Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00200272 Renewal 02/15/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.68(b)The hot water temperature in the bath tub in the only bathroom in the home measured 144.9 degrees F at 10:49 am.Hot water temperatures in bathtubs and showers may not exceed 120°F.On February 17, 2022, the hot water tank was adjusted by the DHS ODP Licensing Lead Representative and QACS staff, in order to lower the water temperature. The temperature was later checked by the QACS staff that came in at 3pm, at that time the temperature was at 116°F. 02/16/2022 Implemented
6400.18(a)(5)Incident #8914919, categorized as neglect, was discovered on 10/3/21 and reported to the Department's information management system on 10/5/21.The home shall report the following incidents, alleged incidents and suspected incidents through the Department's information management system or on a form specified by the Department within 24 hours of discovery by a staff person: Neglect. The provider is aware of the untimely reporting as indicated in the QACS Quarterly IM Report. In the future the agency will report the following incidents, alleged incidents and suspected incidents through the department's information management system (EIM) or on a form (contingency report) specified by the Department within 24 hours of discovery by a staff person. 02/21/2022 Implemented
6400.18(i)Incident #8914919 reported on 10/5/2021 was finalized on 1/19/22. No extensions were requested.The home shall finalize the incident report through the Department's information management system or on a form specified by the Department within 30 days of discovery of the incident by a staff person unless the home notifies the Department in writing that an extension is necessary and the reason for the extension.The provider reclassified incident 8902329 from missing person to neglect as advised and conducted the certified investigation as indicated in the ODP IM Bulletin. In the future the agency will report the following incidents, alleged incidents and suspected incidents through the Department's information management system or on a form specified by the Department within 24 hours of discovery by a staff person. 02/21/2022 Implemented
SIN-00128515 Renewal 01/30/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.163(c)The psychiatric medication reviews for Individual #1 completed 8/1/17, 9/1/17 and 12/1/17 did not include the reason for prescribing the medication and the need to continue the medication. If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a review with documentation by a licensed physician at least every 3 months that includes the reason for prescribing the medication, the need to continue the medication and the necessary dosage.Plan of Correction for: PA 6400.163 (c) Use of Prescription Medications How was it Corrected: On February 9, 2018, The Program Specialist Supervisor; Leslie Law-Ball, Program Specialist; Anisa Tate, Program Supervisor; Tamica Wade will have Quality Adult Care Services psychiatric medication review forms were revised to include the previous specified diagnosis from the psychiatrist. Program Specialist Supervisor had the revised form completed and signed by Individual #1 Psychiatrist. When it was corrected: On February 9, 2018. Who made the corrections: Program Supervisor; Leslie Law-Ball Took revised form to the psychiatrist to complete. What Specific Change will be made: The Program Specialist Supervisor; Leslie Law-Ball, Program Specialist; Anisa Tate, Program Supervisor; Tamica Wade will ensure all components of the psychiatric medication review form are fully completed with the reason for prescribing the medication and the need to continue the medication. Who will make the change: The Program Specialist Supervisor; Leslie Law-Ball, Program Specialist; Anisa Tate, Program Supervisor; Tamica Wade When will the change be made: This will be completed by February 9th 2018 How will the change be made: The Program Specialist Supervisor; Leslie Law-Ball, Program Specialist; Anisa Tate, Program Supervisor; Tamica Wade, will review the form with the psychiatrist for accuracy. What system have you implemented to make sure that the same violation will not occur again: The Program Specialist Supervisor; Leslie Law-Ball, Program Specialist; Anisa Tate, Program Supervisor; Tamica Wade will review quarterly for compliance What training will be provided by you staff: The Program Specialist Supervisor; Leslie Law-Ball, Program Specialist; Anisa Tate, Program Supervisor; Tamica Wade will train the direct care staff on the QUALITY ADULT CARE SERVICES psychiatric medication review form the importance of how the forms needs to be accurately completed with all required information. Supporting Documentation:Training Agenda Form Updated Psychiatric Medication Form 02/16/2018 Implemented
SIN-00169423 Renewal 01/15/2020 Compliant - Finalized
SIN-00107951 Renewal 02/06/2017 Compliant - Finalized