November
16-18, 1999
Valdez,
Alaska
*SITE REVIEW TEAM:
Bobbie
Moustafa, Community Member
John
Havrilek, Facilitator
Nancy
Mathis, Lead DMHDD QA Staff Member
The Site Review Team reviewed DMHDD funded
Developmental Disabilities Supported Services provided by Connecting Ties of
Valdez, Alaska, November 16-18, 1999, using the Integrated Quality Assurance
Review process.
This report is the summation of the impressions of
a community team after interviewing consumers, staff members, community 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.
Connecting Ties is a nonprofit organization
providing support for 19 adults who experience developmental disabilities. It also serves 11 older Alaskans with
disabilities, 1 TEFRA child and has 12 potential consumers on their waiting
list for service. The agency offers vocational services to 9 consumers and day
habilitation services to 9 consumers; chore services to 2 consumers; respite
services for 1 consumer; residential 24-hour care to 1 consumer; waiver
programs for 8 consumers. Connecting
Ties' 5-member board is composed of
community volunteers: community members, guardians, parents and a consumer. The
board sets policy and supervises the executive director. The organization
employs 8 full-time and 3 part-time employees, has a budget of
approximately $300,000.00 and serves
Valdez, Copper Center, and Glenallen.
The agency offers vocational and day habilitation
options in custodial work at the Royal Center, telephone company and Arts
Design; delivery of lunches from Landing Lights and the food bank; SERVES;
delivery of newspapers; work at the Westmark Laundry, ceramic studio and Second
Time Around, and the greenhouse. Day habilitation options occur at the ceramic
studio, Second Time Around and throughout the community based on the consumers'
needs and requests outlined in their habilitation plan.
The agency is also involved and/or collaborates
with the Hospital Task Force, a DVR contractor, in developing housing for older
Alaskans, starting Parents Plus (part of Parents, Inc.), providing an
Alzheimer’s group, participating in the school-to-work program, working with
DSS, the day program, animal shelter, food bank, crisis line and Special
Olympics.
The site review team met for three days at the
Connecting Ties office in Valdez. The
team consisted of one community member and a facilitator. * Gena Kaiser, ARCA,
from the Horizon's review team assisted on file reviews and Wini Crosby,
Frontier Community Services, Soldotna,
met via teleconference to help with the draft report. The second
community member had a family emergency and was unable to participate and the
peer reviewer was unable to participate on site because of flight weather
conditions.
Team members conducted interviews with 8
guardians/consumers, 5 board members, 3 employees, 4 direct service providers
and 4 employers. Of the 8
consumer/guardian interviews, 5 were from the random list and 3 from the
alternate list. The agencies
interviewed were DVR, the school district, Horizons and Parents, Inc. Interviews lasted between 20 minutes and one
hour and were conducted by telephone or in person at people’s homes or at
Connecting Ties.
The team’s impressions are: that Eva and the
Connecting Ties staff work hard to provide a variety of individualized
vocational and habilitation services to people within the confines of the
community; that the consumer is the center of an organization in which
employees feel empowered to problem-solve by using creative, innovative
methods; that Connecting Ties’ greatest strengths are in it being a consumer
services driven organization that collaborates very well within the
community. Connecting Ties has
responded to consumer requests for services both by growing and by providing
innovative services. The agency’s weakness
lies in its paperwork, especially in completed and updated consumer files. The
files are nicely organized but missing vital personal, legal and funding
information
OPEN
FORUM
Connecting Ties planned and advertised an Open
Forum on November 16,1999 at Valdez Library. A notice ran in the local
television scanner and radio. No one attended the Open Forum.
Progress
Since Previous Review:
1. Previous
Recommendation: Continue the arrangements for an internal fiscal audit.
Action Taken:
An internal audit was
completed by Altman Rogers & Co. for the fiscal year 1996-97. The Preliminary Draft is being reviewed by
the board. The board will make any
necessary changes, and the final draft will be finished by the end of the
month.
2.
Previous Recommendation: The Board needs to
establish an evaluation for the Executive Director.
Action
Taken: An evaluation was established and completed by the board for the
executive director.
3.
Previous Recommendation: The agency should have
policies and procedures for handling conflict of interest.
Action Taken: Policies
and procedures for handling conflicts of interest were developed and
implemented in the new-hire paperwork and were made available to all on-going
employees. The policies and procedures
were gone over at a staff meeting in June.
A copy was added to the Policy and Procedure Notebooks which are kept at
all work stations.
4.
Previous Recommendation: The offices of Connecting
Ties are not accessible.
Action Taken: The office
of CTI moved to an accessible location in the Royal Center which is also the
location of the Day Habilitation Center and next door to one of the Vocational
Work Sites.
5.
Previous Recommendation: Develop a process for
periodically assessing your programs and
services.
Action Taken: Connecting
Ties had a Quality of Service Survey for client and guardians combined, but
new, improved separate versions were developed. The surveys are being mailed to
consumers and families, as had been done in the past, for feedback on current
and future needs as well as suggestions in all areas of service.
6.
Previous Recommendation: Begin including background
checks in your hiring screening process.
Action Taken: Fingerprint
cards have been completed by all employees.
Background checks were begun July fifteenth of last year. They are gradually being completed, a couple
at a time, depending on available funds.
7.
Previous Recommendation: Develop ways that
consumers and guardians can be included in hiring and evaluating staff.
Action Taken: Consumer
and guardian participation forms are completed for interview and
evaluation of staff.
8.
Previous Recommendation: Assure that all staff are
knowledgeable of consumer mistreatment laws, policies, and reporting
procedures.
Action Taken:
Mistreatment laws, policies, and reporting procedures were completed and all
staff had read and signed off that they had done so when they were employed at
Connecting Ties. The Policies were not
in our Policies and Procedure Notebook at the time of our site review. They were written in 1995 and have since
been updated and inserted into the Policy and Procedure Notebook and the
orientation packet.
9.
Previous Recommendation: Develop a way to identify
staff training needs and ways to meet them.
Action Taken: Training
needs are determined during annual employment review.
Policies regarding
request for continuing education have been developed and included in policies
and procedures.
10. Previous
Recommendation: Assure that all people who are working really want to work.
Action Taken: A Client
Satisfaction survey is in the process of being developed. Once it is finalized, will be distributed to
clients/families for their options, wants and needs. If there are any concerns, they are to be followed up by phone
and then in person if necessary.
11. Previous
Recommendation: Continue to seek integrated work situations where consumers
could be with non-paid people.
Action Taken: The agency
is developing a "Friends" program to increase non-paid people in work
situations. It has written newsletters
and advertised by various means with little response. The agency intends to contact "Crossroads" in Fairbanks
and review their program for additional ideas.
12. Previous
Recommendation: Assure that plans contain clear, measurable goals and
strategies.
Action
Taken: Recommendation implemented.
13. Previous
Recommendation: Work with employers to assure they become the primary problem
solvers.
Action Taken: Staff works
in consultant roles rather than serving as the primary problem solver for
workplace situations.
The team identified the following strengths under
Choice and Self-Determination for people receiving DD services from CONNECTING
TIES:
+ “Staff are
quick to assist consumers in a very gentle manner to meet their goals. Their
emphasis is always to pursue the consumer’s choice”.
+ “----- was very
emphatic about staying in Valdez after Harborview closed and the agency
supported his choice to keep living in Valdez, which is wonderful.”
The site review team did not find any weaknesses in this area.
The team identified the following strengths under
Dignity, Respect and Rights for people receiving DD services from Connecting
Ties.
+ “”Care-givers
here act as caring, concerned, gentle family.”
+ “Our last
care conference really supported this area for us, especially the way they
treated_____ like an adult and not a child.”
+ “Eva does a
great job, some care providers didn’t.”
+ Consumers feel they have options without being
pushed to accept particular ones.
+ Staff considers consumers’ dreams to be realizable.
The site review results did not find material
weaknesses in the area of Dignity, Respect and Rights.
The team identified the following strengths under
Health, Safety and Security for people receiving DD services from Connecting
Ties.
+ “Connecting Ties is very open to families suggestions”
+ “They go
out of their way to make sure clients are looked after, they play close
attention to safety, showing a lot of consideration for one another.”
+ “____ has some real challenges in her behavior that can put her in dangerous situations, she presents some interesting safety problems and the staff keeps her safe and stays on top of things.”
The site review results did not indicate material weaknesses in the area of Health, Safety and Security.
The team identified the following strengths under
Relationships for people receiving DD services from Connecting Ties.
+ “_____ is a very integral part of the
community. When we took him out for pizza they even gave us a discount because
the owners know him and like him.”
+ “Even though my daughter is on the wait list, she is always invited to participate in activities and welcome at the ceramic shop and parties, which will make her eventual transition into the program very comfortable.”
+ Consumers have opportunities to develop
relationships with people in a wide variety of locations and activities.
The site review results did not indicate material weaknesses in the area of Relationships.
The team identified the following strengths under
Community Participation for people receiving DD services from Connecting Ties.
+ “Connecting
Ties has done an extraordinary job in meeting____ vocational needs within the
Valdez community. They stretched and rethought to always help him out in
finding and holding jobs.”
+ “Eva jumps
right in every time a new job or opportunity opens up in town to see how a
consumer will fit in.”
+ ”Everywhere
you go in town you see a client involved.”
+ “ Staff
bounces back and always looks for new things for clients to do if something
else hasn’t worked out.”
+ “ Eva works
hard and has the clients best interest in mind. She’s down to earth and very
realistic about client’s abilities and possibilities.”
-- “
Sometimes you have to give Eva a little shove to get a job for a client because
she gets so busy doing too many things.”
The site review results did not indicate material weaknesses in services provided by Connecting Ties in the area of Community Participation.
Staff
Interviews
Staff is very supportive of the agency. There is an
open-door policy and they not only feel they can talk about any problems, but
also that they are heard and that actions to correct things will be taken. They
feel that they are part of a team.
The staff is encouraged to take on-going training
on a regular basis and feel very supported by the director. They have recently
gotten a raise and benefits. However, staff evaluations are not connected to
pay raises. Staff evaluations are not completed on time and plans are not
included.
The four related service agency staff interviews
characterized Connecting Ties’ services as being flexible, innovative and
focused on positive outcomes for consumers.
Connecting Ties staff are willing to work with individuals who are hard
to serve or who have complicated histories.
The communication and supervision required between agencies under these
circumstances highlight the willingness of Connecting Ties staff to go the
extra distance to provide individuals with choices.
“Eva has really done well. I see changes and she provides a service, without her the DD population in Valdez would have nothing to do.”
Connecting Ties meets the majority of
Administrative and Personnel Standards. The following standards are rated at a
partial level and need to be addressed by the agency:
1. Connecting Ties’ administrator reported that the
year’s audit is not yet complete because of staff changeover with the
accounting firm. This agency, because of its small amount of grant funding,
isn’t legally bound to have an audit annually, but it is good business practice
especially in light of its total budget.
Standard #3
2. The governing body of the agency oversees the
selection and evaluation of the director, but this is not occurring in a timely
manner and needs to be regular and timely.
Standard #9
3. The program is not obtaining informed consent
from consumers or guardians/family.
They have the forms but are not using them. Also, the agency needs a release of information form. Standard #27
4. A staff
development plan needs to written with each staff member along with their
annual evaluation and placed in their file.
Standard #29
Files were arranged in an organized manner and
contained relevant information. Eight
files were reviewed and one was excellent.
Seven had deficits: 1) lack of signatures on the plans of care, 2) dates
of assessments that did not match with cost sheets (new assessments need to
match with cost sheets), 3) no or minimal progress notes (some progress notes
were only one word like "good"), 4) no client picture, 5) no
emergency numbers, 6) no updates on budgets (old budgets did not match plan of
care), 7) level of determination not on file, 8) no exchange of information
forms, 9) no Estimated Annual Medical Expense Form, 10) no change of status
form, 11) no combined residential habilitation-supported living-vocational form
stating costs and expenses, 12) no copy of guardianship papers.
Areas
Requiring Response
1.
The governing body should oversee the regular
annual evaluation of the director.
Standard #9
2.
The program must obtain and document informed
consent from consumers before initiating services and when services are changed
or modified. Standard #27
3.
A staff
development plan must be written annually for each professional employee and
include an opportunity for employee feedback to the agency. Standard #29
4.
Standardize consumer files to include all necessary
information.
Other
Recommendations
1.
Complete the annual audit.
2.
Complete background checks on remaining direct care
providers.
3.
Finalize the Client Satisfaction Survey.
4.
Continue development of non-paid relationships with the Friends program
and other initiatives.
5.
One person mentioned that they felt job coaches may
need more training to work with clients.
This was only mentioned once and does not reflect
an agency-wide problem. All other
respondents were pleased with the vocational program.
The site review team would like to thank the staff,
board and consumers who aided in the review.
It is a pleasure and an honor to participate in reviewing an agency
where standards of service are excellent.
The commitment of staff to carrying out the wishes of people who use
Connecting Ties, Inc.'s services was a central theme during interviews, as was
your focus on providing services and your collaboration and involvement in the
entire Valdez community.
The final draft of this report will be prepared
within 7-14 days and sent to DMHDD. The
report should be finalized within 30 additional days. At that time, Connecting Ties, Inc. and DMHDD will collaborate on
a plan to make needed changes.