Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00155505 Unannounced Monitoring 05/15/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.61(a)Individuals living within the home use walkers. The bathroom does not accommodate the use of walkers as the space between the sink and bathtub is too narrow.A home serving individuals with a physical disability, blindness, a visual impairment, deafness or a hearing impairment shall have accommodations to ensure the safety and reasonable accessibility for entrance to, movement within and exit from the home based upon each individual's needs. The Shadowfax been direct to follow plan of correction from the previous month and send documentation that this issues has been fixed. 05/28/2019 Implemented
6400.64(a)A baseball sized amount of lint was found in the dryer trap.Clean and sanitary conditions shall be maintained in the home. The Shadowfax been direct to follow plan of correction from the previous month and send documentation that this issues has been fixed. 05/15/2019 Implemented
6400.181(a)A current assessment was not located on site for individual # 1. The most recent assessment is dated 02/16/18. Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the residential home and an updated assessment annually thereafter. The initial assessment must include an assessment of adaptive behavior and level of skills completed within 6 months prior to admission to the residential home. The Shadowfax been direct to follow plan of correction from the previous month and send documentation that this issues has been fixed. 05/28/2019 Implemented
SIN-00106591 Renewal 11/30/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.68(b)The hot water was recorded at 122.3F. Hot water temperatures in bathtubs and showers may not exceed 120°F. The Shadowfax maintenance man had the hot water heater replaced. See attached. Monthly readings have been taken and the water temperature has not exceeded 120 degrees. Hot water temperature checks are performed monthly and recorded on the fire log pages by staff. A check was also added to the home visit form for a random monthly check to be completed by the home supervisors to ensure water is less than 120 degrees. 12/08/2014 Implemented
6400.72(b)The bedroom door and doorframe chuncks of wood were missing 1' to 2' pieces where wheelchair rubs up against at bottom of door and door frames. Screens, windows and doors shall be in good repair. The Shadowfax maintenance man filled in the chunks in the doorway and door. See attached picture. Staff were reminded to complete requests for maintenance to fix items in disrepair. Moving forward, the home supervisor will monitor the condition of the home and document all necessary repairs to ensure all items are in good repair 12/22/2016 Implemented
6400.216(a)Individuals informaton was unlocked in the basement. An individual's records shall be kept locked when unattended. 2 boxes of adult depends were delivered and were unopened in the basement and the labels contained the individuals names and contents. Staff were informed by the manager of the right to privacy and to keep names off packages. A notice was also hung where the boxes are stored to remind staff. Moving Forward, the home supervisor will ensure all records are appropriately locked and their right to privacy is followed by checking on weekly home visit reports. See attached pictures of boxes without labels and nondescript packaging. 12/05/2016 Implemented
SIN-00170345 Unannounced Monitoring 01/15/2020 Compliant - Finalized
SIN-00164216 Unannounced Monitoring 10/10/2019 Compliant - Finalized