On CARF (Very Long)

Hmm, someone was home early yesterday!! Please excuse me, but we’re figurin this to be a pretty long journal entry. Need to clear our mind a bit if that’s ok with you all?

Well, the really exciting part of today is it is over now for three years. We hope at least. The surveyor doesn’t actually say you’ve passed the three year inspection or the one year. Officially, we have to wait 4-6 weeks to get a letter from CARF telling us how we did. Gratefully speaking, CARF does an exit survey. Hehe, we found this guy to be so good, he did it in exactly ½ hour, as promised, without looking at his watch!

This is what we figured ... First, I think it turned out good, but to every survey, there is the "official stuff," and the "unofficial stuff." The official stuff is what you work on for the year previous. The unofficial stuff is what happens between the creases. This year ... both were equally as tough.

The guy, his name was Jim, Jim had an extremely good ability to get a whole lot of information by talking to people. He never looked at all the books that we had prepared for the 94 standards. But, he did allow us to refer to the book as often as we wished. He knew the standards very well. So, he would focus on each "book" 5-6 direct questions, then while you were answering, he was figuring out all the rest, especially from the indirect questions.

The unofficial stuff was all the psychological type stuff from all of the staff. Fortunately, for us ... all except one occasion while we were trying to calm down Sr. Tess, we were actually fairly calm throughout. Had to be really, he spent more time with us, I believe than anyone else. Unfortunately, Sr. Tess had a real tough time with him for the parts that I saw. She was very anxious, defensive, and throughout gave the impression that she wanted him to leave. That all had an affect on the surveyor, who was well able to care for his emotions, but appeared a little hurt.

Late in the day Tuesday after we’d already thought we were through talking to him for the day, he came back for another "session." We knew already that he was very comfortable in our office, and seemed to be enjoying our time with us. He wanted to talk to us about Sr. Tess. He stated that she seemed rather anxious and he’d been having difficulty talking to her.

We acknowledged that we’d seen that and confirmed she was like this sometime. We reminded him of the death of her mother the week before, that she wasin pain because in last two days her foot was bothering her, and that having CARF inspecting us was a lot of pressure. Then to cinch the explanation, we reminded him that she was Italian. *Chuckle* Figured cultural differences counted for everyone in adaption to the environment!

I think he kind of took it personally that she didn’t seem to like him. In fact, Sister had been saying the same kind of thing. She was kinda outraged that he was being so "nit-picky." We had on the other hand thought he was just being thorough and within his bounds. We genuinely liked him and appreciated all the time he was spending with us in a consultive manner.

There was another problem too. The surveyor talked to us about some things that had come up in his interviewing with the staff. As part of the service, CARF asks to act as an intermediary to anyone with complaints. One of the DSP’s complained about not getting enough money, although she’s the highest paid and of lesser deserving on staff. And the other Q, had complained about only getting paid for one job, while she was wearing the hat of three jobs.

I thought the surveyor handled it rather well all considering. You could read his many years in an Administrative position dealing with hundreds of staff. I think also that he was searching out the "weak" spots. We figured out that he had asked each staff at least one question regarding safety, along with questions about their group, their goals, then questions about themselves and reasons in the field and such. A couple of staff appeared to go in some amount of detail about their personal lives and problems they were having professionally. I guess that was to be expected, none had too much experience working with a psychologist.  One of the DSPs really sparkled and he was sure to point her out during the exit interview. 

One of the problems that had come up was that on Monday, the DSP that had complained about money was found by Sr. Tess to have cleaned up a blood incident not well. One of the clients had gotten a small cut, that bled a lot. After the fact, I really don’t know whether the surveyor had found out about this, but at least inadvertently this particular DSP was asked about if she’d been asked if she wanted to receive a Hepatitis B shot from her employer.

That caused kind of a rise as to whether the Center had done something wrong. I hadn’t known about this clause, although we found for the record that the Center had once asked about it on the medical, but had stopped asking because it wasn’t required by the State. Unfortunately, it was required by OSHA. There was another problem in that the DSP who I’ve been having the most problem with, didn’t bother to come in on Wednesday at all. She had been expected to talk to the surveyor, so Sr. read this as, in my terms, job abandonment or neglect.

All three incidents put together with all else, appeared as if some of the staff was very disloyal to her. And, I think that hurt her more than she would ever express. But, again, I thought this was this guys job in an unofficial way. He’d been a psychologist and was extremely good at interviewing.

I know he’d hit us three separate times on money, but each time, we’d said we had made enough. The last time, I had figured he was reaching for something more, so I told him something of ourselves that I’d believed to be a truth. I told him that I had three grown sons, and that the middle 21 year old had already made himself into a millionaire and that I figured that when I got old enough to need assistance he and the other boys would be there for me. After that, he didn’t ask me anymore.

Afterward, Sr. Tess said to me that the guy had, of course, looked at our pay as well and had told Sr. Tess, that I was well worth over the amount she was paying me even in the field of developmental disabilities. Sr. took this as an insult and that she’d been paying enough to everyone. The guy also indicated three times, his distrust for the "religious order" part of things from a business point of view.

To him, I think he believed that Sr. was running things on a pretty tight purse string as if the whole Center had taken with her a vow of poverty, where others might think Sr. Was being very efficient and effective. He believed that every company should be run like a regular business as much as possible and he was proud his company had 4.3 million in the bank. *Sigh*

Late Tuesday afternoon, as well as some of the interpersonal statements, he really did want to get to us (Administration staff), some of his suggestions. We did end up having two recommendations which turned out to be the stuff "you have to fix." One of them was as I’d been saying the other day. We needed to predict the outcome, then state clearly whether we’d met it and offer an explanation (action plan), how we would address this.

The second recommendation had to do with our grievance policy. He said, we needed to be adding a timeline on whatever it was to next happen. Like three days after a complaint made, so and so would do whatever. It was like, OK we can fix that ... not too bad. The suggestions were also not bad. They were minor things that would help us in both the long and short run. There were about 8-10 of these.

What I did was to type out the recommendations and suggestions, he'd been cluing us in on and then I left them (and copies for the Administration staff) on Sr.'s desk.  We knew she gets tired at the end of the day, but in the morning she is very sharp and able to take care of the questions on hand.  Which is exactly what she did.  She was very ready to present the best our Center offers to the surveyor first thing.  She didn't need the Administration staff, like most things that happen at the Center, she took care of the matters personally.  Yay Sr. Tess!!

And, then there were the part about the compliments. There were at least a dozen if not more. He was very giving to us, including the part of the exemplary reports written. As an aside, he’d been happy we’d given him a copy of the reports (about an inch thick *giggle*). There was one other thing that affected his pleasure with the Center. It was really quite wonderful ...

I guess, he was kind of fiddlin around Wednesday morning, so fairly assuredly Sr. Tess pushed him a little to be going to the Thinking Group. So about a little more than half way through, he wandered into where we’d been working with the big group. We were all pretty warmed up at that time and excited that he would come in and sit down. He sat amongst the clients and they warmly greeted him after being introduced by the client who’d been our CARF Rep. I could tell he wasn’t sure what to expect. I’m pretty sure a Chicago "crowd" looks differently than a Kansas "crowd" and ours was pretty animated!

I told him that we didn’t know if he would come, but we were working down the line with the pre-CARF questions. When we looked down at our paper, I realized we’d gotten to the question on their rights and responsibilities. Thought ok ... ok ... we can do this. So, we did whatever it is that we do. (Hehe - I’m not the part in charge of this part). Needless to say, we were being pretty animated too. It’s pretty much a regular trick we do to keep everyone involved.

Well, one way or another, one of the clients started and than it began to run as fast asa greased pig. Man-o-man ... have never been so proud of the clients as we were yesterday. It was the kind of thing that brought tears to my eyes. About 7-8 people indicated they had something to say about rights. And none-of-it was the kind of stuff that was memorized. They spoke from their hearts with true understanding. Some needed a little assistance in the form of framing questions, but most related it to something very real in their life. Very, very spontaneous.

Then as it turned up, the next question was on safety. Basically, I asked them what did they know of safety at the Center. They responded to the first part on this one as a group. I bounced over to the alarm directions on the wall and covered them. And, I said, "what would happen if Sr. had wrung one bell. Most of them responded in a choir they would go out the front door, etc. The proudest moment of all was the question of what would happen if there was to be a tornado? (Hehe - thought this good for our Kansas Surveyor!)

I had previously out loud teased our Rep. about letting some of the others speak, but on this one, she began to wave her hand back and forth excitedly saying, "Oh, Oh, pick me for this one!" So, we said, "Ok, this is your big break, go ahead." Man-o-man ... never, ever before had I heard from either a client or a staff such an excellent explanation of what is done with this drill. From the time the bell had wrung to the time they were all tucked under their hands, this client nailed it! (Hehe we gave her an award for her CARF presentation later after things had calmed down!!)

I don’t remember what the 4th question was, but I think the 3rd question had to do about what did they do in the community. I’d been making sure a variety of them got a chance to convey what they were doing. Oh, I know their was a question on what they would do if they wanted their goals changed. Then about goals in general. Very, very responsive crowd.

We’d seen throughout Jim was very pleased and impressed. I really, really don’t think there is a group that is as excellent of thinkers as is our group. Toward the end, we had five minutes so we started preparing the group that Jim would be leaving within the hour, so we got serious some and asked the group if they had any problems they would like to talk about because Mr. Jim was also a problem solver. They looked confused for a second, then one of the clients said, "me, me!"

Jim looked like he’d put on his serious mask. The client walked over directly in front of the guy and started. I was a little worried, but thought this was a fair deal. Hehe, but what turned out was that the client had instead complimented the Center very well. So, then I spoke once more. I said, I’m very happy that he had wonderful things to say, but we were really wondering if anyone had problems.

Then it started, one after one again 7-8 deep, they all got up and told him that they didn’t have problems, but that they’d loved the Center, the staff, and all their friends. Shoot, could of hugged each one of them. This too after our big bit on who to go to if there was a problem. I’d set up a scenario where I as a staff had pretended to start kicking one of the clients. Oh man, did they think that was a Right’s problem ... ! It was all very, very good.

So, I had to extend the time a little, but I offered the group a chance to say anything they wanted to Jim before he left. It was very, very sweet. Someone even suggested that he would be missed. I think it kind of tore at both our hearts. Then I let them know they could shake his hand before he left. He gathered a crowd.

*Giggle* Having been affected by the Thinking Group might have made it back into his exit summary, umm about like four whole times?!? It got a little embarrassing for all the attention it had soaked up, but our client CARF Rep was at the meeting too, and I could see her beaming. Man-o-man ... You know ... a lot more happened, but in general? This is the part, we’re going to remember the most about the inspection. Just felt so proud of them!!! They stood up and spoke their minds. It’s what self-advocacy is all about.  They are wonderful learners!!

So, after a very, very long while ... I figure we better let you all be getting back to whatever it was you were doing. If you’ve made it this far, I want to really thank you for sharing with us our "CARF" experience. You all are the best!!! Thank you for listening :)  Love 'ya!!

Oh yeah, one more thing ... I'm pretty sure there are too many people to consider us, but none-the-less, we accepted being "nominated" for a CARF Surveyor position! :) :) :)