Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00204165 Renewal 04/25/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.17(c)The Self-Assessment completed on 1/26/22 lists a violation under regulation 6500.121c6; however, there is no written Plan of Correction attached to the document.A copy of the agency's self-assessment results and a written summary of corrections made shall be kept for at least 1 year.Director of Quality Assurance met with Life Sharing Specialist to develop a POC for violation 121c6. The POC was added to the self-assessment on 4/28/2022 as Attachment# 9. 05/12/2022 Implemented
6500.64(a)The toilet in the bathroom that Individual #1 uses, had fecal matter caked throughout the toilet at the time of the inspection. The toilet in the additional bathroom also had fecal matter in the toilet at the time of the inspection.Clean conditions shall be maintained in all areas of the home.The LSP's family was notified of the violation on 4/26/2022, and the toilets were cleaned that day. LSS visited the home on 5/5/2022 and verified that both toilets were clean and marked this on the home check list as attachment # 5. 05/05/2022 Implemented
6500.72(b)The doorway in the basement leading to the outside had a two-three inch gap on either side leading directly to the outside.Screens, windows and doors shall be in good repair.LSP has someone coming to fix the door in the few weeks. The door in the basement will be fixed before the end of the month (May 2022) a picture of the fixed door will be sent as Attachment # 7 once completed. 05/31/2022 Implemented
SIN-00127687 Renewal 04/10/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.151(e)(1)Individual #1's 11/9/17 assessment did not include her functional strengths and needs.The assessment must include the following information: Functional strengths, needs and preferences of the individual.Individual 1 Assessment 9/1/17 was amended on 4/18/18 and sent out to all team members clarifying functional strengths, needs and preferences of individual 1. A copy of the updated assessment as well as the signature sheet reviewing the regulation 6500.151 (e) 1 will be sent as an attachment. 04/18/2018 Implemented
6500.151(e)(13)(i)Individual #1's 11/9/17 assessment did not include progress over the past year in health.The assessment must include the following information:The individual's progress over the last 365 calendar days and current level in the following areas: Health.An amended Assessment was completed updating the individuals progress over the last 365 calendar days and current level health on 4/18/18 this was sent out to all team members and reviewed with individual 1. Attachment of the amended assessment will be sent as an attachment. 04/18/2018 Implemented
6500.151(e)(13)(ii)Individual #1's 11/9/17 assessment did not include progress over the past year in motor and communication skills.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Motor and communication skills.An amended Assessment was completed updating the individuals progress over the last 365 calendar days and current level motor and communication on 4/18/18 this was sent out to all team members and reviewed with individual 1. Attachment of the amended assessment will be sent as an attachment. 04/18/2018 Implemented
6500.151(e)(13)(iii)REPEATED VIOLATION - 1/31/17. Individual #1's 11/9/17 assessment did not include progress over the past year in activities of residential living. The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Activities of residential living.An amended Assessment was completed updating the individuals progress over the last 365 calendar days and current level activities of residential living on 4/18/18 this was sent out to all team members and reviewed with individual 1. Attachment of the amended assessment will be sent as an attachment. 04/18/2018 Implemented
6500.151(e)(13)(v)REPEATED VIOLATION - 1/31/17. Individual #1's 11/9/17 assessment did not include progress over the past year in socialization.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Socialization.An amended Assessment was completed updating the individuals progress over the last 365 calendar days and current level socialization on 4/18/18 this was sent out to all team members and reviewed with individual 1. Attachment of the amended assessment will be sent as an attachment. 04/18/2018 Implemented
6500.151(e)(13)(vi)Individual #1's 11/9/17 assessment did not include progress over the past year in recreation. The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Recreation.An amended Assessment was completed updating the individuals progress over the last 365 calendar days and current level recreation on 4/18/18 this was sent out to all team members and reviewed with individual 1. Attachment of the amended assessment will be sent as an attachment. 04/18/2018 Implemented
6500.151(e)(13)(vii)REPEATED VIOLATION- 1/31/17. Individual #1's 11/9/17 assessment did not include progress over the past year in financial independence.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Financial independence.An amended Assessment was completed updating the individuals progress over the last 365 calendar days and current level financial on 4/18/18 this was sent out to all team members and reviewed with individual 1. Attachment of the amended assessment will be sent as an attachment. 04/18/2018 Implemented
6500.151(e)(13)(viii)Individual #1's 11/9/17 assessment did not include progress over the past year in managing personal property. The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas : Managing personal property.An amended Assessment was completed updating the individuals progress over the last 365 calendar days and current level managing personal property on 4/18/18 this was sent out to all team members and reviewed with individual 1. Attachment of the amended assessment will be sent as an attachment. 04/18/2018 Implemented
6500.151(e)(13)(ix)REPEATED VIOLATION - 1/31/17. Individual #1's 11/9/17 assessment did not include progress over the past year in community integration. The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Community integration.An amended Assessment was completed updating the individuals progress over the last 365 calendar days and current level community integration on 4/18/18 this was sent out to all team members and reviewed with individual 1. Attachment of the amended assessment will be sent as an attachment. 04/18/2018 Implemented
6500.155(b)REPEATED VIOLATION - 1/31/17. Individual #1's Individual Support Plan (ISP) indicated she cannot mange money independently. The ISP also indicated she could handle small amounts of money. According to the financial logs, Individual #1 is receiving between $20 and $80. Individual #1 was not assessed to safely handle this much money.The ISP shall be implemented as written.An email clarifying spending money sent to Supports Coordinator RL to be added to individual 1 Service Plan this change was discussed with individual 1 and Lifesharing Provider. Attachment of email and signature sheet reviewing regulation 6500.155 (b). will be sent. 04/18/2018 Implemented
6500.156(c)(1)REPEATED VIOLATION - 1/31/17. Individual #1's 6/13/17, 9/8/17, 12/12/17, and 3/9/18 Individual Support Plan (ISP) reviews did not include progress toward the ISP outcome of dental health. The outcome does not include a measurable piece to track progress.The ISP review must include the following: 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 family living home licensed under this chapter.This dental health outcome was completed , documentation of new outcome established ensures that the outcome is trackable to ensure progress is being made. This will be tracked on ISP reviews moving forward. Attached will be sent with the new outcome and tracking. Signature sheet reviewing regulation 6500 156 (c) 1. with Lifesharing Specialist CH will be sent as an attachment. 04/18/2018 Implemented
6500.156(e)REPEATED VIOLATION - 1/31/17. The option to decline the Individual Support Plan (ISP) review documentation was not provided to Individual #1's day program.The family living specialist shall notify the plan team members of the option to decline the ISP review documentation.An option to decline was sent to day program, Program Specialist NC. A copy of the updated option to decline letter as well as a signature sheet reviewing regulation 6500.156 (e) by Life sharing Specialist CH will be sent as an attachment. 04/18/2018 Implemented
6500.182(c)(3)Individual #1's record did not include physical exams. Each individual's record must include the following information: Physical examinations.Individual 1 as well as all client physicals have been placed in the individual's file for review. A copy of the signature reviewed by all Life sharing Specialist and sent as an attachment. 04/18/2018 Implemented
SIN-00082119 Renewal 07/21/2015 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.45(b)Staff #1 did not have current or previous years training in annual first aid and Heimlich techniques. The primary caregiver shall be trained by an individual certified as a trainer by a hospital or other recognized health care organization, in first aid and Heimlich techniques prior to an individual living in the home and annually thereafter.Regulation 6500.45c-Staff # 1 did complete 1st Aid/CPR training on 9/19/2013. A copy of 1st Aid/CPR card will be scanned and emailed by Natasha Caruso Lifesharing Coordinator. 08/25/2015 Implemented
6500.46(a)REPEAT: Staff #1 did not have any training records for 24 hours of training in human services field. At licensing last year, Staff #1 did not receive any training in pre-service requirements. The adult family member who will have primary responsibility for caring for and providing services to the individual shall have at least 24 hours of training in the human services field annually.Regulation 6500.46a-Staff # 1 completed 50 hours of training for this licensing year. Training records will be scanned and emailed by Natasha Caruso Lifesharing Coordinator. 08/25/2015 Implemented
6500.74The porch steps and basement steps did not have non skid surfaces. Interior stairs and outside steps that are accessible to individuals shall have a nonskid surface.Regulation 6500.74- Agency contractor added antiskid to interior and exterior stairs of the home. Pictures were taken to show corrections made. A copy of the pictures will be scanned and emailed by Natasha Caruso Lifesharing Coordinator. 09/04/2015 Implemented
6500.110(c)Staff #2 was not trained in fire safety for the current or previous year. Family members and individuals, including children, shall be trained within 31 calendar days of an individual living in the home and retrained annually, in accordance with the training plan specified in subsection (a).Regulation 6500.110c-Staff # 2 completed fire safety training on 07/28/2015 by Crystal Houser Lifesharing Specialist. Staff # 1 and Staff # 2 reviewed regulation 6500.110c and completed a sign in sheet.A new fire manual and a fire safety checklist for the Lifesharing Specialists to complete during home visits was created for each home to better organize and track content a copy of the appendix of the fire manual and checklist . These documents will be scanned and emailed by Natasha Caruso Lifesharing Coordinator. 07/28/2015 Implemented
SIN-00204082 Renewal 04/25/2022 Compliant - Finalized
SIN-00183351 Unannounced Monitoring 02/16/2021 Compliant - Finalized
SIN-00055210 Initial review 07/01/2013 Compliant - Finalized