Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00125758 Renewal 12/06/2017 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2380.111(a)The two most recent physical examinations for Individual #1 were completed 6/14/16 and 7/7/17.Each individual shall have a physical examination within 12 months prior to admission and annually thereafter.For Individual #1 and all individuals, we will continue to send written reminders of due date for annual physical to families/caregivers 60 days prior to required date of completion. Written reminder will be amended to include the following statement, Please schedule necessary appointment and return Verification (page 2) of scheduled appointment within 10 days of receipt of this notice. Families will now have a form to record date/time of physical and return to verify that appointment has been scheduled. Program Director/Program Specialist will follow up with a phone call 30-40 days before physical is due if written verification has not been received. Assistance of SC will be requested if above listed efforts are unsuccessful. 12/15/2017 Implemented
2380.111(c)(5)The two most recent Tuberculin skin testings for Individual #1 were completed 6/12/15 and 7/7/17.The physical examination shall include: Tuberculin skin testing with negative results every 2 years; or, if the tuberculin skin test is positvie, an initial chest X-ray with results noted.For Individual 1 and all individuals on CPS roster, we will continue with the practice of sending written reminders of the need to have the Tuberculin skin testing completed by the required date. The content of written reminder has been amended to include the following statement: Please schedule necessary appointment and return Verification (Page 2) within 10 days of receipt of this notice. Attached to the written reminder is now a form for families/caregivers to record the date/time of scheduled appointment. This form is to be returned in order to verify the fact that the appointment has been scheduled. In the absence of a completed and returned form, Program Director/Program Specialist will place a follow up phone call to families 30-40 days prior to date Tuberculin skin testing is due to be completed. Should the steps listed fail to result in a scheduled appointment, we will solicit the assistance of assigned SC. 12/15/2017 Implemented
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