Everything you need.
Nothing you don't.

The work you do every day shapes the lives of the people who live in our homes, and it shapes the culture of this entire organization. Direct Support Professionals are the heart of Abilities, and every policy in this handbook exists to support the work you do, to protect the people you serve, and to make sure that showing up for this work feels worth it to you. We know what it takes to do this job well, and we do not take it for granted that you choose to do it here. Thank you for being part of this team.

This handbook contains the policies that govern residential services at Abilities, LLC. It applies to all employees in the Residential Services Department: Direct Support Professionals, Lead DSPs, Assistant House Managers, House Managers, Residential Program Managers, the Community Registered Nurse, the Community LPN, the Quality Assurance Professional, and the Due Process Manager.

This handbook works alongside the Abilities, LLC Employee Handbook. The Employee Handbook covers universal policies that apply to every employee regardless of department. This handbook covers everything specific to working in residential. You are expected to know and follow both documents.

If you have questions about anything in this handbook, your supervisor is your first point of contact. Human Resources is always available for guidance.

This tiered framework shapes how the entire Residential department operates. When something goes wrong at work, leadership uses it to decide how to respond — and it applies to everyone, from Direct Support Professionals to ISL Management to leadership itself. We put it at the very start so there is no guesswork: everyone sees the same framework leadership uses. It also makes clear that not every issue ends in discipline — most do not.

The examples are examples, not rules. Every situation has its own context. Two situations that look the same on paper can land in different tiers because of the circumstances around them. Leadership uses judgment, not a checklist. The framework gives the response structure; it does not replace judgment.

Most issues start at Tier 1 and move up only if the pattern continues or the behavior does not change. Some issues start at Tier 2 or Tier 3 because of the severity of what happened. Rights violations, abuse, neglect, theft, and falsification of records are examples of issues that start at Tier 3 regardless of whether the employee has any prior history.

Tier 1 conversations are tracked in coaching notes. Tier 2 and Tier 3 actions are documented in BambooHR as formal employment records. Every employee has access to their own records and can see what is on file.

• Full-time and part-time employees begin accruing PTO immediately upon hire, prorated to start date.
• PTO becomes available for use on Day 61.
• PRN employees are not eligible for PTO or benefits.
• House Manager, AHM, and Lead DSP positions are full-time only.
• Full-time employees must average at least 30 hrs/week to maintain accrual.

All hourly employees accrue PTO weekly, prorated to date of hire. Accrual is applied every Friday and is reflected in the weekly pay cycle.

• Submit and approve all requests in BambooHR.
• Can't request more PTO than what you've banked.
• Include a comment listing the hours you need off.
• Any request of 8 hours or more is treated as a full day off.
• Overnight PTO: two separate requests, one per calendar date.
• House Managers don't request PTO for Saturdays or Sundays — they're not scheduled. They do participate in the weekend on-call rotation per R1.4. This rule does not apply to protected leave.

Report your own tardies in the home's Google Chat. If you do not, ISL Management is responsible for reporting the tardy in the ISL Management chat. If you arrive 60 minutes or more late, it's no longer a tardy — it's a call-in.

• You're removed from the schedule for that shift
• The absence counts as a call-in on your record
• Hours are not made up later by the agency
• You may pick up open shifts later in the week at your discretion

• Call-ins are counted per shift, not per day. Two shifts in one day, calling in for both = two call-ins.
• Four consecutive call-ins require a note from a medical professional.
• Calling in on a holiday = automatic termination, regardless of PTO.

All absences, planned or unplanned, are tracked. House Management is required to report DSP tardies in the house management chat (not the house chat) when the employee does not self-report.

A pattern is the same type of absence happening 3+ times. One off week isn't a pattern. A repeating shape over time is.

• Loading PTO, then calling in within 24 hours of using it, every month
• Calling in every Friday/Saturday/Sunday to skip weekends
• Calling in every Monday to extend the weekend
• Submitting a PTO request, picking up other shifts in the same week to offset the requested hours, then cancelling the PTO before it deducts. Once is administrative cleanup; as a pattern, it's misuse of the system.
• Repeated absences in predictable spots that suggest intentional misuse

Paid by the last payday of the month for the prior month. Mid-month hires aren't eligible in their hire month.

Every year a $10,000 pot. Everyone who hits exceptional attendance for the full year splits it equally. Earning period: one Christmas Party to the next.

Schedules fill in this order to keep homes covered:

• Full-time may be scheduled up to 43 hrs/week (40 reg + up to 3 OT). Not guaranteed.
• Overtime comes from open shifts or coverage needs.
• Weekly schedules publish every Tuesday by midnight, 2 weeks out.
• Check your schedule within 48 hrs of publishing. Report errors to your RPM immediately.
• Already-published shifts aren't edited — changes go through the shift change process.

If you can edit the schedule (RPM, House Manager, AHM, Lead DSP, admin, on-call), you can only contact each employee once per day about an open shift. One follow-up allowed after at least 1 hour. Do not contact employees on approved time off — check BambooHR first.

• DRO: Approves/denies time off, assists coverage, publishes weekly schedule.
• RPM: Monitor staffing for your homes, communicate gaps to DRO. Update W2W in real-time when shifts change. End-of-pay-period (Saturday) updates: enter immediately.
• House Manager: All shifts at your home filled and accurate in W2W. Update in real time when staff stay late, come in early, leave early, etc.
• AHM: Support HM in coverage and schedule accuracy.
• HR: Maintain W2W access and availability records. Process availability changes within 2 business days.
• DSP: Work all assigned shifts unless properly traded. Check your schedule within 48 hrs of publishing. Use W2W for all shift activity.

By 2:00 PM every Friday, the Administrator on-call must:

DRO releases on-call schedules quarterly, no later than the 15th of the month before:

A "holiday weekend" is the weekend the holiday falls on, OR the weekend immediately after.

• No employee scheduled the same holiday weekend two years in a row
• No back-to-back recognized holiday weekends in the same calendar year
• Trading away a holiday on-call shift still counts toward your history
• On-call during a holiday weekend = extra $50 bonus

• ISL Management on-call: limited to one double shift per weekend
• All on-call employees: at least 8 consecutive hours of rest before and after a double shift
• Exception: if the third shift is a sleep shift allowing 6+ hrs uninterrupted rest, mandatory rest may be exempted
• Extreme shortage exception: 80+ open DSP shift hours in a single weekend = on-call may be asked to work a second double

Hourly employees on on-call who respond to work outside their scheduled shifts log and get paid for that time.

• Track time spent on coverage coordination, medical questions, phone/chat support, staff emails
• Combine multiple events into one daily SetWorks entry — comment must explain the type of communication
• Don't log on-call communication that happens during a regularly-scheduled paid DSP shift

Coverage is a collaborative effort between ISL Management and RPMs. Factors: current scheduled hours, weekend on-call rotation, approved time off, urgency.

• RPMs share the load. When staffing requires it, RPMs may be excused from office duties to work direct care.
• ISL Management shouldn't work more than two consecutive double shifts without a day off — if coverage pushes past that, the RPM steps in.
• If ISL Management has approved time off, they're not required to cover weekday shifts.
• If ISL Mgmt + RPM can't cover, the DRO steps in (including direct care). The Executive Director is the last resort.

• Medications
• Clothing for an extended stay
• Phone charger
• Anything else for an overnight

The number of designated sleep hours depends on activation length and is communicated by the Executive Director's office.

The full medical accommodation process — PWFA, ADA, required documentation, agency obligations and rights — lives in the Universal Employee Handbook. This residential policy doesn't replace it. It covers residential-specific operational pieces only.

Human Resources is the accommodation decision-maker and owns the interactive process. In HR's absence, accommodation decisions route to the DCE, then to the Executive Director.

• Any employee who provides medical work restrictions to anyone in residential leadership — those restrictions go to HR the same day.
• Residential leadership doesn't hold, delay, or evaluate restriction documentation.
• Placement (including potential temporary reassignment) is determined through the HR-led interactive process. Not the employee's choice. Not negotiated with House Manager or RPM.

Each ISL has different physical requirements based on the people who live there. A restriction reasonable to accommodate at one home might not be at another.

Some ISLs require Total ADL Care — the individual can't perform any part of dressing, bathing, toileting, eating, or mobility independently. The physical demands include:

• Bathing head to toe with sustained bending/reaching for 10–20 minutes per bath
• Dressing a fully dependent adult — pulling clothing over head/limbs, rolling side to side
• Full toileting support — transferring on/off, perineal cleaning, incontinence products, bed rolls
• Feeding by hand or spoon for the entire meal, supporting safe swallowing per dysphagia protocols
• Repositioning in bed every 2 hours when in bed long-term
• Transferring between bed/wheelchair/toilet/shower chair/recliner — possibly 2-person, mechanical lift, or pivot
• Oral care — brushing teeth, managing dentures
• Grooming — hair brushing, nail care, shaving

✓ = required at this home  ·  Daily = expected daily occurrence (not occasional)

RPMs and the CRN review these lists at least annually and update as individuals move in/out or experience significant changes.

Staff are expected to stay awake, alert, and actively engaged for the full duration of every shift that is not a designated sleep shift. The people we support depend on staff observation to know when something is wrong, and falling asleep on a non-sleep shift puts them at serious risk.

A designated sleep shift is a shift formally marked as such in the schedule and paid under Policy R2.2.

A staff member may be eligible when one of these is true:

• An individual leaves the home with family or another approved party and no longer requires support for the remainder of the shift
• An individual is hospitalized or unexpectedly away from the home, reducing staffing need
• All individuals have retired for the evening and current staffing exceeds what is needed

Applies to: DSPs, Certified DSPs, PRN staff, Lead DSPs, AHMs, Certified AHMs, House Managers, Certified HMs. Meeting one of the conditions above doesn't require approval if other operational needs require coverage.

When release is available and multiple staff are on shift, release is decided by total expected hours through end of the current pay period.

The staff member with the greatest total expected hours is released first. This applies regardless of role.

There is no discretion once total expected hours are compared.

Only the House Manager or Residential Program Manager may approve an early release. This authority cannot be delegated. No staff member may leave a shift early without direct confirmation from the House Manager or RPM.

If a staff member believes an early release decision is being applied inconsistently or unfairly, escalation must happen while the staff member is still on shift.

Concerns may also be reported to HR after the shift if the issue isn't resolved through escalation. Retaliation against any employee for raising a concern under this policy is strictly prohibited.

Most issues at work get solved through coaching, not discipline. The agency's Staff Accountability Tier Reference gives the at-a-glance framework. This policy explains how coaching actually works and the path between coaching and termination when that path is needed.

Before deciding what response a situation needs, leadership looks at how widely the issue is showing up.

This is a diagnostic step that tells leadership what kind of response is needed before any conversation happens.

Coaching is not a write-up. It's a working conversation between the employee and their supervisor that includes:

• A clear, specific example of what the employee did that needs to change
• A clear, specific example of what doing it right looks like
• A defined timeline for the change to take hold — short for black-and-white things (clocking in on time), longer for skills that take practice

When the timeline passes and the employee has not made the change, or when the issue keeps repeating, coaching becomes formal corrective action:

Uncontrolled emotional outbursts directed at a coworker or an individual served are taken seriously regardless of where the employee is in the corrective action path.

Coaching conversations are tracked in coaching notes. Written warnings, final warnings, and terminations are documented in BambooHR as formal employment records. Every employee has access to their own records and can see what is on file.

House Managers and Assistant House Managers cannot work only morning shifts or only evening shifts. They are expected to work across both on a regular cadence.

The reasons are practical:

• The home runs differently in the morning than in the evening — different behavioral patterns, different work being done by the team, different ways the people we support spend their day
• A manager who only works one part of the day cannot effectively manage what they have not seen
• Evening DSPs need to see their leader work the shift they work, and morning DSPs need the same
• New procedures, new training, and culture changes all hold better when the manager is present during the part of the day they're trying to change

• Substantially higher physical toll than any other Abilities ISL
• Serves 4 individuals (other homes serve 3) with much higher per-person care demand

DSPs, Certified DSPs, AHMs, Certified AHMs, House Managers, and Certified House Managers when working at Knob ISL. The $1.00 differential applies in two ways depending on how you're staffed at Knob:

Holiday pay applies only to residential direct-care shifts. Doesn't apply to admin work or other departments.

See Universal Handbook Policy 2.2 for general holiday rules.

Designated sleep shifts in residential are paid at a flat rate of $18.00 per hour. Sleep hours are not included in overtime calculations.

Employees whose primary schedule is every Saturday and every Sunday receive 4 extra paid hours per weekend at their regular hourly rate, on top of the hours they work. These are called Comped Hours. Comped Hours are not included in overtime calculations.

The 4 hours are tied to fulfilling the every-weekend duty. If an employee calls in, uses PTO, or otherwise does not work both weekend shifts, they forfeit the Comped Hours for that week.

All Activity Records follow this daily structure regardless of when your shift is:

First staff member to start in each block creates the record and lists all staff and individuals present. Documentation times can't overlap.

• Individual's name, home location, correct start & end time
• Accurate Staff Attendance times reflecting when you actually worked. Scheduled 3:00 PM, arrived 3:11 PM? Start time = 3:11 PM.
• Accurate Individual Attendance times reflecting when you actually supported each person. Person leaves for day program at 9 AM? Their attendance ends at 9 AM.
• Narrative comment covering the full time, with meaningful detail, using the person's first name or initials
• Answers to all goal, outcome, and plan questions
• Your SetWorks PIN signature

• Shift Tasks: services like disinfecting, cleaning mobility equipment, laundry, etc.
• Visual Checks: visually check on each individual at least once per hour (unless PCSP says otherwise) and document each check
• Split Records: overnight shifts must be split into two separate records, one per calendar day

• Collect data as specified in each individual's BSP, in the format Behavior Services trained you on
• Record everything accurately
• Submit through whatever system Behavior Services specifies (SetWorks, paper, or other)
• Notify the BCBA or Lead RBT in the house chat if you can't collect data, a tracking tool is missing, or you notice a significant behavior change
• Participate in BCBA training on data collection

When an RBT is conducting a scheduled ABA session, that time belongs to the individual on the schedule. Don't interrupt for non-emergency tasks, household requests, or general questions.

If you have a question about why an individual's BSP is written a certain way, or what an intervention is intended to do, that question goes to the BCBA. RBTs implement and train DSPs on the plan as written — they don't have the authority to explain or modify clinical decisions.

When an individual has an active BSP, you're on the implementation team. Behavior Services trains you in person before you implement.

• Follow the BSP exactly as written during your shifts. No improvising, skipping steps, or substituting your own judgment.
• Collect behavioral data as directed (see Policy R3.2)
• Report concerns about BSP implementation, unusual behavior changes, or situations where the plan isn't working — to your House Manager AND the assigned BCBA or Lead RBT

Full RBT/BCBA scope of practice lives in the Behavior Services Handbook.

Many ISL leases say no pets. If the lease says no pets, there are no pets. Abilities, LLC will not violate a lease for any reason. Individual wants a pet but lives in a no-pet home? They may choose to move to one where pets are allowed.

• The landlord lease specifically allows pets, AND
• All requirements in this policy are met and kept up over time

Pet ownership can be denied or ended at any time if it's no longer safe, sustainable, or fair to housemates.

The individual and/or guardian/payee must have their own money for all pet costs:

• Adoption or purchase
• Food, supplies, crates, bedding, toys
• Routine and emergency vet care, medications
• Grooming, licensing, vaccinations

Abilities, LLC does not advance or provide funds for pets.

Abilities, LLC will not allow animal neglect or abuse — intentional or unintentional. Every individual has the right to a pet, and every pet has the right to be safe.

• Housemates: Pets must not disturb housemates through excessive noise or ongoing odors. Ongoing problems = pet must be rehomed.
• Property: Individual and/or guardian are fully responsible for damage to floors, furniture, belongings, plus cleaning and repairs. Abilities does not cover pet-related damage.

Abilities may deny or end pet ownership at any time based on lease, health/safety, housemates, animal welfare, or sustainability.

• Invite and have visitors at any time — evenings, weekends, overnight
• Talk privately with visitors. Staff can't listen in or interfere without due-process restriction.
• Have visitors stay as long as they choose
• Overnight stays permitted for a typical number of nights, like anyone would have a close friend/family stay. Visitors can't move into the ISL or sleep in communal areas.

Only in these specific situations:

• Develop and maintain intimate relationships
• Privacy in relationships and personal expression
• Access age-appropriate information about relationships, sexuality, sexual health
• Make their own decisions about their body and relationships
• These rights cannot be restricted by staff attitudes, house rules, or provider policy without formal due process

• Treat individuals' relationships with respect and without judgment
• Give privacy when asked or when the situation calls for it
• Never mock, discourage, shame, or interfere with relationships or personal expression
• Never apply informal rules without due process — like prohibiting a partner from visiting or requiring a bedroom door to stay open at all times
• Specific concerns? Contact your House Manager.

The right to sexuality and intimate relationships does not include the right to commit a sexual crime or sexually harass another person. Examples:

• Viewing child sexual abuse material
• Attempting to date or sexually pursue minors
• Continuing romantic or sexual advances toward someone who has declined
• Any conduct that's criminal or constitutes harassment

A documented concern that an individual may be exploited, coerced, or harmed in a relationship → report to your supervisor right away. A safety concern does not let you restrict the relationship on your own. Requires a team response.

• Exploitation/abuse concerns: report per Universal Handbook 6.2 (Abuse and Neglect)
• Concerns about ability to consent: bring to the team — may involve BCBA, Community RN, guardian
• Any restriction based on safety concern requires formal due process per Universal 5.4

• Own and use personal belongings without interference
• Furnish and decorate personal living space the way they want
• Have belongings handled with care by all staff
• Be told if something is lost or damaged, and have it addressed

When someone moves into an ISL, ISL Management completes a personal property inventory. Stored in SetWorks > Individual > Additional Info. Updated when major items are added/removed (with consent), or after any incident involving property damage.

• Handle all personal property with care and respect
• Never borrow, use, move, donate, or throw away an individual's belongings without their express permission (or guardian's, where applicable)
• Report lost, missing, or damaged property to the RPM right away
• Never make independent decisions about what an individual should or shouldn't own

Accidents happen. The expectation is: when something goes wrong, you say so. This is integrity. Concealing damage, pretending you don't know what happened, or staying quiet because you're afraid is a more serious problem than the accident itself.

Belongings can only be donated or thrown away with informed consent from the individual and, when applicable, the guardian. Consent must be documented. You cannot decide on your own that something is too old, too broken, or unnecessary.

• Control their own money to the fullest extent possible (unless formally restricted)
• Decide how to spend, save, or use their money
• Get support in learning to budget and manage money
• Access their own financial info in a format they understand
• Make their own choices — including ones staff disagree with — as long as they're not being exploited or placed in danger

An individual's EBT card, household funds, and grocery funds belong to them. Staff support — staff don't control access.

If an individual has a documented support need related to finances/shopping, the support is described in the PCSP and reflects choice, not restriction. Any actual restriction must go through formal due process per R4.9 and Universal Handbook before implementation.

Only through formal due process per Universal 5.4. Staff convenience, accounting ease, and personal opinions about someone's spending choices are not valid reasons for a restriction.

The Nursing Department manages all DNR authorizations, documentation, and staff communication. See Chapter 11 (Nursing) for the Nursing Department's policy.

• Routine medical and preventive care fitting their age and needs
• Dental, vision, and hearing exams + recommended follow-up
• Specialists when health requires it
• Choose their own healthcare providers
• Be told about conditions, medications, and treatment options in a way they can understand
• Refuse medical treatment. If they refuse, staff document and notify house Google Chat.

• Support individuals in attending scheduled appointments and document attendance + outcomes in SetWorks
• Never discourage, delay, or block healthcare access
• If an individual refuses recommended care, document the refusal and notify the house Google Chat
• Encourage and support wellness activities based on what the individual enjoys, prefers, and what their PCSP includes

• Access and use the internet, social media, and digital platforms of their choosing
• Use a phone, television, and radio
• Communicate privately using any platform or device they choose
• Practice their religion or choose not to — including attending religious services and activities
• Participate in political activities — rallies, protests, volunteering, voting
• Vote (and receive support in doing so) unless a court order specifically removes that right
• Participate in civic activities — city council meetings, community organizations, public life

• Support access to internet, social media, and digital tools as part of daily life
• Never restrict phone, TV, internet, or social media without a due-process restriction
• Transport individuals to and from civic, religious, political, and community activities they choose to attend
• Actively support the activity while there — not just passively standing by
• Help the individual participate the way they want — this is their experience, not yours

• No single person can decide to restrict an individual's rights. Takes a full team discussion.
• Rights cannot be restricted by provider policy, staff practices, or house rules.
• Rights cannot be limited without formal due process.
• Restrictions must never be used for staff convenience, as discipline, retaliation, or to save money.
• Positive supports must be tried and documented before any restriction is considered.

These are examples, not exhaustive. Unsure if a practice is a prohibited house rule? Contact the Due Process Manager or your House Manager BEFORE doing it.

• Implement approved restrictions exactly as written in the PCSP and due process documentation. Don't add, remove, or change anything.
• Never impose an informal restriction not in the PCSP
• Collect required due process data using tools/methods the Due Process Manager or Behavior Services specifies
• Report concerns about a restriction's impact on the individual to Due Process Manager or House Manager right away
• Notify your supervisor immediately if you see any restriction being applied differently than the approved documentation

Coordinates, documents, submits, tracks, and monitors all due process activities at the agency. Responsibilities:

• Working with the individual's team to identify restrictions and required data
• Writing all due process documents using agency templates
• Collecting all required signatures
• Submitting documentation to DMH within 30 days of plan starting
• Tracking submission confirmations and deadlines
• Building and monitoring data collection tools in SetWorks
• Reviewing due process data at least every 2 weeks
• Tracking restoration goals
• Reporting prohibited practice referrals to leadership

Any rights restriction identified as a possible prohibited practice → report immediately to Executive Director and DRO, reviewed through the prohibited practice review process, corrected and resubmitted as required.

Many people we support use wheelchairs or can't move independently. Approved evacuation methods:

Power Outage

• Flashlights only — no candles or open flame
• Check that everyone's safe and comfortable
• Power-dependent medical equipment? Activate backup immediately (portable tanks, batteries, or relocation)
• Notify on-call supervisor
• Incident report only when responders called, individual injured, or power-dependent medical equipment affected requiring emergency response/relocation. Routine outages with backup working = no IR.

Water/Sewer Failure

• Notify house chat right away (Maintenance + ISL Mgmt aware)
• Follow Maintenance/on-call instructions for bottled water, hygiene, or temporary relocation
• No incident report required

Maintenance Emergencies

Broken pipes/flooding, no heat/AC during extreme weather, electrical hazards, sewage backup.

• Business hours (M–F, 8 AM – 4 PM): Notify HM or RPM, who contacts Maintenance
• After hours, weekends, holidays: Text the Maintenance Emergency Line at 660-563-0830. Then notify on-call supervisor.
• While waiting: keep individuals safe and away from hazard. Immediate danger (fire, gas, CO)? Call 911 first.

If the individual has an elopement plan in their BSP or Safety Crisis Plan, follow that plan first.

Catastrophic = home seriously damaged, may not be safe to occupy: missing roof, structural damage, unrestorable utilities.

• Call 911 immediately and follow their instructions
• Notify on-call supervisor immediately
• Keep other individuals calm and away from the area

Stay with housemates. Keep the environment as calm as possible. Follow the administrator's instructions for next steps.

• Staff complete an Event Report in SetWorks within 24 hours of the death
• RPM collects all supporting documentation: medical info, incident details, witness statements. Kept secure.
• Finance Director finalizes billing up to date of death within 7 days
• All documentation kept for minimum 7 years per HIPAA and DMH retention standards

Executive Director's Office leads a mortality review with nursing, RPMs, and behavior services as needed. Covers:

• Circumstances surrounding the death
• The person's medical, behavioral, and service history
• Staff actions and response times
• Any potential contributing factors or system issues

Findings documented and submitted to DMH as required.

The Department of Culture and Experience arranges grief support for housemates and staff. Counseling resources offered to both individuals we support and employees.

A medical task an RN has assessed, determined safe to delegate, trained you on, verified your competency for, and formally documented. Only formally delegated employees may perform.

• Delegations written by nursing. Signed by Community RN when applicable.
• Training in person by an RN or LPN only. Demonstrate competency before doing it on your own.
• Refreshed every year and whenever the individual's care needs change
• You + training nurse both sign a delegation signature page

Written guide telling you what to do when a specific medical condition, symptom, or event occurs. Protocols don't assign hands-on nursing tasks — they tell you what steps to take. Examples: blood pressure, seizure, shunt protocols.

• Protocols written by nursing, signed by Community RN
• ISL Management trains new employees on each individual's protocols before independent work
• Refresher training only when protocol updated or individual's condition changes
• Sign the protocol signature page for each protocol you're trained on

Equipment supporting health, safety, mobility, positioning, or daily functioning: medical/adjustable beds, walkers, wheelchairs (manual + electric), shower chairs, lifts, transfer equipment without nursing delegation.

• House Management trains new + current employees in person. Demonstrate competency before working with it on your own.
• Completed forms → RPM for upload to SetWorks
• Refresher training only when equipment changes or use changes affect care/safety

Tools that help an individual express themselves: speech-generating devices, PECS, AAC apps, eye-gaze tech.

Trained direct-care staff perform these as routine support per the PCSP:

• Brief changes, toileting assistance, bathing, personal hygiene
• Mouth care, oral swabs, tooth brushing
• Grooming, dressing, ear cleaning
• Cutting/trimming fingernails and toenails
• Specialized utensils, adaptive dining tools
• Medication administration (under LIMA authority)

• Diet must be on the individual's Physician's Orders AND in the PCSP
• Individual must be told why and must agree
• Diet order reviewed at least annually by registered dietician, physician, PA, or APN
• Meal prep delegations written/authorized by Community RN. Community LPN delivers in-person training. Staff demonstrate competency before preparing/serving independently.

• Double-locked: locked bag/box inside a locked cabinet. Two separate physical locks, each requiring its own key.
• Refrigerated controlled meds: locked container in a locked refrigerator (or locked bag in fridge if locked fridge unavailable)
• Stored separately from all other medications

A count is required when one staff member is leaving while another is arriving and there's a transition of medication custody.

First time or restocked: the person delivering it participates in the initial count with ISL Management. Count together, record starting count on log, both parties sign. Don't place in storage until count is logged and signed.

Update the narcotic log immediately:

• Date and time of administration
• Medication name and dose given
• Subtract dose from previous count, record new total
• Both administering staff and witness sign or initial

Single straight line through the incorrect entry. No scribbling, blacking out, or white-out. Initial next to the stricken entry. Corrections must be neat, legible, transparent.

• Current Abilities employee
• Qualified, authorized, Level I Medication Aide trained
• Follows all medication administration procedures in this policy

• Administered exactly as prescribed
• Never crushed, split, altered, or combined unless explicitly ordered by physician AND documented on POS
• Observe the individual take the medication (unless refused)
• PRN meds administered + documented per physician-ordered parameters

Abilities uses CaraSolva as the electronic Medication Administration Record. SetWorks is the broader documentation platform; CaraSolva is the eMAR specifically. All medication activity — administration, refusals, omissions, errors — documented in CaraSolva. Sign at the time of administration.

Errors include:

• Medication not given or missed
• Given at wrong time
• Incorrect medication or dosage
• Staff forgetting to administer
• Medication unavailable due to pharmacy/insurance issues

• Individuals have the right to refuse. Staff cannot coerce or force.
• All refusals documented in eMAR at the time
• 3+ refusals in one calendar month → House Manager notifies primary care physician, implements follow-up guidance, documents
• Auditors will look for documentation that physician was notified of repeated refusals

One narrow exception. Covert administration may only occur when BOTH are in place:

• Specific physician order authorizing covert administration of that medication for that individual
• Completed due process plan under Universal 5.4, including Columbus Group review, that authorizes covert administration as a documented rights restriction

BOTH conditions must be met. A physician order alone is not enough. A due process plan alone is not enough. Outside this narrow pathway, hiding medication is never allowed for any reason — including staff convenience, individual refusal, or guardian pressure.

• Only PRN meds ordered by physician AND listed on eMAR + POS
• Document why PRN was administered at the time (e.g., complaints of pain, headache, fever)
• Return to eMAR before end of shift and document effectiveness (headache resolved, continued pain, etc.)

• Disposal container clearly labeled with individual's name + "medications for destruction"
• ISL Management collects + turns in to office nurses (CRN or LPN). Nurses handle legal disposal.
• Don't let medications accumulate — routine handoff, not occasional or end-of-quarter cleanouts
• Excessive accumulation = compliance deficiency
• Narcotic meds being pulled for destruction: count first. Deduct from controlled log at removal. Both ISL Mgmt and collecting nurse sign log at that count.
• Be ready to show auditors where disposal meds are kept

Abilities promotes individual independence and treats every administration time as an opportunity for education and skill-building. Self-administration is encouraged when appropriate and documented.

• Bring personal meds into the home? Proper storage at all times is your responsibility.
• All staff meds (including OTC) stored locked in the designated staff area
• Cannot be in the medication cabinet or any individual's medication area
• Staff may NOT purchase meds and bring them in for individuals
• Staff may NOT bring personal meds from home for individual use

Engage individuals during administration in a respectful, age-appropriate, person-centered way. Encourage them to learn:

• Medication names
• Reason for each
• Dosages and timing
• Asking questions

Teaching is ongoing, informal, adjusted to communication style and readiness. Individuals are not required to participate if they choose not to at a given time.

Each month, nursing reviews each home: storage, ordered meds present, removal/destruction of expired/discontinued, overall practices. Written Medication Review Report distributed to RPM, Nursing, and ISL Management.

Only DD Med Aides (LIMA — interchangeable terms) or licensed nurses may administer. At least one med-trained staff on duty in the home 24/7. Scheduling requirement and regulatory obligation.

Med practices are subject to internal audits, nursing review, and DMH oversight. Failure to comply may result in corrective action up to and including termination.

Until the formal process is published, incident review continues under the current Quality Assurance Professional and supervisor workflow. This policy will be updated when the formal debrief process is in place.

A PCSP outcome = a goal the individual wants to work toward (daily living skills, community participation, employment, health, independence). An implementation strategy = the specific written plan for how staff support them: the steps, frequency, and tracking method.

Outcomes are not tasks assigned to staff. They are directions the individual chose for their life — staff are the vehicle for getting there.

• Read each individual's implementation strategies — they're printed and kept in the home and stored in SetWorks (permanent retention)
• Follow exactly as written. No improvising, changing steps, or substituting your own approach.
• Document each implementation in SetWorks at the time it happens: participated, refused, support adjusted, relevant detail
• Notice a strategy not working, unrealistic, or causing problems? Tell HM or RPM — strategies are designed to be reviewed and adjusted

Individual refuses? Document the refusal in SetWorks at the time. Don't skip docs, force participation, or pretend it occurred.

Refusal of every implementation of an outcome for an entire month → RPM documents the pattern in monthly review and the team revisits the strategy.

If an individual has both a PCSP outcome AND a BSP goal, documentation lives in two places. PCSP docs → SetWorks under implementation strategies. BSP data → wherever Behavior Services directed (per R3.2). One does not substitute for the other. Both completed as written.

• Review Activity Records in SetWorks for completeness, accuracy, and Policy R3.1 compliance
• Send Activity Record Exception forms via BambooHR when records are missing/deleted
• Track patterns of non-compliance, report to DRO + ISL Management
• Support training on documentation standards as needed

• Maintain accurate financial ledgers for each individual
• Process individual financial transactions per Finance Department's procedures
• Reconcile on the cadence the Finance Director sets. Finance Director reconciles all accounts where QAP makes ledger entries.
• Flag any concerns about individual financial activity to the Finance Director immediately

• Maintain organized SetWorks files per Policy R6.9
• Required documents in correct subfolders
• Support audit/survey readiness across all individual records
• Coordinate with RPMs + ISL Mgmt on home-level doc issues
• Coordinate with Nursing on medical records + physician orders
• Coordinate with Finance on individual financial matters
• Coordinate with Due Process Manager on rights restriction documentation

Both have two sources:

• Calendar-driven: happens automatically based on month length. 31-day month = 1 day overage. 28-day February = 2 days variance. Calculated every month.
• Event-driven: happens mid-month when something changes — hospitalization, discharge, day program refusal, support ratio change.

The Executive Director calculates the hours affected for each event (authorized monthly hours ÷ 30), prepares the MMAC worksheet for variance, and submits the over-served variance report to REDCap within 30 days of the end of the plan year, then submits to MMAC. Residential staff support by maintaining accurate documentation and reporting service changes promptly. See Finance Handbook Policy F4.6 (ISL Variance Billing) for the related finance workflow.

• ISL Management: prepare bedroom and personal space, ready shared spaces, address environmental modifications
• RPM: introduce all current staff to new individual's information and specific support needs
• Nursing: review medical orders, set up eMAR, arrange medications for move-in day. Draft Physician's Orders, sign delegations/protocols when applicable.
• Behavior Services (if applicable): prepare BSP, behavior tracking, AbiliBucks materials

RPM + assigned ISL Management team present. ISL Management welcomes individual and supports settling in.

• Complete personal property inventory (Policy R4.4)
• Complete home walkthrough with the individual
• Introduce to housemates and any staff present
• Confirm all medications and supplies are at the home
• ISL Management ensures appointment folders, contact info, emergency info are in place

• RPM checks in with individual + ISL Mgmt + direct staff regularly
• Nursing visits within the first week for in-person nursing assessment
• BCBA visits within first week to begin assessment + team coordination (if behavior services apply)
• Fire drill within 7 days of move-in (per R5.1)
• Concerns or adjustments → DRO

• RPM: leads home-level transition, ensures systems/supports in place, present for move-in day
• ISL Management: prepares home/bedroom, supports day-of arrival, completes property inventory + walkthrough, orients individual
• Nursing: medical orders signed, eMAR set up, meds available move-in day, in-person nursing assessment within first week
• BCBA (when behavior services apply): begins assessment + team coordination during first week
• DSPs: review PCSP, BSP, POS before working a shift; welcome the individual with respect and care
• Maintenance: assists with physical move-in — moving furniture/belongings, hanging items, home setup tasks

Two house meetings required after move-in: 1 week after move-in and 30 days after move-in. Receiving home checks the transition is going well; individual is heard.

• Team meets to discuss the move and confirm new home is appropriate
• RPM coordinates with individual, guardian, support coordinator, clinical/behavioral team
• New home receives complete copy of PCSP, POS, BSP, AbiliBucks plan, support docs before move-in
• Personal property inventory updated
• Both ISL Management teams (leaving + receiving) communicate during the move for continuity

• Executive Director coordinates with support coordinator + receiving provider
• RPM prepares records package: PCSP, POS, BSP, AbiliBucks plan, monthly reviews, other relevant docs
• Nursing prepares medications for transfer
• Finance Director closes individual's accounts up to discharge date
• ISL Management supports packing + moving belongings
• All required regulatory notifications by the Executive Director

Rare circumstances. Decision is never made by a single person — formal process led by the Executive Director.

• Reasons may include extended hospitalization (R5.3), documented inability to safely meet needs, persistent safety risks that can't be addressed within current resources
• 30 days advance written notice to individual, guardian, support coordinator (except emergency situations)
• DRO supports team during transition
• All required regulatory notifications completed

• House Manager keeps tracker accurate and current
• AHM and RPM support and back up the HM when needed

• Date of the appointment
• Appointment type (Scheduled, Urgent Care, etc.)
• Physician name
• Location
• Whether the appointment was completed (Yes / No)
• Comments: outcomes, follow-up needed, new prescriptions, and any notes from the visit
• Whether there were medication changes (Yes / No)
• Whether documents have been uploaded to SetWorks (Yes / No)

Update as soon as anything changes — new appointment scheduled, rescheduled/cancelled, completed, or follow-up actions identified.

• RPM writes and signs the monthly review for each individual at their assigned homes
• Sends to Support Coordinator via BoldSign
• SC signature required for review to be considered complete

• Progress on each PCSP outcome for the month
• Implementation strategy data + patterns of refusal (with documentation when individual refused for entire month)
• Health and safety updates: incidents, hospitalizations, medication changes, emergency events
• Service delivery summary including any variances reported
• Recommendations for the next month

Why it works this way: Working clinical references on paper give fast access during a shift (including emergencies and times when SetWorks isn't accessible). SetWorks gives complete, secure, retrievable file for compliance, audit, and continuity of care.

Year-specific folders created annually.

[Year] Medical

• Adaptive Equipment
• Delegations & Protocols
• Destroyed Medications
• Immunizations
• Labs & Imaging
• Medical Documents
• Narcotic Counts
• Nursing Summaries
• Physician's Orders

Behavior Services

• Assessments
• BSPs
• Monthlies

Finances

• Bank Statements
• EBT Receipts > [Year]
• PSA
• SSA/SSI Documents > [Year]
• Tax Documents > [Year]
• UR Packets
• Variance

Mileage > [Year] > [Vehicle]

Misc.

• Adaptive Equipment Cleaning
• Consents
• HCBS Handbook
• Identification
• Leases
• Risk Assessments

Pre-SETworks

[Year] PCSP

• ABI Monthlies
• Due Process
• Implementation Strategies
• PCSPs & Addendums
• SC Monthlies

• RPMs, DRO, Executive Director use Monday.com regularly
• House Managers and AHMs use it for variance reporting + boards their RPM has assigned
• DSPs do not have Monday.com access

See R6.3 for variance reporting requirements. The Variance board lives in Monday.com and is the system of record for all residential variances.

RPMs and DRO may use additional boards for project tracking, cross-department coordination, operational workflows. Any new board involving residential staff must be communicated by the DRO before staff are expected to use it.

• Guardian completes apps/renewals? RPM tracks dates and confirms with the guardian before deadlines that the work is being done
• Agency required to complete? RPM completes them or coordinates through proper agency staff
• Lapse, upcoming renewal, or missing application identified? RPM notifies guardian immediately and documents
• Guardian doesn't respond/act? RPM escalates to DRO and continues working the issue

• RPM maintains current record of EBT + Medicaid status, renewal dates, required documentation for every individual on caseload
• All correspondence with guardians about benefits documented + kept in individual's SetWorks file
• All correspondence with state and benefits agencies documented + kept in SetWorks

Every EBT purchase generates a receipt. Every receipt must be retained and uploaded so we can show how funds were used if an auditor or guardian asks. Part of the benefits accounting trail.

• RPMs upload EBT receipts to the individual's SetWorks file under Finances > EBT Receipts > [Year]

SSA letters arrive at the office for every individual. Each typically reflects a change in benefit amount, eligibility, or status. SSA letters drive the room and budget calculation for the individual's ISL.

• RPMs open SSA letters as soon as they arrive
• Upload each letter to SetWorks under Finances > SSA/SSI Documents > [Year]
• Update the ISL Room and Budget Calculation Worksheet (in Residential for RPMs > ISL R&B Calculation Worksheet)
• Worksheet auto-updates downstream calculations once source figures are entered. Confirm the update populated correctly before closing.
• Letters opened as they arrive; worksheet updated within 1 week of receipt

PSA receipts are kept in the home binder. ISL Management then scans, uploads, and enters them into SetWorks' PSA Ledger — with the receipt attached directly to the ledger entry.

Each individual living in an Abilities, LLC ISL has a sub-lease signed by the individual and/or their guardian and the Executive Director. Abilities, LLC signs and holds the master lease with the landlord.

• The Finance Director sends out sub-leases each year by December 1 for January 1 renewal
• Signed sub-leases are uploaded to SetWorks under Files > Misc. > Leases
• Unsigned or draft documents are never uploaded

See Finance Handbook Policy F6.1 for the full sub-lease workflow.

The Residential Program Manager sends each individual's PSA Ledger for the previous month to the guardian by the last day of the current month. This is a monthly RPM-owned task.

Scheduled in WhenToWork as purple shifts. Paired with an experienced staff member who shows you how the home runs, introduces you to each individual, supports learning the systems.

• New employees complete training shifts as part of orientation
• Existing employees moving to a new home complete training shifts before working solo there
• All training shifts at a home must be completed before you're scheduled solo
• Calling in to a training shift in your first 60 days = immediate termination per R1.1

Exact number for any new hire is set by the DRO based on the home, the new employee, and that employee's experience.

The agency is developing home-specific checklists for each ISL. These will list every task, routine, individual-specific support, and system a new staff member must learn before working independently. Once implemented, the checklist becomes the formal record of completion.

• Hands-on intro to each individual you'll support — PCSP, BSP, POS, individual-specific delegations/protocols
• Daily routines: morning, evening, overnight expectations
• Emergency procedures: posted evacuation route, shelter location, supporting each individual during emergencies (per R5.1)
• SetWorks documentation system
• Where supplies, equipment, and emergency resources are kept
• Communication tools: house Google Chat, where binders/folders are kept

Tools of Choice = positive behavior support training. MANDT = crisis intervention training. Tools of Choice gives you everyday tools to support people in healthy, dignified, person-centered ways. MANDT gives you tools for those rare crisis moments. Both required.

Department of Culture and Experience owns Tools of Choice. Delivers the in-person 16-hour course at hire and 4-hour annual refresher.

Beyond agency-wide requirements: trained on each individual you support — PCSP, BSP (if applicable), POS, nursing delegations/protocols, adaptive equipment, communication device. Required before working independently with that individual; refreshed at least annually or when needs change.

• All required training tracked in BambooHR
• Call in to a scheduled training session → your certification lapses. A lapsed certification means you cannot legally administer medications or perform delegated nursing tasks until it is reinstated.
• Repeated failure to complete required training = corrective action up to and including termination
• QAP schedules DSPs for required ongoing training and tracks completion

The Shadow Day is a confirmation step that runs both ways — before either side commits to a full week or more of training. Most turnover happens in a new hire's first 60 days, and the Shadow Day puts a realistic look at the work at the front of that window.

A new hire's first three days run in the order below. The Shadow Day is the Day 2 piece that takes place in a home.

An assignment pairs one new hire with one experienced staff member in a specific ISL for the four-hour shadow. Every new hire receives one assignment before Day 2. In the assignment, the new hire is the observer.

• Who they shadow: an experienced staff member who has completed training, is established in the role, and is working a regular shift during the shadow window — comfortable working alongside a new person while doing their normal job.
• Who makes the assignment: HR assigns each new hire to a staff member and an ISL.
• Why it's assigned and not chosen: a new hire doesn't yet know the homes, the staff, or the people who live in them. HR pairs them with a staff member and a home that's ready for a visitor and where the real work can be shown.
• How it's set up: HR identifies the staff member and the ISL and schedules the shadow on the new hire's Day 2 schedule in WhenToWork.

The four hours follow the staff member's actual shift. Nothing is staged for the visit.

• The staff member gives the new hire a tour of the home and introduces them to every individual who lives there.
• After introductions, the new hire stays with the staff member and goes where they go for the rest of the four hours — care, meals, errands, pickups, and the ordinary parts of the shift — unless it's not physically possible or appropriate for the new hire to be present.
• The new hire watches and asks questions; the staff member talks them through the work.
• Questions during the shadow go to the staff member or the House Manager.

The assigned staff member works a normal shift and brings the new hire along. During the shadow, the staff member:

• Stays with the new hire for the full four hours.
• Gives the tour and makes the introductions at the start.
• Talks the new hire through the work and answers questions as they come up.
• Keeps the new hire within the limits above — the new hire watches; they do not step in.
• Says so when they don't know an answer, and points the new hire to someone or something that does. They do not guess.
• Does not train the new hire, teach tasks, or transfer job information. That happens after the shadow, in training.

Every new hire signs the Observer Agreement at orientation on Day 1, before any home visit. It's a companion to this policy — the new hire's written commitment to: observe only, stay with the assigned staff member, keep what they see and hear private, respect the home and the people who live there, and never be alone with anyone who lives in the home.

• HR uploads the signed Observer Agreement to the employee's BambooHR file, in the Employee File folder.

The Shadow Day closes with a check-in on Day 3 — a verbal conversation between the new hire and the Director of Residential Operations, 30 minutes or less. It's not a test and it's not disciplinary. Its purpose is to hear how the shadow went, find out whether the job feels like a fit, and confirm whether the new hire is continuing.

• Continuing: the new hire continues with training.
• Undecided: the DRO finds out the reason and what the new hire needs, and sets a follow-up.
• Not continuing: the final paycheck is available by the method selected in BambooHR (direct deposit or check), on the payday following the end of the current pay period.

After the check-in, the DRO enters a brief note in the employee's BambooHR profile. The note records the conversation — it is not a disciplinary record.

• It is not training. The new hire watches the work but does not perform it. Training begins after the shadow, for those who continue.
• It is not a working shift. The new hire provides no care and does not count toward the home's required staffing.

• WhenToWork: the new hire's Day 2 shadow hours and training modules are scheduled here.
• BambooHR: the signed Observer Agreement is filed in the Employee File folder, and the Day 3 check-in note is entered in the employee's profile.

• Kitchen: Dishes washed and put away after each meal. Counters wiped after each use. Floors swept daily.
• Bathrooms: Toilets, sinks, floors cleaned daily.
• Common areas: Surfaces wiped, floors swept/vacuumed, clutter cleared daily.
• Bedrooms: Cleaned daily with the individual's involvement, respecting their personal space and preferences.
• Trash: All trash taken out daily.

• Bathrooms: deep cleaned (showers, tubs, grout)
• Floors: mopped throughout the home
• Kitchen: refrigerator wiped down, expired food removed, appliances cleaned
• Bedding: sheets washed for every individual
• Laundry: all individuals' laundry kept current — never piling up

• Refrigerator and freezer fully emptied and cleaned
• Oven and microwave deep cleaned
• Vents, fans, baseboards dusted
• Cabinets organized and wiped

• Gloves: when cleaning bodily fluids, handling soiled laundry, supporting hygiene tasks involving fluid contact, or any task where contact with bodily fluids is possible. Not required for routine medication administration. ARE required for med routes that may involve fluids: suppositories, eye drops, ear drops, topical to broken skin.
• Hand washing: soap + warm water before food prep, after bathroom, after personal care, after cleaning
• Disinfecting: high-touch surfaces (light switches, doorknobs, handrails, faucets) disinfected daily
• Bodily fluid spills: clean immediately with gloves and approved disinfectants. Tied trash bags for contaminated materials.

All chemical storage requirements are in Policy R8.2. Use chemicals only as directed and only for their intended purpose.

Pest control: Report any pest issues (insects, rodents, etc.) immediately to the House Manager through house chat. Pest issues addressed promptly. Staff may not use store-bought pesticides without Maintenance approval.

• Food & groceries: enough for current meal plans
• Personal hygiene: each individual's preferred products
• Cleaning supplies: enough to maintain R8.1 cleanliness standards
• Paper goods: toilet paper, paper towels, tissues
• Laundry: detergent, fabric softener if used, dryer sheets if used
• First aid & basic health: bandages, thermometers, items per nursing direction

All routine household supplies ordered through Walmart. House Manager submits orders, Walmart delivers, ISL Management puts items in correct storage locations.

• Food stored in shared kitchen spaces (pantry, cabinets, fridge, freezer)
• Each individual's personal food items labeled with their name in Sharpie
• All food (including liquid nutritional supplements) MUST be temperature-controlled. Not in garages, sheds, non-climate-controlled basements, or outdoor storage — regardless of "shelf-stable" claims. Climate-controlled storage protects integrity.
• Expired food removed weekly during cleaning
• Mini-fridges in bedrooms are not permitted.

• Windows: Any bedroom window covered for privacy — frosting, curtains, or blinds.
• Bedroom locks: Every bedroom must have a working lock; the individual living there holds their own key. Two exceptions, both documented in PCSP:
  1. Individual not capable of holding/manipulating a key
  2. Individual previously locked themselves in and couldn't unlock or call for help

Bathroom windows covered for privacy using frosting, blinds, or curtains.

Each home maintains an appointment folder that goes with the individual to every medical appointment, ER visit, or hospitalization. Must contain:

• Physician's Orders (POS)
• Face sheet
• Guardian paperwork
• Consent paperwork
• Allergies

ISL Management keeps appointment folders current.

• Valid driver's license
• Clean driving record per Abilities's insurance requirements
• Added to the agency's insurance
• Vehicle-specific training where applicable (see below)

Two vehicles in the fleet require additional vehicle-specific training before driving with individuals onboard:

Every vehicle equipped with these items at all times:

• Emergency folder: insurance info, registration, emergency contacts
• Fire extinguisher. Maintenance handles inspections/replacements. Concerns? Maintenance request process.
• Mini first aid kit. Pre-purchased and stocked by agency. Report items used or expired so kit can be replaced.

• Seatbelts at all times — yourself and every passenger
• Secure all wheelchairs using appropriate tie-down system before driving. Verify all securement points engaged.
• Drive defensively. Obey all traffic laws.
• No phone while driving. Pull over to take a call or send a message.
• In an accident? Follow R5.1 (Car Accident Procedures).
• Suspect a vehicle is unsafe? Don't drive it. Notify Maintenance + your supervisor immediately.

• Individuals have the right to access community life. Transport must support PCSP outcomes, day program, work, medical appointments, personal preferences.
• Plan trips in advance whenever possible
• Medical appointments? Appointment folder goes with them per R8.2.

Staff may transport individuals in personal vehicles only when staff member is approved by Abilities, the staff member's insurance is on file, AND trip purpose is approved in advance by the Executive Director. No mileage reimbursement without ED pre-approval.

Fuel receipts follow a defined path so every WEX transaction has a verifying receipt and Finance can reconcile.

• Voluntary. Individuals not required to participate.
• Each participating individual has an AbiliBucks plan listing what they earn AbiliBucks for and how much each item is worth
• Staff hand out AbiliBucks during the shift when the individual earns them per the plan
• Tracking in pen. Pencil isn't used (can be erased).
• Individuals come to the office during posted store days/hours to shop

Each participant's plan is built around what they care about, what they want to work on, what's realistic for them. Plans are written by Behavior Services in collaboration with the individual.

• Plan lists each earning opportunity and AbiliBucks value
• Reviewed and updated as interests and goals change
• Earning items in an AbiliBucks plan are separate from PCSP outcomes — may overlap by coincidence, but the AbiliBucks plan is its own document

• Staff support individuals coming to the office to shop during posted hours
• Items chosen with input from individuals and reflect what they actually want

• Lead RBT and RBTs: train DSPs on each individual's AbiliBucks plan. Provide ongoing coaching.
• House Managers: support staff in implementing AbiliBucks plans and reinforce within daily routines
• DSPs: follow each individual's AbiliBucks plan during shifts. Hand out AbiliBucks per the plan, document earnings on tracking sheet in pen, support individuals in coming to the office to shop.

Questions about an individual's AbiliBucks plan? Contact the Lead RBT or the assigned RBT.

Membership is not optional. The RPM maintains each chat's roster and is responsible for adding/removing members when assignments change. Staff no longer assigned to a home must be removed promptly.

Every message is part of the record and is read by the people you work with every day. Use a tone you'd be comfortable with anyone reading. Keep messages clear, factual, respectful.

• Affects an individual's safety, health, or rights → RPM immediately, by phone if urgent
• Law enforcement, emergency responders, hospitalization, or external agency → RPM and DRO immediately
• May need agency-wide attention → Executive Director through chain of command

• All homes: minimum every 8 weeks
• Cypress and Southside (high behavioral): minimum monthly
• Knob and Southside (high medical): minimum monthly

• The House Manager leads the meeting
• The Residential Program Manager attends as support and guidance, not as the leader

• Open with an icebreaker of no more than 5 minutes
• Reserve a minimum of 15 minutes for DSP Q&A, set aside for DSPs only
• Provide the Department of Culture & Experience with 15 minutes at minimum every other meeting, every meeting when issues are present, and additional time when the RPM requests it
• Build the agenda for the DSPs attending. The House Manager creates a separate facilitator guide if needed.
• Keep the agenda concise so there is enough time for each item to be covered fully

The content that follows the icebreaker should focus on the work, the home, and the people inside it.

• Individual updates: any changes in PCSP, BSP, POS, behavior, medical status, or routines the team needs to know
• Operational updates: changes that affect how the home runs day to day — new processes, schedule changes, or system updates
• Policy review or clarification: any new or updated policies that apply to the home, walked through in plain language with time for questions
• Training reinforcement: review of topics where the home is showing patterns of need — documentation, MANDT, Tools of Choice, or medication practices
• Wins and recognition: good work happening in the home, both staff and individual successes worth naming out loud
• DSP Q&A: open floor for DSPs to ask questions, raise concerns, and bring forward what is not working
• Action items: clear close-out of who is doing what, by when, before the meeting ends

Departments attend only when their content is on the agenda. The RPM is responsible for invitations.

• MANDT Instructor: when MANDT is being discussed
• Behavior Team (BCBA and/or Lead RBT): when BSP, escalation response, or behavioral strategies are being discussed. The individual must have active behavior services for the behavior team to attend and discuss.
• Department of Culture & Experience: for discussions on empathy, leadership, setting expectations, building rapport, or morale issues within the house — whether among individuals or staff
• HR: for policy reviews or policy clarification
• QAP: for documentation training or documentation issues
• Nursing: when training is needed for delegation protocols or medical equipment how-tos

• Departments that need time in the meeting (Behavior, Culture & Experience, etc.) create their own agenda for their portion
• That agenda is submitted to the RPM at least 3 business days before the meeting for review and edits
• All ISL house meetings follow the agency Meeting Procedure policy

The RPM is responsible for capturing meeting minutes. To keep them accurate and detailed, the RPM uses an audio-to-transcription device or app during every meeting. After the meeting, the RPM sends the minutes to every DSP and manager assigned to the ISL and uploads them to the shared Google Drive folder for meeting minutes.

Every supervisory role is expected to send four WorkTango recognitions per calendar month. Recognitions must be specific and individual — a generic "good job" does not count. A group recognition naming two or more people counts as one recognition toward the four.

Medical documentation is the spine of an individual's medical history. Missing, late, or lost consults create real clinical risk. They also create real audit and compliance risk. The workflow keeps documentation moving in a defined path with defined accountability at each step.

• House Managers add every new appointment, follow-up, or referral as soon as scheduled
• RPMs review the tracker regularly to confirm appointments aren't missed
• Nursing references the tracker for HRST, monthlies, etc.

Individual misses or cancels? House Manager updates the tracker, notes the reason, reschedules. Repeated cancellations flagged to RPM and Nursing for follow-up.

Medications delivered to the office. Nursing or RPMs review the delivery before it goes to the home. Reviewed meds placed in the home's designated ISL box at the office. ISL Management picks up during scheduled admin visits.

• Verify medication, dosage, and individual name match the order before leaving the office
• Document receipt in the home per Policy R5.6

ISL Management monitors medication supply and orders refills before running out.

TB testing due annually for each individual. ISL Management tracks TB due dates as part of the appointment tracker workflow.

Every choking event documented in SetWorks at the time it occurs. Nursing reviews choking documentation as part of clinical oversight.

Nursing uses the Choking Risk Assessment tool to determine clinical risk for each individual. Scored across five areas: developmental disability diagnosis, physical impairments and positioning, medical diagnoses, medications, and choking history in the past 12 months.

Nursing completes the assessment:

• At admission
• At each annual PCSP review
• After any choking episode
• When there's a change in the individual's ability to chew or swallow

Choking risk decisions, dietary modifications, and swallow study determinations are clinical decisions made by Nursing in coordination with the doctor. Residential staff document accurately, follow Nursing's guidance, and follow any modified diet/feeding plan exactly as written.

• Recognize early. The Fatal Five often present subtly before becoming critical.
• Act on what you see. If something is wrong, escalate to Nursing or call 911. Don't wait for confirmation.
• Document accurately in SetWorks at the time of observation

End-of-life decisions are clinical and personal. Residential staff:

• Follow the documented plan
• Support the individual and the people who love them
• Document care accurately

The team coordinates with the individual, their guardian, their medical team, and any hospice or palliative care providers to ensure preferences, dignity, and comfort are honored.

• Acute medical concerns needing physician evaluation but not requiring 911
• Concerns arising outside the individual's PCP office hours
• Situations needing a physician's order, prescription, or guidance quickly

• StationMD faxes consult documentation to the office. RPMs ensure consult documentation is uploaded to SetWorks.
• House Managers ensure any follow-up appointment from the StationMD visit is added to the appointment tracker

The LPN orders, stocks, and maintains medical supplies kept at the office:

• Incontinence wipes
• Gloves (Medium, Large, Extra Large)
• Blood pressure cuffs
• Forehead thermometers
• Pulse oximeters
• Masks and face coverings

ISL Management requests office-stocked supplies from the LPN as needed.

The Health Risk Screening Tool (HRST) is a statewide screening process implemented by the Missouri Division of Developmental Disabilities through IntellectAbility. Its purpose is early detection of health risks in waiver participants. The HRST screens individuals across 22 health-related areas and produces a Health Care Level (HCL). An HCL of 3 or higher requires a Clinical Review by a Registered Nurse within 14 calendar days.

The CRN and Community LPN complete HRST screenings at Abilities. DSPs do not have rating access.

Answer the CRN or LPN's questions about the individual honestly and thoroughly. Your daily observations directly affect the accuracy of the screening.

Abilities completes the HRST screening. We do not complete monthly reviews, Health Risk Support Plans, or delegations inside the HRST system. Instead:

• Monthly nursing summaries are completed as the RN Oversight Monthly Health Summary PDF and sent via BoldSign
• Health risk support plans are reflected in the individual's protocols
• Nursing delegations are maintained as PDFs and printed copies outside the system

Abilities, LLC is committed to growth from within. The career ladder below shows the path from Direct Support Professional into ISL Management and beyond. Each role builds on the one before it, and every step is grounded in the work of supporting the people we serve.

Direct Support Professional → Lead DSP → Assistant House Manager → House Manager → Residential Program Manager → and other advancement roles.

To move into and stay in ISL Management (Lead DSP, AHM, HM), three things are required:

• Completion of the Certified DSP training program in full — not partial completion, the full program
• Active use of Tools of Choice with both the individuals supported and the employees managed
• Demonstrated leadership qualities, listed below

These are the qualities that matter in residential leadership at Abilities. They are not abstract ideals — they show up in everyday decisions.

• Clarity: You tell people what you need, when you need it, and why. You don't leave the team guessing, and you don't soften feedback so much it disappears.
• Courage: You have hard conversations when they need to happen. You name what is not working. You stand by a decision even when it is unpopular, as long as it is right.
• Trust: You follow through. You do what you said you would do. The people you lead can predict you because you are consistent.
• Purpose: You know why we do this work. You connect daily tasks to the lives of the people we support so the team never loses sight of why any of it matters.
• Belonging: You build a team where people feel like they belong, not just like they fit in. You make space for difference. You notice who is on the edge and pull them in.
• Empathy: You can sit with someone's hard moment without rushing to fix it. You see the person before the problem. You assume your team members are doing their best with what they have.
• Coaching over managing: You teach. You ask questions instead of giving orders when teaching is the better move. You grow the people on your team so they can do more than they could when they started.

Some patterns hold employees back from promotion. These are not zero-tolerance events that result in termination on their own, but they do affect whether someone is considered ready for the next step on the ladder.

• Lack of self-control toward another person — uncontrolled emotional outbursts directed at a coworker, a staff member who reports to you, or an individual we support. Context matters; everyone has a hard day. But a pattern of losing control is different. Leaders are expected to manage their reactions even on hard days because the people on their team are watching.
• Patterns of attendance issues, documentation failures, or missed expectations that have required ongoing coaching
• Inability to receive coaching from your own supervisor or to delegate to people who report to you
• Behavior that damages the trust or the dignity of the people you work with or work for

Leadership work is hard and comes with responsibilities that direct care does not — shift coverage, decisions that affect other people's work, and accountability for outcomes you cannot fully control by yourself. Stepping down from that and back into it inside a year sends a message we do not want to send: that the role can be left when it gets hard and stepped back into when it gets easier. That is not how leadership works at Abilities, and it is not fair to the people who hold those roles full-time.

The 12-month clock applies regardless of why the demotion happened. After 12 months, the employee is considered again on the same basis as anyone else applying for the role.

The specific requirements for advancement at each level are still being developed. As they are finalized, they will be added here. In the meantime, talk to your supervisor or the Director of Residential Operations if you are interested in advancing.

Caregiving is emotionally and physically demanding in ways most other jobs are not. Burnout is a real, common, and treatable consequence of doing this work over time. Recognizing it early, whether in yourself or in someone on your team, is one of the most important skills in this field.

Burnout is not a single feeling — it builds over time, with subtle signs at first and obvious ones later. Common signs across the cycle:

• Emotional exhaustion. Feeling drained at the start of your shift, not just the end. Dreading work in a way that goes beyond "I don't want to go in today."
• Depersonalization. Becoming detached or cynical about the people you support, talking about them as tasks rather than people, and losing the warmth that brought you into this work.
• Reduced sense of accomplishment. Feeling like nothing you do matters, even when the work is being done.
• Physical signs. Headaches, stomach issues, frequent illness, trouble sleeping, exhaustion that does not lift with time off.
• Withdrawal. Pulling back from coworkers, missing more shifts, being less present in the home even when on shift.
• Irritability. Shorter fuse with coworkers, supervisors, or the people you support, with small things prompting big reactions.

The hardest part of burnout is that you usually feel it before you can name it. A few questions worth asking honestly:

• Do I feel different about the people I support than I did six months ago?
• Am I dreading work in a way I did not used to?
• Am I sleeping, eating, and resting in ways that take care of me?
• Am I talking about work outside of work in ways that feel heavy or angry?
• Am I withdrawing from the parts of life that usually fill me back up?

You will often see burnout in a coworker before they see it in themselves. Things to watch for:

• A coworker who used to be warm with the individuals they support is now flat or short
• A coworker who used to engage with the team is now quiet, withdrawn, or skipping interactions they used to be part of
• A coworker is starting to call in more, arrive late, or leave early
• A coworker is talking about the work with bitterness or cynicism that is new for them
• A coworker is making more mistakes than usual on tasks they used to handle without issue

Burnout is not solved by toughing it out. Caregivers who push through it without addressing it tend to either leave the field entirely or become the kind of caregiver who hurts the people they support — both outcomes are preventable.

This work is not done alone. The agency exists to support the team, the team exists to support each other, and burnout is one of the things we watch for together.