ESRD CLAS Facility Self-Assessment The following questions are designed to help your facility identify challenges and goals when implementing the Culturally and Linguistically Appropriate Services (CLAS) standards. ESRD Network --None--Network 8 Network 14 Facility Name CCN Completed By Title Email Phone 1. Does your facility recruit, retain, and promote staff that reflects the cultural diversity of the community? (CLAS Standard 3) --None--Our staff fully reflects the cultural diversity of our community. Our staff partially reflects the cultural diversity of our community. Our program staff does not currently reflect the cultural diversity of our community. 2. Does your facility have written policies and procedures that support recruitment, retention, training and promotion practices? (CLAS Standard 2) --None--All our staff are aware of / universally trained on them. Not all our staff are aware of / universally trained on them. Our facility does not currently have written policies and procedures that support these diversity practices. 3. Do facility staff members at all levels and disciplines receive training in culturally- and linguistically-appropriate service delivery? (CLAS Standard 4) Check ALL that apply. (Press & hold Control key to select more than one value). Training is provided to staff as standard part of orientation for new hires at all levels and disciplines Training is provided at least once a year to staff at all levels and disciplines Our facility does not currently provide this training. 4. Does your facility provide timely professional interpreter services, at no cost, to all Limited English Proficiency (LEP) patients, including those clients who use American Sign Language? (CLAS Standard 5) --None--Always Most of the time Does not currently assess Unknown 5. Do all LEP or Deaf / Hard of Hearing clients receive verbal and written notices about their right to language assistance services? (CLAS Standard 6) Check ALL that apply. (Press & hold Control key to select more than one value). Verbal notices are provided Written notices are provided Our facility does not currently provide either verbal or written notice about this right Unknown 6. Are Deaf / Hard of Hearing clients and clients with disabilities provided a copy of your program's Disability Access notice? (CLAS Standard 6) --None--Always Most of the time Sometimes Our program does not currently provide Disability Access notice to patients 7. Does your facility offer written materials in languages that target the diverse cultural groups in your service area/population? (CLAS Standard 8) --None--Written materials are offered in the languages of all cultural groups in our service area/population Written materials are offered in the languages of some cultural groups in our service area/population Our program does not currently offer written materials in the languages of the cultural groups in our service area/population Unknown 8. Does your facility clearly display images / post signage visibly that shows inclusivity for the diverse cultural groups including LGBTQ and people with disabilities in your service area/population? (CLAS Standard 8) --None--Images / signage visibly posted in the languages of all cultural groups in your service area Images / signage visibly posted in the languages of most cultural groups in your service area Images / signage visibly posted in the languages of some cultural groups in your service area Our facility does not currently post images / signage visibly in the languages of the cultural groups in our service area 9. Does your facility have a plan to identify and address CLAS needs for underserved populations? (CLAS Standard 9) --None--A plan is fully developed and being implemented A plan is currently in draft form or only partially implemented Our facility does not currently have a written plan Unknown 10. Does your program review your written CLAS plan at least once a year to assess CLAS progress and needs? (CLAS Standard 10) --None--Written CLAS plan is reviewed by program about once a year Our program does not currently review our written CLAS plan once a year Not applicable: our program does not currently have a written CLAS plan 11. Does your facility collect client satisfaction data to inform culturally- and linguistically appropriate service (CLAS) delivery? (CLAS Standard 14) --None--Always Sometimes Our program does not currently collect client satisfaction data to inform CLAS delivery Unknown 12. Does your facility use Race, Ethnicity, and Language (REAL) community/service area data to help design and deliver program services? (CLAS Standard 11) --None--REAL community data used in all applicable situations to design/deliver program services REAL community data used most of the time to design/deliver program services REAL community data sometimes used to design/deliver program services REAL community data never used to design/deliver program services Unknown 13. Does your facility use REAL patient data to help design, deliver and evaluate program services? (CLAS Standard 11) --None--REAL client data always used to design/deliver program services REAL patient data used most of the time to design/deliver program services REAL patient data sometimes used to design/deliver program services REAL patient data never used to design/deliver program services Unknown 14. Is there an area that you would identify as needing assistance implementing CLAS? If yes, please explain.
