Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00196136 Renewal 02/24/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.141(c)(14)Individual #5's physical exam dated 7/23/21 did not address information pertinent to diagnosis in case of emergency. This section of the physical exam form was left blank.The physical examination shall include: Medical information pertinent to diagnosis and treatment in case of an emergency. On 7/23/21 medical evaluation pertinent to diagnosis was done. Program specialist will remember to include medical evaluation to sent document. ( see attached medical evaluation emailed to Kristen) 03/01/2022 Implemented
6400.181(e)(13)(i)Health: This area was not on Individual #5's assessment dated 10/5/2021.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Health. on 3/2/22 assessment was corrected including health area. individual has currently progress in the area of portion control, she is able to eat healthy food such as salads and vegetable currently. individual is focusing on weight lose. she is walking with her staff four times a week at the mall.( see attached assessment emailed to Kristen) 03/02/2022 Implemented
6400.181(e)(13)(v)socialization: Progress in this area was not evaluated on Individual #5's assessment dated 10/5/2021.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Socialization. on 3/2/22 assessment was corrected and currently individual is able to participate in group project and contribute her ideas and thoughts independently. she doesn't need encouragement to participate in community activities. ( see attached corrected assessment emailed to Kristen) 03/02/2022 Implemented
6400.181(e)(13)(vii)financial independence: Progress in this area was not evaluated on Individual #5's assessment dated 10/5/2021.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Financial independence. 0n 3/2/22 assessment was corrected. Individual financial independence was evaluated and currently the individual is able to count money up to $100. individual is able to purchase item and count change up to $100 ( See attached corrected assessment emailed to Kristen) 03/14/2022 Implemented
6400.181(e)(13)(viii)managing personal property: Progress in this area was not evaluated on Individual #5's assessment dated 10/5/2021.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Managing personal property. on 3/2/22 assessment corrected and indicate progress made on managing property. Currently individual to able to cared and keep her property safe. she doesn't get involved in property destruction. ( see attached corrected assessment emailed to Kristen) 03/02/2022 Implemented
6400.181(e)(13)(ix)community integration: Progress in this area was not evaluated on Individual #4's assessment dated 10/5/2021.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Community-integration.on 3/2/22 assessment was corrected. Individual community integration progress was evaluated and currently individual is aware of strangers in the community. she can move independently about in her neighborhood to familiar places. ( see attached corrected assessment emailed to Kristen) 03/02/2022 Implemented
6400.181(e)(14)Individual #5's assessment dated 10/5/21 didn't evaluate their ability to swim.The assessment must include the following information:The individual's progress over the last 365 calendar days and current level in the following areas: The individual's knowledge of water safety and ability to swim. 0n 3/2/22 assessment was corrected. Individual's ability to swim was evaluated. Currently individual know how to swim . ( see attached corrected assessment emailed to Kristen) 03/02/2022 Implemented
6400.163(h)Individual #5's pro re nata (PRN) medication Guaifensein expired 2/15/2022. The medication remained with the individual's medications and was not disposed of properly.Prescription medications that are discontinued or expired shall be destroyed in a safe manner according to Federal and State statutes and regulations.on 3/3/21 Staff re-trained. medication was disposed properly. ( see attached training emailed to Kristen ) 03/03/2022 Implemented
6400.165(g)Individual #5 had psychiatric medication reviews on 12/22/21, 9/22/21, 8/25/21, and 5/3/21 and there was no documentation on the necessary dosage for the medication.If a medication is prescribed to treat symptoms of a psychiatric illness, there shall be a review by a licensed physician at least every 3 months that includes to document the reason for prescribing the medication, the need to continue the medication and the necessary dosage.on 3/1/22 program Director wrote a letter to the Physician to notify the physician how proper document of the dosage and reason for all prescribed medication and the need to continue the medication. ( see attached letter to the Physician emailed to Kristen) 03/01/2022 Implemented
6400.182(c)According to Individual #5's assessment dated 10/5/21 they use money, make and/or counts change in any amount, and buys major items independently above $15.00. However, the individuals ISP states they need support with managing her finances in providing the right amount of money, and knowing if she receives the correct change, and requires assistance in making purchases. The individual plan shall be revised when an individual's needs change based upon a current assessment.The individual plan shall be initially developed, revised annually and revised when an individual's needs change based upon a current assessment.on 3/2/22 Assessment was corrected. Individual is able to manager her money. she can count change up to $100. program Director sent an email to the SC on 3/3/22 to update individual's plan with her progress in the area of finances . A team meeting was called by the SC on 3/14/22 including the individual and plan is to be updated by the SC ( see attached emailed to the SC and Corrected assessment emailed to Kristen) 03/14/2022 Implemented
SIN-00181900 Renewal 01/12/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.71Emergency numbers should be located by landline. At the time of inspection the emergency numbers were on the wall in the dining room while the landline phone was located in the living room.Telephone numbers of the nearest hospital, police department, fire department, ambulance and poison control center shall be on or by each telephone in the home with an outside line. Emergency numbers has been placed in the living room, where the landline is. Moving forward emergency phone # will remain by the landline. Staff was retrained. See attached picture of emergency numbers by the landline emailed to Kristen. 01/12/2021 Implemented
6400.111(f)Fire extinguisher that was located under the kitchen sink did not have current dates of annual inspections. The home did have a second fire extinguisher located in the living room that was in compliance. A fire extinguisher shall be inspected and approved annually by a fire safety expert. The date of the inspection shall be on the extinguisher. The first fire extinguisher located under the kitchen sink has been inspected. Moving forward, Quality assurance will make sure all fire extinguisher are inspected annually. See attached picture of inspected extinguisher emailed to Kristen. 02/05/2021 Implemented
6400.32(r)At the time of inspection, Individual #3 did not have a lock on her bedroom door. No documentation of the individual's refusal of the right to have a locking door or team meeting to discuss safety reasons for removing the right were found in the ISP.An individual has the right to lock the individual's bedroom door.Agency have reached out to the SC. The choice of lock in the bedroom was offered to the individual. she agreed to a lock in her bedroom. Lock was placed in her bedroom. Moving forward agency will check on the 6400 regulation on a regular base. See attached picture of lock on the door emailed to Kristen. 02/05/2021 Implemented
6400.52(c)(1)Staff training records for staff # 4 does not reflect training in the areas of community integration, individual choice, and supporting individual to develop and maintain relationship.The annual training hours specified in subsections (a) and (b) must encompass the following areas: The application of person-centered practices, community integration, individual choice and supporting individuals to develop and maintain relationships.Staff was trained. Moving forward these training has been included in the orientation training package. See attached training signed off emailed to Kristen. 02/05/2021 Implemented
SIN-00162282 Renewal 09/30/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.151(c)(2)The initial physical examination for staff #1 did not include a tuberculin skin test, nor was there documentation on the physical examination form or in the record that the employee has a history of positive Mantoux reaction. A chest x-ray was in the employee record indicating no active disease. The initial physical examination for staff #2 did not include a tuberculin skin test, nor was there documentation on the physical examination form or in the record that the employee has a history of positive Mantoux reaction. A chest x-ray was in the employee record indicating no active disease.The physical examination shall include: Tuberculin skin testing by Mantoux method with negative results every 2 years; or, if tuberculin skin test is positive, an initial chest x-ray with results noted. Tuberculin skin testing may be completed and certified in writing by a registered nurse or a licensed practical nurse instead of a licensed physician, licensed physician's assistant or certified nurse practitioner.The agency didn't know that. Moving forward the agency has updated their physical examination form to include a statement to the medical team to indicate if chest xray is done they should state if it's due to a history of positive PPD or other health condition. Attached to Chris email is our updated physical form. 10/03/2019 Implemented
SIN-00157911 Initial review 06/27/2019 Compliant - Finalized