Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00098329 Renewal 07/06/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)Lint, the size of a golf ball was found in the dryer in the basement. There was water leaking from a pipe into the left corner of basement causing water to accumulate in covering approximately 3 feet in radius.Floors, walls, ceilings and other surfaces shall be in good repair. Property owner was notified with all site issues of concern to have them rectify water issue. The plumber fixed the problem on 07/22/2016. Site supervisors will use the Site Safety Check List concern sheet and document all areas of non-compliance issues. Program Director will provide training to Site Supervisors 1. To complete the Site Safety Check List and 2. To bring Check list to weekly meeting 3. To bring immediate concerns to the Program Director 4. Outcome when protocol is not followed. 08/31/2016 Implemented
6400.141(a)Individual #1's previous physical examination was completed on 9/8/14 and the current physical examination was completed on 9/24/15.An individual shall have a physical examination within 12 months prior to admission and annually thereafter. Medical Coordinator will coordinate appointments for all residents. Medical Coordinator will utilize a tickler to include all appointments that are due and the ones that have been completed. The Program Director review the tickler on a weekly basis. Program Director will provide training to Site Supervisors, Program Coordinator and Medical Coordinator: 1. Regulations 2. Appointment protocol 3. Appointment Tickler 4. Outcome when protocol is not followed. 08/31/2016 Implemented
6400.213(1)(i)Individual #2's record did not include a current dated photograph. Each individual's record must include the following information: Personal information including: (i) The name, sex, admission date, birthdate and social security number. (iii) The language or means of communication spoken or understood by the individual and the primary language used in the individual's natural home, if other than English. (ii) The race, height, weight, color of hair, color of eyes and identifying marks.(iv) The religious affiliation. (v) The next of kin. (vi) A current, dated photograph.Program Director had a picture taken of the individual and placed the picture in the individual¿s record. An updated picture was taken and placed in the individual¿s record on 08/10/2016. All individual¿s photos will be updated now. All individuals will have a new photo taken and placed in their record every 4 years. Every 4 years new photos will be taken by Program Director or designee and placed in the individual¿s record. As there are new admissions, a photo will be taken and placed in the individual¿s record. Program Director will provide training to Site Supervisors, Program Coordinator and Medical Coordinator 1. Regarding Regulations 2. Regarding picture taking procedure 3. EMS update procedure 08/31/2016 Implemented
SIN-00075885 Renewal 03/19/2015 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.46(i)Staff A's previous CPR training was completed on 1/7/11; the most recent CPR training was completed on 1/3/14. Staff A's previous First Aid training was completed on 3/4/11; the most recent First Aid training was completed on 1/3/14. Program specialists, direct service workers and drivers of and aides in vehicles shall be trained within 6 months after the day of initial employment and annually thereafter, by an individual certified as a trainer by a hospital or other recognized health care organization, in first aid, Heimlich techniques and cardio-pulmonary resuscitation. HR Coordinator will review the training data base monthly to ensure all employees are up to date with CPR and First Aid. If the employee is within 2 months of their expiration date, HR Coordinator or designee will inform the employee of the impending expiration and of upcoming classes prior to expiration. During this contact, the employee will be reminded as per OFP policy that they will be removed from the schedule if they fail to become re-certified by their card's expiration date. 05/31/2015 Implemented
6400.112(f)The front door was used as the exit during the fire drill on 3/4/14, 5/7/14, 6/9/14, 9/5/14, 10/2/14, 11/12/14, 12/6/14, 1/5/15, 2/8/15 and 3/6/15. Alternate exit routes shall be used during fire drills. The revised fire drill schedule includes six months of alternate exit fire drills. The drill will be unannounced and only the maintenance director will be familiar with the revised fire drill. The Program Director reviews the fire drill records upon completion to ensure compliance. Staff will receive training on the importance of using alternative exits during the fire drills. 05/31/2015 Implemented
6400.151(a)Staff A's precious physical examination was dated 1/12/11; the most recent physical examination was dated 1/4/14. A staff person who comes into direct contact with the individuals or who prepares or serves food, for more than 5 days in a 6-month period, including temporary, substitute and volunteer staff, shall have a physical examination within 12 months prior to employment and every 2 years thereafter. A physical examination form as well as a memo stating the due date of the physical is sent to the employees' home address, three months prior to the due date of the examination. Monthly, HR Coordinator reviews the Physical Examination data base, along with the current physical form to ensure that all employees are in compliance with the 2 year examination deadline. At two weeks prior to the due date, the HR Coordinator contacts the employee and informs their supervisor. During this contact, the employee will be reminded as per OFP policy that they will be removed from the schedule if they fail to submit a physical examination form prior to their due date. 05/31/2015 Implemented
SIN-00057795 Renewal 02/26/2014 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.15(a)The self-assessment form was not dated.(a) The agency shall complete a self-assessment of each home the agency operates serving eight or fewer individuals, 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. In the future, when the Program Director completes the self-assessment of each home, within 3 to 6 months prior to the expiration date of the certificate of compliance (April 1), the document will be dated and submitted to the Program Administrator for review. 01/01/2015 Implemented
6400.67(a)The bathroom toilet seat had the finish worn-thru to the substrate.(a) Floors, walls, ceilings and other surfaces shall be in good repair. The toilet seat was replaced. 03/14/2014 Implemented
6400.77(b)The first aid kit lacked scissors and tweezers(b) A first aid kit shall contain antiseptic, an assortment of adhesive bandages, sterile gauze pads, a thermometer, tweezers, tape, scissors and syrup of Ipecac, if an individual 4 years of age or younger, or an individual likely to ingest poisons, is served. The scissors and the tweezers were purchased and placed in the first aid kit. 04/02/2014 Implemented
SIN-00049230 Renewal 03/14/2013 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(a)A 4 ounce bottle of Mr. Clean was under the bathroom sink. (a) Poisonous materials shall be kept locked or made inaccessible to individuals. The Mr. Clean was removed from under the bathroom sink and put into a locked cabinet on 3/15/2013, so that it is inaccessible to the individuals. Staff training will be provided to include information on the storage of poisonous materials. 06/30/2013 Implemented
6400.171An jar of apple sauce was left open in the kitchen cabinet. The label read: Refrigerate after opening Food shall be protected from contamination while being stored, prepared, transported and served. The jar of applesauce was discarded on 3/15/2013. Staff training will be provided regarding food being protected from contamination while being store, prepared, transported and served. 06/30/2013 Implemented