QR2000 Environmental

1. Are all common areas inside and outside the setting available to the individual(s)?

(Individuals should have freedom of movement and access throughout all common areas of their home. Any limitations to an area of the home should be documented as a restriction/modification in the selected review individual's Implementation Strategy. Record detailed observations. If a modification is adequately documented in the individual's Implementation Strategy, this is answered 'Yes'.)

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2. Does the site offer privacy in the bedroom/private living area?

(If the individual has a private bedroom, this is answered 'Yes'. Applies to selected review individual(s) only - record detailed observations. If a modification is adequately documented in the individual's Implementation Strategy, this is answered 'Yes'.)

IDHS: HCBS Settings Rule: Right to Privacy

IDHS: HCBS Settings Rule: Right to Choose a Roommate in Waiver-Funded Settings

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3. Can the bedroom/private living area be locked?

(Individuals have the right to lock the door of their bedroom unless there is a documented health or safety concern. Applies to selected review individual(s) only - record detailed observations. If a modification is adequately documented in the individual's Implementation strategy, this is answered 'Yes') (Adults ONLY - for individuals under 18 years old, this is answered 'N/A'.)

IDHS: Lockable Doors and Privacy in Provider Owned or Controlled Settings

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4. Does the selected individual have a key/code to the exterior/entrance door of their home?

(Individuals have the right to lock the door of their home unless there is a documented health or safety concern. Applies to selected review individual(s) only - record detailed observations. If a modification is adequately documented in the individual's Implementation Strategy, this is answered 'Yes'.) (Adults ONLY - for individuals under 18 years old, this is answered 'N/A'.)

IDHS: Lockable Doors and Privacy in Provider Owned or Controlled Settings

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5. Is the individual afforded access to foods of their choosing at any time, including snack and meal items?

(Applies to selected review individual(s) only - record detailed observations. If a restriction/modification is adequately documented in their Implementation Strategy, this is answered 'Yes'.)

IDHS: HCBS Settings Rule: Access to Food at Any Time in Waiver-Funded Settings

IDHS: Dietary Supports & Mealtime Practices

• Cabinet or refrigerator doors must not be locked, requiring individuals to ask for staff assistance to access food/snacks, unless there is an assessed and documented need for a restriction/modification outlined in their Implementation Strategy.
• Providers must work with individuals in the home to develop meal ideas and meal times that are based on the wants/needs of the individuals in the home.
• Individuals may be redirected if wanting to eat food purchased by another individual or food that was specifically for a collective meal. In this case they should be offered other available food options.
• Any restrictions/modifications regarding access to food must be supported by a specific, individually assessed need, and identified and justified in the individual's Implementation Strategy.

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6. Does the individual have access to their clothing and other possessions?

(Applies to selected review individual(s) only - record detailed observations. If a restriction/modification is adequately documented in their Implementation Strategy, this is answered 'Yes'.)

• Individuals have the right to get, keep, and use personal property unless it is decided that certain items are harmful to them or others.
• Restrictions/modifications on an individual's access to personal property must be based on a documented, specific assessed need, and must be identified and justified as a restriction/modification in their Implementation Strategy.

Rights of Individuals IL462-1201.pdf

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7. Is the individual able to have visitors of their choosing at any time?

(Applies to selected review individual(s) only - record detailed observations. If a restriction/modification is adequately documented in their Implementation Strategy, this is answered 'Yes'.) 

• Providers may not establish 'visiting hours', nor a policy requiring advance notification of intended visits. 
• Residents of a home may choose to collectively establish rules for the home pertaining to visitors to maintain harmony, however, rules must be mutually agreed upon by all residents. 
• It is allowable for a visitor to stay overnight for short-term visits. Consideration MAY be given for age-appropriateness for overnight romantic visits - limited to individuals 18 years old and older, etc.

IDHS: HCBS Settings Rule: Right to Have Visitors of Their Choosing at Any Time in Waiver-Funded Settings

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8. Does the individual have access to their personal funds?

(Applies to the selected review individual(s) only - record detailed observations. If a restriction/modification is adequately documented in their Implementation Strategy, this is answered 'Yes')

• ANY restriction to how an individual accesses their personal funds/assets is considered a modification and must be adequately addressed in the individual's Implementation Strategy.
• Absent a modification based on an individually assessed need and adequately documented in the individual's Implementation Strategy, individuals should not have to ask staff for access to their money.

IDHS: HCBS Settings Rule: Right to Control Personal Resources

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9. Does it appear that the individual has the freedom to furnish and decorate their bedroom/private living area to their personal preference?

(Applies to the selected review individual(s) only - record detailed observations. If a restriction/modification is adequately documented in their Implementation Strategy, this is answered 'Yes')

IDHS: HCBS Settings Rule: Right to Furnish and Decorate Their Sleeping and Living Units

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10. If there are observation cameras in the setting, are the observation cameras identified as a restriction/modification in the selected review individual's Implementation Strategy?

(If there are NO observation cameras in the setting, mark 'N/A'. Applies to the selected review individual(s) only - record detailed observations. If a restriction/modification is adequately documented in their Implementation Strategy, this is answered 'Yes'.)

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11. If there are alarms on the doors or windows for the purpose of restricting an individual's movement, are the door/window alarms identified as a restriction/modification in the selected review individual's Implementation Strategy?

(If there are NO door/window alarms in the setting, mark 'N/A'. Applies to the selected review individual(s) only - record detailed observations. If a restriction/modification is adequately documented in their Implementation Strategy, this is answered 'Yes'.)

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12. Are sufficient smoke detectors present?

(There must be one smoke detector on every level of the dwelling as well as one within 15 feet of every room used for sleeping purposes.)

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13. Is there a properly inspected and charged fire extinguisher(s)?

(A minimum of one extinguisher is required per residence with an annual inspection tag.)

Date of fire extinguisher inspection: _______________________

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14. Are sufficient carbon monoxide detectors present?

(For dwellings that have ONLY electric appliances/furnace/water heater (no propane or natural gas), this is answered 'N/A'.)

• As of January 1, 2007, homeowners, landlords, and building owners are required to install carbon monoxide (CO) detectors within 15 feet of rooms used for sleeping. The carbon monoxide alarm may be combined with smoke detecting devices, providing the unit emits an alarm that clearly differentiates the hazard.

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15. Are all areas of the building, including exits and emergency areas, physically accessible to the individual(s)? If needed, are modifications/assistive devices present to facilitate accessibility?

IDHS: HCBS Settings Rule: Right to Live and Work in a Site that is Physically Accessible

(Applies to the selected review individual(s) only - record detailed observations. If a restriction/modification is adequately documented in the individual's Implementation Strategy, this is answered 'Yes')

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16. Does the site appear to be a clean and safe environment?

• Are the stairs (including basement and exterior stairs) and halls free of obstacles and appear to be in good repair?
• Do all interior and exterior areas appear to be in good repair?
• Is the building clean, free of foul odors, and free from observable mold?
• Is the building free from evidence of roaches, rodents, flies, fleas, bedbugs, or other vermin?

(All must be answered in the affirmative to mark 'yes'. Record detailed observations for any findings.)

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17. Does the individual have access to a house phone?

(Applies to the selected review individual(s) only - record detailed observations. If a restriction/modification is adequately documented in their Implementation Strategy, this is answered 'Yes')

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18. Is a copy of the selected review individual's current Implementation Strategy available to staff at the setting?

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19. CILA Only - Are there no more than 8 individuals residing in the home? (for CLF and CRW, mark 'N/A')

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20. CILA and CLF Only - Are there no more than 2 individuals per bedroom? (for CRW, mark 'N/A')

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21. CILA and CLF Only - Do traffic patterns avoid going through individuals' bedrooms? (for CRW, mark 'N/A')

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22. CILA and CLF Only - Does the individual's bedroom have (at a minimum) a mattress, box spring/platform frame, and storage space for clothing and other belongings? (for CRW, mark 'N/A')

(Applies to selected review individual(s) only - record detailed observations. If a restriction/modification is adequately documented in their Implementation Strategy, this is answered 'Yes'.)

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23. Is the water at a safe temperature (between 100'-110'F for CILA and CLF/100'-115'F for CRW)?

Tub/Shower temperature is: _______________ °F

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24. Is there at least one working bathroom for every 4 individuals in the home (CILA and CRW) or 8 individuals in the home (CLF only)?

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25. Is the bathroom located and equipped to facilitate independence of use and privacy during personal care activities?

(Applies to selected review individual(s) only - Date of fire extinguisher inspection: _______________________. If a restriction/modification is adequately documented in their Implementation Strategy, this is answered 'Yes'.)

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26. Is there a supplied and unexpired first aid kit available in the home?

Make a First Aid Kit | Supplies & Contents | American Red Cross

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27. Are the Abuse/Neglect (OIG or DCFS as applicable) reporting number, Poison Control, agency on-call staff, and emergency numbers posted in an accessible area?

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28. CILA ONLY - Are food items closed, labeled, properly stored, and within their expiration/use-by dates?

(All must be answered in the affirmative to be 'yes'.)

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29. Does the meal preparation/serving area appear to be clean and sanitary?

(Record detailed observations for any findings.)

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30. Does the individual follow a prescribed special diet? (Diabetic diet, Cardiac diet, Pureed/Mechanical Soft/Nectar-thick liquids, etc.)

(Applies to selected review individual(s) only - record detailed notes regarding prescribed diet and observation of appropriate foods and preparation equipment available.)

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31. If applicable, are all prescribed assistive technology and/or adaptive equipment/devices clean, in good repair, and available to the individuals at appropriate times?

(Applies to selected review individual(s) only - record detailed observations.)

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32. Do staff appear to demonstrate competency in the proper use of the assistive technology and/or adaptive equipment techniques and devices (if applicable)?

(Applies to selected review individual(s) only - record detailed observations.)

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33. Did staff talk to and treat the individuals, co-workers, and others with dignity and respect?

IDHS: HCBS Settings Rule: Right to Dignity and Respect

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34. Did staff appear to perform duties in such a way as to support the individual's right to choose and support the individual's personal choices?

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35. Did staff demonstrate competency in person-specific training needed to support the individual(s) served?

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36. Were staff knowledgeable of individuals' goals and the programs or interventions to assist in progression towards those goals?

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37. Does the site appear to be safe and appropriate to the needs of the individual(s) living in the home?

(All items must be present to answer yes. Record detailed observations for any findings)

• Does the site appear to afford safety and basic comfort for the individual(s) living in the home?
• Are there appropriate safety devices present (smoke detector, carbon monoxide detector, access to a phone, first aid kit, door locks, etc.)?

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____ Yes

____ No

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