Office for People With Developmental Disabilities

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Safety Performance Reports Description


Environmental Safety Reviews: OPWDD has created this page in order to share information about the performance of providers of services. As a first step, we shared the results of reviews of Medicaid Service Coordination. As a second step, we are sharing the results of Environmental Safety Reviews. The report provides information about how well an agency meets OPWDD’s regulations and also how an agency meets quality standards for Safety. Each category has an overall grade in the form of a star and under each star rating is a listing of the items measured and the percentage at which the service met the regulatory or quality requirement.

The report is divided into the following categories:

Evacuation Planning and Performance

This category reports on whether the Provider has implemented processes that result in the successful evacuation in the event of an emergency. It reports on the following areas:

  • The certified site has an acceptable evacuation plan.
  • All fire and evacuation drills or events are documented on the standardized drill report.
  • The Evacuation Plan is practiced through drills with the frequency specified by OPWDD.
  • Evacuation drills are conducted in a manner to effectively train and assess participants.
  • The agency monitors the effectiveness of the fire evacuation plan.
  • Drills are appropriately evaluated and corrective action taken as needed.
  • Individuals' fire safety needs and abilities have been accurately assessed and documented, based on actual performance and this information is available to staff.
  • The certified site provides safe exiting to a public way.
  • In Life Safety Code Facilities, a review of the fire drill records conducted in the last 60 days indicates that all individuals are able to be evacuated from the facility in accordance with the safety level of the building.
  • For facilities that do not meet Life Safety Code, a review of fire drill records conducted in the past year or since last review, indicates all individuals can be evacuated in 3 minutes or less in an Individual Residential Alternative, or evacuate in 2.5 minutes in a Certified Residence.
  • The local fire authority with jurisdiction is kept informed regarding the special needs of the individuals and the facility

Fire Safety Protections and Equipment

This category reports on the following areas:

  • The facility is in compliance with NFPA Life Safety Code as required.
  • The facility maintains a current E-score if required.
  • There is fire protection and detection equipment in the facility as required by regulation.
  • Heat detectors are present in the residential facility as required by OPWDD.
  • Fire alarm and notification systems are operational and effective.
  • Other fire protection equipment is operational.
  • Automatic sprinkler systems have a water supply that is sufficient to operate the required number of sprinkler heads for the period of time that is specific to the system type that is in place.
  • Fire alarm, smoke detection and sprinkler systems are inspected and maintained at the frequency required for each specific system. 
  • Maintenance and inspection of Fire Alarm and Detection Systems is performed by competent parties and according to OPWDD standards.
  • Maintenance and inspection of Sprinkler Systems is performed by competent parties and according to OPWDD standards.
  • At least one fire extinguisher equal to Class-1-A-5BC, 2.5 pound unit, approved and labeled by the Underwriters Laboratories, is located in an accessible place on each floor, and tested and recharged in accordance with the recommendation of the manufacturer and the NFPA.
  • The facility was free from observed fire safety hazards.
  • The fire alarm system is operational upon activation.
  • The sprinkler system is operational.

Building Maintenance

This category reports on the following areas:

  • The maintenance and/or cleaning of any heating, air conditioning and/or air filtration equipment is performed on a regular basis and in accordance with the recommendations of the manufacturer.
  • In situations where individuals live in individual apartments but the group of apartments is considered a supervised site, there are mechanisms in place to ensure that staff can be summoned to individual apartments in an emergency.
  • The environment free from other hazards/hazardous conditions
  • The temperature of the hot water is no greater than 110º F where individuals have not been or are not being trained to use and control water.
  • For All Facilities Smoking is performed in a safe manner.
  • Facilities with a private water source for drinking and cooking test their water annually for conformance with established bacteriologic and chemical standards.
  • All ramps, doors, handrails, elevator controls, telephones and similar devices installed for use by individuals are in an operable/usable condition.
  • Based on observation and/or interview, the facility vehicle(s) are properly maintained, including specialized adaptive equipment.
  • Swimming pools are appropriately secured and maintained.  Applies to sites with pools only.
  • Facilities with pools implement procedures to safeguard individuals and prevent drowning. 
  • The home has a land line (see section 635-99.1) telephone service which is in working order and functions during power outages.
  • When required by other State agencies, the facility keeps records that document compliance with the sanitation, health and environmental safety codes of New York State or the City of New York.
  • There is a carbon monoxide alarm in all new and existing residences containing one or more carbon monoxide sources on sleeping levels.
  • The use of portable or temporary space heaters as the sole source of heat is prohibited, without appropriate exceptions. 
  • Exits are clear of obstructions.

Staff Competency

This category reports on the following areas:

  • There is a written plan available to staff for how the facility will deal with life-threatening emergencies.
  • Facility staff can describe fire safety and emergency evacuation procedures.
  • Facility staff can describe the safe operation of the special adaptive tubs and associated lifts.
  • Based on observation and/or interview, staff is competent to operate the van adaptive equipment safely including utilizing the mechanisms designed to secure wheelchairs for transport.
  • The facility has a communication system and staff is aware of policies for the prompt contacting of on-duty personnel and prompt contacting of other responsible personnel in emergencies.

Comfort of Facility

This category reports on the following areas:

  • The physical plant is appropriate to the needs of the individuals who receive services there.
  • Toilet rooms and Bathrooms Provide Personal Privacy
  • There are insect screens on all windows used for ventilation.
  • The facility is clean.
  • The facility is well maintained for the safety and comfort for the individuals receiving services.


Each category has an overall rating in the form of stars. To obtain an aggregated star rating for a category, the number met and number reviewed are added for each question in the category.  Stars are determined as follows:

96 to 100 % met (total number met divided by total number reviewed)

Five Stars

91 to 95 % met (total number met divided by total number reviewed)

Four Stars

86 to 90 % met (total number met divided by total number reviewed)

Three Stars

81 to 85 % met (total number met divided by total number reviewed)

Two Stars

75 to 80 % met (total number met divided by total number reviewed)

One Star

Below 75 % met (total number met divided by total number reviewed)

No Stars


List of Agencies