Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00209794 Renewal 08/09/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(c)There were two bottles that contained cleaning products which were not in their original labeled containers. One had 'bleach' written at the top and the other was unlabeled.Poisonous materials shall be stored in their original, labeled containers. This was corrected during the inspection 08/08/2022 Implemented
6400.110(e)The home has 3 stories and 4 individuals however the smoke detectors were interconnected. The smoke detectors on each floor operated independently of each other.If the home serves four or more individuals or if the home has three or more stories including the basement and attic, there shall be at least one smoke detector on each floor interconnected and audible throughout the home or an automatic fire alarm system that is audible throughout the home. The requirement for homes with three or more stories does not apply to homes licensed in accordance with this chapter prior to November 8, 1991. A maintenance person had inadvertently disarmed one smoke detector when making a repair the weekend before inspection. This resulted in the smoke detectors working independently of one another. This was corrected during inspection and the licensing representative verified it was corrected. 08/09/2022 Implemented
SIN-00171605 Renewal 02/26/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.72(b)Window blinds in individual#1's bedroom were damaged and need to be replaced. Screens, windows and doors shall be in good repair. The damaged blinds were removed from the bedroom windows. There were also curtains on those windows so there continues to be privacy in the bedroom. The individual will be given the opportunity to purchase new blinds should he want them. In the future the Program Directors will insure that physical site reviews are conducted at least monthly to insure screens, windows and doors are in good repair. 03/02/2020 Implemented
SIN-00145431 Renewal 11/13/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)The plaster on the basement walls was cracked and peeling off on multiple surfaces. It appears as if the wall was crumbling.Floors, walls, ceilings and other surfaces shall be in good repair. This is a home built approximately 100 years ago with a typical unfinished basement for the time period. It had been evaluated by a structural engineer several years ago and a determination was made that the cracking was from typical house settling and not indicative of a structural issue (at that time two posts on the front porch were replaced). The basement is mainly used for storage with an overflow freezer and the washer and dryer. This is a rental property, owned by the neighboring church, and we met with them on 11/16/2018 and are working with them to find the funds in their budget for this cosmetic issue. 11/16/2018 Implemented
6400.112(d)The evacuation time for the fire drill conducted on 08/19/2018 was 2 minutes 45 seconds. Individuals shall be able to evacuate the entire building, or to a fire safe area designated in writing within the past year by a fire safety expert, within 2 1/2 minutes or within the period of time specified in writing within the past year by a fire safety expert. The fire safety expert may not be an employe of the home or agency. Staff assistance shall be provided to an individual only if staff persons are always present at the home while the individual is at the home. A second drill was run on August 25, 2018 but was in the fire book at the home and not in the central fire book. This drill was presented at licensing. All drills will be sent to the office by the 20th of the month and reviewed by the Director of Quality Assurance to insure the drill was conducted properly and is in compliance with regulations and a new drill requested if necessary. 11/14/2018 Implemented
SIN-00062535 Renewal 01/28/2014 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.141(c)(5)Upon admission the diphtheria/ tetanus was dated 1/15/2003; The most recent diptheria/tetanus shot was recieved on 9/20/13. (5) Immunizations and screening tests for individuals 17 years of age or younger, as recommended by the Standards of Child Health Care of the American Academy of Pediatrics, Post Office Box 1034, Evanston, Illinois 60204. This individual was admitted on 3/27/2013 as an emergency placement due to the death of his caregiver. Medical were not readily available upon admission. When medical records were obtained and indicated the diphtheria/tetanus was out of date it was completed. New admissions will not be accepted in the future without complete medical records. The health care coordination will be responsible to ensure all new admission medical records are complete. 02/01/2014 Implemented
6400.141(c)(6)Individual #1 was admitted to the program on 3/27/13; but did not have a TB screening until 6/7/13. (6) Tuberculin skin testing by Mantoux method with negative results every 2 years for individuals 1 year of age or older; or, if tuberculin skin test is positive, an initial chest x-ray with results noted. This individual was admitted on 3/27/2013 as an emergency placement due to the death of his caregiver. Medical were not readily available upon admission. When medical records were obtained and indicated the diphtheria/tetanus was out of date it was completed. New admissions will not be accepted in the future withoutcomplete medical records. The health care coordination will be responsible to ensure all new admission medical records are complete. 02/01/2014 Implemented
6400.186(c)(1)There was no progress documented on Individual #2's monthly summaries from July 2013 to December 2013. (c) The ISP review must include the following: (1) A review of the monthly documentation of an individual's participation and progress during the prior 3 months toward ISP outcomes supported by services provided by the residential home licensed under this chapter. Program Coordinators, who complete the monthly reports were retrained regarding the content of these reports on 2/20/2014. Quality Assurance reviews of these reports will include an increased focus on content regarding progress. The Quality Assurance Training Coordinator will ensure all monthly reports contain the required information. A auditing tool will be developed and implemented to ensure that monthly reports are completed timely and contain the necessary information. A 10% sample of monthly reports will be pulled quarterly to ensure compliance. 02/20/2014 Implemented
SIN-00075618 Renewal 03/02/2015 Compliant - Finalized