Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00199441 Renewal 02/01/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(a)Individual #1 is not safe around poisonous materials. At the time of the 2/2/22 inspection, a bottle of Aveeno Lotion and a bottle of Soft-soap antibacterial soap were unlocked in the bathroom. Both products state to contact poison control if ingested.Poisonous materials shall be kept locked or made inaccessible to individuals. 1) Plan to Fix the Immediate Problem a. WHO: House Manager took all products not in use and placed them in the Cleaning Supply Closet after inspection was completed. b. WHAT: All cleaning supplies/bathroom supplies that are considered poisonous materials were placed back into the cleaning supply closet. 02/18/2022 Implemented
SIN-00173092 Unannounced Monitoring 04/27/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.61(a)During the walk through on 04/21/20, Individual # 2's Bed Shaker was not functional during the smoke detector test. The operations manager of the home was unable to get the bed shaker to work during the inspectionA 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. Immediate Correction: Bed shaker was repaired and tested for compliance on 5/6/2020. Bed shaker was operable and no issues were noted on this check. Faithful Homes has added to check the bed shaker at both residential homes that have one on the company Fire Drills. This was completed on 5/7/2020 and implemented immediately. Please see attached document to POC (POC Bed Shaker- Fire Drill). The new self-inspection tool will be completed for all residential homes and submitted to Licensing by 6/12/2020 ( POC RCG Self-assessments). Faithful Homes will continue to have management complete monthly self-assessments for each residential home. Furthermore, Faithful Homes will train ALL staff on the sections of the RCG including; Individual Rights, Medications, Nutrition, Fire Safety and Physical Site. Staff will also be trained on the specific regulations that were non-compliant through this inspection (6400.61, 6400.62, 6400.66, 6400.71, 6400.74). These training sign-in sheets will be submitted to Licensing by 6/12/2020. (POC All Staff Training) 06/12/2020 Implemented
6400.62(a)A pump bottle of Dial Complete antibacterial soap was unlocked on the kitchen sink. This poisonous material was unlocked and accessible to individualsPoisonous materials shall be kept locked or made inaccessible to individuals. Immediate Correction: At the time of inspection, Dial soap was removed and locked up. On 5/8/2020, the Dial soap was replaced with a non-toxic soap. See picture accompanying this POC (POC Fresh Meadow- Poison) The new self-inspection tool will be completed for all residential homes and submitted to Licensing by 6/12/2020 ( POC RCG Self-assessments). Faithful Homes will continue to have management complete monthly self-assessments for each residential home. Furthermore, Faithful Homes will train ALL staff on the sections of the RCG including; Individual Rights, Medications, Nutrition, Fire Safety and Physical Site. Staff will also be trained on the specific regulations that were non-compliant through this inspection (6400.61, 6400.62, 6400.66, 6400.71, 6400.74). These training sign-in sheets will be submitted to Licensing by 6/12/2020. (POC All Staff Training) 06/12/2020 Implemented
6400.66The light in the accessible Attic was not functional during the physical site inspection walkthrough.Rooms, hallways, interior stairways, outside steps, outside doorways, porches, ramps and fire escapes shall be lighted to assure safety and to avoid accidents. Immediate Correction: Attic Light repaired on 5/11/2020. See picture that accompanies this POC (Attic Light). The new self-inspection tool will be completed for all residential homes and submitted to Licensing by 6/12/2020 ( POC RCG Self-assessments). Faithful Homes will continue to have management complete monthly self-assessments for each residential home. Furthermore, Faithful Homes will train ALL staff on the sections of the RCG including; Individual Rights, Medications, Nutrition, Fire Safety and Physical Site. Staff will also be trained on the specific regulations that were non-compliant through this inspection (6400.61, 6400.62, 6400.66, 6400.71, 6400.74). These training sign-in sheets will be submitted to Licensing by 6/12/2020. (POC All Staff Training) 06/12/2020 Implemented
SIN-00147742 Renewal 02/14/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.22(d)(1)Individual 1 has a ledger dated 11/30/2018 showing that the current balance on that date was $86.56 and was initialed by staff members JM/JC from shift 1st-2nd. Then on 11/30/18 staff members from shift 2nd-3rd wrote the ledger amount as $86.50 thus off by 6 cents and no withdrawals were recorded. The error was later caught on the 1st-2nd shift on 12/3/2018 and the ledger correctly read $86.56, but there were no specific notations in the deposit/withdrawal section to indicate what had occurred. It happened again on 01/14/19... where the ledger reads $115.56 but now reads $115.57. This error was not noticed nor corrected by staff to date.The home shall keep an up-to-date financial and property record for each individual that includes the following: Personal possessions and funds received by or deposited with the home. 1. A plan to fix the immediate problem a. Who: Compliance officer verified that $115.57 is the correct amount House manager will check their respective houses petty cash for correct adding in the month of February and each month thereafter. b. What will be corrected: That balances will correct and will be reconciled by the house supervisor at the end of the week. Additionally, 2 staff members will check petty cash at the end of each shift. ift c. When and How: Starting Mar 1 2019, daily, two DCW¿s will count the petty cash. Weekly the House Manager will audit and document on the petty cash sheet reconciling petty cash amount. 2. A plan to prevent future occurrences: House manager and Operations Manager will audit petty cash logs monthly 3. Training plan for staff: On 2/27/2019 House Managers, Program Specialist, Operations and Compliance officers were trained on proper petty cash procedures 4. Send documentation that will enable validation: A training attendance sign in sheet titled Petty Cash is available for validation. 02/27/2019 Implemented
6400.141(a)Individual1's last physical was completed on 2/14/17 and not again until 8/16/18 which exceeds the one year and 15-day grace period by 6 months.An individual shall have a physical examination within 12 months prior to admission and annually thereafter. 1. A plan to fix the immediate problem: a. Who: A new program specialist was hired on 11/12/2018. This employee is responsible for maintaining all the appointments for all of our individuals and ensuring that they are completed according to the 6400 regulations. Additionally, each house manager, will review their home and the program specialist will verify that all appointment information is correct and that appropriate physical appointments will be made. b. What will be corrected: All physical appointments for all individuals will be timely. c. When and How: The individual #1 appointment was completed on 8/16/2018. The next appointment is not due until 8/15/2019. The remaining individuals appointments will be reviewed by each house manager and then the program specialist by 4/15/2019. The program specialist will update the ¿Due Date¿ Spreadsheet by 4/15/2109. The ¿Due Date¿ spreadsheet is available on Faithful Homes shared drive or can be printed up request. 2. A plan to prevent future occurrences: The Due Date spreadsheet will be reviewed weekly at the Faithful Homes team meeting. The program specialist will be updating the spreadsheet and the Assistant Director of Operations will be review and ensure accuracy. 3. Training plan for staff: All House Managers, Program Specialist, Operations and Compliance officer will be trained that missing a dental appointment without documentation of attempts and or waiver are not acceptable. Training will be completed by 4/15/2019 and a sign off sheet of completed training titled 6400.141(a) will be completed. 4. Send documentation that will enable validation: Sign off sheet of training titled 6400.141 (a). 09/01/2019 Implemented
6400.141(c)(4)Most recent physical form for individual 1 dated 8/16/18 states that the physician is referring the individual out of office for a vision screening, however during time of inspection, no documentation could be found demonstrating that this medical screening was scheduled or that it occurred.The physical examination shall include: Vision and hearing screening for individuals 18 years of age or older, as recommended by the physician. 1. A plan to fix the immediate problem: a. Who: House manager in conjunction with program specialist will contact Vision specialist to obtain an appointment by March 31 2019. Additionally, each house manager, will review their home and the program specialist will verify that all appointment information is correct and that appropriate vision appointments will be made. b. What will be corrected: All vision appointments for all individuals will be timely. c. When and How: The remaining individuals physicals will be reviewed by each house manager and then the program specialist by 4/15/2019. The program specialist will update the ¿Due Date¿ Spreadsheet by 4/15/2109 for any referrals to specialists. The ¿Due Date¿ spreadsheet is available on Faithful Homes shared drive or can be printed up request. 2. A plan to prevent future occurrences: The Due Date spreadsheet will be reviewed weekly at the Faithful Homes team meeting. The program specialist will be updating the spreadsheet and the Assistant Director of Operations will be review and ensure accuracy. 3. Training plan for staff: All House Managers, Program Specialist, Operations and Compliance officer will be trained that missing a vision appointment without documentation of attempts and or waiver are not acceptable. Training will be completed by 4/15/2019 and a sign off sheet of completed training titled 6400.141(c) (4) will be completed. 4. Send documentation that will enable validation: Sign off sheet of training titled 6400.141(c)(4). 04/15/2019 Implemented
6400.142(a)Individual 1 had a yearly dental exam on 10/27/17 but did not have one completed at all in 2018.An individual 17 years of age or younger shall have a dental examination performed by a licensed dentist semiannually. An individual 18 years of age or older shall have a dental examination performed by a licensed dentist annually. 1. A plan to fix the immediate problem: a. Who: House manager in conjunction with program specialist has contacted multiple dental offices to see if anyone will perform dental exam in individual 1¿s wheel chair. Provider has secured an appointment on March 28 2019. o Additionally, each house manager, will review their home and the program specialist will verify that all appointment information is correct and that appropriate dental appointments will be made. b. What will be corrected: All dental appointments for all individuals will be timely. a. When and How: The individual #1 appointment has been scheduled as of 3/7/2019 for an appointment date of 3/28/2019. The remaining individuals appointments will be reviewed by each house manager and then the program specialist by 4/15/2019. The program specialist will update the ¿Due Date¿ Spreadsheet by 4/15/2109. The ¿Due Date¿ spreadsheet is available on Faithful Homes shared drive or can be printed up request. 2. A plan to prevent future occurrences: The Due Date spreadsheet will be reviewed weekly at the Faithful Homes team meeting. The program specialist will be updating the spreadsheet and the Assistant Director of Operations will be review and ensure accuracy. 3. Training plan for staff: All House Managers, Program Specialist, Operations and Compliance officer will be trained that missing a dental appointment without documentation of attempts and or waiver are not acceptable. Training will be completed by 4/15/2019 and a sign off sheet of completed training titled 6400.142 (a) will be completed. 4. Send documentation that will enable validation: Sign off sheet of training titled 6400.142 (a). 04/15/2019 Implemented
6400.144Dental exam was reportedly not completed for individual 1 due to individual not being able to transfer into the dentist chair. No documentation was provided to demonstrate how the agency was going to arrange for this health service to be completed.Health services, such as medical, nursing, pharmaceutical, dental, dietary and psychological services that are planned or prescribed for the individual shall be arranged for or provided. 1. A plan to fix the immediate problem: a. Who: House manager in conjunction with program specialist has contacted multiple dental offices to see if anyone will perform dental exam in individual 1¿s wheel chair. Provider has secured an appointment on March 28 2019. o Additionally, each house manager, will review their home and the program specialist will verify that all appointment information is correct and that appropriate dental appointments will be made. b. What will be corrected: All dental appointments for all individuals will be timely. c. When and How: The individual #1 appointment has been scheduled as of 3/7/2019 for an appointment date of 3/28/2019. The remaining individuals appointments will be reviewed by each house manager and then the program specialist by 4/15/2019. The program specialist will update the ¿Due Date¿ Spreadsheet by 4/15/2109. The ¿Due Date¿ spreadsheet is available on Faithful Homes shared drive or can be printed up request. 2. A plan to prevent future occurrences: The Due Date spreadsheet will be reviewed weekly at the Faithful Homes team meeting. The program specialist will be updating the spreadsheet and the Assistant Director of Operations will be review and ensure accuracy. 3. Training plan for staff: All House Managers, Program Specialist, Operations and Compliance officer will be trained that missing a dental appointment without documentation of attempts and or waiver are not acceptable. Training will be completed by 4/15/2019 and a sign off sheet of completed training titled 6400.144 will be completed. 4. Send documentation that will enable validation: Sign off sheet of training titled 6400.144. 04/15/2019 Implemented
SIN-00131167 Renewal 03/08/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.15(b)The agency did not use the Department's licensing inspection instrument for the community homes for people with intellectual disability regulations to measure and record compliance.The agency shall use the Department's licensing inspection instrument for the community homes for people with intellectual disability regulations to measure and record compliance. 6400.15(b) ¿ WHAT and HOW: The agency shall use the Department's licensing inspection instrument for the community homes for people with intellectual disability regulations to measure and record compliance. Agency did self- inspection however we did not have the correct form. Correct form obtained and will now be utilized. WHO: Responsibility: House supervisors will be in charge of making the correction and implementing the change, Manager of the House Supervisors will conduct a quarterly review. WHEN: March 15, 2018 03/15/2018 Implemented
6400.66Side ramp entryway light bulb was not operative.Rooms, hallways, interior stairways, outside steps, outside doorways, porches, ramps and fire escapes shall be lighted to assure safety and to avoid accidents. 6400.66 ¿ WHAT and HOW: Rooms, hallways, interior stairways, outside steps, outside doorways, porches, ramps and fire escapes shall be lighted to assure safety and to avoid accidents. Side ramp entryway light bulb was not operative. Bulb replaced by March 15 2018. House supervisor will create safety check list including that light bulbs are functioning correctly and perform check and confirm on the same day that fire drill is done. WHO: Responsibility: House supervisors will be in charge of making the correction and implementing the change, Manager of the House Supervisors will conduct a quarterly review. WHEN: March 15, 2018 ADDITIONALLY: All homes for Faithful Homes have been reviewed and were part of the audit. No other issues than what is stated in POC. However, the quarterly review process will continue for all homes. 03/15/2018 Implemented
6400.101Basement exit and steps to yard were covered with mounds of leaves and therefore the door did not open completely or easily. Doritos bag and Nutri-Grain Bar box were observed on the stairway.Stairways, halls, doorways, passageways and exits from rooms and from the building shall be unobstructed. 6400.101 ¿ WHAT and HOW: Stairways, halls, doorways, passageways and exits from rooms and from the building shall be unobstructed. Leaves were blocking the basement exit. There was also trash. Leaves have been removed and exit is unobstructed. In the future, house supervisor will regularly check exits to ensure that they are not obstructed. WHO: Responsibility: House supervisors will be in charge of making the correction and implementing the change, Manager of the House Supervisors will conduct a quarterly review. WHEN: Completed by March 15, 2018. ADDITIONALLY: All homes for Faithful Homes have been reviewed and were part of the audit. No other issues than what is stated in POC. However, this quarterly review process will continue for all homes. 03/15/2018 Implemented
6400.111(a)The attic and basement had 1-A fire extinguishers.There shall be at least one operable fire extinguisher with a minimum 2-A rating for each floor, including the basement and attic. 6400.111(a) ¿WHAT and HOW: There shall be at least one operable fire extinguisher with a minimum 2-A rating for each floor, including the basement and the attic. Basement and attic fire extinguishers had 1-A fire extinguishers. Fire extinguishers have been replaced with 2A rating. WHO: Responsibility: House supervisors will be in charge of making the correction and implementing the change, Manager of the House Supervisors will conduct a quarterly review. WHEN: Completed by March 30, 2018. 03/30/2018 Implemented
6400.112(d)Individuals did not evacuate the entire building within 2 1/2 minutes during the fire drill conducted on 08/25/2017. Evacuation time recorded as 4 minutes on fire drill log. Individuals shall be able to evacuate the entire building, or to a fire safe area designated in writing within the past year by a fire safety expert, within 2 1/2 minutes or within the period of time specified in writing within the past year by a fire safety expert. The fire safety expert may not be an employe of the home or agency. Staff assistance shall be provided to an individual only if staff persons are always present at the home while the individual is at the home. 6400.112(d)- WHAT and HOW: Individuals shall be able to evacuate the entire building, or to a fire safe area designated in writing within the past year by a fire safety expert, within 2 1/2 minutes or within the period of time specified in writing within the past year by a fire safety expert. The fire safety expert may not be an employee of the home or agency. Staff assistance shall be provided to an individual only if staff persons are always present at the home while the individual is at the home. During drill conducted 8/25/2017, evacuation time was recorded at 4 minutes. Provider was not aware the drill could be redone for the month All following drills have been in compliance. Provider is now aware that a drill can be redone for the month until compliance is attained. Going forward, during any current month, Manager of house supervisor will review fire drill logs to confirm acceptable fire drill performance. WHO: Responsibility: House supervisors will be in charge of making the correction and implementing the change, Manager of the House Supervisors will conduct a monthly review. WHEN: May 1, 2018 ADDITIONALLY: All fire drill records for Faithful Homes have been reviewed and were part of the audit. No other issues than what is stated in POC. However, the monthly review process will continue for all homes. 05/01/2018 Implemented
6400.112(e)An unsuccessful fire drill was conducted during sleeping hours on 08/25/2017, and none since.A fire drill shall be held during sleeping hours at least every 6 months. 6400.112(e) ¿ WHAT and HOW: A fire drill shall be held during sleeping hours at least every 6 months. (Individuals shall be able to evacuate the entire building, or to a fire safe area designated in writing within the past year by a fire safety expert, within 2 1/2 minutes or within the period of time specified in writing within the past year by a fire safety expert. The fire safety expert may not be an employee of the home or agency. Staff assistance shall be provided to an individual only if staff persons are always present at the home while the individual is at the home.) During drill conducted 8/25/2017, evacuation time was recorded at 4 minutes. Because this was the sleeping drill it is considered that no sleeping drill was conducted. All subsequent drills have been in compliance. Provider is now aware that a drill can be redone for the month until compliance is attained. Going forward, during any current month, Manager of house supervisor will review fire drill logs to confirm acceptable fire drill performance. WHO: Responsibility: House supervisors will be in charge of making the correction and implementing the change, Manager of the House Supervisors will conduct a monthly review. WHEN: May 1, 2018 ADDITIONALLY: All fire drill records for Faithful Homes have been reviewed and were part of the audit. No other issues than what is stated in POC. However, the monthly review process will continue for all homes. 05/01/2018 Implemented
6400.216(a)Individual's health records and incident reports were observed to be unlocked in the basement staff area. An individual's records shall be kept locked when unattended. 6400.216(a)- WHAT and HOW: An individual¿s records shall be kept locked when unattended. An individual¿s incident and health record was observed to be unlocked in the office. House supervisor and staff will all be retrained that have access to locked records to make sure they are locked when use is completed. House supervisors will provide documentation of this retraining. WHO: Responsibility: House supervisors will be in charge of making the correction and implementing the change, Manager of the House Supervisors will conduct a quarterly review. WHEN: Implementation date: May 1, 2018 ADDITIONALLY: All supervisors and staff of Faithful Homes will be retrained and this will be completed by June 30, 2018. 05/01/2018 Implemented
SIN-00110034 Initial review 03/08/2017 Compliant - Finalized