Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00234634 Renewal 12/12/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(a)At time of inspection the placemats on the table were sticky to the touch with dried circular rings on them. There was visible debris under the refrigerator, the kitchen cabinet doors had visible drips and splashes as well as a sticky substance on the cabinet doors over the microwave. The mirrors in the home were streaked with a milky substance. Large cobwebs were in the left corner of the living room ceiling. (REPEAT VIOLATION 12/22, 3/23)Clean and sanitary conditions shall be maintained in the home. The placemats are now cleaned and none sticky to touch, no dried circular rings on them. The refrigerator was pulled out and cleaned, the Kitchen Cabinet doors were cleaned and polished. Large Cobwebs in the left corner of the living room ceiling was cleaned and the wall was painted. see picture and home depot receipt emailed to kristen 12/19/2023 Implemented
6400.66Three of the four lightbulbs in the bathroom fixture were missing making the lighting in the room inadequate. There was no lightbulb in the fixture of the poison closet, with door closed the room was dark.Rooms, hallways, interior stairways, outside steps, outside doorways, porches, ramps and fire escapes shall be lighted to assure safety and to avoid accidents. All Lightbulbs in the bathroom fixture are now replaced. There is lightbulb in the fixture of the poison closet now. see picture of all lightbulb emailed to Kristen. 12/21/2023 Implemented
6400.67(b)The far wall in the kitchen had an area of approximately six inches by 36 inches where the paint was worn and chipping. The bathroom wall near the tub and floor, behind the door was crumbling away with some debris on the floor. All small items in the home are made inaccessible to Individual #1 due to the ingestion of inedible items. The crumbling wall and chipping paint present a hazard. (REPEAT VIOLATION 12/22, 3/23) Floors, walls, ceilings and other surfaces shall be free of hazards.The Far Kitchen wall is now painted. The bathroom wall near the tub and floor is now repaired. The agency has submitted written request to the apartment management to authorized Heart to Heart to carry out maintenance repair when ever needed. Attached picture and letter emailed to Kristen. 01/02/2024 Implemented
6400.141(c)(13)The physical dated 3/6/23 did not contain allergy or contraindicated medication information. The section to be completed with the information was blank.The physical examination shall include: Allergies or contraindicated medications.The program director wrote a letter to the PCP's office to notify them that all areas of the Physical Exam Must be completed including the allergies/sensitivities and contraindicated medications. 12/14/2023 Implemented
6400.144Individual #1 is prescribed Carafate and Zofran. The medications were listed on the Medication Administration Record (MAR) but were not available in the home to be used as prescribed. (REPEAT VIOLATION 3/23)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. We reached out to the doctor and the Carafate is discontinued and script given for the Zofran. see copy of Discontinued Carafate and new Zofran ordered emailed to Kristen. 12/15/2023 Implemented
6400.163(a)At time of inspection a bottle of Saline Mist nasal spray and a bottle of Sport Sunscreen were in the home for use by Individual #1. Both items had remnants of a pharmacy label but there was no information visible on the labels. All writing had been worn away, leaving administration instructions, date, individual name and dosage unable to be determined.Prescription and nonprescription medications shall be kept in their original labeled containers. Prescription medications shall be labeled with a label issued by a pharmacy.Both the SunScreen and Saline mist now has their prescription labeled issued by Newhard Pharmacy. See copy of the Prescription Labeled by Newhard Pharmacy emailed to kristen. 12/21/2023 Implemented
6400.165(c)Individual #1 is prescribed Denta 5000 plus cream toothpaste. At the time of inspection Pro-sys fluoride tooth gel in an .85oz travel size toothpaste was presented as the toothpaste in use for Individual #1. There was no Denta plus cream toothpaste in the home. The December 2023 Medication Administration Record (MAR) had been initialed as administered as prescribed despite the medication not being in the home at the time of inspection. (REPEAT VIOLATION 12/22)A prescription medication shall be administered as prescribed.The staff Retrained. we reached out to the doctor and obtained a refill for the Dental colgate 5000 plus is now Refilled and in the home. See copy of the script for Colgate 5000 plus emailed to Kristen. 12/14/2023 Implemented
SIN-00162277 Renewal 09/27/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.181(a)An initial residential assessment was not completed within 1 year prior to or 60 calendar days after admission for Individual #2; date of admission was 6/28/19. Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the residential home and an updated assessment annually thereafter. The initial assessment must include an assessment of adaptive behavior and level of skills completed within 6 months prior to admission to the residential home. As assessment is now completed for the individual. Attached to chris email is a copy of the assessment. Moving forward initial assessment completion is added to the new pre-admission check list 10/01/2019 Implemented
6400.166(a)(13)The staff who administered the 9PM dosages of medication, which included buspirone, famotidine, quetiapine fumarate and hydroxyzine PAM, to Individual #2 failed to sign the medication administration record at the time of administration to Individual #2. It appeared that the medications were removed from the blister packs and administered.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Name and initials of the person administering the medication.The staff was re-trained on medication administration. Moving forward it was implemented that, after each shift incoming staff and outgoing staff will do a medication count and double check on the signing off. 10/01/2019 Implemented
6400.213(1)(i)The record for Individual #2 did not contain a social security number.Each individual's record must include the following information: Personal information, including: (i) The name, sex, admission date, birthdate and Social Security number.A new residential form was made for the individual that include her SS#. Moving forward the agency has created a pre admission residential information sheet which contain, the name, sex, admission date, DOB, and SS#. this form will be use upon admission for all new individual's . Attached is a copy of the pre- admission residential information form to Chris's email. 10/01/2019 Implemented
SIN-00196132 Renewal 02/24/2022 Compliant - Finalized
SIN-00157906 Initial review 06/27/2019 Compliant - Finalized