Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00224547 Unannounced Monitoring 05/11/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.165(c)Individual #8 is prescribed Amoxicillin 250mg, 5ml susp, Give 10ml by mouth three times daily for 10 days. This medication was started on 5/2/23 at 3PM and the last dose is to be administered on 5/12/23 at 8AM. The bottle of medication located in the home was almost full. There were three bottles of the medication delivered from the pharmacy and two were no longer in the home as they were used. Based on dosing of 10ml 3 times a day amount of medication Individual #8 would have taken would have been 300ml. Staff contacted the pharmacy during the inspection to determine how much medication would have been sent to the home. The pharmacist reported that three 100ml bottles were sent to the home and all of the medication should have been used upon taking the last dose. Based on the amount of medication remaining in the home (almost a full bottle) the medication is not being administered as prescribed. Staff reported the pharmacy did not send a 10ml syringe with the medication and the only syringe available in the home was 3ml. Staff reported that they would dose the medication out of the 3ml syringe using a 3-3-3-1 method to total the 10ml. Staff failed to administer the medication as prescribed by not obtaining the proper measuring device for the medication. (Repeat Violation 10/28/22, 1/6/23)A prescription medication shall be administered as prescribed.A medication error and neglect incident was submitted to determine what occurred with the Amoxicillin that was prescribed to Individual #8 and whether it was administered appropriately. A proper measuring device for liquid medications was purchased and made available at the home as well to prevent future medication errors. 06/09/2023 Implemented
6400.166(b)Individual #8 is prescribed Risperidone 1mg tablet, give one tablet by mouth twice daily. The name and initials of the person administering the medication was not documented on the Medication Administration Record on 5/5/23 at 9PM. (Repeat Violation 9/16/22, 4/5/23)The information in subsection (a)(12) and (13) shall be recorded in the medication record at the time the medication is administered.The missing initials on the MAR was written in by the person who administered the medication. 06/09/2023 Implemented
SIN-00222342 Unannounced Monitoring 04/05/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(a)Poisons are required to be locked in this home. Dawn brand dish detergent and Gain brand dish detergent were found in an unlocked and accessible cabinet located under the kitchen sink. Both detergents' packaging instructs to call poison control if swallowed.Poisonous materials shall be kept locked or made inaccessible to individuals. The Program Supervisor put away the Dawn dish detergent and Gain dish detergent in a locked closet upon discovery that they were left unlocked. 04/17/2023 Implemented
SIN-00214657 Unannounced Monitoring 10/28/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(a)Individual #4's Individual Service Plan indicates that the individual is not safe around poisons. There was a gallon container of Great Value Lavender Scent Multipurpose Cleaner located in the cabinet to the right of the stove in the kitchen. This cabinet was not locked making the cleaning product easily accessible to all individuals in the home. (Repeat Violation 9/16/2022)Poisonous materials shall be kept locked or made inaccessible to individuals. The Program Supervisor put the gallon container of Great Value Lavender Scent Multipupose Cleaner in a locked cabinet after discovering that it wasn't locked on 10/28/2022. 10/28/2022 Implemented
6400.144Health services such as pharmaceutical are not being provided for Individual #3. Individual #3's Medication Administration Record lists Cepacol sore throat-cough Loz (for sore throat and cough lozenge), give 1 lozenge by mouth every 2 hours as needed for cough. This medication was not available in the home. (Repeat Violation 9/16/22)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. The Program Supervisor called the pharmacy for clarification since the medication record said Cepacol, but Individual #3 was sent Halls Cough Drops instead by the pharmacy. The pharmacy verified the script for Halls Cough Drops and discontinued the Cepacol sore throat-cough Loz. She now has the correct medication that was prescribed to her, Halls Cough Drops, listed on her medication record. 10/31/2022 Implemented
6400.166(c)Individual #3 refused all of the individual's 8AM medications on 10/17/22. There is not documentation of the refusal on the medication administration record and there was no documentation that the refusal was reported to the prescriber.If an individual refuses to take a prescribed medication, the refusal shall be documented on the medication record. The refusal shall be reported to the prescriber as directed by the prescriber or if there is harm to the individual.The Program Supervisor contacted the prescribing doctors to retrieve refusal protocols in case individual # 3 refuses her 8 AM medications again. The back of the MAR was filled out by the Program Supervisor to reflect the refusal on 10/17/22. 11/17/2022 Implemented
SIN-00211531 Unannounced Monitoring 09/16/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(a)At the time of the inspection under the sink cabinet in the bathroom there was a container of Clorox cleaning wipes. This cabinet had a child proof device however it was not a locking mechanism which allowed the Licensing Representative to easily take off the device and easily access the poison. The individuals in the home have the capabilities to operate this locking device. Not all residents of the home are assessed to be safe with poisons.Poisonous materials shall be kept locked or made inaccessible to individuals. A latch and lock were installed on the bathroom cabinet by the Quality Manager on 09/19/22 to ensure that poisonous materials are kept lock and made inaccessible to individuals. 09/19/2022 Implemented
SIN-00206344 Renewal 06/07/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(a)The caulk around the base of the toilet and tub appeared to be covered in a black mold like substance. Additionally, the caulk surrounding both was peeling up from the floor and from their surfaces.Clean and sanitary conditions shall be maintained in the home. The toilet and tub were both recaulked by the property manager on 7/6/22. 07/06/2022 Implemented
6400.77(b)At time of inspection the first aid kit contained a bottle of antiseptic that expired in 8/2019. The botte of antiseptic was disposed of at time of inspection. Antiseptic must be within date to be considered compliant with regulation. A first aid kit shall contain antiseptic, an assortment of adhesive bandages, sterile gauze pads, a thermometer, tweezers, tape, scissors and syrup of Ipecac, if an individual 4 years of age or younger, or an individual likely to ingest poisons, is served. After discovering that the antiseptic expired, the Program Supervisor purchased a new antiseptic and placed it in the first aid kit. 06/09/2022 Implemented
SIN-00191763 Unannounced Monitoring 08/13/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(b)At time of inspection a small rodent ran from behind a piece of furniture and disappeared behind another piece of furniture on the same wall in the bedroom of Individual #1. Staff at the home indicated that glue traps were in place under the furniture to capture rodents. Individual #1 indicated that the rodent has been present in the home for some time.There may not be evidence of infestation of insects or rodents in the home. The room was cleaned and more mouse traps were placed around the room. The Program Supervisor assisted individual # 1 in storing his food properly and recommended that he eats in the dining area to avoid future infestation. 09/20/2021 Implemented
SIN-00189355 Renewal 06/29/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(a)Fog machine solution was located under the kitchen sink. The label of the fog machine solution listed the phone number for poison control. The Individual Support Plan for Individual #1 last updated on 6/10/21 indicated that Individual #1 "Has no awareness of the danger of poisonous substances. The CLA keeps all poisonous substances locked up." Poisons in the home shall be kept locked.Poisonous materials shall be kept locked or made inaccessible to individuals. The fog machine solution was locked away after discovery. Administrative staff followed up on 7/12/21 at 11:00 am to ensure that all poisonous materials are locked away at the home. 06/29/2021 Implemented
6400.64(a)The kitchen cabinets and cabinet handles above the stove were covered in a sticky layer of what appeared to be grease. The small bathroom had a buildup of dust and dirt on the floor, baseboards, and pipes along the baseboard. The exhaust fan in the small bathroom had a thick layer of dust covering the vents. The main bathroom door and doorframe were soiled with dirt. The bottom of the bathtub in the main bathroom was covered with a brown substance.Clean and sanitary conditions shall be maintained in the home. Direct Support Staff and Program Specialist from the Washington Program cleaned the home including the kitchen cabinets, small bathroom including floor, baseboards, pipes, and exhaust fan on 7/8/21. The main bathroom¿s bathtub, door, and doorframe were cleaned on 7/8/21 and the door and doorframe were repainted on 7/15/21. Administration conducted a physical inspection of the home on 7/19/21 to ensure clean and sanitary conditions are maintained. 07/15/2021 Implemented
6400.67(a)An area of peeling paint approximately 1" x 6" on the wall behind the sink in the main bathroom was noted during inspection. The particle board vanity in the main bathroom has several areas of decayed finish leaving the particle board exposed.Floors, walls, ceilings and other surfaces shall be in good repair. The main bathroom was repainted and the vanity with exposed wood was replaced with a new vanity on 07/15/21 by the Property Manager. 07/15/2021 Implemented
6400.76(a)The shelving unit in the main bathroom was covered in a layer of a dark substance and dust. Furniture and equipment shall be nonhazardous, clean and sturdy. Support staff purchased a new shelfing unit to replace the old shelfing unit in the main bathroom on 07/15/21. 07/15/2021 Implemented
6400.112(e)Fire drills were held during sleeping hours on 9/18/20 and 4/11/21, exceeding the six-month time frame.A fire drill shall be held during sleeping hours at least every 6 months. We will conduct the next sleeping hours fire drill within 6 months of the more recent sleeping hours fire drill which was conducted on 4/11/21. 07/15/2021 Implemented
6400.112(g)Fire drills were conducted during sleeping hours on 9/18/20 12:00am and 4/11/21 12:05am. Fire drills shall be conducted at different times of the night. Fire drills shall be held on different days of the week and at different times of the day and night. We will conduct the next sleeping hours fire drills at different times throughout the night. 07/15/2021 Implemented
SIN-00177102 Renewal 09/29/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.68(b)The water temperature at this residence was 122.4 degrees which exceeds the regulated temperature. Hot water temperatures in bathtubs and showers may not exceed 120°F. The water temperature was lowered immediately upon discovery. It was checked again at about 3:30 pm on 9/29/20 and the water temperature was 118 degrees. On 10/7/20 at about 11:15 am, the water temperature was checked again and it was 102 degrees. The water temperature will be monitored monthly by the Program Supervisor and logged. 10/07/2020 Implemented
6400.211(b)(3)There was no name, address and telephone number of the person able to give consent for emergency medical treatment in Individual #3's record.Emergency information for each individual shall include the following: The name, address and telephone number of the person able to give consent for emergency medical treatment, if applicable. The Program Specialist is updating Individual # 3's records, including the Demographic form and the Emergency Medical Treatment Plan to include the person's contact information, including the name, address, and telephone number, to be able to give consent for emergency medical treatment. Individual # 3's ISP will be updated as well to include this information. 10/16/2020 Implemented
SIN-00154033 Renewal 04/05/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.21(a)Staff #1 was hired on 8/27/2018. A criminal history check was not completed.An application for a Pennsylvania criminal history record check shall be submitted to the State Police for prospective employes of the home who will have direct contact with individuals, including part-time and temporary staff persons who will have direct contact with individuals, within 5 working days after the person's date of hire. We will ensure that background checks for all prospective employees are completed. If they have lived in PA for 2 or more consecutive years, a state background check will be completed and if they have not lived in PA for 2 or more consecutive years, an FBI one will be completed for all prospective employees. ((A criminal history check was completed for Staff #1 on 3/26/19 -CH 6/14/2019)) 04/08/2019 Implemented
6400.151(c)(3)Staff #3's physical exam dated 8/14/2018 and Staff #4's physical exam dated 8/6/2018 do not state they are free from communicable diseases. The physical examination shall include: A signed statement that the staff person is free of communicable diseases or that the staff person has a communicable disease but is able to work in the home if specific precautions are taken that will prevent the spread of the disease to individuals. We created our own work physical form which includes a place for the heath care practitioner to sign off whether the employee is free from communicable diseases and if they are not free from communicable diseases to write the preventative measures that we need to take to no spread diseases. ((Staff #3 and Staff #4 will contact a physician to obtain information regarding communicable diseases by 6/30/19)) 04/08/2019 Implemented
6400.186(b)Individual #1's ISP Review covering the period 10/31-1/27/2019 was not signed by Individual #1 and was not dated by her Program Specialist.The program specialist and individual shall sign and date the ISP review signature sheet upon review of the ISP. We will ensure that Individuals are signing their ISP Review cover and will add a line for program specialists to date the ISP review cover as well. ((Individual #1 reviewed and signed their ISP Reviews -CH 6/14/19)) 04/08/2019 Implemented
Article X.1007Staff #2 was hired on 3/18/2019, Staff #3 was hired on 2/28/2018 and Staff #4 was hired on 8/28/2018. There is no verification that they were residents of Pennsylvania for 2 consecutive years in their files & and FBI checks were not performed.When, after investigation, the department is satisfied that the applicant or applicants for a license are responsible persons, that the place to be used as a facility is suitable for the purpose, is appropriately equipped and that the applicant or applicants and the place to be used as a facility meet all the requirements of this act and of the applicable statutes, ordinances and regulations, it shall issue a license and shall keep a record thereof and of the application.We now require our potential new employees to check off whether they lived in PA for 2 or more consecutive years as part of their consent to background check form that they complete during the interview process. ((All Independent Living staff will residency will be reviewed and FBI checks will be completed in accordance with the Older Adults Protective Services Act -CH 6/14/19)) 04/08/2019 Implemented
SIN-00138256 Unannounced Monitoring 07/11/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)Heat pipes were rusted and flaking at the top. The insulation on the pipes was cracked and holes had been wrapped with aluminum foil.Floors, walls, ceilings and other surfaces shall be in good repair. Property Manager painted the pipes and added new insulation around the pipes. 07/12/2018 Implemented
6400.67(b)There was a hole approximately 2 foot by 2 foot cut into the wall of the living room area that was created for an air conditioning unit. There was no air conditioner in the place and a piece of particle board which allowed gaps around the edges and exposed the living area to the outside. Floors, walls, ceilings and other surfaces shall be free of hazards.An air conditioner was placed in the opening and a frame was built around the air conditioner. 07/12/2018 Implemented
6400.101A door in the laundry area had a lock on the outside which could potentially trap someone in the area in the event of a fire or other emergency.Stairways, halls, doorways, passageways and exits from rooms and from the building shall be unobstructed. The door knob was removed and replaced with a door knob that does not have a lock. 07/12/2018 Implemented
SIN-00137046 Unannounced Monitoring 06/11/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(a)The stove in the kitchen was covered with dirt and debris.Clean and sanitary conditions shall be maintained in the home. On 6/29/18, the stove was cleaned and cleanliness will be maintained by Hanade Abualburak 06/29/2018 Implemented
6400.67(a)The floor in the closet located in the back right bedroom felt unstable.Floors, walls, ceilings and other surfaces shall be in good repair. The floor in the closet was replaced and is now stable 07/02/2018 Implemented
6400.67(b)The floor(s) in the doorways between the bedrooms and the hallway were raised and uneven, creating a potential tripping hazard. Floors, walls, ceilings and other surfaces shall be free of hazards.Floors between the bedrooms and hallways were replaced with an even surface to negate the tripping hazard by property manager. 07/02/2018 Implemented
6400.67(b)The walls in the bedrooms had several holes with exposed cable wires. Floors, walls, ceilings and other surfaces shall be free of hazards.Holes in the walls were patched up and exposed cables were covered with plastic wall covers 07/02/2018 Implemented
6400.111(f)The fire extinguisher located in the kitchen was last inspected in February 2017. A fire extinguisher shall be inspected and approved annually by a fire safety expert. The date of the inspection shall be on the extinguisher. Replaced fire extinguisher located in the kitchen with one that is up to date on the inspection. The date is within this year and is up to date. 07/02/2018 Implemented
SIN-00224677 Renewal 05/17/2023 Compliant - Finalized
SIN-00132448 Initial review 04/09/2018 Compliant - Finalized