Volume II - Allen, Shea & Associates

220 Pages·2009·4.63 MB·English

Bay Area Quality Management System
Bay Area Quality Management System
Quality Service Review (QSR)
Quality Service Review (QSR)
Interpretive Guidelines, Technical Assistance, and Resources
Volume II
Interpretive Guidelines,
Technical Assistance,
and Resources
January 2009
(Version 3.0)
Golden Gate Regional Center
Regional Center of the East Bay
San Andreas Regional Center
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Bay Area Quality Management System
Quality Service Review (QSR)

Volume II
Bay Area Quality Management System
Quality Service Review (QSR)
Volume II:
Interpretive Guidelines,
Technical Assistance,
and Resources
January 2009
(Version 3.0)
Golden Gate Regional Center
Regional Center of the East Bay
San Andreas Regional Center
Contact Information
Eric Zigman
QMS Director
San Andreas Regional Center
P.O. Box 50002
San Jose CA 95150-0002
[phone]
[email protected]
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Bay Area Quality Management System
Quality Service Review (QSR)
Interpretive Guidelines, Technical Assistance, and Resources
Table of Contents
Page
Introduction ...................................................................................... 5
Glossary of Operational Definitions .................................................. 7
1. Service Planning and Delivery ...................................................... 11
1. Supports the Individualized Program Plan (IPP) process. ............................ 11
2. Develops and implements an Individualized Support Plan (ISP)
that fully addresses the IPP and reflects individual strengths,
needs and preferences. ............................................................................ 14
3. Determines the effectiveness of the ISP .................................................... 16
4. Responds to the changing needs and preferences of individuals. ................. 19
5. Communicates with each individual ........................................................... 21
Resources .................................................................................................... 23
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2. Choice ........................................................................................... 45
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6. Supports individuals to make choices. ........................................................ 45 b
7. Respects and supports each individual’s cultural and l
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religious preferences ................................................................................ 50

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Resources .................................................................................................... 54
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3. Civic and Human Rights ............................................................... 63
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8. Supports individuals in exercising civic and individual rights ........................ 63 n
9. Treats individuals and families with dignity and respect .............................. 69 t
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10. Maintains confidentiality of individual information ....................................... 71
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11. Provides an environment that supports each individual’s t
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rights and preferences ............................................................................. 72
Resources .................................................................................................... 74
4. Independence, Relationships, and Community Participation ...... 81
12. Provides opportunities for individuals to participate in the life
of the community .................................................................................... 81
13. Supports individuals to have relationships ................................................. 85
Resources ...................................................................................................... 88
5. Safeguards .................................................................................... 97
14. Assures necessary individual safeguards are in place .................................. 97
15. Manages and mitigates risk ...................................................................... 99
16. Manages medication safely ...................................................................... 101
17. Responds to household and environmental emergencies ............................. 104
18. Responds to adverse events by assuring individual well-being .................... 106
19. Provides a home in a safe location and comparable to other
homes in the neighborhood ..................................................................... 108
Resources ...................................................................................................... 110
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Bay Area Quality Management System
Quality Service Review (QSR)

Volume II
Page
6. Health and Wellness ..................................................................... 117
20. Assists individuals to obtain prompt and appropriate routine and
specialized medical services ..................................................................... 117
21. Assists individual to obtain prompt and appropriate oral health care ........... 120
22. Implements individualized Health Care Plan as required in SB 962,
or other health plans as specified in the IPP .............................................. 122
23. Identifies and responds to signs and symptoms of illness or injury,
and medical emergencies ........................................................................ 126
24. Supports individuals to have a healthy lifestyle .......................................... 128
Resources ..................................................................................................... 131
7. Behavioral Health ......................................................................... 139
25. Obtains behavioral consultation when the planning team determines
a behavioral challenge is a barrier to an individual’s life quality ................... 139
26. Supports life quality with a positive behavior plan ...................................... 141
Resources ...................................................................................................... 145
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8. Provider Capacity and Capabilities ............................................... 153
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27. Meets all applicable certification, licensing and/or regulatory requirements .. 153
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28. Retains qualified consultants .................................................................... 156
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n 29. Recruits and hires qualified staff ............................................................... 158
o 30. Assures staff competence to provide services and supports ........................ 160
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31. Provides staffing needed to ensure personal safety and to meet

f individual needs ...................................................................................... 163
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32. Provides a work environment that results in increased staff

e satisfaction and minimizes turnover .......................................................... 164
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b 33. Supports effective communication ............................................................ 166
a Resources ...................................................................................................... 169
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9. Quality Improvement ................................................................... 179
34. Uses a process for continuous quality improvement ................................... 179
35. Involves individuals and family members in planning that affect the
home or agency ...................................................................................... 182
36. Establishes a process for resolving grievances that is communicated
to the individual, their family members and staff ....................................... 184
37. Supports individuals to achieve satisfying lives ........................................... 188
Resources ...................................................................................................... 191
10. Quality Snapshot Training Module .............................................. 201
11. Service Coordinator Review Training Module ............................. 207
12. Registered Nurse Review Training Module ................................. 213
13. Behavior Plan Review Training Module ...................................... 217
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Bay Area Quality Management System
Quality Service Review (QSR)
Interpretive Guidelines, Technical Assistance, and Resources
The Quality Service Review
The Bay Area Quality Management System (BAQMS) monitors the life quality,
health, and safety of individuals who transition from Agnews Developmental Center
to a community residence. Agencies and organizations providing community
residential services and supports must be certified to do so. The Quality Service
Review (QSR) provides the means for this certification.
The QSR is built to accomplish the following four purposes:
• Ensure responsiveness to what is and is not working for the individual.
• Facilitate a team approach for supporting positive individual outcomes and
provider success.
• Establish provider expectations that focus on individual quality-of-life outcomes
and that include and go beyond health and safety compliance.
• Support continuous quality improvement of services and supports.
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Volumes I and II r
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Volume I provides detailed information about the review process. This volume d
(Volume II) provides guidelines for: (1) evaluating expectations and measures; u
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(2) operational definitions of terms used; (3) links to resources that support the
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review and certification process; and (4) training modules for specific tools (e.g., o
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Service Coordinator Review). Its purpose is to make sure that everyone (e.g.,
families, regional centers, service providers) has the same information about QSR
outcomes, expectations, and measures. It also serves as a training and technical
assistance resource guide for those who want to learn about or are involved in using
the QSR process. It is expected that Volume II will grow as QMS Specialists and
Service Providers develop and locate additional resources (e.g., articles, internet
sites, best practices, tools).
Focus Areas
There are nine focus areas in the QSR:
Service Planning and Delivery Safeguards
Choice Health and Wellness
Civic and Human Rights Behavioral Health
Independence, Relationships, Provider Capacity and Capabilities
and Community Participation Quality Improvement
The above focus areas were adapted from the Centers for Medicare and Medicaid
Services (CMS) Quality Framework. 5
Bay Area Quality Management System
Quality Service Review (QSR)

Volume II

Outcomes
Each focus area has an outcome. An outcome is an expectation for what is hoped
will happen for individuals as a result of a service or support. The outcome reflects
all of the expectations and measures in the focus area.
Expectations and Measures
Each focus area has a series of provider expectations. Expectations are
statements of what each Service Provider should be achieving. Measures are
used to determine whether or not expectations have been met. Each measure has
an Interpretive Guideline that provides information about what is meant by the
measure and how a Yes rating is determined. Volume II also includes questions
and observations to guide technical assistance and training on each Provider
Expectation. These questions and observations will help stimulate thought and
improvement activities during the review and certification process.
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Quality Service Rating
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t If one or more Measures in a given Provider Expectation refer to an individual
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u outcome (e.g., Individuals achieve their goals), then the Expectation requires a
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Quality Service Rating in addition to a Yes/No rating. Guidelines for determining the
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r Quality Service Rating of Service Provider Expectation (Partially Met, Met, Exceeded)
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n are provided.
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Resources for Training and Technical Assistance
Each focus area includes resources for the QMS Specialist and Service Provider to
use, as needed, during the review process:
Direct Service Professional (DSP) Curriculum References
The DSP curriculum includes many relevant modules that can provide excellent
resources for understanding the expectations of the QSR. Each subarea in this
workbook contains a reference to the DSP curriculum if appropriate.
Other Resources
At the back of each section of this volume, the workbook contains information
about available resources and, whenever possible, documents that can be
photocopied and used by the provider. Whenever possible, additional resources
are referenced which include helpful web sites, articles, and books.
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Bay Area Quality Management System
Quality Service Review (QSR)
Interpretive Guidelines, Technical Assistance, and Resources
Glossary of Operational Definitions
Choice
A statement of preference. Individuals with developmental disabilities have a right to
make choices including, but not limited to where and with whom to live, the way they
spend their time each day and with whom, what to do for fun, and plans for the future.
Choice Opportunity
Typically, a daily situation that provides an individual with the opportunity to
choose between two or more activities, articles of clothing, foods to eat, and so on.
Meaningful choice is based on options from an individual’s experience. If limited, it’s G
important to support activities that broaden an individual’s experience and expand l
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the horizon of meaningful choices. To support an individual in making meaningful s
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choices, you must provide opportunities for making choices in a way he or she can
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understand. Choice opportunities are typically situations that provide an individual r
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with a choice between two or more items or activities. As with all of us, different

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individuals have different skills for making choices. For example, some individuals
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can make a choice simply by answering a question such as, “What do you want?”
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Those individuals have higher-level choice-making skills; that is, they have significant
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communication and related skills to make a choice in this manner. If an individual e
is not capable of using such skills, you must use different strategies to offer choice r
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opportunities. Other types of choices can affect an individual’s long-term quality of t
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life. These are choices about major lifestyle changes such as where to live and work. o
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Community Participation
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Refers to the involvement of individuals in the community outside of the home where
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they live. The type, frequency, and duration of community participation is based on e
individual preference and choice. Participation is more than just physical presence in fi
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the community. Community participation includes meaningful membership, activities,
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and relationships within an individual’s respective community. t
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Complete and Correct
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Complies with guidelines or directions for completing a form or report.
Cultural Sensitivity
The degree to which an organization modifies or tailors the system of service delivery
to the ethnic, racial, cultural, religious, and national diversity in its service population.
Such tailoring includes personnel selection, training and development; assessment;
service planning and implementation; and program evaluation and consumer care
monitoring. Sometimes referred to as “cultural sensitivity” or “cultural responsiveness.”

Crisis Intervention
The immediate response to the acute needs of a person in crisis including referral to
appropriate community resources, advocacy, support, or direct assistance. 7
Bay Area Quality Management System
Quality Service Review (QSR)

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Family Involvement
Refers to the level of involvement by families with loved ones that meets the
preferences and needs of both the individual and the family. This is different and
unique for each individual and family. Family involvement is supported, as needed, by
the Service Provider and the Regional Center Service Coordinator.
Functional Analysis
A functional analysis is completed prior to implementing a behavior plan. The
components of a functional analysis include: description of behavior; the individual’s
likes and dislikes; environmental and behavioral antecedents; proactive and reactive/
s crisis intervention strategies; positive reinforcers; reinforcement schedule; any
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historical information regarding the behavior; identification of the function of the
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behavior; and, the identification of positive skills/replacement behaviors.
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Health Plans
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e Defined as either the goals and objectives in the Health Domain of the IPP or other
D health care plans as required by statute and regulation (SB 962 Individualized Health
l Care Plan and/or Restricted Health Care Plan).” For example, in SB 962 homes the
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Individual Health Care Plan is defined as “the plan that identifies and documents the
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o health care and intensive support service needs of the consumer.” (California Welfare
i and Institutions Code, 4684 d)
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Individual Program Plan (IPP)
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p An individualized, person-centered plan developed by the individual and his or her
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team which is based on an individual’s strengths, preferences, choice, and needs.

f The IPP is a legal document that defines individualized services and supports
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(California Welfare and Institutions Code, 4646a-g-4646.5a-c). It is a written plan of

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action and should specify the goals and objectives and service strategies which help
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a a person grow and develop. It is reviewed by the individual’s team on an annual basis
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and can be modified throughout the year as preferences and needs change.
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l Individual Service Plan (ISP)
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The ISP is based on the person-centered IPP. It is developed by the service provider
and guides direct support professionals about what it takes to successfully support the
individual. For example, preferred activities, specific health needs, and what and how
to teach skills referenced in the IPP as goals and objectives.
Involvement of Friends
Refers to the level of involvement by friends that meets the preferences and needs
of both the individual and his or her friends. This is different and unique for each
individual and friend. The involvement of friends is supported, as needed, by the
Service Provider and the Regional Center Service Coordinator.
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Bay Area Quality Management System
Quality Service Review (QSR)
Interpretive Guidelines, Technical Assistance, and Resources
Positive Behavioral Supports and Programming
A broad range of systemic and individualized strategies for achieving important social
and learning results while preventing problem behavior.
Preferences
Likes and dislikes. Choices that the individual makes about where and with whom to
live, the living environment (e.g., food, décor, music played) the way they spend their
time each day and with whom, what to do for fun, and plans for the future.

Psychotropic Medication
Refers to drugs that have an effect upon an individual’s mental state including mind,
emotions, and behavior. Categories of medications classified as psychotropic include:
antipsychotic, antidepressant, antimanic, anxiolytic, hypnotic drugs and antiepileptic
when used as a mood stabilizer.
Restricted Health Care Plan
The written plan developed by an individualized health care plan team and approved
by the team physician, or other health care professional designated by the physician
to serve on the team, for the care of restricted health conditions as established in Title
22, Sections 80092.2-80092.8 (e.g., inhalation-assistive devices; colostomy/ileostomy,
insulin-dependent diabetes).

SB 962 Specialized Health Care Plan
A health care plan written for an individual who lives in an SB 962 pilot home.
These homes can provide specialized health care services such as nutritional
support including total parenteral nutrition, gastrostomy feeding and hydration, renal
dialysis, special medication regimes including injections, intravenous medications,
management of insulin dependent diabetes, catheterization, indwelling urinary
catheter management, pain management, and palliative care.

Timely Manner
Typically refers to time lines established in laws and regulations (e.g., reporting
Special Incidents). Also refers to an established best practice of responding to a
request as soon as possible (e.g., close-of-business, twenty-four hours) even if to
request clarification of or delay in response.
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Bay Area Quality Management System
Quality Service Review (QSR)

Volume II
References
Center on Positive Behavioral Interventions and Support (2001).
Council on Accreditation (2006).
Department of Developmental Services (2004). Direct Support Professional
Curriculum, Year 1/Year 2 Teacher and Student Resource Guides.
State of California. Title 22 Licensing Regulations.
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