified Indicators of Good Practice  Four people participate in supported employment! People play valued roles in their community  Three people are active swimmers!  Seven people are members of and attend church.  Eleven people are having their cultural preferences accommodated.  Two people are regulars at their local libraries. 5

6. 2005 Community Practice Review DRAFT Northwest Region Identified Indicators of Good Practice People have friends  Six people enjoy the involvement of family or report use of other positive, natural supports People have natural supports  Seven people were identified as having friends and familiar acquaintances.  Seven people (58%) reviewed were seen as adequately integrated into the community. People are a part of and integrated into their communities  Five people are increasing the number of times they are in the community. 6

7. 2005 Community Practice Review DRAFT Northwest Region Identified Indicators of Good Practice People benefit from long term, caring and respectful staff  Six people were identified as having very involved and positive staff.  Eight people have made progress, in part due to very involved and effective therapists, case managers and direct support staff.  Nine people have daily choices/appropriate autonomy over their lives. 7

8. 2005 Community Practice Review DRAFT Northwest Region Identified Indicators of Good Practice People have proactive advocates Case Manager/Guardian  Six Guardians found the Case Manager helpful.  Four people were identified as having actively involved involved guardians. (Seen 3 times a month) 8

9. 2005 Community Practice Review DRAFT Northwest Region Identified Indicators of Good Practice People live with people they enjoy  Five people reported that they like their housemates. People have shown evidence of progress  Six people have increasing abilities and/or better physical health.  Two people are verbalizing/vocalizing more. 9

10. 2005 Community Practice Review DRAFT Northwest Region Identified Indicators of Good Practice People have shown evidence of progress  Eighty-four individually needed devices are available at all times.  Three people have access to and are using devices which are enabling independence and more personal interactions.  One person took a vacation to the Grand Canyon and is making plans to go back! 10

11. 2005 Community Practice Review DRAFT Northwest Region A. Expectations for Growth and Quality of Life Exemplary Practice: 10 individuals had the support needed to participate in the planning process. (2 CND) Providers do not prevent the person from pursuing relationships and are respecting the rights of 100% of those individuals in the sample. Cultural preferences are being accommodated for 11 (92%) individuals in the sample. 9 individuals (75%) have daily choices/appropriate autonomy over his/her life. What We Learned: Other Findings 11

12. 2005 Community Practice Review DRAFT Northwest Region A. Expectations for Growth and Quality of Life Other Findings Practice Challenges: 7 people (58%) had Team members who did not have an appropriate expectation of growth for the person they support. 5 people (42%) were not offered a range of opportunities for participation in each life area. 12

13. 2005 Community Practice Review DRAFT Northwest Region Quality of Life Response % Yes 87. Is the person is offered a range of opportunities for participation in each of the life areas? 7 Yes 4 Partial 1 No 58% 88. Does the person have the opportunity to make informed choices? (8 CND) 2 Yes 2 Partial 50%  89. About where and with whom to live? (9 CND)2 Yes 1 Partial 67%  90. About where and with whom to work/spend his/her day? (9 CND) 3 Yes100%  91. About where and with whom to socialize/spend leisure time? (9 CND) 2 Yes 1 Partial 67% A. Expectations for Growth and Quality of Life 13

14. 2005 Community Practice Review DRAFT Northwest Region B. Satisfaction Other Findings Exemplary Practice: Of individuals for whom a determination could be made, 100% had sufficient personal money; (10) 100% got along with their residential service staff; (10) 100% got along with their day/employment staff. (8) 100% have adequate food and drink. (12) 83% have adequate transportation. (8) Practice Challenges: Guardians of 5 individuals (45%) did not find the case manager helpful. In 3 of those instances there was a recent turnover of case management staff. 14

15. 2005 Community Practice Review DRAFT Northwest Region C. Assessments Other Findings Practice Challenges: 4 people (33%) had assessments that were adequate for planning. Ancillary service assessments (health and therapies) were most frequently missing, inadequate or not signed. 7 people (58%) did not have all needed, relevant assessments. 15

16. 2005 Community Practice Review DRAFT Northwest Region QuestionNumber of People Percentage 57. Did the team consider what assessments the person needs and would be relevant to the team’s planning efforts? 7 Yes 5 Partial 58% 58. Did the team arrange for and obtain the needed, relevant assessments? 5 Yes 7 Partial 42% 59. Are the assessments adequate for planning?4 Yes 8 Partial 33% 60. Were the recommendations from assessments used in planning? 6 Yes 5 Partial 1 No 50% Other Findings C. Assessments 16

17. 2005 Community Practice Review DRAFT Northwest Region D. Adequacy of Planning and Adequacy of Services Other Findings Exemplary Practice: 9 people (75%) had ISP goals which addressed the person’s major needs – up from 15% in 2004. 9 people (75%) have FSA that give adequate guidance to achieving the long term vision. 9 people (75%) had their FSA used as the basis for goal development. 9 people (75%) had ISP’s that contained specific arrangements for primary health (medical) care. 17

18. 2005 Community Practice Review DRAFT Northwest Region D. Adequacy of Planning and Adequacy of Services Other Findings Practice Challenges: 4 people (33%) had an ISP adequate to meet their needs. 5 people (42%) had staff who were not adequately trained on the implementation of this person’s ISP. 4 staff (33%) were not able to describe their daily care/supports responsibilities. 18

19. 2005 Community Practice Review DRAFT Northwest Region E. Individual Service Planning Other Findings Exemplary Practice: 100% of the individuals in the sample had an ISP that contained a functional supports assessment based on a long-term view. Practice Challenges: 7 of 12 individuals have an ISP that addresses living, learning/working and social/leisure that correlates with their desires and capabilities, in accordance with DOH regulations. 19

20. 2005 Community Practice Review DRAFT Northwest Region Question20002001200220042005 Does the person have an ISP that addresses living, learning/working and social/leisure… 82% 75%69%58% Does the ISP contain a functional supports assessment based on a long-term view? 100% 92%54%100% Does the person receive services and supports recommended in the ISP? 55%73%67%38%42% Does the person have adequate access to and use of generic services and natural supports? 45%82%83%23%50% Is the person adequately integrated into the community? 45%82%67%38%58% Other Findings E. Individual Service Planning 20

21. 2005 Community Practice Review DRAFT Northwest Region QuestionResponse% Yes 146. Overall, is the ISP adequate to meet the person’s needs?3 Yes 9 Partial 25% 147. Is the total program of the level of intensity adequate to meet this person’s needs? 1 Yes 11 Partial 8% Other Findings E. Individual Service Planning 21

22. 2005 Community Practice Review DRAFT Northwest Region F. Team Process Other Findings Exemplary Practice: 3 of 12 persons in the sample changed direct care service providers within the past year – and each instance was appropriately planned for by the IDT. Practice Challenges: 8 individual’s IDT had members who were not adequately following up on their responsibilities. 4 people (33%) had teams which exchanged adequate communication between meetings to ensure program implementation. 1 person’s IDT process was found to be fully adequate for assessing, planning, implementing, and monitoring. 22

23. 2005 Community Practice Review DRAFT Northwest Region  “Missing Members” are typically therapists, direct support staff, guardians and nurses. Other Findings 6 People had an appropriately constituted IDT. (50%) For 5 people, their “missing team members” participated in the development of the ISP. (50%) 2 N/A  83% of the day staff knew the person well, 50% had adequate input into the person’s ISP.  83% of the residential staff knew the person well, 58% had adequate input into the person’s ISP. F. Team Process 23

24. 2005 Community Practice Review DRAFT Northwest Region G. Health Related Needs Other Findings Exemplary Practice: An overall increase of 23%: Team members ability to describe person’s health related needs; Team discussing health related issues; Team adequately addressing health related issues. Practice Challenges: 7 people (58%) had Team members who could not describe the person’s health-related needs. 3 individuals (25%) had their health supports/needs adequately addressed. 24

25. 2005 Community Practice Review DRAFT Northwest Region H. Supported Employment Question20002001200220042005 Need an employment assessment? 45%91%17%62%67% Need supported employment?45%27%8%46%75% Receive supported employment assessment? 100% 75%100% Assessment conforms to DOH Regulations? 100% 13%38% Has a Career Development Plan?100% 0%22% Receives employment services?80%33%100%33%33% Other Findings 25

26. 2005 Community Practice Review DRAFT Northwest Region H. Employment and Day Services Other Findings Exemplary Practice: 83% of day/employment staff “know” the individual they serve – up from 62% in 2004. Individuals with long-term staff (average of 3.4 years) were more likely to be engaged in Sup. Employment! Practice Challenges: 58% of day staff could describe the person’s health related needs. 50% of the day staff have an appropriate expectation of growth for the person. 26

27. 2005 Community Practice Review DRAFT Northwest Region H. Employment and Day Services # of Yes/No % of Yes 37. Did the direct service staff receive training on implementing this person’s ISP? 7 Yes 5 Partial 58% 39. Was the direct service staff able to describe his/her responsibilities in providing daily care/supports to the person? 9 Yes 3 Partial 75% 40. Did the direct service staff have training in the ISP process?8 Yes 4 Partial 67% 41. Did the direct service staff have training on the provider’s complaint process and on abuse, neglect and exploitation? 4 Yes 6 Partial 2 No 33% 42. Does the direct service staff have an appropriate expectation of growth for this person? 6 Yes 6 Partial 50% 43. Is the day/employment environment generally clean, free of safety hazards and conducive to the work/activity intended? (1 N/A, 1 CND) 8 Yes 2 Partial 80% Other Findings 27

28. 2005 Community Practice Review DRAFT Northwest Region I. Behavioral Support Services Other Findings Exemplary Practice: For the individuals who were identified to need behavior support services (6 of 12), the supports provided showed marked improvement over 2004. 5 of the individuals who needed behavior support services had adequate behavioral assessments (83%). 4 of those 5 individuals received behavioral support services consistent with his/her needs, and those services are integrated into the ISP. 28

29. 2005 Community Practice Review DRAFT Northwest Region I. Behavioral Support Services Question 20002001200220042005 Does the person need behavioral services? 45% 33%38%50% Have adequate behavioral assessments been completed? 60%80%75%60%83% Does the person have behavior support plan developed out of the behavior assessments that meet the person’s needs? 60%80%75% 83% Have the staff been trained on the behavior support plan? 40%100%75%50%100% Does the person receive behavioral services consistent with his/her needs? 80% 50%60%67% Are behavioral support services integrated into the ISP? 20%40%75%40%67% Other Findings

30. 2005 Community Practice Review DRAFT Northwest Region J. Adaptive Equipment/Augmentative Communication Other Findings Exemplary Practice: 88% of the individuals identified as needing adaptive equipment received the necessary equipment. Practice Challenges: 5 of 8 individuals did not receive all assistive technology they needed. 6 of 11 individuals did not receive all communication assessments and services they needed. 30

31. 2005 Community Practice Review DRAFT Northwest Region J. Adaptive Equipment/Augmentative Communication Question20002001200220042005 Has the person received all adaptive equipment? 60%70%73%45%88% Has the person received all assistive technology needed? 44%60%57%64%38% Has the person received all communication assessments and services needed? 55%36%42%17%45% Other Findings 31

32. 2005 Community Practice Review DRAFT Northwest Region K. Case Management Practice Challenges: 33% (4) of cm’s do not adequately “know” the person. 25% (3) of cm’s were not available to the person. 50% (6) of cm’s do not provide services at needed levels. Exemplary Practice: 92% of cm’s understand his/her role. 100% of cm’s received training on the topics needed to assist the individual. 32 Other Findings

33. 2005 Community Practice Review DRAFT Northwest Region K. Case Management QuestionNumber% Yes 30. Was the cm able to describe the person’s health related needs? 8 Yes 4 Partial 67% 32. Does the cm record contain documentation that the case manager is monitoring and tracking the delivery of services as outlined in the ISP? 4 Yes 8 Partial 33% 33. Does the cm provide cm services at the level needed by this person? 6 Yes 6 Partial 50% 107. Does the legal guardian find the cm helpful? (1 CND) 6 Yes 2 Partial 3 No 55% Other Findings 33

34. 2005 Community Practice Review DRAFT Northwest Region L. Home/Residential Other Findings Exemplary Practice: 92% of residential staff were able to describe his/her care/supports responsibilities. On average, residential staff have been with the individual for 2.5 years – two individuals had turnover within the last year. Practice Challenges: 58% of residential staff have adequate input into the ISP. 33% of residential staff were not able to describe the person’s health related needs. 25% (3) of residential staff do not have appropriate expectation of growth for the person. 34

35. 2005 Community Practice Review DRAFT Northwest Region L. Home/Residential # of Yes/No % of Yes 46. Did the direct service staff receive training on implementing this person’s ISP? 9 Yes 3 Partial 75% 47. Is the residence safe for individuals? (void of hazards?)12 Yes100% 49. Was the direct service staff able to describe his/her responsibilities in providing daily care/supports to the person? 11 Yes 1 Partial 92% 50. Did the direct service staff have training in the ISP process?8 Yes 3 Partial 1 No 67% 51. Did the direct services staff have training on the provider’s complaint process and on abuse, neglect and exploitation? 6 Yes 5 Partial 1 No 50% 52. Does the direct service staff have an appropriate expectation of growth for this person? 9 Yes 3 Partial 75% 53. Does the person’s residential environment offer a minimal level of quality of life? 11 Yes 1 Partial 92% Other Findings

36. 2005 Community Practice Review DRAFT Northwest Region Lyn Rucker Community Monitor rpaltd@aol.com Office: 785-258-2214 Cell: 785-366-6468 Thank you!