Department of Human Services Oregon Office of Developmental Disabilities Services Kate Brown, Governor 500 Summer St. NE E-09 Salem, OR 97301-1073 Voice: 503-945-5811 Fax: 503-373-7274 TTY: 800-282-8096 Enclosure 1 – HCBS Status Report Note: “Setting HCBS” indicates the setting meets the requirements for a Home and Community-Based Setting based on the information provided. Response Assessment Provider Address Brief HCBS Areas of Non -Compliance Provider Deadline for ID Results Description Review Must Address through Remediation; Compliance or areas where additional assurances of Setting required to show how a provider will ensure continued compliance. (See also the enclosed Training and Technical Assistance guide for additional information). 1037 DSA Community when 2475 Sheldon Village Lp, This is a Substantial 1. A provider day service site must, at 1. September 1, in community and away Eugene community Compliance minimum, facilitate going out into the 2018 for full from the provider site / room at broader community. This means the compliance. DSA Facility when at Sheldon services must include opportunities for site provider owns, Village individualized, integrated activities in the leases, or controls apartments broader community, based on (through an agreement individualized schedules, and to use on regular basis interaction with community members for congregate day that do not have disabilities outside of services). the facility-based setting and in the broader community. Please ensure billing and authorizations are Please document your plan for ensuring correct going forward. full compliance with this requirement, and any changes that may be necessary. Additional information can be found in the enclosed Training and TA Guide. A provider may also use an HCBS Plan of Improvement to further “Assisting People to Become Independent, Healthy and Safe” HCBS related goals. 2. Additionally, provider action plans or 2. Please review implementation strategies must be action plans or developed to implement each implementation individual’s ISP/CDP. These plans or strategies and strategies must show how these remediate where services are used to support necessary within individualized schedules and activities 90 days and in the broader community and notify interaction with community members employment that do not have disabilities outside of regional specialist the provider site or facility. upon completion of remediation. If These strategies must be individualized, you are not able measurable, and individually monitored. to remediate within 90 days, please address this in an HCBS Plan of Improvement. 1041 DSA Community Emerald Lanes, 140 Oakway These are Setting HCBS N/A – Setting HCBS N/A – Setting Rd. Valley River Center, 293 Public places HCBS Valley River center. Putters throughout our mini Golf, 1156 Hwy 99. community. Safeway, 1500 Coburg Rd. Autzen Stadium/PK park, 2700 Martin Luther King Blvd. Mathew Knight Arena, 1840 E 13th Ave. University of Oregon Museum of 1795 DSA Community Matt Knight Arena 1390 These are Setting HCBS N/A – Setting HCBS N/A – Setting Villard St. Sports and Public places HCBS entertainment venue throughout our community. 1796 DSA Community Autzen Stadium/ PK park These are Setting HCBS N/A – Setting HCBS N/A – Setting 2700 MLK Blvd., Outdoor Public places HCBS sports Arena throughout our community. 1797 DSA Community The Duck Store 2735 Leo These are Setting HCBS N/A – Setting HCBS N/A – Setting Harris Pkwy., Retail store Public places HCBS connected to University of throughout our Oregon Athletics community. 1798 DSA Community Eugene Saturday Market 55 These are Setting HCBS N/A – Setting HCBS N/A – Setting E Ave. Public outdoor Public places HCBS market. throughout our community. 1815 DSA Community when 2475 Sheldon Village Loop., Community Same as Same as response #1037 above. Same as in community and away Eugene room in response response #1037 from the provider site / apartment #1037 above. above. DSA Facility when at complex. site provider owns, leases, or controls (through an agreement to use on regular basis for congregate day services). Please ensure billing and authorizations are correct going forward. .