Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00174740 Renewal 08/11/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.121(c)(14)Individual # 1's physical exam dated 08/30/19 did not include information pertinent to diagnosis in case of an emergency. The space was left blank. The physical examination shall include: Medical information pertinent to diagnosis and treatment in case of an emergency.Regulation: 6500.121(c)(14) Medical information pertinent to diagnosis and treatment in case of an emergency. Explanation: This section of the completed physical form was left blank. Correction: 1. Anthony Fisher, Program Director, will train all the Life Sharing Specialists on the regulation. 2. The Life Sharing Specialists will train all primary caregivers on the regulation. 3. The physical form for the individual in question will be corrected by the PCP on 9/3/2020. The new physical form will be provided to validate the correction. 4. A check will be done to verify that this section of the physical form is not blank for any other individuals in the program. 5. Corrections will be made before 9/15/2020. Attachments: 1. Training Summary Form for all Life Sharing Specialists (Attachment #1) 2. Training Summary Form for all primary caregivers (Attachment #4) 3. Copy of corrected physical form scheduled for 9/3/2020 (Attachment #7) 4. Program check to verify compliance with this regulation for all client physicals (Attachment #8) 09/15/2020 Implemented
SIN-00206002 Renewal 06/14/2022 Compliant - Finalized