Nonotuck & DDS Licensure, Part II: Licensure Begins

In Part 1 of our licensure series, we explored the months of preparation that make every Department of Developmental Services (DDS) licensure review possible—from year-round Quality Enhancement (QE) efforts to the organization-wide commitment to keeping records, homes, and supports continuously review-ready. But preparation is only half the story; once DDS selects homes and records for assessment, the licensure process truly begins.

Program Director Dylan Zukowski of Auburn had a direct message for his staff as licensure began: “If you fail, I fail. If I fail, you fail. We’re in this together.” It was a mindset reflected throughout the organization, where licensure became less an individual responsibility than a collective effort.

Once DDS selects the homes and records that will be evaluated, staff across Nonotuck mobilize. Care Managers, Shared Living providers, nurses, clinicians, Quality Enhancement staff, operations staff, and office teams all play a role in preparing documentation, supporting providers, and ensuring people are ready for interviews and home visits.

As teams prepare the selected records and homes for review, QE provides another set of eyes, examining records, answering questions, identifying gaps, and helping teams correct issues before surveyors arrive.

During home visits and record reviews, DDS surveyors examine medication administration, financial documentation, health records, and home safety, including water temperatures, smoke detectors, carbon monoxide detectors, and other environmental safeguards to ensure both quality services and safe living environments. “They do everything from finances to safety stuff… water temperature… They turn over every stone,” Dylan says.

For Dylan, that scrutiny is also an opportunity for Nonotuck to demonstrate the standards staff work toward throughout the year. “We have our own standards here that are above and beyond the licensure standards. For us, it was more about showcasing our work to DDS. We should be proud of the work we put forward,” he says.

At the same time, Dylan says licensure creates opportunities to identify where the organization can improve. “It brings out the best in people, but it exposes areas where maybe we thought we were better than we were, and areas we can improve on.”

Doug Watts, Vice President of Quality Enhancement Eastern Services, says the success of licensure ultimately belongs to frontline staff. “We try to guide, support, consult, rally, control, but it’s the people in the programs that are doing most of the work,” he says.

Program Director Nichole Bourke was inspired by the support provided across departments at Nonotuck. When every Care Manager in her program was selected for review, she found herself relying on colleagues from across the organization.
“The willingness of colleagues across the agency to step in and help was truly remarkable. Their dedication, teamwork, and generosity with their time made a significant difference and is something I will always appreciate,” she says, naming Lee Program Director Jessica Schram as someone whose support left a lasting impression.

During the site visit itself, DDS surveyors visit offices, examine records, meet with staff, and conduct home visits that include safety checks, medication and financial audits, and conversations with the people receiving services and their Shared Living providers.

Throughout the process, Nonotuck staff remain in close communication with one another and with DDS, responding quickly to questions, addressing immediate action items, and identifying trends that may require follow-up. Throughout it all, the QE department maintains an active presence.

“One of the best things about being in QE is being able to be the sounding board for people when they have questions. How can you direct them? How can you help them? How can you support them?” says Kari Barschdorf, Quality Enhancement Specialist.

Program Director Jessica Schram of the Lee office participated in her fifth licensure review—and her first as a Program Director—this year. She says licensure is “our time to shine.”

“It is an opportunity to demonstrate how we, as an organization, not only meet regulatory expectations but often exceed them, all while supporting people to live authentic, meaningful lives,” she says.

“More importantly, it allows us to reflect on the purpose behind the regulations and recognize how they ultimately promote the health, safety, rights, and well-being of the people we support,” she adds.

Quality Enhancement Specialist Craig Manning has experienced licensure as both a Care Manager and a member of the QE staff. He similarly sees the process as an opportunity for reflection and accountability.

“I’ve always welcomed other people’s input and feedback when assessing my work because I always want to be 100% in compliance,” he says. “Licensure was always a positive experience for me. I welcomed people talking with the families I supported, getting to know them, and making sure their services were where they needed to be. It was accountability in the best sense of the word.”

After the survey, DDS shares its findings, beginning with organizational strengths before identifying areas that may need improvement. Nonotuck then evaluates those findings, provides follow-up training, updates systems when needed, and reports back on corrective actions.

In that way, licensure doesn’t end when the surveyors leave. Every piece of feedback becomes another opportunity to strengthen systems, support staff, and improve services. While the process is demanding, staff across Nonotuck say it also reinforces the values and practices that guide their work every day.

In Part 3, we’ll explore how DDS Licensure informs and enhances the services we provide to the people we support.