Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00209655 Renewal 08/02/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.17(a)The completed self-assessment was not dated so compliance was unable to be measured.If an agency is the legal entity for the home, the agency shall complete a Self-Assessment of Homes the agency is licensed to operate 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 date the self-assessment was completed has now been put in the correct location. The Life Sharing Program Director Ryan Stumph has marked on his yearly calendars the timeframe for completing future self-assessments within the regulatory requirement. The Life Sharing Program Director Ryan Stumph will complete a self-assessment for each licensed facility. Ryan will then present the completed self-assessment to the Executive Director Nathaniel Haggerty for review and accuracy. A checklist form has been developed to use when reviewing self-assessments for accuracy. The Program Director and Executive Director will use and complete the form when reviewing and completing the self-assessments. 09/02/2022 Implemented
SIN-00191215 Renewal 08/11/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.135(g)Individual #1 is prescribed Lithium Carbonate, 300 mg tablets, 2 tablets at bedtime, to treat Anxiety. Individual #1 had medication reviews completed 10/21/20 and then again on 2/24/21.If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a review by a licensed physician at least every 3 months to document the r reason for prescribing the medication, the need to continue the medication and the necessary dosage.Individual's psychotropic review was completed on 2/24/2021 although it was late. The Life Sharing Specialist is now using a completed chart with due dates already listed for the next two years. The Life Sharing Program Director will also have a copy of the chart and be responsible to ensure that appointments are scheduled and the psychotropic reviews are done on time. 08/23/2021 Implemented
SIN-00096965 Renewal 06/28/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.151(f)The program specialist did not provide the assessment for Individual #1 dated 4/8/16 to the all the plan team members including the day program.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).Community Living & Learning, Inc. has updated the signature page of the Assessment to include all team members and the date that the assessment was sent out to them. Community Living & Learning, Inc. is also working with the Support Coordinator to make sure the current list of plan team members is accurate.[The program specialist provide Individual #1's assessment to all the plan team members on 7/1/16. Within 30 of receipt of the plan of correction, the CEO will review the responsibilities of the program specialist position with the program specialist(s) including 6500.43(d)(1)-(20) and 6500.151(f) and sign upon review. Within 60 days of receipt of the plan of correction, the program specialist(s) will review all individuals' ISPs, invitation letters and other records to ensure all plan team members are provided the assessment as required. Correspondence confirmation that the program specialist provided the assessments to all plan team shall be kept and a 25% sample of correspondence shall be reviewed by the CEO at least quarterly for 1 year to ensure the program specialist provide individuals' assessments to all plan team members at least 30 days prior to an ISP meeting as required. Documentation of quarterly reviews shall be kept. (AS 9/8/16)] 07/22/2016 Implemented
SIN-00058618 Renewal 05/28/2014 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.17(a)The agency's certificate of compliance expired on April 25, 2014; however, the self-assessemnt for the home was not completed 3 to 6 months prior to the expiration date.If an agency is the legal entity for the family living home, the agency shall complete a self-assessment of each home the agency is licensed to operate 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.LII will be completed for each Family Living Home from October 25 to January 25 which is three to six months prior to the Expiration of Compliance (April 25). A large print page stating the dates needed for the self inspections to be done has been placed in all the regulations binders in the Family Living department. Also the program director wrote the date to begin and end self inspections on her calendar. The program director will complete the self inspection forms in a timely manner. See copy of large print reminder page. 06/07/2014 Implemented
6500.104A portable space heater that was not permanently mounted or installed is located in the enclosed porch of the home. Portable space heaters defined as heaters that are not permanently mounted or installed, may not be used while individuals are in the home.The portable space heater was removed by the family living provider and checked by the program director that this was done. This will be checked periodically by the program director or program specialist during monitoring visits. See photo. [All family living homes will be checked for portable space heater during monitoring visits. (AS 6/18/14)] 06/07/2014 Implemented
SIN-00045780 Renewal 01/17/2013 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.101On 1/18/2013, the attic entrance within Individual #1's bedroom had a padlock on the outside of the door. (Fully-implemented, CEM, 3/26/2013)Stairways, halls, doorways and exits from rooms and from the home shall be unobstructed.All Program Specialists for the Family Living Program were trained concerning this regulation. All homes in this programs were rechecked to insure that the attic access is either inaccessible or all locks were removed to insure no one could be accidently locked in the attic. All new Family Living homes will be checked regarding Regulation 101 by using the Self-inspection forms for New Family Living Homes. The Program Specialist will complete these forms with the Program director checking and signing off on the forms for each new home. Documentation that each of the homes were checked as well as confirmation of the training will be submitted with this POC. 03/25/2013 Implemented
SIN-00227541 Renewal 07/11/2023 Compliant - Finalized
SIN-00176239 Renewal 09/15/2020 Compliant - Finalized
SIN-00154657 Renewal 05/01/2019 Compliant - Finalized
SIN-00135882 Renewal 05/22/2018 Compliant - Finalized