Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00200718 Renewal 02/08/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.66The outdoor light of the side egress door was not working during the physical site walk through on 02/09/22Rooms, hallways, interior stairways, outside steps, outside doorways, porches, ramps and fire escapes, that are used by individuals shall be lighted to assure safety and to avoid accidents.Light bulb was replaced on 2. 9.22 by life sharing provider, please see attachment E 02/22/2022 Implemented
6500.74The side egress wooden steps did not have non-skid surfaces.Interior stairs and outside steps that are accessible to individuals shall have a nonskid surface.Non skid surface was applied to steps on 2.11.22 by life sharing provider, please see attachment F 02/22/2022 Implemented
6500.78(a)The landing of the side egress was covered with ice and snow during the physical site walk through on 02/09/22.An outside walkway that is used by individuals shall be free from ice, snow, obstructions and other hazards.Landing was cleared of ice/snow by Life Sharing provider on 2.9.22 please see attachment G 02/22/2022 Implemented
6500.101There was a laundry basket blocking the side egress during the physical site walk through on 02/09/22Stairways, halls, doorways and exits from rooms and from the home shall be unobstructed.Laundry basket was removed on 2.9.22 by life sharing provider, please see attachment D 02/22/2022 Implemented
6500.151(e)(4)Individual assessment 7/30/2021 states individual is able to have unsupervised time while in the community up to 3 hours while he is attending church and men's social coffee social. It also states he can be unsupervised while in a store with his provider. Individual does not have unsupervised time in the community, and he does not attend men's coffee social for that amount of time. Per provider and current ISP dated 2/8/2022, individual can be left unsupervised in a store specifically for up to 30 minutes.The assessment must include the following information: The individual's need for supervision.Program Specialist updated Assessment on 2.15.22 - see attachment B 02/15/2022 Implemented
6500.152(a)ISP dated 2/8/2022 states individual uses his cell phone. He does not use a cell phone. ISP states under "Important to individual" that it is essential for staff to assist with the administration of his medication. Individual self-administers his medication.The life sharing specialists shall coordinate the development of the individual plan, including revisions, with the individual and the individual plan team.ISP updates were sent to the SC by the RDS program specialist on February 14, 2022 and updates were made to the ISP on 2.17.2022, please see attachment C (ISP date and email) 02/17/2022 Implemented
SIN-00159236 Renewal 07/09/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.151(f)The current Assessment was sent to the Supports Coordinator on 08/17/18, not 30 days prior to the 09/06/18 ISP meeting.The life sharing specialist shall provide the assessment to the individual plan team members at least 30 calendar days prior to an individual plan meeting.Program Specialist reviewed her current practices to evaluate why error occurred and to ensure no other individuals had the same issue -Program Specialist created a document (attached) which she will use to track dates to mail assessments. She will also begin using her outlook calendar so reminders of these dates will be sent. -This tracking tool will be reviewed monthly by the program director at supervision to ensure dates are being met. -July 22nd, 2019: This tracking tool was put into use and all dates were entered into Program Specialist¿s outlook calendar by the Program Specialist 07/22/2019 Implemented
SIN-00094642 Renewal 05/05/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.182(c)(8)Individual #1 record did not contain the current ISP. The current ISP is dated 4/13/16 and the ISP in the record was dated 1/4/16. Each individual's record must include the following information: A copy of the current ISP.Individual #1 record did not contain the current ISP. The current ISP is dated 4.13.16 and the ISP in the record was dated 1.4.16.¿ all records were checked by the Program Specialists by 5.13.16. All records had the same issue so all were printed and placed in file by the Program Specialists by 5.20.16. Program Specialists created a file for each individual that says ¿most current ISP¿ and put the last updated plan in the record. Please see attachment A showing individual #1¿s most current plan which is now in the file as well as Attachment B to show another individual¿s most current plan that was placed in the record. 06/06/2016 Implemented
6500.182(c)(10)Individual #1's ISP states that he does not manage his own finances. He is financialy independent. Each individual's record must include the following information: Content discrepancy in the ISP, the annual updates or revisions under §  6500.156.Individual #1 ISP states that he does not manage his own finances. He is financially independent. Program Specialist emailed SC on May 10th to update the plan with the corrections which is attachment C. The updated plan is attachment D. All other files were checked by the Program Specialists by 5.13.16, no similar issues were found. Program Specialists created a checklist to attach to the assessments to ensure content captured in the assessment is consistent in the plan against plan which is attachment E. Attachment K is a completed checklist done post licensing. 06/06/2016 Implemented
SIN-00058255 Renewal 12/16/2013 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.109(d)The fire drill logs did not indicate if the smoke detectors were operable.A written fire drill record shall be kept of the date, time, the amount of time it took for evacuation, the exit route used, problems encountered and whether the smoke detector was operative.ADEQUATE PROGRESS FS Manager revised the drill form including this information and sent it to all providers via memo on 1.2.14 (attachment A). The revised drill is attachment B and will be used as of 1/2014. A completed drill on the new form is attachment C. 01/05/2014 Implemented
6500.134(a)The medication logs for Individual #1 did not include the time of administration for Lorazepam.A medication log listing the medications prescribed, dosage, time and date that prescription medications, including insulin, were administered, and the name of the person who administered the prescription medication or insulin shall be kept for each individual who does not self-administer medication.ADEQUATE PROGRESS A memo was resent to providers on 12.20.13 by the LPN reminding them of this along with an example med log (see attachment D). Individual 1 has a completed log showing this done correctly for the month of December (See attachment E) 12/20/2013 Implemented
6500.151(f)The assessment for Individual #1 was not sent to team members 30 days prior to the ISP meeting. The ISP meeting was held on December 6, 2013. The assessment was sent on December 6, 2013.The program specialist shall provide the assessment to the SC, as applicable, and plan team members at least 30 calendar days prior to an ISP meeting for the development of the ISP, the annual update, and revision of the ISP under § §  2380.182, 2390.152, 6400.182 and 6500.152 (relating to development, annual update and revision of the ISP).ADEQUATE PROGRESS The FS manger sent an email to all Program Specialists (see attachment F) to explain this information/clarification. Program Specialist did an assessment and sent it out on 12.31.13 (see attachment G) for an ISP meeting scheduled for 1.31.14. 12/31/2013 Implemented
6500.156(c)(2)The ISP reviews for Individual #1 did not review the supervision needs or community activities that Individual #1 participated in. (c) The ISP review must include the following: (2) A review of each section of the ISP specific to the family living home licensed under this chapter.This form was reviewed by Mangers on 1.9.14 and found that the form includes all sections necessary, but Program Specialists need to ensure they are completing them with more detail. This will be included in the agenda for weekly supervision with each Program Specialist. A revised quarterly report for individual 1 (attachment H is the page with these sections) was done by the FS program specialist on 1.14.14 with the needed information now included. 01/14/2014 Implemented
SIN-00181507 Renewal 01/19/2021 Compliant - Finalized
SIN-00136039 Renewal 07/10/2018 Compliant - Finalized
SIN-00109010 Renewal 05/01/2017 Compliant - Finalized