CARF surveyors stated that overall, the survey has been a delightful experience. They have enjoyed interacting and sharing experiences with staff! “The agency itself is mission-focused.”
Section I:
Leadership-
Strengths:
- The organizations leadership is clearly committed and structured. A written code of ethics is present as a part of orientation.
Governance-
- The next survey will probably require agencies to be surveyed under these standards.
Strategic Planning-
Strengths:
- The leadership of LOQW has developed an extensive Strategic Plan which is reviewed on a regular basis and serves as a guide to fulfilling the agency’s mission.
Input from Persons Served:
Strengths:
- The organization makes an effort to get input from persons served. Input is utilized to develop strategic plans and is used to evaluate quality of services.
Legal Requirements-
Strengths:
- The organization has developed a written procedure for staff to follow on legal matters.
Consultation:
- May add a header and a developed/reviewed date on the policy so that if it is separated from the book it can be recognized as the most up-to-date policy.
Financial Planning & Management-
Strengths:
- Management provides accurate and complete financial reports to board. Has sustained a long history of financial stability. Ongoing and accurate reflection of how the organization is doing financially.
Consultation:
- LOQW is encouraged to explore bidding processes and fee structure to ensure the agency is providing services in a cost-effective manner. This will enable the agency to develop a better financial reserve “rainy day fund”.
Risk Management-
Strengths:
- The organization has developed a risk management plan to address the prioritized areas of potential liability. This is reviewed by leadership on a regular basis.
Health & Safety-
Strengths:
- The organization does take safety very seriously. A lot of reporting/drills, etc. are completed on a regular basis.
Consultation:
- It is suggested that road hazard warning devices are located in agency vehicles.
Recommendations:
- Although LOQW extensively tracks incidents. It is recommended that information is analyzed on an annual basis for trends, etc. and is used for training.
- When the organization does self-inspections, areas needing to be corrected are documented and an action plan is put in place to ensure correction.
Human Resources-
Strengths:
- The organization maintains complete and comprehensive personnel records. All staff appears qualified and well suited for their positions. General sense of teamwork and cohesiveness and staff morale. Feels good when you are here and interacting with staff. Sense of caring.
- The personnel policy manual is beautifully maintained and well organized.
Technology-
Strengths:
- The organization is effectively using technology. Staff understands the importance of utilizing technology and are encouraged to continue using it and learning about coming trends.
Recommendations:
- LOQW is urged to expand technology plan to include assistive technology and upgrading it virus protection.
Rights of Persons Served:
Recommendations:
- A statement on freedom of retaliation is needed in client handbook. Urged to clearly state and uphold that a person will not be retaliated against for reporting violation of rights. Whistle blower policy.
Accessibility-
Strengths:
- The organization has developed a comprehensive plan which is created with input from board, stakeholders, etc.
Consultation:
- Once completed, goals should be checked off the accessibility plan. LOQW should designate a responsible party for completing this.
Information Measurement & Management-
Strengths:
- The organization collects data from a broad range of places. Information is shared with stakeholders, staff, etc.
Performance Improvement-
Recommendations:
- At least annually it is recommended that program and services outcomes are analyzed and that data is used to revise performance standards or program services. Formats should be able to be shared with consumers, members of the community, etc. Analyze what the information tells us.
Quality Individualized Services & Supports-
Consultation:
- Goals were not measurable or specific, etc. Goals are poorly written in Individual Plans. Make sure that LOQW staff is teaching advocating for goals that are measurable and achievable. “Jessica will maintain her weight + or – 5 lbs. over the next six months.”
- Staff use words that are meaningful to progress rather than “he did a good job.” Put some meaning into the words. “He followed directions, he had good attention to detail, etc.”
Records of Persons Served-
Strengths:
- Keep records organized, etc.
Consultation:
- Must check the box on the release form the box which tells the person what the information is being shared for.
Medication Management-
Strengths:
- Good records. You do a great job. If the organization increases the number of customers taking medication, make sure to label the individual medication with the person’s name.
Employment Principle Standards-
None
Community Services Principle Standards-
None
Employment Services Coordination-
Strengths:
- Huge strength with connecting with others. Keep collaborating and networking, especially in a small community.
Employment Transition Services-
None
Community Employment Services-
Strengths:
- Everyone does a great job. Unique one on one funding to really make community employment a reality for people.
Consultations:
- Great job at securing employment opportunities. The agency is encouraged to continue to develop relationships with employers to go beyond cleaning, etc. Building relationships with employers now and wait for the economy to change.
- Encouraged to develop in house talent to do benefits planning.
- Many staff and consumers are skilled in corporate cleaning. Encouraged to partner for a skill-based training to get a certificate.
Community Services-
None
Overall Strengths:
- Great drivers! Felt safe. Felt like she was taken care of well when out in the community.
- Tremendous strength in a staff as a resource. Because you have strong staff you have a strong program.
- Each person felt like they were in the right position. Didn't’t seem like they needed to become the supervisor, etc. This is an outstanding asset.
- Strong positive community presence and reputation in the community as a whole. Though communities are small, seem to make a great impact. Only suggestion is that we “toot our horn stronger”.
- Consumer files are easy to navigate and seem consistent in formatting.
- The job analysis is outstanding. Written in language that is understandable by any staff.
- Staff training opportunities are abundant and thorough. Guide staff through all works.
- Administrative organization of policies and procedures and client files is admirable.
- Overall agency has quality staff, programs, etc.
- Will receive exemplary in the training diversity, etc. of staff. Training program is probably the best he has seen. Has done between 160 and 180 surveys. Scope, availability, etc. is admirable.
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