Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00220859 Renewal 03/09/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.17(b)The self-assessment completed 9/07/2022, was last updated in 2018 and did not include all of the regulations.The agency shall use the Department's licensing inspection instrument for this chapter to measure and record compliance.The Snr. Dir. of IDD provided the LS Specialists with the current / correct self-assessment form and older versions of the form have been discardedas of 3/10/23. The LS Specialists will re-do the self-assessments for all licensed homes on the new forms by 7/31/23. 03/10/2023 Implemented
6500.71During the inspection conducted 3/10/2023, the phone in the living room next to the television did not include telephone numbers of the nearest hospital, police department, fire department, ambulance and poison control center.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.A proper label / sticker with all necessary emergency numbers was given to the LS Caregiver to place on her phone on 3/16/23. 03/16/2023 Implemented
6500.72(b)During the inspection conducted 3/10/2023, Individual #1's bedroom door did not have a doorknob. It was removed.Screens, windows and doors shall be in good repair.A knob was placed on the individual's bedroom door on 3/16/23. 03/16/2023 Implemented
6500.101During the inspection conducted 3/10/2023, there was a privacy hook and eye latch lock on the outside of the second-floor full bathroom, and if engaged could cause a blocked egress. During the inspection the exit from the kitchen to the side of the home had a 13-gallon trash can obstructing the exit door to the outside.Stairways, halls, doorways and exits from rooms and from the home shall be unobstructed.The hook & eye latch was removed from the bathroom door during the licensing visit and a new knob was installed on that door on 3/16/23. The trashcan was also removed from in front of the exit door in the kitchen. 03/16/2023 Implemented
6500.183During the inspection conducted 3/10/2023, Individual #1's current record information was not kept in the home.Copies of the most current record information required in §6500.182(c)(1)¿(14) (relating to individual records) shall be kept in the family living home.The current assessment and ISP will be provided to the LS Caregiver along with a letter reminding them that all client records must be kept in a locked and secure location within their home on 3/20/23. 03/20/2023 Implemented
6500.133(d)During the inspection conducted 3/10/2023, the first aid kit contained Aspirin 325mg and Antacid 420mg and is kept unlocked and accessible by the individual. Individual #1 is not able to self-administer medications.Prescription medications and syringes, with the exception of epinephrine and epinephrine auto-injectors, shall be kept in an area or container that is locked.The Aspirin and Antacid were removed from the first aid kit during the inspection. 03/23/2023 Implemented
SIN-00151189 Renewal 02/21/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.132(a)Individual #1 is prescribed a Nystatin topical cream with the instructions "apply to affected areas as needed." The Nystatin did not have a pharmaceutical label with the individual's name, the date the prescription was issued and the prescribing physician.The original container for prescription medications of individuals shall be labeled with a pharmaceutical label that includes the individual's name, the name of the medication, the date the prescription was issued, the prescribed dose and the name of the prescribing physician.All medications on site were checked by 3/15/19. The Monthly Site Visit checklist used by the Life Sharing Specialists was updated to include checking all medications to ensure that they are in their original packaging and currently prescribed. The specialists will be trained on the updated form by 4/5/19. The Director of Community Residential Services will audit the monthly checklists quarterly to ensure that medications are being checked for proper storage. [Within 45 days or receipt of the plan of correction, all family members responsible for assisting individual with medications administration shall be educated in the requirements of medications as per 6500.131-138. Documentation of the trainings shall be kept. (DPOC by AES,HSLS on 4/4/19)] 03/15/2019 Implemented
6500.125(c)(2)Family Member #1 does not have a Tuberculin skin test by Mantoux method with a negative result.The physical examination shall include: (2) Tuberculin skin testing by Mantoux method with negative results every 2 years for family members 1 year of age or older; or, if a tuberculin skin test is positive, an initial chest X-ray with results noted. Tuberculin skin testing may be completed and certified in writing by a registered nurse or licensed practical nurse instead of a licensed physician.All family member physicals were reviewed by 3/15/19 to ensure that all had a TB test on file. The TB test for this family member was read on 2/27/19. The Orientation Site checklist used by the Life Sharing Specialists was updated to include obtaining TB tests/physicals for all family members living at the site. The specialists will be trained on the updated form on 4/5/19. The Director of Community Residential Services will review the Orientation Site checklist to ensure that it was completed in its entirety by the specialists. 03/15/2019 Implemented
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SIN-00202824 Renewal 03/31/2022 Compliant - Finalized
SIN-00186178 Renewal 04/13/2021 Compliant - Finalized
SIN-00090029 Renewal 02/19/2016 Compliant - Finalized