Only providers of services in provider-owned or controlled residential settings need to complete the remainder of this evaluation. In provider-owned or controlled residential settings, in addition to the above requirements, the following requirements must also be met: Federal Requirement #6: The unit or dwelling is a specific physical place that can be owned, rented or occupied under a legally enforceable agreement by the individual receiving services, and the individual has, at a minimum, the same responsibilities and protections from eviction that tenants have under the landlord/tenant law of the State, county, city or other designated entity. For settings in which landlord/tenant laws do not apply, the State must ensure that a lease, residency agreement or other form of written agreement will be in place for each participant and that the document provides protections that address eviction processes and appeals comparable to those provided under the jurisdiction’s landlord tenant law. Guidance: As applicable, does each individual have a lease, residency agreement, admission agreement, or other form of written residency agreement? Are individuals informed about how to relocate and request new housing? Does the service and/or program meet this requirement? Yes No Please explain: Federal Requirement #7: Each individual has privacy in his/her sleeping or living unit: have entrance doors lockable by the individual, with only appropriate staff having keys to doors as needed. Individuals sharing units have a choice of roommates in that setting. Individuals have the freedom to furnish and decorate their sleeping or living units within the lease or other agreement. Guidance: Do individuals have a choice regarding roommates or private accommodations? Do individuals have the option of furnishing and decorating their sleeping or living units with their own personal items, in a manner that is based on their preferences? Do individuals have the ability to lock their bedroom doors when they choose? Does the service and/or program meet this requirement? Yes No Please explain:
Federal Requirement #8: Individuals have the freedom and support to control their own schedules and activities, and have access to food at any time. Guidance: Do individuals have access to food at any time? Does the home allow individuals to set their own daily schedules? Do individuals have full access to typical facilities in a home such as a kitchen, dining area, laundry, and comfortable seating in shared areas? Does the service and/or program meet this requirement? Yes No Please explain: Federal Requirement #9: Individuals are able to have visitors of their choosing at any time. Guidance: Are visitors welcome to visit the home at any time? Can individuals go with visitors outside the home; such as for a meal or shopping, or for a longer visit outside the home, such as for holidays or weekends? Does the service and/or program meet this requirement? Yes No Please explain: Federal Requirement #10: The setting is physically accessible to the individual. Guidance: Do individuals have the freedom to move about inside and outside the home or are they primarily restricted to one room or area? Are grab bars, seats in bathrooms, ramps for wheelchairs, etc., available so that individuals who need those supports can move about the setting as they choose? Are appliances and furniture accessible to every individual (e.g., the washer/dryer are front loading for individuals using wheelchairs)? Does the service and/or program meet this requirement? Yes No Please explain: CONTACT INFORMATION