ar. Unknown/ Not Known 3 3 0 ……………………………………………………………………….. as. Not Service Related 0 0 0 at. Other 1 0 1 au. Total (Must be to the Total # of Complaints in 1.c.) ≥ 79 67 12 …………………………………. 9. Residential Is An Issue In The Complaint: (from 8.af.) 11 8 3 ………………………………… 10. Identify Residential Service Type For Each Complaint List each complaint in only one Included in 9: category a. Own Home 0 0 0 b. Home Parents/ Guardian’s 0 0 0 …………………………………………………………………… c. Supervised Living 5600 A (Adult with Mental Health 0 0 0 Concerns ………………………….. d. Supervised Living 5600 B (Minor with 0 0 0 Intellectual/Developmental Disabilities) e. Supervised Living 5600 C (Adult with Intellectual 2 2 0 /Developmental Disabilities) f. Supervised Living 5600 D (Minor with Substance Abuse 0 0 0 Concerns) …………………….. g. Supervised Living 5600 E (Adult with Substance Abuse 1 1 0 Concerns) h. Supervised Living 5600 F (Alternative Family Living) - 1 1 0 Licensed ………………………… i. Supervised Living 5600 F (Alternative Family Living) - 0 0 0 Unlicensed ……………………… j. Therapeutic Foster Care 1 1 0 k. Psychiatric Residential Therapeutic Facility (PRTF): 2 2 0 ………………………….. l. Psychiatric Residential Therapeutic Facility (PRTF): 0 0 0 within 40 miles ……. m. Psychiatric Residential Therapeutic Facility (PRTF): 0 0 0 outside 40 miles n. MH Apartments- Supervised 1 0 1 ………………………………………………………………… o. Family Care Home 0 0 0 p. Level III Group Home 1 1 0 q. Level IV Group Home 0 0 0 r. SA Halfway House 0 0 0 s. Other 2 0 2
ar. Unknown/ Not Known ……………………………………………………………………….. 3 3 0 as. Not Service Related 0 0 0 at. Other 1 0 1 au. Total (Must be ≥ to the Total # of Complaints in 1.c.) …………………………………. 79 67 12 9. Residential Is An Issue In The Complaint: (from 8.af.) ………………………………… 11 8 3 10. Identify Residential Service Type For Each Complaint Included in 9: List each complaint in only one category a. Own Home 0 0 0 b. Parents/ Guardian’s Home …………………………………………………………………… 0 0 0 c. Supervised Living 5600 A (Adult with Mental Health Concerns ………………………….. 0 0 0 d. Supervised Living 5600 B (Minor with Intellectual/Developmental Disabilities) 0 0 0 e. Supervised Living 5600 C (Adult with Intellectual /Developmental Disabilities) 2 2 0 f. Supervised Living 5600 D (Minor with Substance Abuse Concerns) …………………….. 0 0 0 g. Supervised Living 5600 E (Adult with Substance Abuse Concerns) 1 1 0 h. Supervised Living 5600 F (Alternative Family Living) - Licensed ………………………… 1 1 0 i. Supervised Living 5600 F (Alternative Family Living) - Unlicensed ……………………… 0 0 0 j. Therapeutic Foster Care 1 1 0 k. Psychiatric Residential Therapeutic Facility (PRTF): ………………………….. 2 2 0 l. Psychiatric Residential Therapeutic Facility (PRTF): within 40 miles ……. 0 0 0 m. Psychiatric Residential Therapeutic Facility (PRTF): outside 40 miles 0 0 0 n. MH Apartments- Supervised ………………………………………………………………… 1 0 1 o. Family Care Home 0 0 0 p. Level III Group Home 1 1 0 q. Level IV Group Home 0 0 0 r. SA Halfway House 0 0 0 s. Other 2 0 2
QMC-Exec-Summary-Jan-March20151.docx