QR1110 Settings ISC

REVISED 1/18/23

ISC Name:

Primary Program Provider:

Individual Name:

Individual's Address:

Sample #:

W#:

Provider Services: ? CDS ?CILA ? SDA ? AHBS ? CSW ? CRW

Date of Review:

Date of Discovery Tool:

Date of DT version used:

Reviewer:

Date of Personal Plan:

Date of PP version used:

For all HCBS Settings requirements, review both the Discovery Tool and Personal Plan to ensure that the required information related to each Settings requirement listed is present in either the DT or PP. For FY24, this ISC-Settings validation tool will be completed on at least 1 out of every ten (10) ISC Waiver Sample participant record reviews.

For each Settings item, if it is addressed in the Discovery Tool and/or Personal Plan, answer 'Yes'. If there is no mention of the required Settings item anywhere in the Discovery Tool or Personal Plan, answer 'No'. If the required Settings item is present but a more thorough exploration of the Settings item is needed in the Discovery Tool/Personal Plan, comments and suggestions for improvement will be provided to the ISC for informational/training purposes.

Settings Item/Expectation: What does this mean? Yes No N/A Remediation required by:

1. Does the individual have opportunities to seek employment and work in competitive integrated settings, if they so choose? (1a) (Adults only)

Comments:

 People have the right to be supported to access competitive integrated employment. The state/ISC are responsible for this especially through the person-centered planning process. Providers also can share any expressed interest in employment and make referrals to DRS. - - - -

2. Does the DT/PP reflect that the individual has the opportunity to engage in community life? (1b)

Comments:

 People have the right to engage in life in the community generally. Providers need to support people to engage in community life in the ways they choose. This means responding to and recording choices and expressed interests and supporting those requests as much as they can. - - - -

3. Does the DT/PP reflect that the individual has the opportunity to control their personal resources? (1c)

Comments:

 People have the right to control their personal resources as much as they choose. This can include having their own bank account, access to their funds at any time, having a bank card, and choice of rep payee. Providers need to support people to have as much independence as possible in controlling, directing, and accessing their resources. - - - -

4. Does the DT/PP reflect that the individual has the choice to receive services in the community to the same degree of access as individuals not receiving Medicaid HCBS? (1d)

Comments:

 People have the right to go out into the community to access services such as healthcare, groceries, and other general services in an integrated manner as much as they choose. Providers need to support people to have choice about utilizing integrated services and participating in community services with other people not receiving waiver services. - - - -

5. Does the DT/PP reflect that the Setting is selected by the participant from among setting options including non-disability specific settings and including an option for a private unit in a residential setting? (2a)

Comments:

 People have the right to choose a variety of services in different settings including in non-disability specific settings. The state is responsible for offering this opportunity to people receiving waiver services. ISCs should use the person centered planning process to identify interest in changes in services and support people to identify new services. Providers should share with the ISCs if people express the desire for different services. - - - -

6. Does the DT/PP reflect that the individual's Setting options offered were based on the individual's needs and preferences? (2b)

Comments:

 People have the right to have choice in the types of services and who providers them. The state is responsible to ensuring service capacity across the state. ISCs should use the person centered planning process to identify interest in changes in services and support people to identify new services. Providers should share with the ISCs if people express the desire for different services. - - - -

7. Does the DT/PP explore what 'privacy' means to the individual and identify any issues related to ensuring the individual's right to privacy? (3a)

Comments:

 People have the right to have privacy in their homes, day programs and bedrooms. For Providers, this could include understanding and supporting what people want related to privacy and what is important to them and working to address privacy issues. If a person wants their own room, this should be documented, and steps taken to address it. ISC should also explore what privacy might mean for a person through the person centered planning process. - - - -

8. Does the totality of the DT/PP evidence the assurance of the individual's right to dignity and respect? (3b)

Comments:

 People have the right to dignity and respect in how they are treated in their homes and at their services including verbally and by staff action. Providers should train staff on this concept, share the rights document to people receiving services and guardians and have policies in place that support this. - - - -

9. Does the DT/PP reflect that the individual's Setting optimizes individual initiative, autonomy, and independence in making life choices (including daily activities and daily schedules)? (4a/6a)

Comments:

People have the right to choose their daily activities and direct their schedules. This should be an individualized approach that is not fixed and can change over time. They have the right to be as independent as they want.

People have the right to control their own schedule and the right to be supported to make decisions. Individuals should be supported in expressing choice, and Providers should work to support the person in that choice or interest.

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10. Does the DT/PP reflect that the individual's Setting optimizes the individual's independence in making life choices regarding their physical environment, access to all areas of their home, and access to food? (4b/6b)

Comments:

People have the right to have access to all areas of their homes. CDS, as a commercial site, can limit access to some areas, but should still consider making as much of the site accessible to people as possible.

People have the right to access food at any time in their kitchens or at CDS programs. The kitchen is never "closed", and people can choose to eat their meals when they would like. At CDS programs, they can access food they bring when they want.

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11. Does the DT/PP reflect that the individual has the opportunity to exercise choice related to with whom they wish to interact, and to have visitors of their choosing? (4c/7)

Comments:

People have the right to choose with whom to interact in their homes and other service sites whether friends, housemates, or staff. Providers should support and encourage people to identify opportunities for building friendships, community, and natural supports.

People have the right to have visitors at any time. Even with COVID protocols, people cannot be told that they cannot see people. Providers should work with a person and visitor to assure visitation. If conflict arises between housemates because of visitors, conflict resolutions efforts should be made to establish agreed upon boundaries. If they cannot, referrals to the ISC should be made to identify other service options.

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12. Does the DT/PP reflect that the individual's Setting is physically accessible based on their individual needs? (8)

Comments:

 People have the right to have a home that is physically accessible for them. A provider should help identify any areas of assistive technology needs or modifications needs. If circumstances change, the ISC, state and provider should help the person move to more accessible supports. - - - -

13. (Provider controlled residence only) Does the DT/PP reflect that the individual has privacy in their sleeping/private living unit? (11a)

Comments:

 People have the right to have privacy in their homes and bedrooms. Providers and ISCs must understand what people want related to privacy and what is important to them and work to address privacy issues. If a person wants their own room, this should be documented, and steps taken to address it. - - - -

14. (Provider controlled residence only / Adults only) Does the DT/PP reflect that the individual has a key to their home and can lock their bedroom door, or does it address a necessary modification? (11b)

Comments:

 People have the right to receive locks to their homes and to their bedrooms if they want. Locks and keys should be provided, and people can choose to use or not use them. Where there are guardians, they should be involved in the discussion, and if it is determined a modification due to safety should be made, the ISC should be involved with outlining this in the personal plan. Physical accessibility accommodations should be made where needed. - - - -

15. (Provider controlled residence only)

If the individual shares a bedroom/private living space, does the DT/PP reflect that the individual had the opportunity to choose their roommate in that setting? (11c)

Comments:

 People have the right to choose their roommate/housemates if they have them. If there are any disputes or disagreements regarding a roommate/housemate, is there indication that the ISC is working with the individual and provider to resolve this issue? (As long as any indicated roommate/housemate issues are acknowledged in the DT/PP and being addressed by the ISC, this can be answered 'yes'.) - - - -

16. (Provider controlled residence only)

Does the DT/PP reflect that the individual has the freedom to furnish and decorate their sleeping or private living unit as they desire? (11d)

Comments:

 People have the right to decorate their homes and bedrooms how they like. This goes once again to the fact that this is the person's home, not a facility. - - - -

17. If the individual's DT/PP identifies any Settings modifications, is justification for each modification provided? (9)

(If no modifications are present, answer N/A.)

 Please briefly identify and list all of the Settings modifications present in the individual's DT/PP, and the justifications provided: - - - -