Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00223883 Renewal 04/19/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.71There was no number for poison control on the emergency contact list. Staff reprinted the emergency contact list to include poison control after the inspection.Telephone numbers of the nearest hospital, police department, fire department, ambulance and poison control center shall be on or by each telephone in the home with an outside line. The number for poison control was added to the emergency phone list at the time of the walkthrough. 05/24/2023 Implemented
6400.166(b)Medication for individual#1, Diclofenac Sodium Gel, 12 PM dosage, was not signed off as administered on 4/19/23.The information in subsection (a)(12) and (13) shall be recorded in the medication record at the time the medication is administered.1. TOOL: Medication Observation, MAR review and review of 15 steps was completed with staff on 4/21/23 by PM 2. TRAIN: Staff will attend medication re-training on 5/4/2023 ¿ to review the 15 steps 3. An internal incident report (GER) was completed documenting the medication documentation error 05/04/2023 Implemented
SIN-00159103 Renewal 07/16/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(f)The two trash cans outside in front of the house did not have lids on them.Trash outside the home shall be kept in closed receptacles that prevent the penetration of insects and rodents.New trashcans with lids were purchased for Mary Lane. See receipt attachment # 08. The House Supervisor is responsible to conduct monthly Physical Walk Through of home and submit to Program Manager by 10th of each month. Se attachment # 09. 09/06/2019 Implemented
6400.67(b)The electric baseboard cover was not in good repair, and the curtain covered exposed heat element leading to a potential hazard in individual #1 bedroom Floors, walls, ceilings and other surfaces shall be free of hazards.The heater cover was scraped, sanded, painted and hung on 8-5-19. See work order attachment # 06. The curtain has been hemmed so that it does not hang near heat element. See photo attachment # 07.The House Supervisor is responsible to conduct monthly Physical Plant Walk-Through of home. Form is to be given to Program Manager by 10th of each month. See attached procedure for physical Plant Walk-Through # 04 and completed form attachment # 05. 08/05/2019 Implemented
6400.82(e)There was no nonslip mat or surface in the main bathroom shower. Bathtubs and showers shall have a nonslip surface or mat. The Program Director purchased nonslip strips for bathroom shower. Strips are installed in bathroom. See photo: attachment # 03. The House Supervisor is responsible to conduct monthly Physical Plant Walk-Through of home. Form is to be given to Program Manager by 10th of each month. See attached procedure for physical Plant Walk-Through # 04 and completed form attachment # 05. 09/09/2019 Implemented
6400.82(f)The Bathroom in Individual #2 bedroom did not have soap, the dispenser was emptyEach bathroom and toilet area that is used shall have a sink, wall mirror, soap, toilet paper, individual clean paper or cloth towels and trash receptacle. The House Chore List created by the Program Director implemented in all homes. Every shift at all homes have house chores, which includes ¿Ensure soap is available in every bathroom and kitchen¿. This requirement is for Day, Evening and Overnight shifts. All staff instructed. House Supervisors monitor House Chore Document daily. See attachment # 01, picture of bathroom with soap. # 02, Residential Procedure ¿Cleaning Supplies¿. 09/09/2019 Implemented
SIN-00108140 Renewal 02/01/2017 Compliant - Finalized