DDA Provider Applicant Quality Assurance / Improvement Plan
Template
Provider Applicant Name: ____________________________________
Region Servicing: ________________________________
Quality Assurance Plan: Self-assessment plan to document, evaluate, and monitor performance of the agency. A working agency document used to remediate challenges and deficiencies in order to create systemic improvements. The plan is a system of internal quality assurance which focuses on the individual’s choices, preferences and satisfaction.
Mission Statement: (Please include a statement that defines your agency’s mission. Make sure that it is consistent with DDA’s mission and vision (http://dda.dhmh.maryland.gov) and focus’ on individual choice and preferences. It must also include personal contact with the individuals.
Development Process: (State how the plan was developed. Include input from individuals with intellectual and developmental disabilities and advocates. Focus on choices and preferences. This is an opportunity to cite staff skills and expertise.)
Standing Committee: (Refer to COMAR 10.22.02.14E 1-7) Include membership composition and ratio; chairperson’s name and contact information; and member names and affiliation. Be sure to indicate the frequency of the committee meetings and all of the functions that are required. There is a Standing Committee training curriculum posted on the DDA website http://dda.dhmh.maryland.gov )
Action Plan: Refer to COMAR 10.22.02.14(4-5). Describe how the agency will collect, evaluate data and analyze trends. The plan should track the use and timeframes for behavior plans that employ medications, restrictive procedures or right restrictions, and provide prompt and appropriate response to health/safety risks. Proactive strategies: Include strategies that demonstrate preventative measures to help improve quality of services, including health and safety. Describe objective data sources that will be used.
Goals: Establish goals and standards that measure the quality of services being delivered and define how the standards are measured. Outcomes and results should be measurable, and maybe incorporated into future IP’s and used for systemic changes. The agency will use this information to implement changes based on the results of the evaluated data.
Goals are statements about general aims or purposes of the program that are broad, long- range intended outcomes and concepts. Objectives are brief, clear statements that describe the desired outcomes. Goals express intended outcomes in general terms and objectives are measurable and express them in specific terms. Outcomes are achieved results.
Performance Measures: The core standard performance measures which apply to all DDA Licensed providers have been incorporated within this provider Quality Assurance Report format. Providers should further enhance each goal assessment area by including goals they feel directly affect and drive their quality improvement.
Providers who have identified additional quality measures in their Quality Assurance Plans shall add and report on those specific measures with their annual report. For each the report must include the Provider’s analysis, remediation in relation to areas of non-compliance, and associated systems improvements.
Area to be Assessed: Individual Plans
Performance Measure 1: Proportion of IP’s containing required information per COMAR 10.22.02.14
Goal 1.1: 100% of all individuals being supported have IP’s containing all of the required information.
Discovery Results Time Period ______________
% of individuals with IP’s containing required information. Quarter 1 Quarter 2 Quarter 3 Quarter 4 FY Aggregate Compliance Non- Compliance
Total
PROVIDER’S ANALYSIS:
Remediation:
SYSTEMS IMPROVEMENTS:
Performance Measure 2: Excluding initial IP’s, the proportion of IP’s that document progress toward the individual’s specific goals.
Goal 1: All IP’s will document supports necessary and progress, 100% of the time.
Goal 2:
Discovery Results Time Period _______________
% of IP’s that document progress toward the individual’s specific goals. Rate (%) # in the Sample Compliance Non-Compliance Total
PROVIDER’S ANALYSIS:
Remediation:
SYSTEMS IMPROVEMENTS:
Performance Measure 3: Proportion of IP’s that were reviewed by the team within 365 days.
Goal 1: All IP’s will be reviewed within 365 days, 100% of the time.
Goal 2:
Discovery Results Time Period _______________
% of IP’s that were reviewed by the team within 365 days. Rate (%) # in the Sample Compliance Non-Compliance Total
PROVIDER’S ANALYSIS:
Remediation:
SYSTEMS IMPROVEMENTS:
Performance Measure 4: Proportion of individuals receiving services specified on their IP.
Goal 1: All individuals are provided the services specified on their IP’s, 100% of the time.
Goal 2:
Discovery Results Time Period _______________
% of individuals receiving services specified on their IP. Rate (%) # in the Sample Compliance Non-Compliance Total
PROVIDER’S ANALYSIS:
Remediation:
SYSTEMS IMPROVEMENTS:
Area to be Assessed: Qualified Providers (Training)
Performance Measure 1: Proportion of licensed providers that offer all required direct care staff training to their employees.
Goal 1: 100% of all direct care staff will be offered training by their employers.
Goal 2:
Discovery Results Time Period _______________
% of direct care staff offered training by their employer. Rate (%) # in the Sample Compliance Non-Compliance Total
PROVIDER’S ANALYSIS:
Remediation:
SYSTEMS IMPROVEMENTS:
Area to be Assessed: Health & Welfare of Waiver Participants
Performance Measure 1: Number of people that receive medical services as recommended by their physicians.
Goal 1: All individuals supported by the agency will receive medical services as recommended by their physicians, 100% of the time.
Goal 2:
Discovery Results Time Period _______________
Number of people that receive medical services as recommended by their physicians. Rate (%) # in the Sample Compliance Non-Compliance Total
PROVIDER’S ANALYSIS:
Remediation:
SYSTEMS IMPROVEMENTS:
Performance Measure 2: Individuals are free from abuse, neglect, and exploitation.
Goal 1: All individuals supported by the agency reported they were free from mistreatment, 100% of the time.
Agency Consumer Satisfaction Survey Time Period ___________________
Survey Tool Question Yes No Family – Yes Family –
No
In the past year, did you report
abuse or neglect?
In the past year, did any consumers
report abuse or neglect?
PROVIDER’S ANALYSIS:
Remediation:
SYSTEMS IMPROVEMENTS:
Performance Measure 3: Number of incident reports involving unauthorized or inappropriate use of restraints.
Goal 1: Baseline number of incident reports involving unauthorized or inappropriate use of restraints will be reduced by ___% by the following reporting period.
Goal 2:
Discovery Results Time Period _______________
Number of incident reports involving unauthorized or inappropriate use of restraints. Rate (%) # in the Sample Compliance – Authorized Non-Compliance – Unauthorized
Total
PROVIDER’S ANALYSIS:
Remediation:
SYSTEMS IMPROVEMENTS:
Area to be Assessed: Financial Accountability
Performance Measure 1: Number of rate based DDA licensed providers with complete annual independent audits.
Goal 1: Agency will conduct annual, independent audits, 100% of the time.
Goal 2:
Annual Independent Audits Discovery Results
Time Period _______________ Annual independent audit completed.
Yes No
PROVIDER’S ANALYSIS:
Remediation:
SYSTEMS IMPROVEMENTS:
Satisfaction Survey: COMAR 10.22.02.14. B. (1) Please develop an individual satisfaction survey tool including questions focusing on individuals’ self-determination, choices, preferences, and overall satisfaction of services. Discuss survey procedures and frequency in the plan. The survey should seek feedback directly from the individuals receiving services or families and be used for agency wide quality improvement. The survey should be designed to provide the agency with useful responses, such as a rating scale of satisfaction versus “yes” / “no.” Consider providing an area for comment to encourage additional, helpful information from individuals and families. Please attach the survey form.
Goal 1: Provided with the satisfaction survey and supports necessary to complete, all of the individuals supported will be ___% satisfied with their services provided.
Goal 2: Baseline individual satisfaction will improve by ___%, by the following reporting period.
PROVIDER’S ANALYSIS:
Remediation:
SYSTEMS IMPROVEMENTS:
- Provider Applicant Name: IVORY SERVICES
- Region Servicing: CENTRAL & SOUTHERN MD
- on individual choice and preferences It must also include personal contact with the individuals:
- This is an opportunity to cite staff skills and expertise:
- Action Plan Refer to COMAR 1022021445 Describe how the agency will collect:
- undefined:
- Time Period: Quarterly
- Quarter 1Compliance:
- Quarter 2Compliance:
- Quarter 3Compliance:
- Quarter 4Compliance:
- FY AggregateCompliance:
- Quarter 1Non Compliance:
- Quarter 2Non Compliance:
- Quarter 3Non Compliance:
- Quarter 4Non Compliance:
- FY AggregateNon Compliance:
- Quarter 1Total:
- Quarter 2Total:
- Quarter 3Total:
- Quarter 4Total:
- FY AggregateTotal:
- Time Period_2: End of each month
- of IPs that document progress toward the individuals specific goalsRow1:
- Rate Compliance:
- in the SampleCompliance:
- Rate NonCompliance:
- in the SampleNonCompliance:
- Rate Total:
- in the SampleTotal:
- Time Period_3: Quarterly
- Rate Compliance_2:
- in the SampleCompliance_2:
- Rate NonCompliance_2:
- in the SampleNonCompliance_2:
- Rate Total_2:
- in the SampleTotal_2:
- Time Period_4: Once a week
- of individuals receiving services specified on their IPRow1:
- Rate Compliance_3:
- in the SampleCompliance_3:
- Rate NonCompliance_3:
- in the SampleNonCompliance_3:
- Rate Total_3:
- in the SampleTotal_3:
- Time Period_5: End of each month
- Rate Compliance_4:
- in the SampleCompliance_4:
- Rate NonCompliance_4:
- in the SampleNonCompliance_4:
- Rate Total_4:
- in the SampleTotal_4:
- Time Period_6: Every 90 days
- Rate Compliance_5:
- in the SampleCompliance_5:
- Rate NonCompliance_5:
- in the SampleNonCompliance_5:
- Rate Total_5:
- in the SampleTotal_5:
- Time Period_7: once a week
- Survey ToolRow1:
- YesIn the past year did you report abuse or neglect:
- NoIn the past year did you report abuse or neglect:
- Family YesIn the past year did you report abuse or neglect:
- Family NoIn the past year did you report abuse or neglect:
