| Regulation | LIS Non-Compliance Area | Correction Required | Plans of Correction | Correction Date | POC Status |
| 6400.104 | The fire letter that was sent on 5/27/19 did not indicate what room Individual #1 was located in and to what extent of assistance is needed in the event of a fire. There was also no letter sent at the time of move in date for individual #2 indicating where his bedroom was located, and the level of assistance needed in the event of an evacuation. | The home shall notify the local fire department in writing of the address of the home and the exact location of the bedrooms of individuals who need assistance evacuating in the event of an actual fire. The notification shall be kept current.
| A letter has been sent to the fire company outlining the support needed in case of a fire for the current residents at Norway. In the future, the COO at BOLD will ensure that a fire letter is sent for anyone that will be staying at respite longer than 30 days. |
09/25/2019
| Implemented |
| 6400.141(c)(11) | The Health Maintenance Needs section in individual #2's physical dated 7/23/19 was left blank. | The physical examination shall include: An assessment of the individual's health maintenance needs, medication regimen and the need for blood work at recommended intervals. | In the future, support staff attending the physical will check the physical prior to departure from the doctor to ensure every section is completed. Once the paperwork has returned to the program, it will be reviewed by the respite coordinator prior to being sent to the medical coordinator. Three checks will be completed prior to entering the physical into the file. The form will be returned to the doctor to be completed if any area is left blank. The health maintenance needs question has been faxed to JL's doctor to be answered. A copy of the answers will be added to JL's file once received. |
09/25/2019
| Implemented |
| 6400.141(c)(12) | The Physical Limitations section in individual #2's physical dated 7/23/19 was not addressed on the physical form. | The physical examination shall include: Physical limitations of the individual. | We have received a physical form from our AE that includes all missing questions including physical limitations. This form will be used for everyone moving forward. Specific to JL, we have faxed the list of questions to be answered to his doctor so that we have the needed information; including physical limitations. |
09/25/2019
| Implemented |
| 6400.141(c)(14) | Information pertinent to diagnosis in case of emergency on individual #2's physical dated 7/23/19 was not addressed on the physical form. | The physical examination shall include: Medical information pertinent to diagnosis and treatment in case of an emergency. | We have received a copy of a physical form from our AE that has all missing questions including information pertinent to diagnosis and treatment in case of an emergency.. We will be using this form for everyone moving forward. Also in regards to JL, his doctor has been faxed a list of the missing questions so we can have the information needed; including information pertinent to diagnosis and treatment in case of an emergency |
09/25/2019
| Implemented |
| 6400.141(c)(15) | Special Diet instructions on individual #2's physical dated 7/23/19 was not addressed on the physical form. | The physical examination shall include:Special instructions for the individual's diet. | We have requested and received a physical from our AE that includes all areas required for the physical including special diet instructions. This form will be used for all physicals moving forward. In the matter of JL, his doctor was faxed a list of questions missing from the physical that need to be addressed including special diet. |
09/25/2019
| Implemented |