Individualized Service Plan Quality Review Questions
Is the plan clear? / ☐Yes / ☐No**If No, ensure it is addressed
Does the plan leave you with unanswered questions? / ☐Yes / ☐No*
*If No, ensure it is addressed
If someone who had no knowledge of the person read the plan, would they have the necessary information to provide them with a service? / ☐Yes / ☐No*
*If No, ensure it is addressed
Do services/supports identified in the ISP address needs reflected in the NJ CAT/PCPT? / ☐Yes / ☐No*
*If No, ensure it is addressed
Do outcomes reflect strengths, preferences, desires, etc. of the individual (as identified in the PCPT)? / ☐Yes / ☐No*
*If No, ensure it is addressed
Are the outcomes/goals individualized? / ☐Yes / ☐No*
*If No, ensure it is addressed
Are any services/supports included that do not meet a need identified in NJ CAT/PCPT? / ☐Yes / ☐No*
*If No, ensure it is addressed
Are the goals measureable? / ☐Yes / ☐No*
*If No, ensure it is addressed
Comments: ______
______
Individual Service Plan Documentation Checklist
Demographic Information
Participant DDD ID# / ______
Support Coordinator / ______
Support Coordinator Supervisor / ______
Date Plan Submitted / ______
Date Plan Approved / ______
Was Plan Submitted on Time / ☐Yes / ☐No
If Not, Why Not? / ______
☐First year ☐Renewal ☐ Revision
NJISP Document Review - Are the following documents complete and up to date?
PCPT / ☐Yes / ☐No
ISP / ☐Yes / ☐No
CCW Sign Off Form (if applicable) / ☐Yes / ☐No
Comments: ______
______
PCPT Review – Throughout the body of the PCPT:
Was each section of the document completed? / ☐Yes / ☐NoIf No, What section is missing? ______
Was that section applicable? / ☐Yes* / ☐No
*If Yes, ensure that the section gets completed
Are the contents and comments written in a respectful and person-centered manner? / ☐Yes / ☐No
When a need was identified, in any section, was that need addressed in the ISP (i.e. if the need for assistance with voting was identified were services to address that need included in the ISP)? / ☐Yes / ☐No*
*If No, ensure it is addressed
Does the PCPT explore employment options for the individual as appropriate? / ☐Yes / ☐No
Comments: ______
______
ISP Review
Was each section of the document completed? / ☐Yes / ☐NoIf No, What section is missing? / ______
Was that section applicable? / ☐Yes* / ☐No
*If Yes, ensure that the section gets completed
Are the contents and comments written in a respectful and person-centered manner? / ☐Yes / ☐No
When a need was identified, in the PCPT, was that need addressed in the ISP (i.e. if the need for assistance with voting was identified were services to address that need included in the ISP)? / ☐Yes / ☐No*
*If No, ensure it is addressed
Does each of the Outcomes reflect the desired achievement of the individual (i.e. the skill, ability, goal)? / ☐Yes / ☐No
Is at least one of the Outcomes related to employment? / ☐Yes / ☐No
Do the Planning Goals indicate the major activity/activities designed to achieve the Outcomes? (I.e. what steps need to be done to reach outcomes, where is help needed to reach outcome?) / ☐Yes / ☐No
Are the services listed needed to help the individual achieve their Planning Goals and Outcomes? / ☐Yes / ☐No
For each service funded by DDD, is the correct procedure code included? / ☐Yes / ☐No
If No, please address
For each service funded by DDD, is the assessment tool showing a need for the service identified? / ☐Yes / ☐No
If No, please address
For each service funded by DDD, is how often the service will occur indicated? / ☐Yes / ☐No
If No, please address
Are approved providers identified to provide services? / ☐Yes / ☐No
If No, please address
Are any religious and cultural restrictions the person follows clearly noted and addressed in services being provided? / ☐Yes / ☐No
Is the box checked under Employment First Implementation consistent with the information provided through the Employment Pathway discussion in the PCPT? / ☐Yes / ☐No
If employment is not currently being pursued, is the reason listed? / ☐Yes / ☐No
Has DDD reviewed and approved that the individual is not pursing employment at this time? / ☐Yes / ☐No
If No, please address
Are any Health & Safety concerns/needs indicated in the DDRT, PCPT, or other assessment tool included in the monitoring and support needs table? / ☐Yes / ☐No
If No, please address
Are any special dietary needs clearly indicated and consistent with the DDRT and PCPT? / ☐Yes / ☐No
If No, please address
If the individual uses any adaptive equipment, is the information provided in the plan consistent with the DDRT and PCPT? / ☐Yes / ☐No
If No, please address
Is all of the needed information provided in the Emergency Back-Up Plan (if applicable) to ensure that needs are addressed when/if a provider does not show up? / ☐Yes / ☐No
If No, please address
As indicated by signatures, were at a minimum, the Individual, Guardian (if applicable), and Support Coordinator present at the plan meeting as required? / ☐Yes / ☐No
Are the necessary signatures included? / ☐Yes / ☐No
If No, please address
Comments: ______
______
Final Authorizations – To Begin Plan Services:
If Yes*, please sign and date
______/ ______
Signature / Date
If No**, please review the necessary revisions with the support coordinator
1
Version 1 09/13/13