PCI – 11.24.14
Person Centered Information
Person’s legal name:
Sarah Wilson
Preferred name:
Sarah
Date of last update: 12/1/2014
Use the space under each topic to describe what is currently happening in this person’s life. If the person does
not wish to discuss a topic, please note that. Seek perspectives from others that the person directs.
Hopes and Dreams Personal goals, career goals, where the person wants to live or work, etc.
Person’s perspective
Travel:
GO TO DISNEYLAND AND SEA WORLD!!!
Go to the coast and stay for the weekend at a Hotel with a hot tub and a nice
view of the ocean. Spend the weekend shopping and playing the slot machines at
the casino (maybe do this twice a year).
Family:
Spend more time with my sister Teri and see her nieces and nephews, someday I
would like to take another vacation with them.
Education:
Learn to take my medication by myself
Ride a horse or take horseback riding lessons somewhere.
Home:
I would like to live more independently without
having staff assistance.
Buy a new TV and DVD player for my room.
Likes:
I would like to be Queen for the day.
Activities:
Spend the day at the zoo or at Wildlife Safari.
Additional input
Home and Living:
 Spending time with her family
 Having staff she can have fun with and trust
 No sharing staff
o If I have to share staff I prefer to be notified prior to the time this will
happen.
 Sarah does not like to be bossed around
o If you need me to do something please ask me do not demand.
Routines:
 Having a daily fountain pop
o I can negotiate about where I get my pop and sometimes when I get
my pop, but I must have my pop when I want it.
 Spending time with Family and Friends
o I can be flexible about changing the time I see my family and friends, however it is very
important that this happens often.
 Going to the store on Friday nights
o I can negotiate about what store it is, but it must happen on Friday night.
Person receiving services:
Sarah
Date of last update:
Page 1 of 14
PCI – 11.24.14

It is important that Sarah sit in the front seat of the car.
o If there is a good reason why she needs to ride in the back seat, i.e., broken seat belt you will
need to try to use public transportation, or partner with another house to use their vehicle.
Relationships:
 Visiting with her friends at work
 Sarah would like to have a boyfriend
o Sarah would like a boyfriend who will buy her things and treat her well. She did have a
boyfriend, but he was not very attentive and only did things when Sarah asked him to, so she
ended that relationship. She likes to make her own decisions and choices and values having
staff that are available to help her “process”.
Communication Describe how this person communicates including the person’s preferences for expressing
and receiving communication and how the person communicates their wants, needs, and pain.
Person’s perspective
I like to call my Aunt every week and visit when I can. I keep in touch with my friends on Facebook and
Snapchat. I will let people know what I want.
Additional input
Sarah communicates her wants and needs very well. There are some rare times that she will not want to communicate
and work through something on her own
Communication Styles and Supports:
When Sarah does this…
Include if it matters where it
happens and the intensity in
which it happens
We think it means…
This is our best guess or what
Sarah has told us.
And we should…
How to take action and responses
that have been successful in the
past.
Gets loud and assertive when she
is talking to you...
She is upset, isn’t feeling well,
wants your attention and wants
you to listen...
Remind Sarah that it is not nice to
yell, then ask her to talk with you.
Raises the tone of her voice to a
really high pitched sound
She is excited and happy...
Enjoy it with her.
She is upset about something,
Crying- Sobbing and does not
want to talk to anyone. We usually isn’t feeling well, could be
hormonal ...
see this at home
See her Behavior Support Plan.
Talk with her to calm her down so
it doesn’t progress into a
problem.
Looks at you without
acknowledgment
She may not have heard or
understood what you said.
Ask her if she heard you and to
repeat it back to you.
Goes to her room suddenly
She needs a break
Give her space.
Give her time. She will let you
She may want to talk, isn’t feeling
Gets very quiet
know what she wants when she is
well, or she is tired
ready.
Life in Current Living Arrangements Where and with whom the person lives, who provides supports,
meal planning, cleaning, personal care, opportunities to develop skills at home, hobbies, pets, safety,
opportunities to contribute to the household, etc.
Person receiving services: Sarah
Date of last update: 12/1/2014
Page 2 of 14
Person’s perspective
I love where I live, I just wish I was closer to family.
Additional input
Living Arrangements:
Sarah has lived in several places since graduation and has been associated with Spruce Villa, Shangri La, Sunny
Oaks, and has been with PCL since 2001.
How We Support Sarah With Personal Care:
Staff assists with all medications and treatments. Sarah can rub in her cream around her toes.
Sarah needs cued around all her hygiene, i.e., brushing her hair, brushing her teeth, putting on her glasses,
and hearing aids.
Sarah has a hair stylist that she enjoys going to. She has built a relationship with her. Her name is Jackie
Atwater.
Routines that are Important to Sarah:
Weekday
Morning:
Sarah wakes up at 8 a.m., takes her medications, and goes back to bed until 9 am. She then gets up and
does her personal care and gets dressed.
At 9:30 a.m. she makes her lunch for work and leaves for work at 9:40 a.m. She arrives at Goodwill on
Lancaster to work at 10 a.m.
Afternoon:
Staff picks her up at 2 .pm. If her roommate is not with staff when picked up, Sarah enjoys having one on
one time with staff to talk about her day.
At 2:15 p.m. she arrives home and sometimes wants to talk a bit longer. She enjoys doing some crafts
especially beading. She will usually needs some transition time and will watch TV in the front room. She
may also decide to nap.
Evening:
Sarah sometimes will help prepare dinner. Dinner is usually ready around 5:00 p.m. Sarah helps with dinner
clean-up and gets some of her chores done, i.e., laundry, sweeping, and mopping. During the evening she
may want to do some of her planned activities.
From 6 p.m. to 8 p.m. Sarah has her medications and treatments, takes a bath, does any personal care, gets
on her PJ’s, and usually watches TV until she goes to sleep. Sarah usually goes to bed between 8:00 p.m.
and 10:00 p.m. She sets her own bed time.
Weekend
Weekends look much like the weekday but it is important to note that she gets up, takes her medications,
and does any needed treatments before returning to bed. If you have a preferred activity planned it is much
easier for Sarah to get motivated to get out of bed. Sarah has lunch around 12:00 p.m., does her chores.
Dinner is usually around 5 p.m. - 6 p.m. This change depending on the time of year. Sarah enjoys taking her
bath whenever she desires on the weekend, sometimes more than one a day. Sarah’s meds and treatments
will follow the same schedule as weekdays.
Saturday:
Person receiving
services:
Sarah
Date of last 12/1/2014
update:
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14
Saturday’s she likes to attend the dances and likes plenty of time to get ready.
Sunday:
Sunday’s she usually likes to hang with friends or just relax around the house.
Pre-Employment and/or Work Job exploration, job development for self-employment or paid work, job
coaching, career goals, job satisfaction, developing job skills, planning for retirement, workplace safety,
opportunities for continuity between work and home, opportunities to contribute to the workplace, financial
concerns, childcare needs, lack of resume, distance to work, etc.
Person’s perspective
I like learning new things and helping people at my job
Additional input
What’s Most Important at Work/ Day Supports & Activities/School:
Most Important
To & For
Schedule in advance
Lunch break at the same time
15 minutes to visit with coworkers before or after her
shift
Clear instructions and direction
Someone she can trust to talk
to at work. Sarah will tell you
who she trusts.
Nice quite place to take her
breaks and eat her lunch
What we do to help Sarah in making these things happen? How do we
best support when these things can’t happen?
Supervisor will go over Sarah’s schedule with her for the next day at the
end of her shift.
Sarah’s lunch is always scheduled at 12:30pm
Staff remind Sarah that she needs to complete her task list so she will
have time after her shift to visit
Sarah’s supervisor goes over her task list with her at the start of every
shift and asks Sarah to repeat back what the plan is.
Staff schedule Sarah with co workers she trusts and enjoys working with
There is a break room available for staff. If that room is too busy for Sarah
there is a small room at the south end of the store that she can eat her
lunch in that is available to her every day.
What are Sarah’s Current Job Duties/Day Supports & Activities/School Activities (if not described above)?
Check box if one
Please provide details on how this job/duty is done and what
Current Duties
of Sarah’s
helps Sarah to be successful with these duties?
Favorite Duties
Sorting
Sarah sorts clothes according to the Goodwill sorting process
posted on the sorting area wall. Making sure her sorting station
located in the back room second one to the right (It is clearly
labeled) is clean when she arrives to work
Folding Clothes
Sarah sometimes needs a demonstration on folding clothes. There
is a picture card at her station used to show how the different
articles of clothing are folded and lays out all the steps in the
folding process.
Person receiving
services:
Sarah
Date of last 12/1/2014
update:
Page 4 of
14
Arranging
displays
Cleaning and
organizing the
store room
Sarah assists staff with arranging displays. She takes direction from
the staff.
Sarah will clean up and organize the store room according to the
store room map provided by the store manager. When Sarah is
having a difficult day she likes doing this to get away from people
and calm down
X
Important Relationships at Work/Community Inclusion/School:

Important relationships include:
o Supervisor: Jill Johnson
o Co workers: Kevin Smith and Shelly Brown
o Regular Customers Sarah likes to help: Bob and Sally
How do we support Sarah with personal care at Work/Day Supports &
Activities/School?
 All staff review Sarah’s protocols and procedures
 Sarah will tell staff she needs help or support with her personal
routines and care
 Staff remind Sarah to take bathroom breaks every couple of hours
because she forgets sometimes and has to run to the bathroom
What is Sarah’s dream for earning money?
Sarah would like to be a cashier and find a job closer to her house.
She has also talked about starting her own business selling her crafts but then
decides it would make her crafting a task rather than being a fun hobby.
Employment-related skills Typing, answering phones, timeliness, organization, follow-through,
friendliness, technical or computer skills, etc.
Sarah likes to use a computer and can answer phones. She likes being around people.
Employment-related preferences Hours, pay, location, etc.
She likes to work Monday through Thursday. She does not like to wake up early so likes to start work after 9:00am.
If the person chooses not to work in or explore individual, integrated employment: Explain why the person made this
decision. What work experience was this decision based on? Does the person have any concerns about employment? Would the
person like to revisit this decision within the next year?
School and Life-Long Learning Things this person would like to learn, opportunities for continuity of
supports between school and home, continuing education, personal or professional development, accessing
school options, graduation preferences and diploma options, etc.
Person’s perspective
I would like to learn:




How to take my own medication
How to quilt
How to use the camera I am going to get
Ride a horse
Person receiving
services:
Sarah
Date of last 12/1/2014
update:
Page 5 of
14
Additional input
Sarah is a good listener and learns things fast. She would like to be more crafty.
Day Services Location, participation in chosen activities, attendance, relationships, safety, opportunities for
continuity between day service settings and home, etc.
Person’s perspective
NA
Additional input
NA
Community and Social Life Recreation/leisure activities, community activities, accessing community
locations, shopping, visiting friends and family, social networking, clubs, volunteer work, safety, opportunities
to develop social skills, opportunities to contribute to the community, etc.
Person’s perspective
I love to spend time with friends. I think everyone is my friend and it can get me in trouble sometimes. I like to
go to the movies, shopping and to dances. I want to find a boyfriend so I can go to these places with him.
Additional input
Social Supports Needed to Develop Relationships and Enjoy the Community:
Sarah has staff with her in the community to help her make good choices and to keep her safe. She does not
hear well and might need help. She is not always safe around strangers and men. She is very friendly. She
wants and needs people to like her. These staffing and stranger danger issues are addressed on her Behavior
Support Plans at home and at work.
Sarah likes to shop and be out and about, she is willing to try new things and go to new places.
Sarah buys a fountain drink everyday at US Market. She pays for it herself with her spending money.
Enjoying Life: Sarah’s Favorites
(Things Sarah likes, gets excited about, hobbies, ect.)
Home:
 All kinds of music – especially country
 Taking long baths with bubbles, soaps and oils
 Word puzzles
 One on one time with staff
 Sleeping
 Talking on the phone
 Getting her hair and nails done
 Dressing up
 Enjoys arts and crafts and beading
Person receiving
services:
Sarah
Date of last 12/1/2014
update:
Page 6 of
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Out and About:
 Going to dances- Likes to socialize and not dance
 Parties
 Camping
 Having pictures taken of her and also taking pictures
 Going on vacations and trips
 Salem’s Carousel
Friends:
 Being social
 Doing fun activities with her roommates
General:
 Animals – horses and cats
 Favorite colors are blue and baby blue
 Likes to give people she knows well hugs
Family Camping Trip
Summary of Previous Year:
Goals and Achievements:
 Sarah vacationed at the coast and had a great time. She has been trying to save to go San Diego and
Sea World but realizes that may take several years to accumulate the money to go. She also wants
to take another vacation to the coast.
Relationships:
 Sarah was unable to spend the holidays with her sister and her family as it is too much for Teri to do
with 5 children at this time
Living situation:
 Sarah continues to live with Missy on one side of a duplex and Heather who lives on the other side of
the duplex.
 Sarah is extremely proud of her room which was painted the color of her choice, purple. She has
been able to purchase a new TV for the living room, and for her “new” room a desk and small
refrigerator.
Community Involvement:
 Sarah has attended SPARC sporadically and has begun to talk about volunteering in her community.
 Sarah wanted to help out so she went to the Capitol to talk to legislators about the importance of DD
services in her life.
 Sarah helped plan and participated in a neighborhood clean up day.
 Sarah attended the OSU football spring game.
Strengthening Independence:
 Assisted in the kitchen and taken an interest in helping with meal preparation
 Helped pick out paint colors for her room and the rest of her home
 Had input and taken an interest in redecorating her home
 Taken an active part in keeping the home cleaner and straighter and has a sense of pride in her
surroundings
 Assertively told boyfriend that she wanted nothing to do with him and to stop calling her
 Used her Leap Pad to improve her reading skills
Person receiving
services:
Sarah
Date of last 12/1/2014
update:
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
Filed a grievance – when Sarah was having problems with a staff, she dictated to her Coordinator her
concerns in the form of a grievance utilizing the existing process. When meeting on the issue, she
was very clear on how she felt the staff treated her and the way she didn’t like being talked to by the
staff. During the process, Sarah was very compassionate and concerned about the staff but very
clear that she did not like the way she was treated. The outcome was that the staff was moved to
another location.
Additional Information:
Relationship Map
Does the person want support to maintain
these relationships? If yes, how?
Who
People I love and/or
support
People I seek out every
now and then
People who make me feel
loved and supported
People I like to have fun
with
People I’d like to have in
my life
Sister Teri Tucker and 6 Nieces and
nephews
My relatives at our family reunions
Sister Teri, Jackie Atwater, Brenda
Jones
Kathy Smith, Andrew Mason
I would like to meet Bon Jovi
I send cards to my sister, Teri, and my
nieces and nephews. I like to do things
with them as much as possible and visit
with them on holidays.
I call my Aunt Karen and see her several
times throughout the year.
I see my friends, Kevin and Shelly, at
work every day.
Jackie does my hair monthly at Jackie’s
Hair Salon on State St. in Salem.
My staff- Kim, Elaine, and Jamie,
Jackie Atwater (Hair Dresser)
Relationships Anything about current relationships that this person would like to change, suggestions from
others on changing relationships, what will it take to have closer relationships in his/her life, etc.
Person’s perspective
I would like more friends and spend more time with my family.
People who help me
Additional input
Sarah really enjoys spending time with family and would like to see them more often. She talks about going on
vacation with them and about a time they went to Disneyland together. She has the pictures from that trip
framed on her wall.
Characteristics of people who support this person best
Interests:
 People who love to shop
 Staff who does arts and craft projects with her
Personality:
 Fun
 Sense of humor
 Likes to tease
 Consistent and dependable
Person receiving
services:
Sarah
Date of last 12/1/2014
update:
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14





Kind
Calm
Outgoing
Someone who will make sure she has one on one time with staff
People who are social
Health and Wellness Adequacy of current supports, medication administration, unmet needs, relationships
with medical professionals, physical fitness, preventative care, health screenings, nutrition, nursing services,
occupational therapy, dental care, planning for end of life care, etc.
Person’s perspective
I like to take walks to get my exercise and I hate being on a diet. I like veggies with ranch and fruit.
Additional input
Medical:
 Sarah has had surgery to repair her heart. She has a protocol that must be followed when she has
chest pains as well as a PRN.
Staff Expectations:
 Give Sarah space in the morning while she is getting ready. When needed, remind her about things she
may have forgotten.
 Staff need to stay in the same room while she is on the phone to keep her safe and help promote
healthy relationships.
 Help her with chores by giving her little reminders. Don’t boss her around and tell her what to do.
 Don’t tell Sarah what to do. ASK her for help instead.
 All male friends, acquaintances, or interests need to be monitored to be sure Sarah is safe.
 People supporting Sarah need to know about her family and past to help understand what is needed to
keep her relationships healthy.
 Staff need to know the people she is communicating or associating with to make sure she is safe.
Sarah does not have alone time.
 Sarah may not agree with seeing her Doctor for Physicals. Encourage her by saying that it is important
for all of us to go even though we may not want to.
 Getting up in the morning is hard for Sarah but make sure she has a plan to keep her motivated.
General:
 Sarah likes to have someone to talk to away from home, about important things.
 Sarah feels safe when doors are locked and the windows are shut. She usually prefers to have the
windows shut during the day, and her bedroom window open a little bit at night.
 Sarah knows how to call 911.
Person receiving
services:
Sarah
Date of last 12/1/2014
update:
Page 9 of
14
Financial Life Budgeting, managing money, planning for the future, special needs trust, benefits, risk of
exceeding resources, etc.
Person’s perspective
I would like to make more money. I like to go on vacation and buy presents for my family.
Additional input
Sarah likes having money, however, she does not handle her money well. She will spend it all in a couple of
days and not save any for the rest of the month.
Protection and Advocacy Advocating for self, protection from exploitation, participating in self-advocacy
groups or activities, making choices and decisions, personal privacy, identity protection, any supports that
interfere with privacy, etc.
Person’s perspective
I would like to be a part of the SPARC committee.
Additional input
Sarah does a great job of advocating for herself and she cares about others.
Cultural Considerations Family, traditions, faith, heritage, rituals, celebrations, food, planning for end of
life, etc.
Person’s perspective
My family likes to go to church and celebrate holidays together. My favorite holiday is Christmas and I like to
go to my sisters to celebrate. Every year for my birthday we meet at Red Robin (Yumm) for dinner then my
sister takes me to a movie after dinner.
Additional input
History, Events, & Milestones:
(Include spiritual, holiday, and cultural beliefs.)
Family:
Sarah is the eldest of four children and her siblings are Tim, Teri and Elizabeth. Sarah visits with Teri and her 5
children as Teri’s time allows. Her nieces and nephews are Don, Lily, Kira, Paige, and a new baby.
General History:
Sarah was born in Multnomah but grew up in Salem and graduated from South Salem High School in 1985.
Over the years she has been active in Special Olympics, been on the board of People’s First, and is an active
member of SPARC.
Sarah likes to take vacations and would like to vacation twice a year. She traveled to Washington, D.C. several
years ago and really enjoys the coast.
Sarah joined a “Choices” therapy group to help her make healthy choices regarding relationships but
discontinued it this year.
Living Arrangements:
Sarah has lived in several places since graduation and has been associated with Spruce Villa, Shangri La, Sunny
Oaks, and has been with PCL since 2001.
Person receiving
services:
Sarah
Date of last 12/1/2014
update:
Page 10 of
14
Work:
Sarah has worked at Goodwill Industries for 15 years and in 2010 attended a banquet in Portland to receive
her 15 year plaque for her service to Goodwill.
Medical:
Sarah has Williams Syndrome and was born with a heart defect that was surgically corrected. She does have
hearing loss and wears hearing aids in both ears. She has diabetes and needs to watch her diet.
Food Likes:
Mexican Food is Favorite!
Healthy Food
Chinese
Chef Salad w/ Ranch
Cereal
Pizza
Orange Julius
Fresh Fruits
Donuts
Carrots
Chicken & Shake & Bake
Omelets
Buffets
Nachos
Coffee – Decaf w/ Cream & Sugar
Burritos
Pickled Beets
Ham
Eggs & Bacon
Spaghetti
Diet Caffeine Free Soda i.e., Root
Beer
Spinach
Fish (or the smell)
Food Dislikes:
Liver
Rice
Meal Preferences:
Mexican- Tacos, burritos and Enchiladas with rice and beans
Chinese – Sweet and sour chicken
Pizza- Combination From Woodstock’s
Sexuality and/or Intimate Relationships Education, support, family planning, support for family,
privacy, safety considerations, etc.
Person’s perspective
Person receiving
services:
Sarah
Date of last 12/1/2014
update:
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Sarah would like to have a boyfriend
Additional input
Sarah has stranger issues and can have difficulty being appropriate with people she just meets. It helps Sarah if
staff remind her when she is being inappropriate with someone
Mental Health Adequacy of current supports, unmet needs, relationship with mental health professionals,
availability of helpline or other resources, effective strategies, etc.
Person’s perspective
I feel very supported and cared for at my home by my staff.
Additional input
Sarah has a good relationship with all of her health care providers and seems to enjoy going to all her
appointments
Behavior Considerations Adequacy of current supports, unmet needs, effective strategies, relationships
with consultants or other professionals, etc.
Person’s perspective
Sarah did not want to comment on this
Additional input
Sarah does a good job following her treatment plans and is very open and honest will all her providers.
Transportation To/from work, day services, school, activities, means of transportation such as cycling or
driving, learning how to get around independently, etc.
Person’s perspective
Person receiving services:
Sarah
Date of last update: 12/1/2014
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My staff drive me to work and I like it
Additional input
Sarah has showed no interest in using public transportation and enjoys the ride to and from work with staff.
Assistive Devices or Technology that are needed to increase independence, reach personal
goals or lessen the need for other paid support. Assistive Technology tool is available to research
options, explore funding, acquire devices or technology, and establish monitoring and maintenance for AT
already in place.
Person’s perspective
I would like to look into possible technology to help me
Additional input
Sarah would like to get an Ipad or something like that to help her stay in contact with family and friends. She
does not know about a lot of the possible things that could help her and would like to have more information.
Environmental Modifications that are needed to increase independence, reach personal
goals, lessen the need for other paid support. Research options, explore funding, acquiring
modification, establish monitoring and maintenance for modifications already in place.
Person’s perspective
No comment
Additional input
NA
Other Individualized Planning Documents
Person receiving
services:
Sarah
Date of last 12/1/2014
update:
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14
List other available documents such as Essential Lifestyle Plan (ELP), Summary of Performance (from
School), Discovery Profile, Individual Education Plan (IEP, from school), Individual Plan for Employment (IPE,
from VR).
Contributors
Name
Sarah Wilson
Teri Tucker
Angie Anderson
Joy Smith
Person receiving services:
Title/Relationship
Name
Title/Relationship
Person receiving services
Sister
Residential Representative
Employment
Sarah
Date of last update: 12/1/2014
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