| Regulation | LIS Non-Compliance Area | Correction Required | Plans of Correction | Correction Date | POC Status |
| 6400.21(b) | The FBI background check for Staff #4 is dated 3/14/22, which is more than 6 months after their date of hire, which is 8/19/21. | If a prospective employe who will have direct contact with individuals resides outside this Commonwealth, an application for a Federal Bureau of Investigation (FBI) criminal history record check shall be submitted to the FBI in addition to the Pennsylvania criminal history record check, within 5 working days after the person's date of hire.
| All staffing records were reviewed, and we will make sure that all incoming staff will have their Pennsylvania Criminal Records checked within the 5 working days after the person¿s date of hire. Also, Every prospective employee who will have direct contact with individuals resides outside this Commonwealth, an application for Federal Bureau of Investigation criminal history record check shall be submitted to the FBI in addition to the Pennsylvania criminal history record check; within 5 working days after the person¿s date of hire. |
04/07/2022
| Implemented |
| 6400.62(c) | There was an unlabeled bottle containing what staff stated was hand sanitizer in the hall closet. | Poisonous materials shall be stored in their original, labeled containers. | The hand sanitizer was removed from the closet, and every household detergent was removed and locked. |
04/07/2022
| Implemented |
| 6400.151(a) | The physical for Staff #4 is dated 10/12/21 which is after their hire date of 8/19/21. | A staff person who comes into direct contact with the individuals or who prepares or serves food, for more than 5 days in a 6-month period, including temporary, substitute and volunteer staff, shall have a physical examination within 12 months prior to employment and every 2 years thereafter. | We will make sure that all staff have their physical done prior to working with the individuals, and every 2 years thereafter. |
04/07/2022
| Implemented |