Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00146724 Renewal 12/06/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.23(d)Family Member #1 most recently had a Pennsylvania criminal history record checks completed 11/15/16. Individual #1 began residing in the home on 11/13/18.Pennsylvania and FBI criminal history record checks shall have been completed no more than 1 year prior to an individual living or receiving respite care in the homeFamily member #1 had a Pennsylvania criminal history record check completed on 12/6/18. Results were "has no criminal record in Pennsylvania. "The family living specialist will continue to monitor when family criminal history checks are due when new individual moves into the home by way of creating a form for documentation of these dates. The current dates will be entered onto the form. If a new individual is placed in an existing home, the family living specialist will immediately refer to the dates on this form. If a new check needs to be completed for a provider and current family members, the family living specialist will complete this immediately via the PATCH website and document and initial this date on the new form. The program director will then review the form and dates and initial as well. This document will be received anytime a new individual or family member moves into the home. Supporting documentation attached. The program director will follow up on this and check to ensure that PA criminal history checks are completed in a timely fashion. All family living providers and family living specialists were trained on this regulation 12/20/18. Supporting documentation is attached. 12/06/2018 Implemented
6500.125(a)Family Member #1 did not have physical examination. Individual #1 began residing in the home on 11/13/18.Family members and persons living in the home shall have a physical examination within 12 months prior to the individual living in the home.Family member #1 completed a physical on 12-8-18. The family living specialist will continue to monitor when family physicals are due when new individual moves into the home. The program director will follow up on this and check to ensure that physicals are completed in a timely fashion. All family living providers and family living specialists were trained on this regulation 12/19/18. Supporting documentation is attached. By creating a form for documentation of these dates, as soon as it is determined that a new individual will move into an existing family living home, the family living specialist will refer to this form to check dates of physicals and Tuberculin tests to determine whether new exams are necessary for the family living provider and all family members. The family living specialist will then notify the family if these tests need done. These tests will be completed immediately, and the family living specialist will document the new dates and initial. The program director will then review the new date and document as well. If new physicals and TB tests are needed, they will need to be completed immediately upon notification of the placement. Supporting documentation attached. 12/08/2018 Implemented
6500.125(c)(2)Family Member #1 did not have a Tuberculin skin testing by Mantoux. Individual #1 began residing in the home on 11/13/18.The physical examination shall include: (2) Tuberculin skin testing by Mantoux method with negative results every 2 years for family members 1 year of age or older; or, if a tuberculin skin test is positive, an initial chest X-ray with results noted. Tuberculin skin testing may be completed and certified in writing by a registered nurse or licensed practical nurse instead of a licensed physician.Family member #1 completed a Tuberculin skin test by Mantoux method. The test was administered on 12/8/18 and read on 12/10/18. Results were negative. The family living specialist will continue to monitor when Tuberculin skin tests are due are due when new individual moves into the home by creating a form for documentation of these dates, as soon as it is determined that a new individual moves into an existing family living home, the family living specialist will refer to this form to check dates of physicals and Tuberculin tests to determine whether new exams are necessary for the family living provider and all family members. The family living specialist will then notify the family if these tests need done. These tests will be completed immediately, and the family living specialist will document the new dates and initial. The program director will then review the new date and document as well. If new physicals and TB tests are needed, they will need to be completed immediately upon notification of the placement. Supporting documentation attached. The program director will follow up on this and check to ensure that Tuberculin tests are completed in a timely fashion. All family living providers and family living specialists were trained on this regulation 12/19/18. Supporting documentation is attached. 12/08/2018 Implemented
SIN-00074131 Renewal 01/07/2015 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.17(a)The self-assessment of the home was completed on 7/3/14; however, the certificate of compliance expired on 10/1/14.If an agency is the legal entity for the family living home, the agency shall complete a self-assessment of each home the agency is licensed to operate within 3 to 6 months prior to the expiration date of the agency's certificate of compliance, to measure and record compliance with this chapter.Self-assessment to be done 3 to 6 months before expiration of license. Self-inspections to be dated after April 1, 2015, and before July 1, 2015. Self-assessment form attached. 02/14/2015 Implemented
6500.73The 6 outside basement steps did not have a handrail.An interior stairway exceeding two steps that is accessible to individuals, ramp and outside steps exceeding two steps, shall have a well-secured handrail.Ramp installed, photo attached. Safety checklist created attached. Family living provider to review on a monthly basis and information given to the family living specialist at which time all necessary repairs will be completed. Training given to family living provider and family living specialist. 02/14/2015 Implemented
6500.121(c)(9)The most recent prostate examinations for Individual #1 were completed on 7/11/13 and 11/13/14. The physical examination shall include: A prostate examination for men 40 years of age or older.Prostate examination scheduled. Form created to make sure that all medical appointments are completed within the annual time frame. Form attached. Family living specialist responsible for seeing that appointments are done within the time frame, and the program director will oversee this as well. Training given to family living provider and family living specialist. 02/14/2015 Implemented
6500.133(c)Medication reviews for Individual #1 were completed on 11/12/13, 2/20/14, and 8/7/14. If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a review with documentation by a licensed physician at least every 3 months that includes the reason for prescribing the medication, the need to continue the medication and the necessary dosage.Form created to keep track of due dates for psychotropic medication reviews. Next review already scheduled (form attached). Family living specialist responsible for seeing that appointments are scheduled and completed. Program director to review this information as well. Training given to family living provider and family living specialist. 02/14/2015 Implemented
6500.151(e)(1)Individual #1's assessment, dated 10/4/14, did not include the functional strengths, needs and preferences of the individual.The assessment must include the following information: Functional strengths, needs and preferences of the individual.Functional strengths, needs, and preferences of the individual completed on the assessment. Family living specialist to review that the assessment was completed annually after signing off on the assessment. It will also be reviewed by the program director. Training given to family living provider and family living specialist. 02/14/2015 Implemented
6500.151(e)(2)Individual #1's assessment, dated 10/4/14, did not include the likes, dislikes and interests of the individual.The assessment must include the following information: The likes, dislikes and interest of the individual.The likes, dislikes, and interests of individuals #1 and #2 were completed on the assessment. Family living specialist approved the changes. Family living specialist will review the assessment annually to see that all information is completed and current. The program director will then also review the assessment. Training given to family living provider and family living specialist. 02/14/2015 Implemented
6500.182(c)(1)(vi)Individual #1's photograph was dated May, 2001.Each individual's record must include the following information: Personal information, including: A current, dated photograph.Current photo taken and dated. All photographs to be retaken within a 5-year period. The family living specialist will supervise that the time frame has been met and the program director will also see that the family living specialist has checked to see that photos are current. Training given to family living provider and family living specialist. 02/14/2015 Implemented
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