Northern Community Resources
(907) 225-6355
FAX 225-6354
Shawna Baldwin (Community Member)
Juanita Richard (Community Member)
Margaret Lowe (DD Peer Reviewer)
John Havrilek (DD Facilitator)
A review of the Developmental Disabilities (DD) services
provided by Hope Community Resources-Network Seven (Kodiak) was conducted from
This report is the summation of the impressions of a community team after interviewing consumers, staff members, community members, community resource team members and staff of other related 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.
Hope-Kodiak (HCR) has provided services to this area since 1992. The agency serves 63 individuals who experience developmental disabilities in Kodiak, Afognak Island villages, the Alaska Peninsula, the Aleutian Islands to Adak and the Pribilof Islands. The agency operates with a budget of about $750,000 and approximately 16.5 part time and full time staff.
The agency has a 10-member community resource team (CRT);
most of them have a family member who is a Hope consumer. Hope management
describes the CRT as an advisory body and asserts that the governing board,
specifically for the purposes of the Administrative and Personnel Standards, is
the Board of Directors of Hope based in
HCR provides a broad array of services: Assisted Living, Supported Living, Respite, In-Home Supports, Subsistence, Supported Employment, Day Habilitation, and Foster Care. Most of the 63 consumers use DD Respite Services.
This report will focus exclusively on services offered to the sixty-three consumers served by Hope Community Resources, Network Seven (Kodiak).
Description of
Process
A team of four conducted the consumer-centered site review. The team members included two community members, a peer reviewer, and a facilitator. Over the course of the three-day review the team conducted 25 interviews with 3 CRT members, 5 representatives of related agencies, 13 DD consumers or their parents or guardians, and 4 staff members.
The interviews lasted from 15 minutes to one hour and were conducted by telephone or in person, in private homes, at Hope or at other community agencies.
An Open Forum was made available to the community on the
first evening of the review starting at
The agency also made available the local phone number for the facilitator in the event community members preferred a telephone interview. No one took advantage of this option.
Progress Since Last
Review
The last Integrated
Quality Assurance Review of HCR was conducted in May 1999. This section summarizes the findings of that
review and indicates the progress that the agency has made in meetings those
Areas Requiring Response.
1.“Strengthen collaborative ties with related agencies.” (Standard #17)
These relationships still need to be
strengthened. Standard not met.
2.“Strengthen
and develop on-going monthly staff training.” (Standards #19 and #30)
Staff and parents of consumers report this is
still an area of need. Standards not met.
3.“Conduct training with CRT members to increase involvement from CRT members and
consumers.”
The CRT members interviewed report that
this remains an area of need. Standard not met.
4.“Develop a pool of respite providers to allow families and consumers more choices of
providers.”
The agency has made efforts to provide consumers with a pool of respite providers and had an
open house. Short profiles of respite providers were developed. Hope management reports a
list of those providers is posted on the Hope office bulletin board. The agency further reports
that consumers did not attend the open house and showed little interest in the respite provider
pool. Despite the agency’s efforts, consumers and staff report this remains an
area of need.
The agency should continue and extend this effort. Standard partially met.
5.”When developing individual plans with families, educate families on their options regarding
respite and encourage families to have a
stronger voice about where respite is delivered.”
Consumer families report they don’t know
their options or the array of services Hope offers.
Standard not met.
6.”Distribute information regarding HCR
services to consumers and the community.”
Families
and
agencies again report that they do not know what Hope’s services are. No advertisements,
brochures, or etc., were evident in the community. Standard not met.
7.”Determine if there is a need for a support group that meets regularly and offers support and
training (possibly through a collaborative effort with ILP and Providence Mental Health).” A staff
member reported HCR tried both an afternoon and an evening support group but only one
parent participated. This was not mentioned as a need in our interviews this week. Standard
met.
8.”Expand pre-vocational and vocational job
options.” This remains an area of need.
Standard
not
met.
9.”Through HCR and/or collaboration with other agencies, offer summer and yearly activity
options to increase activities for consumers.” HCR has recently completed a survey focusing on
this need and this appears to be the sole purpose of the CRT according to interviews with 3 of
the CRT members. Standard met. (Note: Hope management states that it will provide “a
summer recreation program for all individuals in Kodiak who experience a disability, not just the
individuals Hope serves.”)
10.”Provide community education regarding the lives and opportunities of people with
disabilities.” This was not mentioned as a
concern in any of the interviews.
Standard met.
The team noted the following strengths in the area of Choice and Self Determination for those receiving DD services from HCR:
+ “I speak to Patrick all the time and he helps me.”
+ “I started off with Kathy Sergeant nine years ago and
have been lucky to have gotten help ever since.”
+ “Hope has done a lot of research and leg work for me.
They provide what I need.”
+ “Nicola is great.
Without her I’m afraid I wouldn’t get services.”
+ “We really like the voucher for respite.”
The team noted the following weaknesses in the area of Choice and Self Determination for those receiving DD services from HCR:
- Most families report not knowing what their options or choices are.
- Consumers state they are able to choose what they want but the agency doesn’t honor their choices.
- “I don’t know what programs are available through Hope except respite.”
- Parents have to provide, recruit and train providers.
- A family in a rural area reported only seeing a care coordinator once or twice a year.
- “Services get put in my child’s plan and then they stop and I don’t know why.”
- “We get services but don’t know where they come from.”
- Case coordination from ILP to school is needed. Children are put on the wait list for long periods of time and with no services.
- “Hope does not advertise their services.”
- “I still don’t know how to access Hope’s services.”
- One parent found their child was taken off the wait list after six years, designated as fully served and no longer eligible for services.
- “(A staff member) is not relaying individual needs to
the CRT or for grants.”
- “They don’t
make the changes I request.”
- “(I currently
get services through) the fourth care coordinator in four years.”
The team identified
the following strengths in the area of Dignity, Respect and Rights for those
receiving DD services from HCR:
+ “Generally we
are treated okay.”
+ “(It) feels
like I am treated with respect.”
+ “ Nicola is
great.”
+ “ Patrick is
nice to me.”
+ “ Vic is my case coordinator and responds right away.”
+ “Nicola tracked down my kid’s waiver. You can depend on her.”
+ “Gretchen is a dynamo.”
+ “Velma is
doing a great job for us.”
(Note: Hope offers subsistence activities including fishing, hunting, trapping, and berry picking, etc. as a means of dignifying Native culture according to Hope’s management.)
The team identified the following weaknesses in the area of Dignity,
Respect and Rights for those receiving DD services from HCR:
- Two team members
visited the View Crest Home and apartments.
They report that conditions in certain areas of these residences are
sub-standard to the degree that they deny the dignity owed the residents there
and impinge on the residents’ right to a clean and safe environment. (The agency states that the CRT is culpable
for not approving repairs requested by management and denies that conditions
are sub-standard.)
- “(A former
worker) caused a lot of problems in late payments for respite, missed grant
deadlines and would order the wrong equipment for my child and yell at me.”
- “Hope doesn’t
respect my privacy. They just want to
know about my money.”
- “There doesn’t
seem to be a regular care coordinator. I don’t know who to talk with.”
- “(Our provider)
is nice but has no skills.”
- “Hope has thrown a lot of obstacles in our way. (We were told) we got services in spite of Hope.”
- “You have to make a lot of noise before Hope will
give you services.”
- “Parents have to find and train their own respite
workers and then Hope tries to get those workers to work with other consumers
once they’re trained.”
- “My child’s plan of service is a blank.”
-“Care-coordinators are not seeing families twice a
month as required. We are not signing off on waivers or getting copies of
them.”
-Parents don’t feel they have a forum/grievance procedure to go to for problems.
-“(A staff member) closes his door when I come in rather
than help.”
The team identified the following strengths in the area of Health, Safety and Security for those receiving DD services from HCR:
+ “Nicole is helping me bring my child to Anchorage for
medical attention.”
+ A consumer reports feeling safe.
The team identified the following weaknesses in the area of health, Safety and Security for those receiving DD services from HCR:
-Two team members visited the View Crest Home and apartments. They report that conditions at these residences are sub-standard to the degree that they represent a threat to the health and safety of the residents. (Hope management states that the CRT is culpable for not approving repairs as requested by management and denies that conditions are sub-standard.)
-A team member is concerned about the extreme weight gain of a consumer.
-A consumer in a rural area says he had medical needs and asked for help in getting to Anchorage. The staff member never got back to him.
-Some consumers say they are charged twenty-eight dollars for gas every month. This charge is for transportation to appointments and the store. However, they report being told repeatedly that the van is not in use due to a lack of gas or because it is in need of repair.
-A guardian reported that they told a consumer not to pick up broken glass. The Hope worker contradicted the guardian, telling the consumer to pick up the glass from a broken window. The consumer suffered cuts.
-Families report that HCR does not provide for health needs, which are left to the consumer and their family.
-“One of the problems is they don’t do any staff
training.”
-“I don’t know what the requirements are for Medicaid and
neither does the staff.”
-“Local people are hired with no background or training.”
(Note: Hope management states that a review of waivers and waiver training has recently been provided for the care coordinator and the director. Further, twelve staff trainings have been provided in the last four months.)
The team identified the following strengths in the area of Relationships for those receiving DD services from HCR:
+ “Hope got me a respite provider to take me to dinner
and spend time with me.”
+ “Hope is good at notifying me when I need to sign
papers.”
The team identified the following weaknesses in the area of Relationships for those receiving DD services from HCR:
-HCR is ineffective in encouraging ties with families and friends.
-“I want to visit family and friends in Anchorage but
(the staff member) won’t get back to me.”
-Few consumer report activity with friends and family. Adult consumers seem especially isolated.
-Consumers report difficulty getting to the store for groceries.
-There is evidence of neither socialization training nor job coaches.
(Note: Hope management states that they have made efforts at family reunification in the past few months.)
The team identified the following strength in the area of Community Participation for those receiving DD services from HCR:
+ “Nicole came out to our village and helped me get a
grant and apply for SSI, so I can do things.”
The team identified the following weaknesses in the area of Community Participation for those receiving DD services from HCR:
-Hope is not seen as an advocate for getting consumers involved in the community.
- “I had to find
a job on my own. Hope didn’t help me.”
-“My funding has
been cut so I can’t participate in activities.
The gym at school costs five dollars.”
- “Hope does not
follow through on anything I want to do.”
- “I would like
to get a job but need help and can’t get it.”
- “There is no
help at all to get into community activities.”
- One person would
like to do community activities but needs 1:1 and was told that is not
available.
- “I would like
to go to the store but there is no money for gas.”
(Note: Hope management states that in recent months they have increased community inclusion efforts.)
A total of 4 staff
members were interviewed from the DD program. The staff interviewed had been
employed by the agency from 8 months to 8 years.
The staff feel that
services are very consumer-driven and consumer-responsive. Most staff feel that
they need training to do their job and that training is hard to get. Hope management states, on the other hand,
that twelve trainings have been provided to staff within the last four months.
All staff feel that
the orientation to the agency and its mission is very good.
Five staff from five related agencies were interviewed: DFYS, ILP, Thresholds, DVR, and a community employer. Their responses varied from one saying “I have no contact with the Hope staff as an employer” to one agency reporting that there were problems in the past but that things are working well now.
The following are quotes from interviews with related agency staff:
+ “Problems in the past but not since Nicola has been on
staff.”
+ “ Nicola is real responsive and follows through. It’s a nice change.”
+ “ It depends who I work with at Hope: get the right
person, I get results.”
+“Nicola does come to meetings.”
- “(A staff member) was not very responsive when I tried
to work with Hope.”
- “ (The care coordinator) was useless.”
- “ We (agencies) need to know what Hope’s policies and
procedures are. We would like to do mutual trainings and a lot more
communication.”
- “There are no collaborative efforts from Hope
management.”
-“Hope doesn’t appear to tap into community resources.”
(Note: Hope management states that recent visits have been made to other community agencies “seeking input about Hope’s services in Kodiak and requesting to partner with them in the future.”)
In lieu of the formal case file review of DD files that is to be piloted later this spring, two team members looked at fifteen consumer files. They found the files to be reasonably suitable. The contents are organized and most essential materials are in the notebooks. However, there are blank pages, extraneous contents and loose material (invoices, notes, etc.) in the notebooks. Case notes seem to be very brief or missing and are not very informative.
Some files were missing client and/or agency representative signatures. At least one file did not indicate the child’s diagnosis. Another file states than an adult is his own guardian, but evidences the mother’s signature on the paper work.
(Note: Hope management states that they have provided
records review and training in proper documentation techniques in recent months.)
Administrative and
Personnel Narrative
The Administrative
and Personnel Standards Checklist is attached to this report. This is a summary of how the findings listed
above affect the outcome of the checklist. Ten of the thirty-four
standards are not fully met.
Standards 7 and 9
regarding governing boards are not met locally, but are met by the parent
organization’s board in Anchorage.
Standard 11 (accessibility) is not met in all residences although all
consumers currently in residence are accommodated. Standards 13 and 14 (use of consumer opinion
in planning and evaluating services and in setting annual goals and objectives)
are not met locally.
The dissatisfaction
with Hope’s collaboration with other agencies to date is evidenced in Standard
17. The training issues with staff are
reflected in Standards 19 and 30 and the dissatisfaction with relationships and
community participation influence the response to Standard 26.
The file concerns
affect the response of the agency’s compliance with Standard 27 regarding consumer or family approval of plans and
changes.
Many of these areas
were also problematic in the previous review and are listed under the “Progress
Since Last Review” section of this report.
The majority of families,
related agency staff, open forum participants, and CRT members interviewed had
major differences, frustration and conflict with the present Hope
administration. This was noted as a problem in the previous review two years
ago and has now worsened.
The people
interviewed are more upset due to a lack of communication, confrontational
communication, feeling ignored or frustrated because they don’t know to whom to
talk. High turnover and inadequate
knowledge of options and programs contribute to these difficulties. Also, some of the consumers interviewed state
that they have been “yelled at” by staff.
During the initial
agency overview, a representative of Hope Community Resources, Anchorage, the
parent organization, was present. This
representative stated that he had been traveling to Kodiak over the past three
to four months to address some of the concerns that had been brought to Hope’s
attention. He said he has been meeting with consumers, the CRT, and contacting
related agencies to try to improve services in this area.
Areas Requiring Response
1. Use the CRT or a local advisory board as an
entity to ensure program quality. (Standard #7; prior and current reviews)
2. Involve the CRT or a local advisory board in the hiring process of the new director. (Standard #9; prior and current reviews) (Hope management states that the CRT has, indeed, been invited to meet with the applicant for this position.)
3. Improve accessibility of the agency’s residential units. (Standard #11)
4. Use the CRT, a local advisory board and/or consumer/community surveys to involve people in agency planning. (Standard #13; prior and current reviews)
5. Use the CRT, a local advisory board and/or community survey to set agency goals and objectives. (Standard #14; prior and current reviews)
6. Strengthen collaborative ties with related
agencies. (Standard #17; prior and
current reviews)
7. Strengthen and develop on-going monthly staff training. (Standard #19; prior and current reviews)
8. Enhance the development of non-paid relationships and the quality of community participation for consumers. (Standard #26)
9. Assure that
files are signed by the legal representative (consumer, parent or guardian) before providing services. (Standard #27)
10. Develop staff
training plans in conjunction with regular staff evaluations. (Standard #30)
11. Conduct
training with CRT members to increase the involvement from CRT members and
consumers. (Prior and current reviews)
12. Develop a pool of respite providers to allow families and consumers more choices of providers. (Prior and current reviews)
13. When developing individual plans with
families, educate families on their options regarding respite and encourage
families to have a stronger voice about where respite is delivered. (Prior and current reviews)
14. Distribute information regarding
services to consumers and the community.
(Prior and current reviews)
15. Expand pre-vocational and
vocational job options. (Prior and current reviews)
We would like to thank the HCR staff for their hard work in setting up the review process, the interviews, making space for us and answering all our questions. We also appreciate the overview given of each consumer we were interviewing. That was an excellent touch, thank you.
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