1. Community Strategies: Connecticut Coventry, Manchester, Simsbury and Windsor Comprehensive Program Review July 25, 2014 1

2. CSCT is serving the 1 st CRJ individual with a hearing impairment Decrease in prescribed medications and behavior with several key individuals Increase in community involvement, and lifetime accomplishments (including three individuals graduating high school) Staff turnover & retention High number of Medication Incidents & Occurrences Increase scores of SQA audits to comply with the Community Living Arrangement regulations 2

3. DELIGHTING OUR CUSTOMERS Below is an email from Cheryl LaPorte (Mother and Guardian) to Alisha N., an individual residing in our Manchester, CT Program. Prior to her daughter moving to CRJ, she called me daily to several times a day, concerned, worried and anxiety stricken. Eight months later she may be one of our most delighted customers. I cannot tell you how absolutely thrilled I am with every aspect of CRJ and the staff in general! Alisha has thrived in every part of her life since she became "part of CRJ". Alisha has accomplished more in the 7 months with CRJ then she has in the past 10 years. I can honestly say I finally have piece of mind that my daughter is in the best place possible, with the best care. Never before has she considered any place other than my house as "home" until now. She has become confident and more mature in addition to healthier and happier. I can't thank you enough. In the past, everyone’s answer to Alisha’s issues was to medicate one way or another. Add, change, increase.... in addition to looking to place "blame" on issues rather than try to determine the triggers and work her through them. Then along comes CRJ. Alisha has become the person she once was, once again. All of this success at the same time her meds are decreasing. Alisha is thriving!!!! I had high hopes of Alisha being successful with CRJ, but you have far surpassed my highest hopes already. Kudos to all involved in her care! I feel it is important to let you know how very special and how very much appreciated you all are. You have changed the lives of an entire family, and we are very grateful. Keep up the good work, and thank you again. Sincerely, Cheryl LaPorte (mother) and the family of Alisha 3

4. STAFFING Staff Turnover Rates Staff Retention Rates Overdue Performance Evaluations Staff Training Hours 4

5. STAFF TURNOVER RATES (December 2013 – May 2014)  Last CPR, the CSCT turnover rate average was 38.6% compared to the CRJ average of 30.1%  Coventry data for last CPR = N/A; (opened in October 2013) 5 Information obtained from HR Staff Turnover & Retention Reports

6. STAFF RETENTION RATES (December 2013 – May 2014)  Retention looks at the number of employees who stay. It is the number of staff at the beginning of the period that are still there at the end. So if one-year retention is 0%, none of the employees at that program a year ago are still with CRJ.  Coventry = N/A (opened in October 2013) Program is less than one year’s old, therefore data is not applicable. 6 Information obtained from HR Staff Turnover & Retention Reports

7. Programs Overdue Evaluations as of 5/31/14 Overdue Evaluations as of 9/30/13 FTPTFTPT Coventry00N/A Manchester 2010 Simsbury00 10 Windsor  5061 CSCT Total 7081 7 Information obtained from HR Reports  2 out of the 5 overdue evaluations for Windsor are staff on extended medical leave. The total number of overdue evaluations, factoring out staff on medial leave = 5

8. Data obtained from MMRs and HR Reports  Total of 2,184.5 staff training hours; Overall average of 57.5 hours per staff over six months  Total hours for Manchester, Windsor and Simsbury = 1,213.5; overall average of 51.6 hours per staff over six months  Last CPR: total of 1,392.5 training hours were completed (data does not include Coventry)  Overall average of 61.1 hours per staff over six months 8

9. CLIENT RELATED Clinical Hours Elopements Medication Incidents & Occurrences s De-escalation and Restraints Mainstream/Community Inclusion Activities 9

10.  Manchester – increased from 0.4 to 3.6; Simsbury - increased from 2.9 to 4.8; Windsor – increased from 2.5 to 4; CSCT increased from 2.4 to 3.8 (58% increase)  Last CPR, the total number of clinical hours = 99; the average clinical hours per client/month = 2.4 (April – Sept. 2013) Data for last CPR did not include Coventry. 10 Data obtained from MMR

11. ELOPEMENTS December 2013 – May 2014 April – September 2013 % of Increase/ Decrease Coventry0N/A Manchester4333% increase Simsbury112045% decrease Windsor1367% decrease CSCT - Overall162638% decrease 11 Data obtained from MMR

12.  Total of 96 medication incidents and occurrences (5% decrease from last CPR)  50 out of 96 medication incidents and occurrences or 52% are client refusals of psychotropic medications  Overall average for CSCT is 1.4 per client over six months compared to 2.1 per client over six months last CPR; this is a 33% decrease  Last CPR, a total of 101 medication incidents and occurrences;  58 out of 101 medication incidents and occurrences or 57% are client refusals of psychotropic medications 12 Data obtained from MMR

13. DE-ESCALATIONS : RESTRAINTS December 2013 – May 2014April 2013 – September 2013 Total RatioTotal Ratio Coventry63 : 154 : 1N/A Simsbury90 : 0 93 : 224 : 1 Windsor6 : 0 52 : 317 :1 Manchester135 : 1211: 1* 26 : 8 * Data from 8/13 -9/13. Program opened in late July. 3 : 1 Overall - CSCT294 De-escalations: 27 Restraints 11 : 1 171 De-escalations: 33 Restraints 5 : 1  Total of 294 De-escalations (71% increase) and 18% decrease in restraints from last CPR 13 Data obtained from MMR

14. Client Activities Participated In and Offered (December 2013 – May 2014)  Total of 263 community inclusion activities participated in (100% increase from last CPR)  Average of 3.8 community inclusion activities participated in per client/over six months  Factoring out Coventry, the average per client/over six months = 4.8 (41% increase from last CPR)  Last CPR, a total of 131 community inclusion activities participated in. Last CPR, Coventry was not included in data.  The CSCT overall average = 3.4 community inclusion activities participated in per client over six months 14 Data obtained from MMR

15. Mainstream Activities Participated In and Offered (December 2013 – May 2014)  Total of 757 mainstream activities participated in; average of 10.8 mainstream activities participated in per client/over six months  Factoring out Coventry, the average per client/over six months = 14.7 (49% decrease from last CPR)  Last CPR, a total of 1,100 mainstream activities participated in. Last CPR, Coventry was not included in data.  The CSCT overall average = 28.6 mainstream activities participated in per client over six months 15 Data obtained from MMR

16. KEY MMR RESULTS SQA AUDITS 16

17. As of May 31, 2014: Client Related:  6 out of 13 (46%) of the individuals are in Day Programs  3 out of 13 (23%) of the individuals are in sheltered workshop/job training  2 out of 13 (15.5%) of the individuals are in school  2 out of 13 (15.5%) of the individuals are employed  4 individual incidents involving contraband; last CPR = 4  11 out of 13 (83%) of the individuals choosing healthy living opportunities within program; last CPR = 78% Staff Certifications:  71.2% of staff certified in Medication Administration; last CPR = 43%  Current CPR: Coventry = 71.4%; Manchester = 50%; Simsbury = 80%; Windsor =83%  Last CPR: (Coventry = N/A) ; Manchester = 25%; Simsbury = 40%; Windsor = 63%  100 % certified in First Aid/CPR/AED and PAC/CPI 17

18. Positives Average Scores – Confidential Files = 80% – Financial Records = Not scored this round – Program Forms = 68% – Walk-Throughs = passing **Strengths of the Cluster – IP Paperwork – Fire Drills Areas In Need of Improvement – The first round of audit scores for CSCT reflected low scores, however all CSCT programs were audited on CLA [Community Living Arrangement] regulations even though 3 out of the 4 programs are CRS’s [Continuous Residential Supports]. The CLA’s regulations are more stringent. 18

19. CPR ACTION PLAN ISSUE: Reduce Medications Incidents and Occurrences COMMENTS: Dec. 2013 CPR, a total of 101 medication incidents & occurrences IMPROVEMENTS MADE: Current CPR, a total of 96 medications incidents and occurrences (MIOs) Simsbury went from 89 MIOs down to 12; Windsor went from 28 MIOs down to 24. Manchester went from 1 MIOs up to 59 MIOs. ISSUE:Decrease staff turnover COMMENTS:The current CS CT turnover rate = 37.8% (Coventry = 11.8%; Manchester = 35.7%; Simsbury = 40.7%; Windsor = 66.7%) IMPROVEMENTS MADE: Within the early development of programs it is not unusual to see higher turnover while the programs establish their “core” staff. CSCT has experienced a few terminations and a few workers comp cases that were back filled and a large majority has been transfers or staff going FT from PT. Will continue to work with recruitment to hire and retain quality staff to assist CSCT in their current turnover. ISSUE: Reduce Elopements COMMENTS:A total of 26 elopements documented in the last CPR; CSCT went from 26 elopements down to 16 (refer to Slide#15) IMPROVEMENTS MADE: Current CPR, a 38% decrease in elopements from previous CPR. ISSUE:Overdue Performance Evaluations COMMENTS:A total of 8 FT and 1 PT performance evaluations overdue at the last CPR. IMPROVEMENTS MADE: Current CPR, a total of 5 FT evaluations are overdue 19