Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00199587 Unannounced Monitoring 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, there was a bottle of Palmolive dish detergent and a bottle of Method hand soap by the kitchen sink and various bottles of powder and lotions in a caddy beside the bathroom sink. These products are required to be locked in this home when not actively in use.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
6400.141(c)(4)Individual #1's 5/26/20 and 5/25/21 annual physicals indicate that the physician was "unable to perform" hearing and vision exams. There are no records maintained that Individual #1 has had a completed hearing or vision exam.The physical examination shall include: Vision and hearing screening for individuals 18 years of age or older, as recommended by the physician. 1) Plan to Fix the Immediate Problem a. WHO: Operations Manager will schedule both a hearing exam (ENT) and vision exam (Optometrist) for the individual to have these exams completed. b. WHAT: These appointments will ensure that individual has an up to date hearing and vision exam. 04/06/2022 Implemented
6400.141(c)(6)Individual #1 had a tuberculin test on 8/19/19 and not again until 12/29/21.The physical examination shall include: Tuberculin skin testing by Mantoux method with negative results every 2 years for individuals 1 year of age or older; or, if tuberculin skin test is positive, an initial chest x-ray with results noted. 1) Plan to Fix the Immediate Problem a. WHO: Program Specialist caught error prior to licensing but still was overdue by 4 months. Tuberculin test was completed/read on 12/29/2021. b. WHAT: Program Specialist corrected non-compliance by getting Tuberculin test completed for individual on 12/29/21. c. WHEN/HOW: Tuberculin test was completed on 12/29/2021. 02/08/2022 Implemented
6400.165(c)Individual #1 has a PRN prescription for acetaminophen that is to be administered, "every 4 hours as needed for pain." On 9/2/21 and 9/3/21, this medication was administered for the reason of "running nose."A prescription medication shall be administered as prescribed.1) Plan to Fix the Immediate Problem a. All medication administration records were reviewed on 2/9/2022 to ensure no other errors in administration occurred throughout agency in relation to regulation 165(c). No other issues found at this time. 02/18/2022 Implemented
6400.166(a)(11)There is no diagnosis or purpose listed on Individual #1's Medication Administration Record for the following medications: clobazam, vimpat, and omeprazole.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Diagnosis or purpose for the medication, including pro re nata.1) Plan to Fix the Immediate Problem a. Contacted providers and received updated orders instructing on diagnoses/purposes completed on 2/14/2022. 02/18/2022 Implemented
6400.167(a)(1)The following medications were not administered to Individual #1 at 8pm on 7/25/21: topiramate, divalproex, vimpat, clobazam, melatonin. Individual #1 did not receive their 8am dose of clobazam on 11/20/21 and their 8pm dose of clobazam on 11/21/21. Individual #1 did not receive their 12am dose of divalproex on 11/26/21.Medication errors include the following: Failure to administer a medication.1) Plan to Fix the Immediate Problem a. All medication errors were reviewed and ensured they were reported. 02/18/2022 Implemented
6400.167(b)There is no documentation maintained that the failure to administer Individual #1's 8pm medications on 7/25/21 was reported as a medication error.Documentation of medication errors, follow-up action taken and the prescriber's response, if applicable, shall be kept in the individual's record.1) Plan to Fix the Immediate Problem a. This medication error was reported on the EIM system on 2/2/2022 after it was identified as an error by the Executive Director. 02/18/2022 Implemented
6400.167(c)The failure to administer Individual #1's 8pm medications on 7/25/21 was not reported as an incident in the department's incident management system.A medication error shall be reported as an incident as specified in § 6400.18(b) (relating to incident report and investigation).1) Plan to Fix the Immediate Problem a. Incident reported onto the EIM system on 2/2/2022 by Executive Director. 02/18/2022 Implemented
6400.181(f)Individual #1's 2020 ISP meeting was conducted on 12/4/20. Their assessment was not sent to the plan team until 11/6/20. Individual #1's 2021 ISP meeting was conducted on 12/3/21. Their assessment was not sent to the plan team until 11/5/21.The program specialist shall provide the assessment to the individual plan team members at least 30 calendar days prior to an individual plan meeting.1) Plan to Fix the Immediate Problem a. Reviewed all other assessments to ensure compliance with other assessments within Faithful Homes. 02/18/2022 Implemented
SIN-00147744 Renewal 02/14/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.15(c)Self-assessments with violations do not include summary of corrections for all homes except Judie and Goldenfield.A copy of the agency's self-assessment results and a written summary of corrections made shall be kept by the agency for at least 1 year. 1. Plan to fix the immediate problem a. Who: Compliance officer will create a self-assessment correction summary log by 3/1/2019. b. What will be corrected: Documentation will be available for each home of what the self- assessment determined were needed corrections as well as the action plan to correct and the completion of that action plan. c. When and How: A self ¿assessment correction summary log has been created. It will be used at all homes on the next quarterly review of the homes which is scheduled for no later than 3/31/2019. The section of the summary log that lists the findings will be completed by 4/9/2019. Then any needed corrections will have specifics dates for completion. This will be reviewed and approved by Operations on 4/15/2019. 2. A plan to prevent future occurrences The self assessment correction summary will be attached to the licensing tool. The licensing tool will be completed monthly by house manager and reviewed by DOO or the Operations Manager. 3. Training Plan for Staff House managers and administrative staff will be trained by 3/31/2019. The training will be documented on the sign in sheet 6400.15 (c). 4. Send documentation that will enable validation: The sign in sheet titled 6400.15 © is available for validation as well as the Self-assessment correction summary sheet. 03/31/2019 Implemented
6400.113(a)Individual 1 had fire safety training on 8/18/17 and not again until 10/24/2018. An individual, including an individual 17 years of age or younger, shall be instructed in the individual's primary language or mode of communication, upon initial admission and reinstructed annually in general fire safety, evacuation procedures, responsibilities during fire drills, the designated meeting place outside the building or within the fire safe area in the event of an actual fire and smoking safety procedures if individuals smoke at the home. 1. A plan to fix the immediate problem Individuals will now be trained on a 6 month cycle in all homes. a. Who:House Manager, Operations manager and/ or Director of Operations will complete the individuals training in all homes. b. What will be corrected: Fire safety training for individuals completed on a 6 month cycle. c. When and How: This new process was implemented October of 2018. Director of Operations visited each home and performed training with the house managers. 2. A plan to prevent future occurrences: FH is now on a training cycle of 6 months, each April and October. Individuals fire safety training from all homes for residents that were living in homes at the time is available . The form for verification is titled Individual Fire safety training. 3. Training plan for staff: House manager training will occur in March 2019 in order to again ensure for April¿s residents training. Operations will conduct the training and the compliance officer will verify that training occurred. Training will be documented on sign in sheet titled 6400.113(a). 4. Send documentation that will enable validation: All residents will be trained no later than April 30, 2019. Individuals will sign a training sheet titled Individual Fire Safety training 6400.113(a) 03/31/2019 Implemented
SIN-00131169 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 individuals with an intellectual disability regulations to measure and record compliance. Agency completed the self- inspection however we did not have the correct form to use. Correct form has been obtained and will now be utilized for all houses. House supervisor manager will train house supervisors in use of the correct form. 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 and ongoing 05/01/2018 Implemented
6400.67(a)Hallway walls and doorways throughout the home are scuffed and marked up by wheelchair usage in the home. Pieces of walls were taken off at doorway entrances.Floors, walls, ceilings and other surfaces shall be in good repair. 6400.67(a) ¿ WHAT and HOW: Floors, walls, ceilings and other surfaces shall be in good repair. Hallway walls and doorways were found to be scuffed and marked by wheelchair usage in the home. Repairs have been completed and pictures are attached. To prevent recurrence House supervisor will create safety check list including wall damage and perform check and confirm on the same day that fire drill is done each month. This will be implemented in each house. 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: March 15, 2018 03/15/2018 Implemented
6400.216(a)Individual's appointment book containing information was unlocked on shelf in staff office. 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 appointment book was observed to be unlocked on a shelf in the office. House supervisors will retrain all staff 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 05/01/2018 Implemented
SIN-00173081 Unannounced Monitoring 05/05/2020 Compliant - Finalized