|
| Regulation | LIS Non-Compliance Area | Correction Required | Plans of Correction | Correction Date | POC Status |
| 6400.66 | No light bulb in the front light (one was put in the fixture while the inspector was there) | Rooms, hallways, interior stairways, outside steps, outside doorways, porches, ramps and fire escapes shall be lighted to assure safety and to avoid accidents.
| What was done immediately to correct the specific issue cited?
On 11/10/2022 the matter was discovered and reported to maintenance. The landlord of the home was notified and repairs/replacement were requested. On 1/5/2023, Landlord and Maintenance confirmed the lighting by the front door of the residence was repaired and is operable.
What specific change will be made?
All staff and management are required to attend Quarterly Regulatory Workshops facilitated by the Quality Improvement Department. A variety of topics are discussed each quarter, all specific to the regulations followed. Household common areas and spaces specific to the individual(s) are expected to meet the regulatory and agency standards. The Site Supervisor is responsible for conducting a weekly site inspection and completing the Weekly Residential Site Checklist. All staff are responsible for recognizing violations, areas in need of improvement, and following the reporting process. The checklist captures all regulatory and agency expectations. All discovered areas of concern or violation initiate follow-up by the Site Supervisor, or designee, which includes the purchasing and installation of items and/or submission of a maintenance request. If the matter requires maintenance, the Real Estate Department (RED) is responsible for providing updates and follow through. If the matter can be resolved by the Program, the Site Supervisor is responsible for the resolution. If unresolved within one (1) week from the date of discovery, the Program Director is responsible to address the Site Supervisor regarding the status, delay in resolution, and plan of action. If unresolved within two (2) weeks from the date of discovery, the Regional Director is contacted to either: escalate the matter to RED or escalate the matter to the Program Director to address and resolve immediately. Program Director and Site Supervisor will ensure that any unresolved area(s) of concern, do not pose a health and/or safety risk to the Participants or staff.
Who (by title) will make the change?
Program Director and Site Supervisor will be responsible for making the change.
When will the change be made?
Change was implemented on 11/17/2022 and 1/5/2023. From the discovery date until the date of repair, Participants were provided with continued supervision and necessary assistance when utilizing the front entrance of the home, especially when natural light was no longer present.
What system has been implemented to make sure the same violation does not occur again?
Site Supervisors are required to complete thorough site inspections weekly. Site Supervisors submit checklists to their Program Director, who ensure receipt and review of each. On a quarterly basis, Program Directors complete Quarterly Residential Site Verification Visits. This requires an in-depth inspection of the residence while comparing the findings to the Weekly Residential Site Checklists. All areas of non-compliance require the Site Supervisor, or designee, to adhere to the process identified to ensure resolution which includes but is not limited to: submission of maintenance requests, follow up and through with persons responsible, and ensure resolution.
What education and training has been provided to staff?
Staff were educated on this regulation during a staff meeting held on 11/17/2022; Rooms, hallways, interior stairways, outside steps, outside doorways, porches, ramps and fire escapes shall be lighted to assure safety and to avoid accidents. All staff are aware that any regulatory violation requires the above-mentioned process to be immediately followed through resolution. Site Supervisors are aware that site inspections and the resolution of all violations is their responsibility. All Site Supervisors have been trained and have completed a site inspection utilizing the revised checklist and process.
Attachment #3 |
11/17/2022
| Implemented |
| 6400.67(a) | There were significant knicks and gouges on the drywall in the kitchen around the dining area
There was a large stain on the kitchen ceiling above the sink
There was a large stain on the carpet in Ind. #3 bedroom | Floors, walls, ceilings and other surfaces shall be in good repair. | What was done immediately to correct the specific issue cited?
Prior to inspection, these violations were previously reported and maintenance had been in communication with the landlord regarding their responsibility to repair. As of 1/17/23 The landlord has been provided a two-week notice deadline to complete repairs as responsible to do so. Due to the number of repairs necessary, the landlord has confirmed that replacing carpets in the home will occur following the painting of several areas around the home. The agency anticipates resolution to all matters by the end of January 2023.
What specific change will be made?
All staff and management are required to attend Quarterly Regulatory Workshops facilitated by the Quality Improvement Department. A variety of topics are discussed each quarter, all specific to the regulations followed. Household common areas and spaces specific to the individual(s) are expected to meet the regulatory and agency standards. The Site Supervisor is responsible for conducting a weekly site inspection and completing the Weekly Residential Site Checklist. All staff are responsible for recognizing violations, areas in need of improvement, and following the reporting process. The checklist captures all regulatory and agency expectations. All discovered areas of concern or violation initiate follow-up by the Site Supervisor, or designee, which includes the purchasing and installation of items and/or submission of a maintenance request. If the matter requires maintenance, the Real Estate Department (RED) is responsible for providing updates and follow through. If the matter can be resolved by the Program, the Site Supervisor is responsible for the resolution. If unresolved within one (1) week from the date of discovery, the Program Director is responsible to address the Site Supervisor regarding the status, delay in resolution, and plan of action. If unresolved within two (2) weeks from the date of discovery, the Regional Director is contacted to either: escalate the matter to RED or escalate the matter to the Program Director to address and resolve immediately. Program Director and Site Supervisor will ensure that any unresolved area(s) of concern, do not pose a health and/or safety risk to the Participants or staff.
Who (by title) will make the change?
Program Director and Site Supervisor will be responsible for making the change. Maintenance is responsible to assist on matter that warrant repairs or replacements.
When will the change be made?
Change went into effect on 11/17/2022. Although discovered prior to inspection for purposes of corrective action, from the date of violation discovery until the date of confirmed repairs and replacements, staff are ensuring daily, thorough carpet cleaning to prevent worsening conditions. Ceiling stains and wear and tear throughout the home are not currently presenting health or safety risks, however, staff continue to provide supervision as required and expected to prevent any areas of concern from presenting.
What system has been implemented to make sure the same violation does not occur again?
Site Supervisors are required to complete thorough site inspections weekly. Site Supervisors submit checklists to their Program Director, who ensure receipt and review of each. On a quarterly basis, Program Directors complete Quarterly Residential Site Verification Visits. This requires an in-depth inspection of the residence while comparing the findings to the Weekly Residential Site Checklists. All areas of non-compliance require the Site Supervisor, or designee, to adhere to the process identified to ensure resolution which includes but is not limited to: submission of maintenance requests, follow up and through with persons responsible, and ensure resolution.
What education and training has been provided to staff?
Staff were educated on this regulation during a staff meeting held on 11/17/2022; floors, walls, and ceilings must be in good repair in the home which includes all areas such as: damaged walls, ceilings, carpeting, bedroom walls, and appliances. All staff are aware that any regulatory violation requires the above-mentioned process to be immediately followed through resolution. Site Supervisors are aware that site inspections and the resolution of all violations is their responsibility. All Site Supervisors have been trained and have completed a site inspection utilizing the revised checklist and process.
Attachment # 3.1 |
11/17/2022
| Implemented |
| 6400.80(a) | There were excessive leaves and grass clippings on the stairs to the basement (exterior-only entrance), creating a slipping hazard that would increase during inclement weather | Outside walkways shall be free from ice, snow, obstructions and other hazards. | What was done immediately to correct the specific issue cited?
The excessive leaves on the basement stairs were cleared on 11/15/2022.
What specific change will be made?
All staff and management are required to attend Quarterly Regulatory Workshops facilitated by the Quality Improvement Department. A variety of topics are discussed each quarter, all specific to the regulations followed. Household common areas and spaces specific to the individual(s) are expected to meet the regulatory and agency standards. The Site Supervisor is responsible for conducting a weekly site inspection and completing the Weekly Residential Site Checklist. All staff are responsible for recognizing violations, areas in need of improvement, and following the reporting process. The checklist captures all regulatory and agency expectations. All discovered areas of concern or violation initiate follow-up by the Site Supervisor, or designee, which includes the purchasing and installation of items and/or submission of a maintenance request. If the matter requires maintenance, the Real Estate Department (RED) is responsible for providing updates and follow through. If the matter can be resolved by the Program, the Site Supervisor is responsible for the resolution. If unresolved within one (1) week from the date of discovery, the Program Director is responsible to address the Site Supervisor regarding the status, delay in resolution, and plan of action. If unresolved within two (2) weeks from the date of discovery, the Regional Director is contacted to either: escalate the matter to RED or escalate the matter to the Program Director to address and resolve immediately. Program Director and Site Supervisor will ensure that any unresolved area(s) of concern, do not pose a health and/or safety risk to the Participants or staff.
Who (by title) will make the change?
Program Director and Site Supervisor will be responsible for making the change.
When will the change be made?
Change was implemented immediately on 11/15/22. Additionally, the weekly residential site checklist and its process are implemented as of 1/13/2023.
What system has been implemented to make sure the same violation does not occur again?
Site Supervisors are required to complete thorough site inspections weekly. Site Supervisors submit checklists to their Program Director, who ensure receipt and review of each. On a quarterly basis, Program Directors complete Quarterly Residential Site Verification Visits. This requires an in-depth inspection of the residence while comparing the findings to the Weekly Residential Site Checklists. All areas of non-compliance require the Site Supervisor, or designee, to adhere to the process identified to ensure resolution which includes but is not limited to: submission of maintenance requests, follow up and through with persons responsible, and ensure resolution
What education and training has been provided to staff?
Staff were educated on this regulation during a staff meeting held on 11/17/2022; all exterior surfaces, specifically stairs and walkways, must be free of all hazards including leaves, debris, snow, etc. All staff are aware that any regulatory violation requires the above-mentioned process to be immediately followed through resolution. Site Supervisors are aware that site inspections and the resolution of all violations is their responsibility. All Site Supervisors have been trained and have completed a site inspection utilizing the revised checklist and process.
Attachment #3.2 |
11/15/2022
| Implemented |
| 6400.141(a) | The annual physical for Ind. #3 is past due (last exam was conducted on 10/14/21) | An individual shall have a physical examination within 12 months prior to admission and annually thereafter. | What was done immediately to correct the specific issue cited?
The annual physical was completed on November 16, 2022. Last annual physical was completed on 10/14/21.
What specific change will be made?
Program Director advised the site supervisor to schedule the annual physical exam at least three months before the expiration of the current physical exam. Program Director will review all upcoming medical appointments with site supervisor during monthly supervision to ensure all medical appointments remain current. All staff will be trained on the Monthly Calendar and the expectations for completing the calendar which includes entering all scheduled appointments and entering updates upon completion of any medical appointment. The calendar is reviewed by the nursing staff and the Program Director. All issues and areas of concern will initiate follow-up by the Site Supervisor or designee (including consulting with nursing staff to ensure appointments are scheduled and completed as required).
Who (by title) will make the change?
Program Director and Site Supervisor will be responsible for making the change
When will the change be made?
Changes went into effect on 11/16/2022 when the overdue physical was completed.
What system has been implemented to make sure the same violation does not occur again?
Site Supervisors are required to complete an annual medical calendar which is to be updated monthly and following each medical appointment. The medical calendar is reviewed by the Program Director during monthly supervision.
What education and training has been provided to staff?
Staff were educated on this regulation during a staff meeting held on November 17, 2022. All were informed that each participant is to have a physical exam each year. All were made aware that failing to support an individual with completing medical appointments as scheduled, poses a health and safety risk and is a regulatory violation that requires the immediately follow up through resolution. Site Supervisors are aware that medical appointments are to be completed as prescribed and in accordance with regulations. All Site Supervisors have been trained on the medical calendar and utilizing the calendar to ensure regulatory compliance.
Attachment #3.3 |
11/16/2022
| Implemented |
| 6400.163(g) | The PRN medication 118 Promethazine-DM (liquid cough syrup) was not on the MAR but found in the medication box
The PRN medication Acetaminophen 500mg tablet was listed on the MAR but was not in the med box (the house manager reported that the pharmacy was called on 11/14 about a new blister pack being delivered, and that it was supposed to arrive the same day | Prescription medications shall be stored in an organized manner under proper conditions of sanitation, temperature, moisture and light and in accordance with the manufacturer's instructions. | What was done immediately to correct the specific issue cited?
Tylenol was reordered by physician and delivered and placed in box on 11/17/22. Cough Medicine was added to the MAR on 11/16/22.
What specific change will be made?
All staff will ensure all prescribed medications are on site and available for each administration, all medications prescribed will be entered onto the MAR.
Who (by title) will make the change?
Program Director and Site Supervisor.
When will the change be made?
November 17, 2022 and ongoing.
What system has been implemented to make sure the same violation does not occur again?
Supervisors are responsible for completing the Medication Administration Review Checklist 3 times a week to ensure all medications are administered as prescribed and all doctor¿s orders followed. When completing the medication administration checklist, the site supervisor will ensure all entries on the medication administration record is correct. Compliance in this area will be monitored on a Monthly basis by the Program Director during monthly supervisions.
What education and training has been provided to staff?
The site supervisor conducted a training with all staff on 11/17/2022 the importance of ensuring all meds are available as prescribed. Program Director provided training to the Site Supervisor on the Medication Administration Review Checklist on November 17, 2022. During the training the supervisor was advised of the expectation to complete the Medication Administration Review Checklist three times each week. In the absence of a site supervisor the Program Director or his/her designee will complete the Medication Administration Review Checklist three times a week.
Attachment #3.6 |
11/17/2022
| Implemented |
| 6400.213(1)(i) | The face sheet of Ind. #3 is missing identifying marks | Each individual's record must include the following information: Personal information, including: (i) The name, sex, admission date, birthdate and Social Security number. | hat was done immediately to correct the specific issue cited?
On 11/25/2022 the Site supervisor updated the Participant facesheet and included the information regarding identifying marks.
What specific change will be made?
Program Specialist and Program Managers review face sheets during quarterly reviews, ensuring all areas are completed using the identified checklist.
3. Who (by title) will make the change?
Program Specialist and Program Supervisor
4.When will the change be made?
11/25/22
5. What system has been implemented to make sure the same violation does not occur again?
Upon completion of the Face Sheet, Program Specialist or Program Supervisor will use the checklist that will ensure all areas of the participant¿s face sheet is filled in correctly. The chart review form has also been updated to ensure that it captures whether the Face Sheet has been completely filled out. Any incomplete areas on the Face Sheet will be immediately addressed by Program Specialist and Program Supervisor.
6. What education and training has been provided to staff?
Program Specialists were reminded of the need to ensure all personal information for participants is reviewed and updated on an annual basis, and that the form is completely filled out. The face sheet was reviewed with the program specialist outlining all the areas of the face sheet that must be completed.
Attachment 3.4 |
11/25/2022
| Implemented |
| 6400.213(1)(i) | Photo on the face sheet is not dated for Ind. #3 | Each individual's record must include the following information: Personal information, including: (i) The name, sex, admission date, birthdate and Social Security number. | What was done immediately to correct the specific issue cited?
On 11/25/2022 the Site supervisor updated the Participant facesheet and included a new picture with the date.
What specific change will be made?
All Program Management are required to attend Quarterly Regulatory Workshops facilitated by the Quality Improvement Department. A variety of topics are discussed each quarter, all specific to the regulations followed. Program Specialists are responsible for Participant programmatic documents; these are required to be specific to the individual(s) and expected to meet the regulatory and agency standards. The Program Specialist is responsible for completing and updating all Participant programmatic documentation (specific demographic sheets, assessments, plans) accordingly. All documents, initial and annual, are then reviewed by the Director of Service Coordination and discussed during monthly supervision. The Program Specialist is then responsible for the distribution of these documents to those identified as team members. The Site Supervisor is responsible for conducting monthly record reviews to ensure all documentation necessary is present and completed entirely. It is the responsibility of the Site Supervisor to ensure each Participant record has a current photo of the Participant with the date of when the photo was taken. Should any documentation be missing, incorrect, or incomplete, it is the responsibility of the reviewer to document this on the identified record review tool. The Program Director is responsible to review the record review tool and monitor the resolution. Once resolved, the Site Supervisor is responsible for updating the Participant record, if necessary. The following record review will identify the previously non-compliant area as resolved.
Who (by title) will make the change?
Program Director and Site Supervisor will be responsible for making the change.
When will the change be made?
Change was implemented immediately on 11/25/2022
What system has been implemented to make sure the same violation does not occur again?
The Site Supervisor is responsible for conducting monthly record reviews to ensure all documentation necessary is present and completed entirely. Should any documentation be missing, incorrect, or incomplete, it is the responsibility of the Site Supervisor to document this on the identified record review tool. The Program Director is responsible to review the record review tool to assess and resolve the non-compliant areas. Once resolved, the Program Director and Site Supervisor are responsible for updating the Participant record, if necessary. The following record review will identify the previously non-compliant area as resolved.
What education and training has been provided to staff?
Staff were educated on this regulation during a staff meeting held on 11/17/2022; Each individual¿s record must include the following information, personal information, including: a current, dated photograph. All Program Management are aware that any regulatory violation requires the above-mentioned process to be immediately followed through resolution.
Attachment #3.5 |
11/25/2022
| Implemented |
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| Regulation | LIS Non-Compliance Area | Correction Required | Plans of Correction | Correction Date | POC Status |
| 6400.62(d) | At the time of inspection, a large bag labeled "Royal Basmati Rice," which contained dried rice intended for consumption, was stored underneath the kitchen sink next to the following poisonous substances: Ajax Dish Soap, Ajax Powdered Bleach Cleaner, and Great Value Dish Detergent Pods. The rice was relocated during inspection in order to ensure the health and safety of individuals in the home. | Poisonous materials shall be kept separate from food, food preparation surfaces and dining surfaces. | 1. What was done immediately to correct the specific issue cited?
Rice was moved from the area under the kitchen sink where dish liquid was also stored. Notice posted on under sink cabinet advising staff that all food items must be stored separate from poisonous materials.
2. What specific change will be made?
All food and food storage items will be stored separate from poisonous materials.
3. Who (by title) will make the change?
Managers and Program Directors
4. When will the change be made?
November 18, 2021 and ongoing thereafter.
5. What system has been implemented to make sure the same violation does not occur again?
Management is responsible for ensuring all food and food storage items are stored separate from food. Compliance with this regulation will be monitored through completion of the Daily Shift Checklist by staff that will include checking to ensure food and poisonous materials are stored separately on each shift. The Site Supervisor will review the Shift Checklists and sign off to ensure that all items in need of correction have been addressed.
6. What education and training has been provided to staff?
Managers receive training on the completion of the Daily Shift Checklist at the time of their orientation. Managers receive follow up education and training at the time of their monthly supervisions when the a sampling of the Daily Shift Checklist will be reviewed by the Program Director.
Attachment #9 |
11/18/2021
| Implemented |
| 6400.66 | The front porch light was inoperable at the time of inspection. The lightbulb was replaced prior to the conclusion of the inspection. | Rooms, hallways, interior stairways, outside steps, outside doorways, porches, ramps and fire escapes shall be lighted to assure safety and to avoid accidents.
| 1. What was done immediately to correct the specific issue cited?
Front porch light bulb was immediately replaced. Verification that bulb was replaced and operable was completed by inspector on November 17, 2021.
2. What specific change will be made?
A Daily Shift Checklist has been created that includes checking to ensure that light fixtures are in working order. Extra light bulbs are present at the site should a light bulb need to be replaced.
3. Who (by title) will make the change?
Manager¿s and Program Directors.
4. When will the change be made?
November 17, 2021 and ongoing thereafter.
5. What system has been implemented to make sure the same violation does not occur again?
All residential staff is responsible for completing the Daily Shift Checklist to ensure all lights are operable. The Site Supervisor will review the Shift Checklists and sign off to ensure that all items in need of correction have been addressed
6. What education and training has been provided to staff?
Staff Meeting was conducted with all during which time all were informed of the need to always have sufficient lighting throughout the service location per 6400.66. All staff were instructed to replace blown out bulbs immediately upon discovery going forward.
Attachment #9.1 |
11/17/2021
| Implemented |
| 6400.67(b) | There was a golf-ball-sized deposit of lint found in the dryer's lint tray. This was removed from the dryer during inspection | Floors, walls, ceilings and other surfaces shall be free of hazards. | 1. What was done immediately to correct the specific issue cited?
Dryer lint trap was immediately removed and cleaned of all debris and lint.
2. What specific change will be made?
Manager posted a dryer cleaning reminder on the door to the laundry area instructing staff to clean dryer lint trap after each use of the dryer. A Daily Shift Checklist was created so staff can complete a review of each shift. The dryer lint trap will be checked on each shift to ensure that it is clear of all lint and debri.
3. Who (by title) will make the change?
Site Supervisors and Program Directors.
4. When will the change be made?
November 18, 2021 and ongoing thereafter
5. What system has been implemented to make sure the same violation does not occur again?
Residential staff is responsible for completing the Daily Shift Checklist. The Site Supervisor will review the Shift Checklists and sign off to ensure that all items in need of correction have been addressed. Managers are responsible for completing random weekly checks of the link trap to ensure dryer cleaning protocol is being followed.
6. What education and training has been provided to staff?
Staff Meeting was conducted with all staff on 11/18/21 during which time all were informed of the need to clean the dryer lint trap after each use per 6400.67b.
Attachment #9.2 |
11/18/2021
| Implemented |
| 6400.82(e) | At the time of inspection, there was no bathmat located within the full bathroom's shower. Staff on site reported that the bathmat was being cleaned but could not locate it within the home during the site inspection. A bathmat was present in the shower during a virtual follow-up at this site | Bathtubs and showers shall have a nonslip surface or mat. | 1. What was done immediately to correct the specific issue cited?
At the time of discovery, a bathmat was placed into the shower for use.
2. What specific change will be made?
A staff on each shift will complete a Daily Shift Checklist that includes checking that a bathmat is in each shower. The availability of a bathmat in the shower is also captured on the Monthly Residential Site Checklist that is done by the Site Supervisor. Access to extra bathmats and back up supplies will always be available to staff at all times, who will ensure that it is placed in the bathrooms as needed.
3. Who (by title) will make the change?
Site Supervisor
4. When will the change be made?
On November 17, 2021 a bathmat was immediately placed in the bathroom of the home.
5. What system has been implemented to make sure the same violation does not occur again?
A Daily Shift Checklist has been developed for staff on each shift to check various areas of the site, and this includes bathmats in the shower. The Site Supervisor will review the Shift Checklists and sign off to ensure that all items in need of correction have been addressed.
6. What education and training has been provided to staff?
The staff was educated by the Program Director on the importance of having a bathmat in the shower at all times for safety reasons on 12/17/21.
Attachment #9.3 |
11/17/2021
| Implemented |
| 6400.82(f) | There were no clean paper or cloth hand towels located within the home's full bathroom at the time of inspection. Staff on site located paper towels during the inspection and placed them in the bathroom | 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. | 1. What was done immediately to correct the specific issue cited?
At the time of discovery, a paper towel was immediately placed into the shower for use.
2. What specific change will be made?
A staff on each shift will complete a Daily Shift Checklist that includes checking that a paper towel or hand towel is in each bathroom. The availability of a paper or cloth towel is also captured on the Monthly Residential Site Checklist that is done by the Site Supervisor. Access to extra cloth or paper towel and back up supplies will always be available to staff at all times, who will ensure that it is placed in the bathrooms as needed.
3. Who (by title) will make the change?
Site Supervisor
4. When will the change be made?
On November 17, 2021 a paper towel was immediately placed in the bathroom of the home.
5. What system has been implemented to make sure the same violation does not occur again?
A Daily Shift Checklist has been developed for staff on each shift to check various areas of the site, and this includes cloth or paper towel in the bathroom. The Site Supervisor will review the Shift Checklists and sign off to ensure that all items in need of correction have been addressed.
6. What education and training has been provided to staff?
The staff was educated by the Program Director on the importance of having a cloth or paper towel in the bathroom at all times on 12/22/21.
Attachment #9.4 |
11/17/2021
| Implemented |
| 6400.52(a)(1) | Staff member #1 did not complete 24 hours of annual training related to job skills and knowledge, the staff member completed 6.5 hours. | The following shall complete 24 hours of training related to job skills and knowledge each year: Direct service workers. | 1. What was done immediately to correct the specific issue cited?
The Program Director registered the staff for the remaining hours needed to complete their annual 24 hour training requirements. These will be completed by 12/31/21.
2. What specific change will be made?
QI developed a training tracker in order to monitor and ensure that staff have completed their annual trainings and that the 24 hours of training have been completed on time. This tracker will be reviewed in the Quality Council meetings monthly.
3. Who (by title) will make the change?
Site Supervisor, Program Director, Regional Director, Chief Services Officer of DS, Learning and Development Manager
4. When will the change be made?
12/31/2021
5. What system has been implemented to make sure the same violation does not occur again?
The QI department created a training tracking system that has color coded indicators to notify the Program Director when staff trainings are almost due or overdue. The date on the Training Tracker Spreadsheet will automatically change to yellow if the trainings are due within the next 60 days, change dates to red for trainings that are past due, and show green for training dates that are current. This visual color coded system will easily alert Site Supervisors and Program Directors on what trainings are current, coming due, or past due. This tracker will be maintained by the Learning and Development Manager who will email it monthly and also present it in the Quality Council Meetings monthly.
6. What education and training has been provided to staff?
The program director reviewed the 6400.52(a)(1) regulation with the site supervisor and stressed the importance that staff should complete their annual 24 hours training related to their job skills and knowledge each year.
Attachment #9.5 |
12/31/2021
| Implemented |
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