1. What is our organization's Mission Statement or Philosophy? We strive to provide unique and creative services to meet the needs of individuals, and to help people navigate through the complex service delivery system to secure everything possible to ensure the success of individuals living in the community and at home.
2. How long has our organization been serving persons with Intellectual Disabilities? South Texas Community Living Corp. has been providing ICF/ID services since 1992. Texas HCS and Integrated Community Services have been providing HCS services since 1993.
3. How many individuals do our ICF/ID and HCS programs serve, at the present time, and what is our capacity? In San Antonio, and McAllen, South Texas Community Living Corp is licensed to serve 86 individuals (56 in San Antonio and 30 in the Rio Grande Valley). Across the state of Texas, Texas HCS, Inc. and Integrated Community Services presently serve approximately 200 individuals in the group home and natural home setting. Our programs have no capacity limits at this time.
4. Does our organization provide a reference list of families to talk to, regarding the services we provide to their family member? Yes, our current families are happy to discuss their experiences with potential families seeking information about our program. Our current family members remember the stresses and fears associated with the search for a quality provider and are eager to help relieve some of the pressure by giving a reference.
5. What type and/or length of experience do our staff members have serving individuals with mental retardation; special problems, i.e., MH, PDD, or Autism? Our management staff all have several combined years of experience in providing ICF/ID and HCS services, and our Regional Directors have been working in a management capacity for over many years. Together, we have served a variety of individuals with a variety of pervasive developmental disorders, including Autism. In addition, we have served many individuals with dual diagnoses, including a wide range of mental health issues and related behavioral challenges.
6. How many staff are employed? What is the staff turnover rate? Statewide, our programs combined employ approximately 200 people. Our current turnover rate is approximately 30% annual (retention is approximately 70% annual).
7. What background checks are conducted before a staff is hired? We conduct a criminal background check through the Texas Department of Public Safety and an Employee Misconduct Registry check (to determine confirmed abuse or neglect) through the Texas Department of Aging and Disability Services for all applicants who are in consideration for employment prior to any contact with the individuals we serve, and always prior to hire. In addition, we carefully investigate a comprehensive application and check all references to ensure honesty and quality of past work. We strongly consider relevance of previous work experience, as well as length of stay in past jobs. We favor long-term dependable applicants who can prove stable work history in previous jobs and individuals who have left previous jobs for valid reasons. We conduct at least three verbal interviews with past supervisors.
8. What are the educational requirements for staff? Most of our direct care staff have graduated from high school or have a GED. All of our management staff have at least a 4-year Bachelor’s in a related field or a professional license (e.g., nurse).
9. What is the level of training, experience, and credentialing for staff? All of our staff participate in extensive training on all necessary subjects related to serving people with intellectual disabilities, as well as individual-focused special needs training to know the unique issues of each individual the employee may directly serve. Our training is competency-based, which means that our staff must be able to demonstrate the ability to perform all of the tasks necessary to serve our individuals. Some more significant training subjects include:
10. How do our more experienced and professional staff mentor new staff? We do have several veteran Direct Care staff to whom we pair new staff to “shadow” train so that new staff can benefit from the knowledge that each veteran staff has of each individual’s special needs, as well as the hands-on explanation of policies and procedures in each location. We have at least one key “anchor” staff at each group home.
11. What training records does our agency maintain? What subjects? All training records are kept on file at our regional offices. Some more significant training subjects include:
12. How does our agency involve the individual/guardian/family into the development of the individual's program plan? Whenever requested, a Person-Directed Plan and Implementation Plan is always developed with a family member and individual present, even if that individual has an alternate legal guardian. Each member present at the time of planning services is encouraged to express his/her wishes for the individual’s program plan. Such information is always written into every plan. In addition, as such wishes change, Integrated Community Services will tailor every program plan to the wishes of family members on an ongoing basis. Potential families seeking placement are strongly encouraged to ask current family members this specific question when seeking a reference about our agency.
13. How does our agency incorporate the family’s wishes, when those wishes are different from what the agency wants? Our professional and management staff make every possible effort to communicate the limitations of the services we can provide, and to effectively compromise to “meet in the middle” on all issues related to services that are rightfully expected to be provided by an HCS program. In many cases, we are willing and available to assist families to reach outcomes that are way beyond the scope of services provided by an ICF/ID or HCS program, and we reach far to ensure that each family member is satisfied.
14. What procedures will staff implement in a crisis situation? How are staff trained to address potentially aggressive behavior? We provide extensive training in prevention of aggressive behaviors, focusing on recognizing the signs of possible aggression and simple effective communications strategies for de-escalation of agitation. Recognizing the source of upset, validating the emotions associated with such upset, and carefully developing strategies to address the problem. Staff are taught how to interact with an upset individual in an calm, interactive, non-threatening, and non-judgmental manner. Staff are also taught how to document such episodes in order to facilitate the development of specialized behavior plans that more effectively address recurring “target” behaviors.
15. How does our agency develop Behavioral Support Plans? We develop plans from baseline data in the form of behavior notes from staff that describe many aspects of each behavioral episode in narrative form. Then, a licensed psychologist or psychological associate will interview staff and family, as well as thoroughly review all written reports. With all of that information, the professional will develop a plan that can shape each problem behavior into a more appropriate replacement behavior. Such plans are reviewed and modified regularly in order meet the changing needs of individuals, especially since we know that we don’t always get it right the first time. All plans are approved by the Human Rights Committee (in ICF/ID) or Consumer Advisory Committee (in HCS), which include representation from outside professionals, as well as current individuals served.
16. What are our policies regarding visitors? We impose no visitation limitations, unless there is a court-ordered visitation restriction due to a previous incident of abuse. Families are encouraged to show up unannounced at any time. Shift staff are restricted from having visitors. Live-In staff may have visitors that have been properly screened.
17. What are our policies regarding privacy? All individuals in our HCS programs all have their own bedrooms, and are encouraged to enjoy the full benefit of privacy and quiet time alone. Individuals are never forced to participate in group activities, and may be alone when they wish. In addition, staff are trained to knock on bedroom and bathroom doors to request permission to gain access, whenever possible…and may only enter without such permission in the event of an emergency or when the individual lacks the ability to communicate such permission.
18. What type of leisure / recreational activities do we provide, and how do individuals choose? Our individuals are out a lot. They participate in many regularly scheduled recurring outings including shopping trips, movies, bowling, church activities, and meals at restaurants. In addition, they attend special events including local sporting events, holiday dances, rodeos, and even local theater and major concerts. We also conduct regularly scheduled “planning meetings” during which individuals participate in making decisions about activities and many other choices.
19. What type of transportation does our agency provide? We own and operate our own fleet of company vans.
20. How do we accommodate non-ambulatory individuals? Non-ambulatory individuals are assisted by additional staff, at the expense of our agency. In addition, we secure all adaptive equipment and home modifications necessary to promote independence and freedom of movement.
21. Do we employ staff who speak other languages? We do have bi-lingual staff who speak Spanish and English. All of our programs serve individuals in multi-culturally diverse locations.We do not anticipate any difficulty in hiring staff who can effectively communicate with any individual.
22. How we accommodate non-verbal individuals? Are staff trained in sign language, use of picture schedules, picture books, augmentative communication devices? We employee staff who can accommodate individuals for whom sign language is the primary means of communication. In addition, we utilize the services of outstanding local Speech Therapists, who assist us in developing effective communication techniques for non-verbal individuals, including picture book wallets and picture boards for individuals in wheelchairs. Finally, we have assisted several individuals in securing sophisticated electronic communication devices through waiver and non-waiver payer sources….some of these devices costing thousands of dollars.
23. What provisions are made for individuals to attend the religious service of choice? Presently, our individuals attend a variety churches on Sundays simultaneously. We respect and celebrate the diversity of the individuals we serve, and we will ensure that every individual can worship as he/she chooses, regardless of the resources necessary to make that happen. We are very proud that our current group attends services weekly at multiple locations at the same time.
24. What are our emergency back-up procedures when there is crisis or the home is short staffed? Our agency maintains a pool of cross-trained employees who are knowledgeable of the special needs of all of the individuals we serve. In addition, we employ a management team of professionals who are very involved in the day-to-day activities of all of the individuals we serve and are on-call to step in at a moment’s notice whenever necessary.
25. What is your plan in the event of a hurricane? During Hurricane Ike, all of our individuals evacuated for 12 days to San Antonio, where we covered the cost of all accommodations and activities, including hotel, food, and SeaWorld! In addition, we extended an offer to all of our regional staff in the affected area to come with us and bring their families; we need our staff with us, and we know they will not be comfortable leaving their own family members behind. We will spare no expense to make sure our individuals are comfortable, safe, and remain in our care at all times during any crisis…and all staff and family members are invited and encouraged to join us.
26. How and where will an individual be cared for when ill? We keep a sick individual home from day activities. We provide additional staff to stay home with the individual during recovery to provide any needed care and to monitor for signs of more serious problems. Of course, we seek outside medical attention whenever necessary, and never take chances by making medical decision outside of the scope of our own professional qualifications.
27. Who is our physician? All of our programs statewide maintain a large network of local physicians. The choice of physicians is the decision of individuals and their family members. We make suggestions, but we don’t force all our individuals to see only our own primary physicians…and we encourage the continuation of long-term physician/patient relationships that existed before enrollment in our program.
28. Do we have medical staff on site or on call, for medical issues? We have nurses on duty and on call at all times. Our nurses engage actively in communication with families prior to significant medical appointments in order to ensure that the wishes of family members are followed through and communicated with physicians during medical appointments. Also, family members are always invited to attend all appointments.
29. What choices will my family member have concerning day programming, vocational training, supported employment, etc.? Family members are invited and encouraged to participate in all aspects of choosing and planning all services. We are willing to contract with any day hab facility that charges a reasonable daily rate, and are also willing to transport individuals residing in group homes to any such program. The choice of day programming is driven by individuals and their families.
30. What if someone does not wish to go to a particular day hab program? First, we would investigate what was missing from the current day hab that lacked sufficient stimulation for that individual, and work closely with that day program to correct the problem, if possible. We encourage all eligible individuals to participate in no less than 6 hours a day, for five days a week of meaningful activity outside the home. However, we understand that there are alternatives to formal day hab that meet can meet this goal, and we are open to many possibilities, including employment, adult day care (for interested seniors) and/or other structured community activity.
31. How are individual finances managed? Can I manage the finances for my loved one? Yes, a family member can elect to manage the finances of a loved one in lieu of assistance from our agency. If the family elects not to manage funds, each individual is formally assessed by a management staff for money management skills. For individuals who are unable to manage personal finances, our management staff are able to assist in order to ensure that all funds are safeguarded at all times, and to ensure that all bills are paid, as planned. Our agency implements the strictest possible safeguards and systems to ensure the security and proper accounting of all funds….and all related documentation (e.g., bank statements, receipts, etc) is available for review upon request. Also, these systems are carefully and regularly monitored by outside regulatory authorities.
32. How are meals planned? All of our group homes use a rotational menu plan as a general guideline to ensure healthy balanced meals, three a day. However, we encourage menu item substitution in order to include the individual preferences of the people we serve, and monitor meals closely to ensure that our direct carte staff do not impose their own preferences and attitudes related to food on individuals.
33. How do staff train individuals with daily living skills? Training objectives to promote skill development are developed by management staff, who utilize individualized assessments to determine training needs specific to each person. The assessment process includes information from direct care staff who know the individuals’ skills. Training objectives are developed with detailed written methodologies (step-by-step procedures for implementing the objective) that are simple enough to be understood by all employees and included right on each data sheet. Staff takes data on predetermined days that indicates the level of assistance necessary for the individual to complete the step. Management team members review documentation regularly and modify training objectives appropriately to address progress or lack of progress. In addition, management staff observe training regularly at all sites in order to ensure that training methodologies are being implemented, as written. Finally, management staff and direct care staff maintain ongoing open communication in order to resolve misunderstandings that are common is this complex process, including training skills not appropriate for the individuals and/or misunderstanding about how to conduct the training, related documentation, etc.
34. How do we build community awareness in the neighborhoods of our group homes? We knock on doors and introduce ourselves. We have been very fortunate to have accepting neighbors who demonstrate a genuine fondness for our individuals. We have not had to resolve any such issues, but we would take an active approach if we did…which would include increased visibility and efforts to engage concerned parties in communication and exposure. We also provide significant staff training, which includes how to prevent issues that are known to be upsetting to neighbors, including incorrect parking at group homes, unacceptable language, inappropriate attire, etc.
35. How are complaints addressed? Our agency actively solicits feedback from families and individuals in an effort to increase our awareness of concerns before those concerns become serious complaints. All occurrences of dissatisfaction are considered valid, and never dismissed. Individuals and family members are strongly encouraged to air grievances, and we never take a defensive posture. We encourage all families and individuals to work with members of our management team to get issues resolved. However, all families and individuals are also provided with detailed information regarding how to file a formal complaint with the Department of Aging and Disability Services (DADS) complaint hotline if an issue remains unresolved.
36. Are state inspections and audits available to family members? Yes, all audits are available for review by any interested party.
37. What does our agency offer to enhance the lives of individuals? Ultimately, we provide a safe, fun, and active environment that promotes learning, caring, respect, self-esteem, and personal growth. The individuals we serve live and function in their local communities. They remain engaged in activities daily, and truly feel like they are part of the world around them. We offer a maximum of choices in every area possible. We ensure that individuals remain closely connected to their families, even though they may be living with us. We actively reach out to families in order to tailor our services to meet the individual choices and preferences. Most importantly, we serve individuals on a non-controlling manner that fosters warmth and satisfaction…all while maintaining a structured environment that promotes success.