Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00193003 Renewal 09/15/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.81(k)(6)There was no mirror present in Individual #1's room at time of inspectionIn bedrooms, each individual shall have the following: A mirror. A ¿shatter-proof¿ mirror has been purchased, see attachment labeled Mirror invoice 09.30.21¿. Individual has behavioral management issues that result in severe property destruction. A typical mirror would not be safe as it would be smashed and become a safety risk for individual JS. Please see attachment labeled ¿JS Mirror Email SC¿ for communication to Individual Supports Coordinator informing them of the ¿shatter-proof¿ mirror. 10/08/2021 Implemented
6400.163(g)Individual #1's Hytone Hydrocortisone cream 2.5% not found at site at time of inspection.Prescription medications shall be stored in an organized manner under proper conditions of sanitation, temperature, moisture and light and in accordance with the manufacturer's instructions.PRN Hydrocortisone was removed from individual medication list, see attachment labeled Med List & Doctors¿. Individual dermatologist recommended discontinuation, see attachment labeled PS Note 9.15.21¿. 09/15/2021 Implemented
6400.166(a)(6)The medication list for Individual #1's did not include the dosage form for the following medications: - Tavaborole Solution 5% - Prevident 5000 -- 100MLA medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Dosage form.Individual medication list was revised to include dosages for the two medications in question. Please see attachment labeled Med & Doctor¿s List¿. 09/19/2021 Implemented
6400.166(a)(10)There are several instances of medications having only the frequency listed rather than the administration time on Individual #1's Medication list. The following did not have times listed: -Celexa -- 30mg -- QD -Calcium and Vitamin D -- 600MG & 200MG -- BID -Centrum -- 1 Tab -- BID -Tavaborole Solution -- Apply to affected area once daily Ammonium Lactate 12% cream -- listed as BID on med list but listed as 8am on bottleA medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Administration times.Individual medication list was revised to include administration time for the five medications in question. Please see attachment labeled Med & Doctor¿s List¿. 09/19/2021 Implemented
SIN-00172960 Renewal 02/26/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.22(e)(3)On 12/15/19 and 1/4/2020 there were purchases made for individual 1 in the amount of 50.00 and 25.00 with no itemization on the receipt and therefore there is no way to establish what the funds were used for. If the home assumes the responsibility of maintaining an individual's financial resources, the following shall be maintained for each individual: Documentation, by actual receipt or expense record, of each single purchase exceeding $15 made on behalf of the individual carried out by or in conjunction with a staff person. The Individual is not able to hold his is own money as outlined in his Assessment and ISP. Staff hold onto his debit card for him and assist him in making purchases. Individual does not handle cash and all purchases are made on his behalf with his debit card. Individual requested assistance from staff to make purchases on 12/14/19 and 1/4/20 for the amounts of $25 and $50. These purchases were made at business Total Liquidators, an establishment that does not provide itemized receipts. Staff should have recorded the items purchased on the receipts before submitting them to his Program Specialist. Individual has since confirmed that he requested assistance from staff to make those purchases and has signed off on the receipts to verify the purchases. Staff has not worked with agency since mid April, 2020, due to Covid19 complications and is unable to be retrained on our financial procedure at this time. Once staff recovers and returns to work, he will be retrained on the financial procedure. The Individuals' Financial Documentation Procedure has been updated to specify the need for receipts to be itemized. - When an itemized receipt is not available, the staff will complete a written receipt that identifies the items. The individual will sign the receipt. - The receipts and ledgers will be reviewed by the Program Specialist and submitted to the individual funds manager. - The individual funds manager will review all receipts submitted monthly. If a blank receipt is submitted, the funds manager will request the PS to obtain a written receipt documenting the purchase. - (Please see attachment labeled ¿Individuals¿ Financial Documentation¿) 03/13/2020 Implemented
6400.64(a)The kitchen walls had spills and residue on them, the refrigerator had dirt and spills on the inside and outside of the unit. The kitchen door was very marked up with black spots consistent with finger and hand prints.Clean and sanitary conditions shall be maintained in the home. The kitchen has been cleaned and maintained at this point. (Please see attachments labeled 'JS 219 Deb Ln Walls' and JS 219 Deb Ln Refrigerator) - The Overnight Staff has been provided with a cleaning checklist and weekly schedule of tasks. - The Program Specialist will complete a monthly home inspection. The PS will take necessary corrective action if the cleaning tasks have not been completed. - The Risk Manager will complete a quarterly review of the home using the 6400 Physical Site Checklist. This will be submitted to the Compliance Department and Executive Director on a quarterly basis. (See attachment labeled '6400 Physical Site Checklist') 03/10/2020 Implemented