Customized Community Supports for adults is intended for individuals who are eighteen (18) years of age or older. Any age exception shall be pre-approved by DDSD on at least an annual basis by the DDSD Community Inclusion Bureau Chief.
A. Providers must comply with the DDSD Employment First Principle. When Customized Community Supports is selected as a service for an individual rather than Community Integrated Employment, the ISP shall include a documentation summary of the employment options discussed and the basis for the determination of informed choice regarding the selection of Customized Community Supports over Community Integrated Employment.
B. Providers must comply with the Meaningful Day requirements as specified in these Standards and in ISP Regulations.
C. Group Customized Community Supports are not segregated vocational or prevocational activities (e.g. center-based or sheltered work). Individuals participating in this type of activity as a continuation of previous service models must have a transition plan, developed by the IDT, which will lead to more integrated, age appropriate options such as employment. The plan must be implemented within one hundred ninety (190) days following the annual ISP.
D. Staffing Ratios:
1. Individual Customized Community Supports: The ratio is one-to-one (1:1) and is to be delivered in the community exclusively;
2. Intensive Behavioral Customized Community Supports: The ratio is one-to-one (1:1) or as necessary to adequately support the individual with challenges in both an individual and group setting;
3. Community Inclusion Aide: The ratio is one-to-one (1:1) and is to be delivered in the community exclusively;
4. Small Group Customized Community Supports: The group ratio is one-to-two (1:2) or one-to-three (1:3) and is to be delivered exclusively in the community; and
5. Group Customized Community Supports: Staff ratios, depending upon the individual’s NM DDW group are not to exceed:
a. NM DDW Groups A-D: one-to-six (1:6) at a day facility or in the community; or
b. NM DDW Groups E-G: one-to-four (1:4) at a day facility or in the community; and
c. At least 50% of Group Customized Community Supports is expected to occur in the community with the exception of those individuals who also receive Intensive
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Medical Living Services. (Individuals in Intensive Medical Living Services who access Customized Community Supports should be in the community as often as they are able according to their ISP.)
E. The agency nurse(s) for Customized Community Supports providers must provide the following services:
1. Implementation of pertinent PCP orders; ongoing oversight and monitoring of the individual’s health status and medically related supports when receiving this service;
2. Provision of oversight, training, and guidance to DSP as necessary, based on the individual’s health needs and diagnosis; PCP orders; Healthcare Plans and MERPs for those issues or needs that are relevant during Customized Community Supports including any delegated nursing tasks;
3. Provision of documentation by the nurses of these efforts in designated electronic or paper documents according to DDSD policy. Customized Community Support Providers are required to provided ADULT Nursing Services and complete the scope of services for nursing assessments and consultation as outlined in the Adult Nursing Standard. The agency nurse will provide the individual’s team with a semi-annual nursing report that discusses the services provided and the status of the individual over the last (6) months. This may be provided electronically or in a paper format to the team no later than (2) weeks prior to the ISP and semi-annually;
4. Provision of nursing services based on prudent nursing practice and compliance with all DDSD policies, procedures and standards and the New Mexico Nurse Practice Act;
5. For individuals who receive Family Living, Supported Living, Intensive Medical Living Services, or Adult Nursing Services, the Customized Community Supports Nurse will:
a. Collaborate with nurses from these agencies in order to review their assessment findings and existing Health Care Plans and MERPs in order to develop and implement Healthcare Plans and MERPs that are pertinent during Customized Community Supports; and
b. Train, monitor, and provide oversight for DSP to meet the individuals’ health care needs during Customized Community Supports services and to support the implementation of pertinent Health Care Plans and MERPs.
6. For individuals who do not receive Supported Living, Intensive Medical Living or Adult Nursing Services:
a. An e-CHAT shall be completed by the Customized Community Supports agency nurse for any individual with conditions that require ongoing medically related supports when receiving this service;
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b. If the e-CHAT summary report lists Health Care plans or MERPs as required (indicated by an “R” for required in report) that are not applicable to the individuals needs during Customized Community Supports, the nurse is not required to proceed with care planning and shall document the reason in the comment section of the e-CHAT summary sheet; and
c. At the nurse’s discretion and based upon the results of the e-CHAT, the Customized Community Support provider may direct the team to request prior authorization for Adult Nursing Services for ongoing nursing supports.
3. AGENCY REQUIREMENTS
Customized Community Support Agencies must comply with all of the following requirements:
A. Maintain and comply with all provisions of the annual Performance Contract that covers all individuals receiving services by the provider agency, including:
1. Ensure that appropriate staff from the Customized Community Supports Agency will participate on each individual’s IDT, as specified in the ISP regulations [NMAC 7.26.5];
2. Enter General Events Reporting into Therap.
B. Provide fiscal management to individuals served for the purchase of tuition, fees and/or related materials associated with adult education opportunities as related to the ISP Action Plan and Outcomes.
C. Employ or subcontract with at least one RN to comply with services under “Nursing and Medical Oversight Services as needed” that is detailed in the Scope of Services above for Group Customized Community Supports Services. If the size of the provider warrants more than one nurse, a RN must supervise LPNs.
1. Ensure compliance with the New Mexico Nurse Practice Act and DDSD Policies and Procedures regarding Delegation of Specific Nursing Functions, including:
i. Provider agencies (Small group and Group services) must develop and implement policies and procedures regarding delegation which must comply with relevant DDSD Policies and Procedures, and the New Mexico Nurse Practice Act. Agencies must ensure that all nurses they employ or contract with are knowledgeable of all these requirements;
ii. When delegation of specific nursing functions has been granted the nurse must:
a) Train each DSP to skill level competency;
b) Monitor ongoing staff performance, skill level and the individual’s health status; and
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c) Rescind delegation at any time the nurse determines that the DSP is unwilling or unable to safely perform the delegated task.
iii. All activities related to delegation must be documented by the delegating nurse and retained in a separate staff file at the agency office; and
iv. Delegation is a unique relationship between a nurse and a DSP that cannot be mandated and cannot be transferred between nurses or between DSP. If a staff nurse or DSP is no longer employed or contracted by the agency, the delegation relationship is nullified.
D. Ensure that when an individual changes providers that safe and appropriate planning takes place which shall be the responsibility of both the existing and new provider. An IDT meeting to develop a transition plan shall be held to address the following:
1. Exchange of health- related information;
2. Individual preferences;
3. Required documentation; and
4. Training of staff.
E. Meet all Customized Community Supports Agency Staffing Requirements:
1. Qualifications and Competencies: Agencies will maintain qualified and competent staff. Staff providing direct services must, at a minimum:
a. Be eighteen (18) years of age or older;
b. Have a high school diploma or GED;
c. Complete any additional training required as part of Regional Office Technical Assistance or Performance Improvement plan;
d. Know the individuals they support well (e.g., likes, dislikes, preferences, choices, interests, gifts, needs, etc.);
e. Communicate effectively and respectfully with the individual;
f. Contribute ideas to support the individual in achieving desired ISP outcomes;
g. Assist the individual to identify desired activities throughout the day and actively help the individual accomplish them;
h. Provide instruction to facilitate the development of new skills and generally support individual learning and development;
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i. In collaboration with the IDT, identify and become familiar with any community resources and options needed to fulfill ISP outcomes, Action Plans, and personal Meaningful Day definitions;
j. Contribute to developing and implementing purposeful activities that meet the individual’s definition of a meaningful day;
k. Document and effectively communicate daily progress toward achievement of desired outcomes, as well as barriers/concerns encountered;
l. Communicate effectively with community members, other staff and IDT members to accomplish the individual’s desired outcomes;
m. Model appropriate behaviors;
n. Instruct and assist with the implementation of therapy, healthcare, PBSP, BCIP, MERP, CARMP and other risk management plans, if applicable;
o. Implement individual specific strategies to help the individual achieve desired outcomes and maintain health as stated in the ISP action plans, strategies, Therapy WDSI, and applicable behavioral or healthcare related support plans such as PBSP, BCIP, or MERP;
p. Maintain safety standards and required related documentation at all times to ensure health and wellness;
q. Understand and implement crisis or emergency responses needed for individuals served;
r. Report incidents;
s. Implement DDSD standards, regulations and performance contract requirements;
t. Effectively implement relevant activities from the provider Quality Management System;
u. Agencies may not employ or sub-contract direct care personnel who are an immediate family member or who are a spouse of the individual served to work in the setting in which the individual is served;
v. Maintain current First Aid and CPR certification; and