Provider Quality QR1000P

1. Were the following documents in the agency's records?
Discovery Tool Date:  ___
Personal Plan Date:  ___
EOR Implementation Strategy Date: ___ (for SDAs & participant-directed PSWs)
Implementation Strategy Date: ___ (for agency-based DSPs/PSWs)
(Must have first two and the applicable Implementation Strategy document(s))

Comments:

2. Is the Implementation Strategy developed within 20 days of the date on the provider's signature page of the personal plan?
Provider Signature Page date signed:    

Comments: 

3. Did the person and/or guardian review and sign the Implementation Strategy?
Individual date signed: 
Guardian date signed:  

Comments:

4. Was the Implementation Strategy signed either by pen/ink or via authenticated electronic signature for all signatures? (Rule 120.95)

Informational Finding ONLY for FY25

Comments:

5. Was the Implementation Strategy completed on the correct new form (version 10/2022 or later - IL462-4470) or is the agency on the BQE approved list to utilize their own electronic IS?

(See FY25 QR1000P Guidance for list of approved software/agencies.)

Comments:

6. Is the 'Important Things To Know' section of the Implementation Strategy completed (including supervision needs)?

Comments:

7. Does the Implementation Strategy address ALL critical life areas, including identifying and defining all support needs?

Comments:

8. Does the Implementation Strategy give direction to provider staff on how to support the individual and ensure consistent implementation of his/her desired outcomes?

Comments:

9. Does the Implementation Strategy address all identified risks in the Personal Plan for which the provider is responsible and describe strategies used to mitigate identified risks?

Comments:

10. Does the Implementation Strategy identify any rights restrictions and/or Setting modifications in the Personal Plan that impact the individual receiving services and include justification for the restrictions/modifications?

Comments

11. Does the Implementation Strategy reflect ongoing monitoring and include measurable data kept which verifies the consistent implementation of each of the outcomes so a determination can be made regarding the progress or lack of progress toward the individual's outcomes?

Comments:

12. Are all rights restrictions (including psychotropic medications), Settings modifications, and uses of restraint (if applicable) identified in the individual's record, reviewed, and approved at least every 6 months by the Human Rights Committee (HRC)?

Refer to: Title 59 IAC 115.320 (c) (3)

https://www.ilga.gov/commission/jcar/admincode/059/059001150C03200R.html

https://www.dhs.state.il.us/page.aspx?item=138629#a_toc26

Comments:

13. Does the individual's record contain evidence that he or she was evaluated and assessed for the decision-making capacity to give consent to sexual activity and for developmentally appropriate Sex Education materials and resources?

[MH/DD Code: 405 ILCS 5/4-211. Sex Education for persons admitted to a developmental disability facility and receiving habilitation. Effective 1/1/2020.]

Refer to Sex Education Curriculum (Consent section)

IDHS: Statute - HB3299 (state.il.us)

Comments:

14. (CILA, CDS, and CLF ONLY) Does the individual's record or file contain a signed consent for/declination of participation in sex education?

Comments:

15. Does the record indicate the individual has access to their personal funds (personal needs allowance, earned income, trust assets, etc.)?

Comments:

16. Does the agency have reliable means to account for and communicate the individual's funds and other assets?

Comments:

17. If the record indicates an individual has an assessed need for assistive technology and/or adaptive equipment, does the record also indicate that the individual has received all recommended assistive technology and/or adaptive equipment?

Comments:

18. Does the individual's record indicate that all identified CIRAS-reportable events in the past 12 months were reported to CIRAS? (If there have been no CIRAS-reportable events in the past 12 months, mark 'Yes'.)

Comments:

19. Does the individual's record indicate that all identified incidents of restraint in the past 12 months were reported on a UIR (Unusual Incident Report - for CRW/CSW) or agency-specific Incident Report (Adult Waiver)?

Comments: