those Individuals know how to relocate or request new housing health information is kept private Individual’s Non-Residential: evidence supports that the individual has the same Recommendations/Comments rights/protections as not receiving Medicaid Services: person’s Acceptable evidence of support may include: Information is kept private Review a sample plans of individual’s Setting assures that staff interact/communicate with individuals respectively care for agency and in a way the person would like to be addressed Review applicable policy/procedures Each support plan is person centered and reflective of their individual’s for the agency individual needs/preferences and is not the same as everyone else in the Review a sample of individual’s setting schedules Setting offers a secure place to store belongings Interview some of the individual’s The setting supports individuals who need assistance with their personal supported by the agency appearance to `appear as they desire and if assistance is needed it is provided If the agency completes satisfaction in private with the they survey’s individual’s, Setting is free from gates, Velcro strips, locked doors or other barriers that support could review a sample of might prevent entering/exiting certain areas those Free from restrictive measures Setting offers a variety of meaningful non-work activities that are responsive to individual goals, interests and needs of the Individual Individuals are able to choose with whom to do activities Options are available to have meals/snacks at the time and place of their choosing Living Arrangements **This section is only addressed on the 3 2 1 Recommendations/Comments Residential Assessment; you can enter N/A for this item and move Acceptable evidence of support may include: to the next if you are reviewing a Non-Residential Assessment. Review a sample plans of individual’s care for agency Evidence provided supports that individuals have choice and access to privacy within Review applicable policy/procedures their living setting: for the agency Individual is able to have privacy-lockable doors, close and lock Review a sample of individual’s bedroom/bathroom doors, private cell phone, computer, or other schedules communication device, and has space around to ensure privacy Interview some of the individual’s Individuals have freedom to decorate home as they desire
those Individuals know how to relocate or request new housing Individual’s health information is kept private Non-Residential: evidence supports that the individual has the same rights/protections as person’s not receiving Medicaid Services: Information is kept private Setting assures that staff interact/communicate with individuals respectively and in a way the person would like to be addressed Each individual’s support plan is person centered and reflective of their individual needs/preferences and is not the same as everyone else in the setting Setting offers a secure place to store belongings The setting supports individuals who need assistance with their personal appearance to `appear as they desire and if assistance is needed it is provided in private Setting is free from gates, Velcro strips, locked doors or other barriers that might prevent entering/exiting certain areas Free from restrictive measures Setting offers a variety of meaningful non-work activities that are responsive to individual goals, interests and needs of the Individual Individuals are able to choose with whom to do activities Options are available to have meals/snacks at the time and place of their choosing Recommendations/Comments Acceptable evidence of support may include: Review a sample individual’s plans of care for agency Review applicable policy/procedures for the agency Review a sample of individual’s schedules Interview some of the individual’s supported by the agency If the agency completes satisfaction survey’s with the individual’s, they support could review a sample of those Living Arrangements **This section is only addressed on the Residential Assessment; you can enter N/A for this item and move to the next if you are reviewing a Non-Residential Assessment. 3 2 1 Recommendations/Comments Acceptable evidence of support may include: Review a sample individual’s plans of care for agency Review applicable policy/procedures for the agency Review a sample of individual’s schedules Interview some of the individual’s Evidence provided supports that individuals have choice and access to privacy within their living setting: Individual is able to have privacy-lockable doors, close and lock bedroom/bathroom doors, private cell phone, computer, or other communication device, and has space around to ensure privacy Individuals have freedom to decorate home as they desire
STP102616CG.docx