Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00231161 Renewal 09/26/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.142(d)The dental examination shall include teeth cleaning or checking gums and dentures. Individual #1 had a dental examination on 1/11/23 and the form did not include or indicate if a teeth cleaning occurred.The dental examination shall include teeth cleaning or checking gums and dentures. On 10/4/2023 Individual #1 had a SRP completed and will continue to visit his dentist every 3 months for this deep cleaning. 10/26/2023 Implemented
6400.34(a)Individual #1's date of admission is 3/7/22 and they were not informed of their rights until 3/8/22. Individual #1 was then informed of their rights on 6/1/23.The home shall inform and explain individual rights and the process to report a rights violation to the individual, and persons designated by the individual, upon admission to the home and annually thereafter.The program supervisor will review the Rights and Responsibilities Document with Individual#1 no later than 10/26/2023. Individual #1 will sign the document. 10/26/2023 Implemented
6400.213(1)(i)Individual #1's record did not include religious affiliation this section was left blank.Each individual's record must include the following information: Personal information, including: (i) The name, sex, admission date, birthdate, Social Security number, and the religious affiliation.Associate Director will add Individual #1's religious affiliation to his face sheet no later than 10/19/2023. 10/26/2023 Implemented
SIN-00163414 Renewal 10/02/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.15(a)The license for this chapter expired on 10/1/2019. The self-assessment for this residence was not completed until 9/24/2019.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. The Residential Services Administrator reviewed with all Program Specialist the completion of self assessment no later than July prior to the license expiration and completion no earlier than April prior to the expiration of the license. 10/08/2019 Implemented
SIN-00066530 Renewal 09/17/2014 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.22(c)Individual #2 has a receipt from 12/14/13 from Super Shoes Store with a total of $29.99. However, on the financial log for Individual #2, this purchase was entered and deducted as $39.99. Individual funds and property shall be used for the individual's benefit. Financial policy and procedure will be followed. Supervisor will reexamine all receipts prior to submission to fiscal personnel. Fiscal personnel will be instructed to reexamine both receipts and calculations. Program Participant will be reimbused $10.00 for mis calculation of funds 10/28/2014 Implemented
6400.76(a)In Individual #3's bedroom there is a broken dresser. The last dresser drawer is stuck inside the dresser. The second to the last dresser drawer has been removed from the dresser and placed on the floor of the bedroom. Furniture and equipment shall be nonhazardous, clean and sturdy. Program Particpant will receive new furniture. On site manager will assess furniture on a weekly basis. All requests for repairs and/or replacement will be done by on site supervisor 10/30/2014 Implemented
6400.161(e)Located in a night stand drawer in the staff bedroom an expired medication for Individual #3 was found. The Anti-Diarrheal caplets 2mg for Individual #3 was prescribed on 2/20/2013 with an expiration date of 10/2013. Discontinued prescription medications shall be disposed of in a safe manner.Medications that are discontinued or expired will be put in the medicaiton box to be taken back to the pharmacy. The on site manager will make sure that all discontinued and/or expired medications be disposed of properly. Employees will be reeducated on proper disposal procedures. 10/30/2014 Implemented
6400.213(11)In the ISP for Individual #2, it is stated that the individual is "self-medicating with 1 medication." However, in the residential assessment for Individual #2, it is stated that the individual "does not self-medicate." Each individual's record must include the following information: Content discrepancy in the ISP, The annual update or revision under § 6400.186. Supports Coordinator was requested to make changes to the ISP to reflect assessment. To prevent non matching information in the future: the ISP will be read and compared to the assessement when the ISP is made available to the provider. If changes are needed request will be sent to Supports Coordinator and documentation of the request will be kept with the ISP. 09/22/2014 Implemented