Home and Community Based Services

Directions for Completing the RI Developmental Disabilities Provider Residential/Non-Residential Self-Assessment-Evidence of Compliance forms.

  1. Use the copies of the Provider Self-Assessments surveys that were submitted to BHDDH. BHDDH has provided the Focus Area/Questions from the self–survey.
  2. Provider Source Demonstrating Compliance - For each setting, provide the evidence you used to determine your response to the focus area question. Examples of evidence can include: a policy, procedure, training manual, person centered plan, and/or any other materials that meets the HCBS standards. For example, if the source of evidence is the, XYZ training manual, please list in this column.
  3. Text Demonstrating Compliance - Provide the text from the evidence you used to determine your response listed Provider Source in column. The text needs to site the specific language that supports compliance with the HCBS regulations.
  4. Action Plan for Non-Compliance or Partial Compliance – This column is only completed for focus areas that are not in compliance or only partially compliant. ( An example of partially compliant is a routine practice by staff that support the HCBS rule, but are not yet supported by a written policy or procedure). The Action plan must explain how you will come into compliance with HCBS. Please include as much detail as possible along with a timeline. For example, if part of the action plan is writing a new procedure on a specific focus area, agency will say the new procedure for xyz will be written by January 2017. Also, you may want to include possible mandatory trainings for direct support staff and or any education to participants and families on this focus area. (Example: Trainings for direct support staff to be developed by March 2017 with training to start in April and be completed by June 2017).
  5. Please complete form(s) listed below and e-mail it to: Christine.Botts@bhddh.ri.gov by September 16, 2016.

Forms