Section 2 – Service planning Question # Question Guidance/Additional Information Compliant Yes/No Plan of Correction 2.001 Does the assessment process consider; What is important to the individual What is important for the individual and likely risk Place on the path to employment Desired community employment outcome What is working and not working 5123:2-1-11; 5123:2-2-05 Assessment considers the individual’s skills Important to promotes satisfaction Important for promotes health and welfare Trends of unusual incidents Major unusual incident review Serious chronic medical conditions There are four places on the path to community employment: Place One: has a job; needs support to maintain or move up Place Two: would like a job; needs support to find one Place Three: not sure about employment; needs support to identify career options Place Four: Does not express a desire to work; needs support to make an informed choice 2.002 Using person centered planning, has the plan been developed based on the results of the assessment as it relates to: Ensure health and welfare, Assist the individual to engage in meaningful activities Support community connections Assist in improving self-advocacy skills Ensure achievement of outcomes ISP promotes: Rights Self-determination/Individual Choice Physical well-being Emotional Material Personal development Interpersonal relationships Community inclusion
A list of persons interviewed and documents reviewed A summary of each interview and documents reviewed A Findings and Conclusion section which includes the causes and contributing factors to the incident that support the findings and conclusions 5123:2-17-02 8.020 Is there evidence that no later than five working days following the county boards, developmental centers, or department's recommendation via the incident tracking system that the report be closed, the county board, developmental center, or department shall provide a written summary of the administrative investigation of each category A or category B major unusual incident, including the allegations, the facts and findings, including as applicable, whether the case was substantiated or unsubstantiated, and preventive measures implemented in response to the major unusual incident to the following unless the information in the written summary has already been communicated: The individual, individual's guardian, or other person whom the individual has identified, as applicable; in the case of a peer-to-peer act, both individuals, individuals' guardians, or other persons whom the individuals have identified, as THIS QUESTION WILL ONLY BE ASKED BY DODD MUI STAFF In the case of an individual's death, the written summary shall be provided to the individual's family only upon request by the individual's family. The county board shall provide a copy of its full report of the administrative investigation to the intermediate care facility. The department shall resolve any conflicts that arise.
and health and welfare alerts from the previous year? 5123:2-17-02; 5123:2-3-01; Required for CEO and/or Administrators annually 9.022 Did the provider staff have annual training on the Rights of Individuals with DD? ORC 5123.63; 5123:2-2-01; 5123:2-9-20 Once during each calendar year Not required to be within 365 days Required for CEO and/or Administrators annually 9.023 Beginning in the second year of employment and annually did direct services staff receive training related to person-centered planning, community integration, and self-advocacy? 5123:2-2-01; 5123:2-3-01 Once during each calendar year Not required to be within 365 days 9.024 Did the person providing HPC OR Adult Foster Care waiver services receive annual training in their role in providing behavior supports? 5123:2-9-30; 5123:2-9-33 Once during each calendar year Not required to be within 365 days Could be included as a component of principles of positive intervention culture Required regardless of whether there is a behavior support plan 9.025 Did the Support Broker successfully complete the Support Broker training established by DODD? 5123:2-9-47 SELF Support Broker only 9.026 For day waiver services, did the provider ensure that within the first 90 days of employment, new employees completed either PATHS "Certificate of Initial Proficiency" program OR an 8-hour orientation Also, applies to SELF Integrated Employment
9.034 Are all vehicles used to transport individuals covered by a current insurance policy that meets the requirements of the service provided? 5123:2-9-18; 5123:2-9-24; 5123:2-9-58; 5123:2-9-57 9.035 If the provider is responsible for providing Per Trip non-medical transportation, does the person have a signed form establishing the driver's physical qualification to provide non-medical transportation? 5123:2-9-18 This form must be completed and signed by a person who is licensed, certified, and/or registered in accordance with Ohio law to perform physical examinations 9.036 If the provider is responsible for providing Non-Medical Transportation, did the staff person receive testing for controlled substances and was the staff person found to be drug free prior to providing transportation services? 5123:2-9-18 Per trip and per mile Non-medical transportation Drug testing must be from a lab, cannot be Reviewer must see the results of the testing, not just receipts 9.037 Has the agency obtained and maintained general liability insurance for at least $500,000? Effective 1/1/16 9.038 Are all staff enrolled in RAPBACK within 30 days of the initial and/or the 5-year criminal records check by the bureau of criminal investigation 5123:2-2-01, 5123:2-3-01 Effective October 1, 2016 If an employee is not able to get a BCII via fingerprints they cannot be enrolled in Rapback. The provider agency must continue to complete the 5 year BCII/FBI 9.039 Has the provider agency established an internal compliance program that ensures compliance with (1) provider certification, (2) Please refer providers to “My Learning” on DODD applications page or to; Select “Internal Compliance for Agency Providers”
policy? 5123:2-1-02 DS, PT, OT, ST, RN, Teaching, SW, Counseling, Psychologist (and others) On the new IFSP form section IV and attachment A is eligibility and section V and attachment A is where assessment is recorded. This includes determination of need for services 13.008 Do the county board staff /contractors participating in assessments have the appropriate license/certification per ODH policy? 5123:2-1-02 This includes determination of need for services EIS/DS, PT, OT, ST, RN, Teaching, SW, Counseling, Psychologist (and others) 13.009 Does the county ensure that there are 2 different disciplines for the evaluation and assessment? 5123:2-1-02 This includes redetermination of eligibility and need for services Evaluation and assessment information has been included in the IFSP starting 1.15.15, required use at annual meeting. 13.010 Did the CB staff/contractors participate in the development of the IFSP? 5123:2-1-02 IFSP reflects a team process; including participation of the E and A team and service providers, facilitated and coordinated by the SC. 13.011 Did the County Board assure that the provision of CB specialized services (e.g. Special Instruction, therapies, nursing, transportation) were provided as documented on the IFSP? 5123:2-1-02 Check documentation that services are delivered according to frequency, intensity and duration as stated on Section VI of IFSP. 13.012 Did the county service providers ensure that “Prior Written Notice” is given to parents when services specified in the IFSP are changed? 5123:2-1-02 If changes were made to any EI service on an existing IFSP the provider proposing the change is required to provide the family and SC with PWN. (HEA 8022).
14.004 If audio and/or video equipment is used, did everyone in the home give written informed consent? 5123:2-9-35 Applies to monitoring that involves viewing or listening to activities or conversations in the home SSA has to keep a copy of the consent with the ISP 14.005 Is there a notice prominently displayed in the home informing people that audio/video equipment is in use? 5123:2-9-35 A notice that says and/or video equipment is in use that allows others to view activities and/or listen to conversations must be prominently displayed in the home 14.006 Did the provider train its staff on the use of the remote monitoring system? 5123:2-9-35 Provider is required to provide initial and ongoing training to its staff on the use of the remote monitoring system 14.007 Does the provider have a back-up system in 5123:2-9-35 Provider is required to have a back-up power system (battery or generator) The provider also has to have other back-up systems and additional safeguards in place that include contacting the backup support person in the event the remote monitoring system stops working 14.008 Does the remote monitoring provider have an effective system for notifying emergency personnel? 5123:2-9-35 This includes police, fire, emergency medical services and psychiatric crisis response entities 14.009 Does the ISP address the following: training to be provided to the individual on the remote monitoring system, acceptable timeframe for back up support person to arrive at individual's home? 5123:2-9-35 This is not a citation for the provider, please follow up with the SSA
SECTION 18- WAIVER ADMINISTRATION ACTIVITIES Question # Question Guidance/Additional Information Compliant Yes/No Plan of Correction (If not compliant) 18.001 Was the ODDP revised when significant changes occurred? 5123:2-9-06 County Board Only Examples: changes in living situation, natural supports, behavior, medical or mobility needs, etc. Not all changes require ODDP revision 18.002 Were needs identified in nursing quality assurance reviews addressed? 5123:2-1-11 County Board Only 18.003 Was the individual’s PLOC/LOC reviewed at annually and/or based on changes in the individual’s needs? 5123:2-1-11 Determine through documents, interview and observation Issue citations only to the county board If major changes occur, the LOC should be revised 18.004 Was the “Freedom of Choice” form for this individual reviewed on an annual 5123:2-1-11 Determine through document, interview and observation. Issue citations only to the county board Signed by the individual and the guardian annually 18.005 Were due process rights provided? 5123:2-1-11 Determine through documents, interview and observation. Issue citations only to the county board CB is required to provide the individual and the guardian their due process rights each time a waiver service is approved, denied, reduced or terminated