AGENCY NAME

StarkMHARQUALITY ASSURANCE REPORT – RECOVERY SUPPORTS

QUARTER - STATE FISCAL YEAR

Months:

ACTIVITIES COMPLETED AND NUMBERS SERVED

SFY
Insert name of activity or service below. / Program Provided / 1ST QTR #s Served
(Jul–Sept) / 2ND QTR #s Served
(Oct–Dec) / 3RD QTR #s Served
(Jan–Mar) / 4TH QTR #s Served
(Apr–Jun) / SFY YrEnd
Total #

Trends/Lessons Learned/Concerns for Quarter:

Explanation and Action Plan for Trends/Lessons Learned/Concerns:

UNPLANNED DISCHARGES(Examples below)

·Left on own, against staff advice with satisfactory progress

·Left on own, against staff advice without satisfactory progress

·Involuntarily discharged due to non-participation

·Involuntarily discharged due to violation of rules

·Incarcerated due to offense committed while in treatment/recovery with satisfactory progress

·Incarcerated due to offense committed while in treatment/recovery with unsatisfactory progress

·Incarcerated due to old warrant/charged from before entering treatment/recovery with satisfactory progress

·Incarcerated due to old warrant/charged from before entering treatment/recovery with unsatisfactory progress

·Client death specific to suicide and overdose

Total number of unplanned discharges in quarter:

What percentage of total discharges for the quarter were unplanned?

RISK MANAGEMENT

MAJOR UNUSUAL INCIDENTSPER QUARTER:

SFY / 1st QTR
(Jul-Sept) / 2nd QTR
(Oct-Dec) / 3rd QTR
(Jan-Mar) / 4th QTR
(Apr-Jun) / SFY Yr End
Total #
# reported to ODMHAS
# reported to StarkMHAR

Trends:

Explanation and Corrective Action Plan for Trends:

FINANCIAL:

Describe any significant financial risk, loss and/or gain including pending lawsuits, gained/lost grants or other funding.

STAFF RETENTION

KEY LEADERSHIP

(Chief Executive Officer, Chief Fiscal Officer, Chief Operating Officer, Clinical Director, Senior Management, and other like positions)

Total number of key leadership turnover in quarter:

Percentage of key leadership turnover (divide the total number of key leadership turnover in quarter by total number of key leadership positions within the agency):

DIRECT SERVICE

Total number of direct service staff turnover in quarter:

Percentage of direct service turnover (divide the total number of direct service turnover in quarter by total number of direct service positions within the agency):

COMPLAINTS AND GRIEVANCES

  1. Total Number of Complaints in Quarter:

Total of each StarkMHAR Category
Provisions of Service / Monetary / Staff Issue
Medication / Misunderstanding / Non-Staff Issue
Housing / Confidentiality / Other
  1. Total Number of Grievances in Quarter:

Total of each OhioMHAS Right
Respect, dignity, autonomy & privacy / Service in humane, least restrictive setting
Information of condition and services / Consent to or refuse service or treatment
Current, written, individualized service plan / Active & informed participation of service plan
Unnecessary medication / Unnecessary restraint or seclusion
Participation in any non-precluded service / Information/refusal of unusual/hazardous treatment
Notification/refusal of observation tools / Specialist or legal consultation at own expense
Confidentiality / Access to psychiatric/medical/treatment records
Notice/reason/plan of discontinued services / Clear explanation of denial of service
Non-discrimination / Know the cost of services
Fully informed of all rights / Exercise all rights without reprisal
File a grievance / Oral and written instructions for filing a grievance
# of Grievances referred to a higher level for dispute resolution
  1. Total Number of Other in Quarter:

SATISFACTION SURVEYS

CLIENT SATISFACTION SURVEYS:

Trends:

Explanation and Corrective Action Plan for Trends:

COMMUNITY SATISFACTION SURVEYS:

Trends:

Explanation and Corrective Action Plan for Trends:

PERFORMANCE TARGET OUTCOMES / MILESTONE REPORTS

PTO worksheets are due to be emailed in to StarkMHAR quarterly by the 23rd of the month following the reporting quarter. Quarterly narrative milestone reports are also due as applicable.

Submitted by:

7/22/16