| Regulation | LIS Non-Compliance Area | Correction Required | Plans of Correction | Correction Date | POC Status |
| 6500.34(a) | Individual #1 was informed and explained individual rights on 4/14/21. The rights document did not include the following rights: 6500.32e through 6500.32g, to choose, accept risks, and refusal and control the individual's schedule, activities and services; 6500.32n, unrestricted and private access to telecommunications; 6500.32p through 6500.32u, choosing with whom they share a bedroom, decorating and furnishing bedroom and common areas, locking doors in bedrooms and in the home, access to food at any time, and making healthcare decisions. | Individual rights and the process to report a rights violation shall be explained to the individual, and persons designated by the individual prior to moving into the home and annually thereafter. | updated rights were given to individual on 11/3/21. rights were reviewed and he signed off. FLS took outdated rights off of shared drive so these will not be used again. Rights were updated last year and will be used with all individuals upon yearly review. FLS trained in rights of individuals. |
11/08/2021
| Implemented |
| 6500.48(b)(5) | Life Sharing Provider #1's annual training did not include the safe and appropriate use of behavior supports.. | The annual training hours specified in subsection (a) must encompass the following areas: The safe and appropriate use of behavior supports. | Provider is trained behavior management practices annually with individual. This is not recorded in training documentations. See attached. FLS will include this review of behavior management practices in the training record for the family living provider annually. |
11/09/2021
| Implemented |
| 6500.48(b)(6) | Life Sharing Provider #1's annual training did not include implementation of the individual plan. | The annual training hours specified in subsection (a) must encompass the following areas: Implementation of the individual plan. | provider reviews ISP of individuals plan quarterly with team members. The ISP review and training of individual ISP was not listed on training documentation. TRaining of individual plan and its implementation was added to training doc on 11/9/21. |
11/09/2021
| Implemented |
| 6500.133(a) | Individual #1's medications included a tube of hydroquinone topical cream. This medication did not have the original packaging, nor did it have a pharmacy label. This medication is not listed on the October 2021 medication administration record. | Prescription and nonprescription medications shall be kept in their original labeled containers. Prescription medications shall be labeled with a label issued by a pharmacy. | hydroquinine topical cream was removed from med box and no longer being used. medications prescribed will have label and original container. FP will only administer medications prescribed by doctor. JA has a followup doctor appt on 1/18/22 to discuss medications needed to treat foot itch. Family retrained in med admin. |
11/09/2021
| Implemented |
| 6500.135(c) | Individual #1 is prescribed Loratadine 10 mg with instructions "take 1 tablet daily as needed for allergies;" however, Life Sharing Provider #1 purchased and administered Allegra-D and documented the Loratadine as administered for October 2021. Life Sharing Provider #1 is purchasing the Allegra-D over-the-counter. | A prescription medication shall be administered as prescribed. | Allegra D was immediately stopped and not administered further . Loratidine was administered with a script from Dr david Williams. JA is scheduled for pcp on 1/18/22 to discuss what medication is beneficial for his diagnosis of seasonal allergies |
11/09/2021
| Implemented |
| 6500.136(a)(11) | Individual #1 is prescribed Ketoconazole Cream 2% with instructions to apply twice daily to feet. The October 2021 medication administration record does not include diagnosis or purpose for the medication. | A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Diagnosis or purpose for the medication, including pro re nata. | All med logs were updated to include diagnosis. See attached med log. FLS will review med log and medication labels monthly to ensure that labels and logs match and include the diagnosis. FLS and family trained in accurate med documentation including the diagnosis for each medication. |
11/01/2021
| Implemented |
| 6500.136(b) | Individual #1 is prescribed Loratadine 10 mg with instructions to take 1 tablet daily as needed for allergies. Life Sharing Provider #1purchased and administered Allegra-D and documented the Loratadine as administered. | The information in subsection (a)(12) and (13) shall be recorded in the medication record at the time the medication is administered. | Allegra D was immediately stopped and not administered further . Loratidine was administered with a script from Dr david Williams. JA is scheduled for pcp on 1/18/22 to discuss what medication is beneficial for his diagnosis of seasonal allergies |
11/01/2021
| Implemented |
| 6500.136(d) | Individual #1 is prescribed Ketoconazole Cream 2% with instructions to apply twice daily to feet. Life Sharing Provider #1 has been administering hydroquinone cream instead of the Ketoconazole cream. Individual #1 is prescribed Loratadine 10 mg with instructions to ttake 1 tablet daily as needed for allergies; Life Sharing Provider #1 purchased and administered Allegra-D and documented the Loratadine as administered. Life Sharing Provider #1 is purchasing the Allegra-D over-the-counter. | The directions of the prescriber shall be followed. | Both medications Allegra D and hydroquinone topical cream were immediately stopped and not administered further . Loratidine was administered with a script from Dr david Williams. JA is scheduled for pcp on 1/18/22 to discuss what medication is beneficial for his diagnosis of seasonal allergies and foot itch. |
11/09/2021
| Implemented |