Northern Community Resources
(907) 225-6355
FAX 225-6354
INTEGRATED
QUALITY ASSURANCE REVIEW
Access
Site Review
Team
Tamela Ranicke, Community Member
Laurel Pfanmiller-Azegami,
Community Member
Ronnie Reynolds, Peer Reviewer
Carl Evertsbusch, Facilitator
INTRODUCTION
A review of the Developmental Disabilities (DD) services provided
by Access Alaska Southcentral Region (AASR) was conducted from May 22 to
This report is the summation of the impressions of a community
team after interviewing consumers, staff members, community members, Access
board members and staff of other agencies.
It also includes a limited administrative review. It does not represent or reflect a
comprehensive review of this agency. The
community team has collaborated on this report and the findings represent their
consensus.
Description of Services
AASR has provided services to this area since 1982. An agency
staff of ten provides support to people throughout south central
These services are funded at a level of $214,000 and include
independent living services, care coordination, information and referral,
advocacy and mediation, transportation, support groups and independent living
skills training.
An 8-member board governs the agencies, 6 of which either
experience a disability or have a family member that is an Access consumer.
This report will focus primarily on services offered to the 23
consumers who are served by AASR.
Description of Process
A team of four conducted the consumer-centered site review. The team members included two community
members, a peer reviewer, and one facilitator.
Over the course of the three-day review the team conducted 17 interviews
with 2 Board members, 2 representatives of related agencies, 8 DD consumers or
their parents (3 of whom are served through Fairbanks), and 5 staff members.
Seven participants attended an Open Forum.
The interviews lasted from 15 minutes to one hour and were
conducted in person or by telephone, in private homes, at Access or at other
community settings.
Open Forum
An Open Forum was made available to the community on the first
evening of the review starting at 7:30 P.M. and was held at Hope Community
Resources. The agency notified people through a mailed invitation. Seven
members of the community and two members of the review team attended the Open
Forum.
Many comments were given to the review team. The most significant comments are the
following:
“The people working for the agency are very nice and helpful.”
“They really do care about us.”
“Access could use more staff to be able to serve more people.”
“What exactly does Access Alaska do?” and, more
specifically, “What can Access do for me or my family?”
FINDINGS
Progress Since Last Review
In the last site review, the team identified areas that needed
attention from the organization and made the following recommendations:
1. “Increase the level of staff to match the
level of services the agency provides.”
Comments were made to the review team by consumers that they wished
Access could hire more staff so more people could benefit from their services.
Standard not met.
2. “Provide a higher level of care coordination
training up to and including certification.”
Three Access staff have attended the Care Coordination training and
have earned certification. Standard met.
3. Use printed and electronic (Web page)
resources to improve individuals’ knowledge of funding and service options.
The Access Website has not been updated for some time. Standard not met.
4. Open board meetings to the public and staff
and advertise them.
The meetings are now open to the public and the staff. Notices of Board meetings are run in the
Anchorage and Fairbanks newspapers.
Standard met.
5. Develop a policy to do
criminal checks on new hires.
This is only being done
for personnel with fiscal responsibilities.
Standard not met.
Areas
of Excellence
1. Consumers nearly universally report how much they like Access
staff and how much they appreciate the extent to which they work to assist them
in their lives. There is little doubt
that the staff very much care for and
respect the people they support.
This demonstrates the passion they have for the work they do.
2.
Seventy five percent of the Board of Directors of Access Alaska is people with
disabilities or their family members.
3. The value of consumer-directed services is also demonstrated in
Access’ strong commitment to employing
people with disabilities.
4. Access Alaska’s willingness to accept the responsibility required
to support consumer-directed personal
care places this agency in an excellent position to lead the way for
consumer-directed Medicaid services.
The
Five Life Areas
Choice and Self Determination
Access Alaska strongly supports consumers’ self-determination as
evidenced from interviews with consumers and their families, as well as
interviews with employees from related agencies, staff members and board
members.
The team identified the following strengths in Choice and Self
Determination for those receiving DD services:
+“I picked where I live and I
like it there.”
+“I spill it out and they follow
through.”
+“They understand the rural
community, why we choose to live here.
They respect that, and are willing to work with us even though it is
sometimes hard to find workers.”
+”They let us choose our own
respite providers.”
+ “They helped me find work when
I was ready.”
+” When changes need to be made
I feel comfortable about telling them about changes.”
+ “I can sit down with (staff)
and tell them what I want.”
+ Access will be in the lead of person-directed services when they
implement their training packet for consumer-directed personal care.
The team identified these weaknesses in the area of Choice and
Self-Determination for those receiving DD services:
+“I’m not sure who can take
advantage of Access’ supports and services.”
+ “I kept waiting for Access to
build me a ramp, so I finally did it myself.
It’s got a hole in it now.”
+ “They gave me a Johnny-Jump-Up
and said they would bring me some special toys, but I haven’t heard from them
for a while.”
+ There are instances where documented goals are different from
those the consumer identified.
Dignity, Respect and Rights
The team identified the following strengths in Dignity, Respect
and Rights for those receiving DD services:
+ “They have helped me with my
lawyer and my divorce.”
+ “ I always feel at home at the
office.”
+ “What would I do if I had
a complaint? I don’t know, I’ve never
had one.”
+ “Access Alaska has been a
great place for me.”
+ “Access has been so helpful.”
+ “(A staff member) listens to
me and treats me with respect.”
+ The team observed staff interactions with people with
disabilities as extremely positive.
+ Access staff and Board take seriously the opinions of consumers.
+ Access has created opportunities for people with disabilities to
work or volunteer at Access.
The team identified the following weaknesses in the area of
Dignity, Respect and Rights for those receiving DD services:
-
“I’m not sure what my rights are.”
-
“When I
disagree with staff, they get mad at me.”
Health, Safety and Security
The team identified the following strengths in Health, Safety and
Security for those receiving DD services:
+ “ I felt a lot more
independent after they helped me get reliable transportation.”
+ “I didn’t feel safe where I lived and they
helped me when I found a new place.”
+ “Access is a safe place for
me.”
+ Access understands well, and does a nice job with, physical
supports.
The team identified these weaknesses in the area of Health, Safety
and Security for those receiving DD services:
-
“I haven’t felt safe or comfortable (in my
residence) for 12 years.”
-
“There wasn’t
any killings (in my neighborhood), but (there were) gunshots and drugs.”
Relationships
The team identified the following strengths in Relationships for
those receiving DD services:
+”Someone helped me attend a
singles group.”
+ Access staff have a talent for matching peer supports.
The team identified the following weaknesses in the area of
Relationships for those receiving DD services:
-
“The biggest nightmare in my life is
relationships, because I have none.”
-
“They don’t
understand how lonely it is in this body.”
-
Some consumers report they are lonely and would like to meet more
people.
Community Participation
The team identified the following strengths under Community
Participation for those receiving DD services:
+ “My case worker sure doesn’t
give up easily. “
+ Access is committed to assisting people to live and work in the
community.
+ Access supports consumer advocacy in public forums.
+ Access staff view people with disabilities as being valuable
members of the community.
+ The fluidity and flexibility of Access staff support enhance
people’s participation.
The team identified these weaknesses in the area of Community
Participation for those receiving DD services:
-
“I want to learn how to be a friend.”
-
One consumer reports that the only activity she has is to “sit at the computer all day until my arms
swell up.”
Staff
Interviews
A total of 5 staff members from AASR were interviewed regarding
their roles in providing services to people with developmental
disabilities. Staff unanimously report
that they work from a very consumer driven perspective. “The
consumers run the agency.”
Staff have high regard for the people
they support and are willing to do whatever it takes to support their
independence. They stress the importance
of determining what is most important to the consumer. They strongly believe in the ethic that all
people belong. There is a feeling among
consumers that Access staff “will not give up” for even the most
challenging support needs.
Staff also share that they “love
what they are doing.”, and, “wouldn’t
change anything.” Staff also feel
very good about the work they do, and they are very appreciative of the support
they receive from each other.
Staff would like to receive more training, especially in the area
of developmental disabilities. The
majority of the staff has been in their present positions for such a short time
that they haven’t received annual work evaluations. For those that have been evaluated, they
report the bulk of their training occurred when they were first hired.
The recent management transition has created concerns for some
staff members. One reports a real
concern for the “future of the agency”. These concerns and conditions should be
alleviated if the conditions for hire of the new Associate Director are met.
Staff also share that the current office is not a healthy
workplace, and they are looking forward to moving on June, 2001 to the new
office location.
Interviews
with Staff of Related Agencies
The responses from the two related agency staff that were
interviewed were very positive. Related agency staff report they are satisfied
with their collaboration and cooperation with Access. They report that there is good follow-up to
their referrals. The interviews
reflected good communication between agencies.
“We have worked well together
through a very challenging package of support.”
“Access really cares about the
clients wants and needs.”
“Access helps other agencies
advocate on behalf on individuals.”
“Consumers seem to be satisfied
with the care they receive from Access.”
Administrative
and Personnel Review
Of the 34 Administrative and Personnel
Standards, 17 are not fully met.
Standard #2 While it is clearly the case that Access Alaska staff
supports consumer driven services, it is not so clear how Access orients its
staff to its mission and values.
Standard #5 Interviews of Board members revealed some conflicts
regarding the perceived responsibilities of the Board regarding the
establishment of policies.
Standard #6 While noted above that Access is exemplary in
recruiting consumers for its Board of Directors, the team recommends that the Board
actively recruit and support a person with a developmental disability.
Standard #12 The team recognizes that Access makes an effort to
solicit consumer input. It is not clear
how this information is included in policy setting and program delivery.
Standards #13and #14 While Access takes consumer feedback very
seriously and actively seeks input, there is no formal process for including
this information into the organization’s annual planning.
Standard #19 Based on staff interviews and record reviews there
appears to be a need for training to meet all necessary legal, ethical, and regulatory
requirements
Standard #22 There is no documentation of consumers participating
in the hiring and evaluating of direct service providers.
Standard #24 Access Alaska does not currently conduct background
checks for people who have direct contact with consumers.
Standard #25 There is no documentation as to exactly what training
each employee receives upon hiring.
Standard #26 There doesn’t appear to be a policy or practices that
foster the development of non-paid natural supports.
Standard #27 Files do not contain documentation of informed
consent from consumers or guardians before services are initiated.
Standards #28, #29, #30, #31, #32 Staff performance appraisal and
work improvement planning for staff are inconsistent and incomplete.
File
Review Summary
The team reviewed files of those interviewed and reported that
several of the plans had been completed within the last few weeks. This caused some concern as to how timely the
staff have been in developing individual plans.
The plans typically do not address the Five Life Areas, but focus
on the specifics of what the consumer has requested. Some of the plans are Core service plans,
which don’t typically require measurable goals and objectives. However, if Access were going to plan with
individuals regarding their goals for independence, it would be helpful if the
plans contained goals that could be monitored over the year. There also are no goals related to Independent
Living Skills training, which appears to have been a primary component of the
DD grant.
The team believes that some of the consumers would benefit greatly
from skills training. One person
requested parenting skills training, but there was no documentation identifying
who would provide it or when.
The contact logs contain very cryptic entries and were typically
unrelated to an individual plan. There
was one set of notes that described a current living situation that is far from
independence with no record of what will be done to support that.
It appears that the contact notes are used primarily for recording
interactions and not for monitoring progress of individual plans. It is important that Access determines how
they are to document the planning and service monitoring within the near future
and develops a systematic way for tracking individual goals.
Program
Management
AASR has recently hired a new Associate Director. Since September 2000, the day-to-day
operations were overseen by the Direct Service Supervisor with occasional
visits by the statewide Director. The
new Associate Director was hired on a two-year plan to reorganize the agency
and recruit and mentor a person with a disability to become the Associate
Director. The new Associate Director will focus on organizational mission and
efficiency.
In light of several comments shared with review team members, this
is an excellent opportunity for Access Alaska to clarify exactly what its goals
are for people with developmental disabilities.
Given the strength of Access Alaska’s mission to support
independent living for people with disabilities, this review team encourages
the organization to develop proficiency in supporting independent living for
people with developmental disabilities.
The team sees this as an essential component in the developmental
disabilities service system and would like to see Access Alaska become a viable
option for many individuals and families.
Areas
Requiring Response
1. Formalize the
orientation to your agency’s mission, philosophy and values. (Standard #2)
2. Orient Board
members to Board responsibilities regarding the establishment of policies.
(Standard #5)
3. Actively
recruit to the Board and provide the necessary support to a person with a
developmental disability. (Standard #6)
4. Establish a
policy that identifies how consumer input is included in policy setting and
program delivery. (Standard #12)
5. Develop a
systematic way to include consumer feedback into annual agency planning and
delivery of services. (Standard #13)
6. Develop a
systematic way of developing annual goals and objectives based on consumer,
community and self-evaluation activities. (Standard #14)
7.
Assure that all staff receive training to meet all necessary legal,
ethical, and regulatory requirements. (Standard #19)
8. Develop a
practice and document consumer participation in the hiring and evaluating of
direct service providers. (Standard #22)
9. Assure that
background checks are conducted for people who provide direct service to
consumers. (Standard #24) (Prior and
current reviews)
10. There is no
documentation as to exactly what training each employee receives upon hiring.
(Standard #25)
11. Establish a
policy for facilitating the development of non-paid natural supports. (Standard
#26)
12. Document
receipt of informed consent from consumers or guardians before services are
initiated. (Standard #27)
13. Establish an
evaluation system that allows for feedback to the employee and for employee
feedback. (Standard #28)
14. Establish an
evaluation system that includes an annual staff development plan for each staff
member. (Standard #29)
15. Establish an
evaluation system that identifies available resources to meet the training
needs of staff. (Standard #30)
16. Establish an
evaluation system that adheres to reasonably established timelines. (Standard #31)
17. Establish an
evaluation system that includes goals and objectives for each period of
appraisal. (Standard #32)
18. Provide Board
sensitivity and awareness training in developmental disabilities.
19. Reconsider
specialization of staff responsibilities to minimize the risk of categorizing
services.
20. Update and
organize individual files.
21. Update contact
information to more accurately determine active caseload.
22. Update the
Policy and Procedure Manual.
23. Institute
practices that assure all consumers understand their rights.
24. Develop
practices that assure that consumers’ fears and people’s abilities to
experience more everyday social possibilities are identified and addressed in
the planning process.
25. Develop a
documentation system that more accurately records individual outcomes.
26. Clarify for
consumers and potential consumers what services Access offers and where they
may turn to receive other services.
(Prior and current reviews)
27. Consider
whether staffing is adequate for the range of services offered. (Prior review)
Other Recommendations
1. Access Alaska fills an important niche in the service delivery
system and is well positioned to lead the provider community towards greater
autonomy for people with disabilities.
The review team recognizes that the appointment of a new director, the
relocation to a new office, a grant submission and a site review all in the
space of a few weeks can disrupt even the most efficient operations.
2. Upon completion of the move, it is recommended the agency partake
in some morale building activities as a means to restoring its corporate
health. Following that, a process such as a PATH, would help the organization
to clearly determine what it wants to do and how it wants to do it and then do
what is required to be in the position to deliver it to people with
developmental disabilities. Once
established, this information should receive widespread distribution to all
interested parties.
3. The team further recommends that within the next ninety days
Access Alaska provide DMHDD Regional staff a detailed plan describing what
services will be provided to people with developmental disabilities, what
training staff will receive to provide those services and what mechanisms will
be developed to identify and monitor each individual’s desired outcomes.
Closing Note
The final draft of this report will be sent to Northern Community
Resources for review. You will receive the final report within approximately
thirty days, including a Plan of Action form, listing the Areas Requiring
Response. You will then have an
additional thirty days to complete the Plan of Action. The directions on how to proceed from there
will be included in a cover letter you will receive with the final report and
Plan of Action form.
Once NCR has reviewed the completed Plan of Action, it will be
sent to the DMHDD Quality Assurance Section.
The QA Section will then contact you to develop collaboratively a plan
for change.
Attachments: Administrative and Personnel Checklist, Interview
Form for Staff of Related Agencies (tallied), Score sheet (tallied)
NCR 8/00