Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00170338 Unannounced Monitoring 01/15/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.82(f)The hallway bathroom didn't obtain hand soap.Each 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. ShadowFax will comply with the settlement agreement to aide in the correction of this violation. 01/15/2020 Implemented
SIN-00149738 Unannounced Monitoring 02/05/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)Wall in garage damaged from repeated hits from house van. One missing kitchen drawer knob, one came off when pulled.Floors, walls, ceilings and other surfaces shall be in good repair. Agency will correct the immediate issue. Agency will review the issue for violation and correct. Then agency will train all staff on the violation. Program specialist will review monthly and supervisor will review quarterly and complete tracking form. 02/28/2019 Implemented
SIN-00145392 Unannounced Monitoring 11/07/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(a)Poisons must be locked in the home. The following was unlocked in the main bathroom in the sink drawers and under the sink: Oceanmist handsoap, Moisture barrier ointment, Ultra Brite toothpaste, Ave deodorant, Speed Stick x2, Degree x2Poisonous materials shall be kept locked or made inaccessible to individuals. Agency will correct the immediate issue. Agency will review the issue for violation and correct. Then agency will train all staff on the violation. Program specialist will review monthly and supervisor will review quarterly and complete tracking form. 12/31/2018 Implemented
6400.67(a)Individual # 1 bathroom right side of the shower bottom wall is scrapped and needs painted.Floors, walls, ceilings and other surfaces shall be in good repair. Agency will correct the immediate issue. Agency will review the issue for violation and correct. Then agency will train all staff on the violation. Program specialist will review monthly and supervisor will review quarterly and complete tracking form. 12/31/2018 Implemented
6400.81(k)(6)No mirror in Individual # 2's bedroom.In bedrooms, each individual shall have the following: A mirror. Agency will correct the immediate issue. Agency will review the issue for violation and correct. Then agency will train all staff on the violation. Program specialist will review monthly and supervisor will review quarterly and complete tracking form. 12/31/2018 Implemented
6400.181(e)(10)Individual # 3's Assessment was completed 2/1/2018 and his LMH was last updated 12/8/2016.The assessment must include the following information: A lifetime medical history. Agency will correct the immediate issue. Agency will review the issue for violation and correct. Then agency will train all staff on the violation. Program specialist will review monthly and supervisor will review quarterly and complete tracking form. 12/31/2018 Implemented
SIN-00105243 Unannounced Monitoring 12/14/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.33(k)Individual # 1 was interviewed on 12/14/16. He/She reported that he/she is unable to attend church regularly due to some staff being unable to drive as well as not enough staff in the home. He/She reported thathe/ she has missed about half of the Sunday services in past month. An individual has the right to practice the religion or faith of the individual's choice. This page is the same as Individual #1. James Richards stated this page will be deleted. 11/16/2016 Implemented
SIN-00082832 Renewal 07/07/2015 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.103The written emergency evacuation procedure for all the individuals living in the home, did not include their responsibilities. There shall be written emergency evacuation procedures that include individual and staff responsibilities, means of transportation and an emergency shelter location. There are written emergency evacuation procedures that include staff responsibilities, means of transportation and an emergency shelter location. Our procedures did not include specific emergency procedures for each person. An emergency plan was developed for each home listing the individual responsibilities during an emergency. See attachment 21. This plan of individual responsibilities is now filed in the fire log and the Associate Director is responsible for ongoing monitoring of the responsibilities to ensure they are current and updated. 07/21/2015 Implemented
6400.110(f)The bed shaker in Individual #2's bedroom was inoperable. When the smoke detector was set off, the bed shaker did not go off. If one or more individuals or staff persons are not able to hear the smoke detector or fire alarm system, all smoke detectors and fire alarms shall be equipped so that each person with a hearing impairment will be alerted in the event of a fire. A Safe Awake bed shaker has been purchased to ensure the bed shaker goes off when any smoke detector is set off (currently the bed shaker in use goes off based on one detector and when that alarm is sounded the bed shaker will go off). In the future, the Associate Director will monitor on house visits by testing the alarm system as part of their home visits. See attached for receipts for the bed shakers (Attachment 20) 09/28/2015 Implemented
6400.186(a)The program specialist did not complete the Individual Support Plan (ISP) reviews. The program specialist, Staff #1, had residential staff workers at the home writing the ISP reviews every three months. Staff #1 signred off as reviewing the document once it was created. The program specialist shall complete an ISP review of the services and expected outcomes in the ISP specific to the residential home licensed under this chapter with the individual every 3 months or more frequently if the individual's needs change which impacts the services as specified in the current ISP. Our master ISP review form was changed in August 2015 to include the following statement: "I have coordinated, completed and reviewed progress on the ISP and assessment as stated in this review: Program Specialists are now responsible for completing the ISP reviews. See attachment #19 for a review completed since the date of inspection. 09/10/2015 Implemented
SIN-00226864 Unannounced Monitoring 06/08/2023 Compliant - Finalized
SIN-00219407 Unannounced Monitoring 02/08/2023 Compliant - Finalized
SIN-00215257 Unannounced Monitoring 11/21/2022 Compliant - Finalized
SIN-00207636 Unannounced Monitoring 07/05/2022 Compliant - Finalized
SIN-00200291 Unannounced Monitoring 02/15/2022 Compliant - Finalized
SIN-00200290 Unannounced Monitoring 02/15/2022 Compliant - Finalized
SIN-00195601 Unannounced Monitoring 11/01/2021 Compliant - Finalized
SIN-00194454 Unannounced Monitoring 10/15/2021 Compliant - Finalized
SIN-00182618 Unannounced Monitoring 01/25/2021 Compliant - Finalized
SIN-00164214 Unannounced Monitoring 10/10/2019 Compliant - Finalized
SIN-00155514 Unannounced Monitoring 05/14/2019 Compliant - Finalized
SIN-00106589 Renewal 11/30/2016 Compliant - Finalized