Nonotuck and DDS Licensure, Part 1: Preparation

In many ways, this year’s licensure review at Nonotuck is a vivid reminder of how much we continue to evolve as an organization. New departments stepped into leadership roles, virtually every staff member contributed, and—most importantly—Nonotuck’s core values carried us through every challenge. 

Every two years, Nonotuck undergoes a comprehensive licensure review by the Massachusetts Department of Developmental Services (DDS). Led by Nonotuck’s Quality Enhancement (QE) Team, the process brings together staff from across the organization—from Program Directors and Care Managers to Human Resources, the Fiscal, Clinical and IT departments, Shared Living Providers and the people they support—to ensure our services, documentation, and values are reflected accurately. 

Executive Vice President of Operations Angela Procopio Rahilly says there was nothing routine about this year’s licensing. “This was a comprehensive survey of all of our services. Twelve DDS surveyors from every Quality Enhancement office across Massachusetts came together to review more than 150 licensure indicators across the organization. This also came during a period of significant transition within DDS, with new leadership at the Commissioner level and throughout the state,” she says. 

“Our survey leadership came from the Central/West region, and one of their biggest challenges was bringing surveyors from across Massachusetts together to ensure consistent interpretation of every indicator. That was no small feat,” she continues. “Naturally, they were navigating a new process, and we were cautiously optimistic. We believed in our services, our people, and the systems we have built over many years.”

During the review, DDS examines records, visits selected homes, interviews caregivers and the people we support, and evaluates everything from emergency preparedness to personalized supports. The goal is to ensure Nonotuck’s Shared Living program meets state standards for health, safety, human rights, and quality of care. 

While the formal review lasts only a few weeks, as multiple Nonotuck staffers put it, preparation for the next licensure begins immediately after the current one concludes.  The Quality Enhancement (QE) team works year-round with staff to strengthen systems, provide training, review documentation, and continuously improve services.

Rather than waiting until licensure approaches, QE keeps preparation woven into the fabric of daily operations. Through regular STRIVE Reviews, programs routinely examine records, homes, and supports to ensure they remain compliant while accurately reflecting each person’s life. 

Those reviews are reinforced by QE Corner, recurring agency-wide meetings where staff receive updates on regulations, discuss evolving standards, review changes to documentation, and work through real-world questions together. The result is a culture of continuous readiness—one in which compliance, quality, and personalized supports are strengthened throughout the year rather than rushed in the weeks before a survey.   

That philosophy has fundamentally changed how Nonotuck approaches licensure. “We’ve really made this shift several years ago to take these standards and really train them, incorporate them, and implement them through the lens of Nonotuck’s values,” says Vice President of QE Grayson Fleischner. “And that has been the most successful approach.”  

One might say licensure prep has become more of a mindset. As QE Associate Kari Barshdorf says, “We should always really be in licensure prep. We should always be preparing. Our records should be able to be looked at at any point and be DDS licensure ready,” she says. “Licensure is accountability—making sure that you as the care manager are doing your job and supporting the person… It’s really a reflection of the care manager, the supports they receive from your APD and PD, and really how they’re upholding Nonotuck’s values.”

About six months before the review, that preparation becomes more focused, with staff reviewing records, revisiting licensing standards, and  participating in the above trainings, and making sure documentation is aligned with DDS expectations.

“The ultimate goal would be to have it not be sort of an all-hands-on-deck event when licensing comes,” says Vice President, QE Eastern Services Doug Watts.  “Everything’s in place. Nobody’s nervous about it. Everybody knows what’s going on.” 

What happens when two years of preparation finally pays off? In Part 2, we’ll go inside the licensure review itself—from home visits and record reviews to the teamwork, collaboration, and lessons learned as Nonotuck’s values are put into practice.