Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00239400 Renewal 02/27/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)Several tiles lining the entrance to the shower in the bathroom attached to Individual #1's bedroom were missing, exposing the grout underneath. Another tile in this area was loose to the touch, wiggling visibly. This surface was in not in good repair.Floors, walls, ceilings and other surfaces shall be in good repair. Tiles replaced and secured to floor. Completed work order attached. 03/04/2024 Implemented
6400.67(b)There were two hazards identified in the home during the inspection: 1. After entering the home, this Licensing Representative noted that the air was noticeably humid to an extent that it was unusual. Upon inspection of the home, there were small, black, splotchy marks consistent in appearance with mold visibly coating portions of several surfaces, including: The windowpanes, windowsills, and window frames of the windows in Individual #1's bedroom; The windowpane and window frame of the window in the bathroom attached to Individual #1's bedroom; The windowpanes, windowsills, and window frames of the windows in Individual #3's bedroom. The presence of mold in a home constitutes an environmental health hazard to individuals residing there. 2. Upon examination, the home's dryer lint trap contained a ping-pong-ball-sized accumulation of lint. This accumulation posed a fire hazard in the home. Floors, walls, ceilings and other surfaces shall be free of hazards.Servpro was called to come and do an evaluation and identified the issue. Treatment has started inside the home to remediate the mold. Additional recommendations to be completed following further professional evaluation. Air quality test performed, see attached invoice. Lint trap was cleaned. Staff were reminded to check and clean the lint trap before and after each use. 03/01/2024 Implemented
6400.72(a)One window in Individual #2's bedroom lacked a window screen at the time of inspection. There were no screens within the home that could be fit into this window should it be opened; therefore, this window was incapable of being securely screened.Windows, including windows in doors, shall be securely screened when windows or doors are open. Screen put in place. 03/05/2024 Implemented
6400.82(e)The shower in the bathroom attached to Individual #1's bedroom was not equipped with a nonslip surface. There was no bath mat available in the home to be placed in the shower if it were to be used. Bathtubs and showers shall have a nonslip surface or mat. Bath mat installed in the bathroom. 03/06/2024 Implemented
6400.82(f)The bathroom attached to Individual #1's bedroom lacked a trash receptacle at the time of inspection.Each bathroom and toilet area that is used shall have a sink, wall mirror, soap, toilet paper, individual clean paper or cloth towels and trash receptacle. Trash receptacle was installed. 03/06/2024 Implemented
6400.141(c)(9)Individual #1's two most recent prostate examinations occurred on 08/24/2023 and 06/15/2022---more than 365 days apart. Individual #1 did not receive a prostate examination as a part of the individual physical examination annually as is required.The physical examination shall include: A prostate examination for men 40 years of age or older. Prostate exam for 2024 is scheduled for 6/2024. 03/04/2024 Implemented
6400.142(g)Individual #1's two most recent Dental Hygiene Plans are dated 01/24/2024 and 05/26/2022---more than 365 days apart. Individual #1's Dental Hygiene Plan was not rewritten at least annually as required.A dental hygiene plan shall be rewritten at least annually. Supervisor retrained on regulation regarding regulation for Dental Hygiene Plans. 03/07/2024 Implemented
6400.166(b)Individual #1 is prescribed the following medications at 8:00am: Clonazepam 0.5mg, Sertraline 100mg, Levothyroxine 88mcg, Ferrous Sulfate 324mg, Pantoprazole 40mg, Daily Vitamin, and Metformin ER 500mg. Individual #1 is prescribed the following medications at 8:00pm: Clonazepam 0.5mg, Olanzapine 10mg, Atorvastatin 40mg, Tamsulosin 0.4mg, and Metformin ER 500mg. Individual #1's prescription medications come packaged together in plastic AM and PM dose packets such that all medications given at the 8:00am administration time are packaged together, and all medications given at the 8:00pm administration time are packaged together. Individual #1's February 2024 Medication Administration Record (MAR) contains a separate page for each administration time and each page lists the medications to be administered at that time. However, instead of having a separate way for staff to record the administration of each individual medication given at the administration time, the MAR provides only one line for staff to sign their initials in order to signify that all medications at the administration time were given. The MAR must contain a way to record the administration of each medication individually.The information in subsection (a)(12) and (13) shall be recorded in the medication record at the time the medication is administered.MAR updated to include spaces for initials for all medications given at the 8am dose. 02/29/2024 Implemented
6400.213(1)(i)Individual #2's Individual Record contains a demographic sheet titled "Intake Form." This form has a field to denote the presence or absence of identifying marks on the individual; however, this form field was left blank. It could not be determined whether the individual lacks identifying marks or whether the field was left blank unintentionally. Information relating to identifying marks was not located elsewhere in the Individual Record.Each individual's record must include the following information: The race, height, weight, color of hair, color of eyes and identifying marks.Intake form updated to include identifying marks. 02/29/2024 Implemented
SIN-00202554 Renewal 03/28/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.165(g)Individual #1 had a psychiatric medication reviews on 2/03/2022 via telehealth and there was no documentation completed by the physician or prescriber recording the reason for prescribing the medications, the name and dosage of the medication and the need to continue the medications.If a medication is prescribed to treat symptoms of a psychiatric illness, there shall be a review by a licensed physician at least every 3 months that includes to document the reason for prescribing the medication, the need to continue the medication and the necessary dosage.Medication form has been revised as of 3/30/2022. Form contains information to cover the reason, name, dosage, and need to continue medication. 03/30/2022 Implemented
6400.166(a)(11)There was no diagnosis or purpose for prescribing the following medications that are prescribed for Individual #1: clonazepam, ferrous sulfate, levothyroxine, pantoprazole, sertraline, atorvastatin, olanzapine and tamsulosin.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Diagnosis or purpose for the medication, including pro re nata.Medication Administration Forms updated to include diagnosis and purpose for prescribing medications. Forms were updated on 3/30/2022. Supporting documents attached. 03/30/2022 Implemented
SIN-00069110 Renewal 01/06/2015 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)The shower wall was missing ceramic tiles in a large area ( approx. 3 feet by 5 feet ) and had a temporary patch covering the area. Staff indicated that Individual #1 pulled the soap tile plus many more tiles off the wall.Floors, walls, ceilings and other surfaces shall be in good repair. A bid has been accepted from Northeast Home Improvements, Inc., for a complete remodel of the bathroom. The bathroom will be gutted and the existing shower/tub, vanity, sink and top, toilet, and faucets will all be replaced. All walls will be torn out as will flooring and replaced. The work is scheduled to begin on March 23, 2015. The Arc Properties Manager, Joe Sepe, is attempting to move that date up, if possible. Patrick Quinn will be responsible for oversight of the project to its completion. 03/01/2015 Implemented
SIN-00169572 Unannounced Monitoring 01/21/2020 Compliant - Finalized
SIN-00147561 Renewal 01/23/2019 Compliant - Finalized
SIN-00129466 Renewal 02/20/2018 Compliant - Finalized
SIN-00108233 Renewal 03/21/2017 Compliant - Finalized
SIN-00089414 Renewal 02/02/2016 Compliant - Finalized