"Ddds Programmatic Features Assessment (Pfa) Form" - Delaware

Ddds Programmatic Features Assessment (Pfa) Form is a legal document that was released by the Delaware Health and Social Services - a government authority operating within Delaware.

Form Details:

  • Released on September 19, 2005;
  • The latest edition currently provided by the Delaware Health and Social Services;
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Download "Ddds Programmatic Features Assessment (Pfa) Form" - Delaware

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DDDS PROGRAMMATIC FEATURES ASSESSMENT (PFA)
Names of person/s who
reside in the home:
(if applicable)
Property Address:
Provider:
Names of person
completing PFA:
Date Completed:
Instructions:
Using the drop-down menus, please assign the appropriate number of points based on
property characteristics. Refer to the DDDS Programmatic Features Assessment Guidelines document
for additional information.
A. Community Features
(up to 10 points)
1.
Within .25 miles of DART and / or other public transportation resources
(only applies to persons
who independently use these services or who are in the process of learning to use them)
(2 points)
2.
Within 10 miles of family and friends who are actively engaged in the lives of persons who reside
within the residence
(or individuals targeted to be served) (active engagement defined as at least
one interaction per week)
(2 points)
3.
Within 10 miles of employment, day services, or other service resources frequently-used by the
persons who reside within the residence
(or individuals targeted to be served) (frequent use
defined as at least once per week)
(1 point)
0
4.
Within 5 miles of the following community resources routinely / frequently-used by the individual
(frequent use defined as at least once per week)
(up to 5 points total)
General Shopping
(e.g., clothing stores, specialty stores)
(1 point)
Church / House of Worship (1 point)
Hospital
(only applies to persons with medical needs requiring close proximity)
(2 points)
Recreational Facilities
(e.g., YMCA, parks, etc.)
(1 point)
B. Interior Physical Features of Home
(up to 10 points)
(applies only to features paid for by the landlord; excludes any features paid for by DDDS or the provider agency).
1.
Safety windows
(e.g., Plexiglas)
(1 points)
Reinforced walls
(specialized paneling to reduce damage)
(2 points)
2.
3.
Safety / soft edging
(wall or window corners, other sharp corners)
(1 point)
4.
Specialized doors
(heavy, solid wood, hard core, etc. to reduce damage)
(2 points)
5.
Alarmed doors / windows (1 points)
6.
Larger site needed
(e.g.: for privacy, ability to separate, for large equipment, etc.)
(1point)
7.
Other
(maximum of 2 points)
(please explain)
Programmatic Features Assessment: PM-62 Policy Memorandum Addendum B - Amended 05/09/19
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DDDS PROGRAMMATIC FEATURES ASSESSMENT (PFA)
Names of person/s who
reside in the home:
(if applicable)
Property Address:
Provider:
Names of person
completing PFA:
Date Completed:
Instructions:
Using the drop-down menus, please assign the appropriate number of points based on
property characteristics. Refer to the DDDS Programmatic Features Assessment Guidelines document
for additional information.
A. Community Features
(up to 10 points)
1.
Within .25 miles of DART and / or other public transportation resources
(only applies to persons
who independently use these services or who are in the process of learning to use them)
(2 points)
2.
Within 10 miles of family and friends who are actively engaged in the lives of persons who reside
within the residence
(or individuals targeted to be served) (active engagement defined as at least
one interaction per week)
(2 points)
3.
Within 10 miles of employment, day services, or other service resources frequently-used by the
persons who reside within the residence
(or individuals targeted to be served) (frequent use
defined as at least once per week)
(1 point)
0
4.
Within 5 miles of the following community resources routinely / frequently-used by the individual
(frequent use defined as at least once per week)
(up to 5 points total)
General Shopping
(e.g., clothing stores, specialty stores)
(1 point)
Church / House of Worship (1 point)
Hospital
(only applies to persons with medical needs requiring close proximity)
(2 points)
Recreational Facilities
(e.g., YMCA, parks, etc.)
(1 point)
B. Interior Physical Features of Home
(up to 10 points)
(applies only to features paid for by the landlord; excludes any features paid for by DDDS or the provider agency).
1.
Safety windows
(e.g., Plexiglas)
(1 points)
Reinforced walls
(specialized paneling to reduce damage)
(2 points)
2.
3.
Safety / soft edging
(wall or window corners, other sharp corners)
(1 point)
4.
Specialized doors
(heavy, solid wood, hard core, etc. to reduce damage)
(2 points)
5.
Alarmed doors / windows (1 points)
6.
Larger site needed
(e.g.: for privacy, ability to separate, for large equipment, etc.)
(1point)
7.
Other
(maximum of 2 points)
(please explain)
Programmatic Features Assessment: PM-62 Policy Memorandum Addendum B - Amended 05/09/19
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C. Exterior Physical Features of Home
(up to 7 points)
(Applies only to features paid for by the landlord; excludes any features paid for by DDDS or the provider agency.
1.
Traditional fence
(picket, chain link, etc.)
to enclose area for typical use (2 points)
2.
Stockade / Privacy fence (2 points)
3.
Ample parking to support site
(staffing, program needs)
(3 points)
D. Other Property Features / Advantages
(up to 3 points)
(Provider may note up to three additional property factors not included in Sections A, B, or C that may impact property rent.
Excluded are any features paid for by DDDS or the provider agency. Please provide a brief, one-line summary of the
property factor for DDDS to consider.)
1.
2.
3.
E. Geographic Location / Features
(up to 3 points)
Provider may comment on geographic location and/or features of the property that meet unique
needs of the individuals served.
Please provide a brief, one paragraph summary of the geographic location / features for DDDS to
consider. Any geographical features included in Addendum C of PM-62 are excluded.
0
Group Home Scoring Total
0 %
CLA Scoring Total
0 %
=
=
Total Feature / Advantage Points possible:
GH = 33
CLA = 26
GROUP HOME scoring
CLA Scoring (apartments, townhomes, duplex, condos)
0 to 5 points
=
0 %
0 to 4 points
=
0 %
6 to 14 points
= 10 %
5 to 11 points
= 10 %
15 to 24 points
12 to 19 points
= 20 %
= 20 %
25 to 33 points
= 30 %
20 to 26 points
= 30 %
Signatures
Date
Completed by:
Case Manager / Team Member
Reviewed by:
RPD / Designee
Approved by:
Director of Professional Services / Designee
Programmatic Features Assessment: PM-62 Policy Memorandum Addendum B - Amended 05/09/19
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