Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00240555 Renewal 03/13/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.63(a)The water temperature at the kitchen sink was 122.5 degrees Fahrenheit.Heat sources, such as hot water pipes, fixed space heaters, hot water heaters, radiators, wood and coal-burning stoves and fireplaces, exceeding 120°F that are accessible to individuals, shall be equipped with protective guards or insulation to prevent individuals from coming in contact with the heat source. The water heater's gauge was decreased by maintenance on day of physical site inspection. 04/08/2024 Implemented
6400.66The lightbulb to the right of the rear entrance was not working during the physical site walk through.Rooms, hallways, interior stairways, outside steps, outside doorways, porches, ramps and fire escapes shall be lighted to assure safety and to avoid accidents. Work order was submitted to maintenance. Lightbulb was changed the day of physical site inspection. 04/08/2024 Implemented
6400.82(f)The upstairs bathroom did not have soap during the physical site walk through.Each bathroom and toilet area that is used shall have a sink, wall mirror, soap, toilet paper, individual clean paper or cloth towels and trash receptacle. All bathrooms will have hand soap available 04/08/2024 Implemented
6400.106The furnace inspection for this home was completed on 12/4/22 and/or 12/7/22 and not again until 12/23/2023, which exceeds the one year and 15-day grace time period allowed for this regulation.Furnaces shall be inspected and cleaned at least annually by a professional furnace cleaning company. Written documentation of the inspection and cleaning shall be kept. The company will schedule the annual furnace inspection 30 days prior to the previous inspection. Furnace inspections are completed by Rhoades Plumbing and Heating. 04/08/2024 Implemented
6400.145(2)The emergency medical plan does not indicate the method of transportation to be used in the event of emergency and non-emergency situations.The home shall have a written emergency medical plan listing the following: The method of transportation to be used. The emergency medical plan will be updated to provide a method of transportation. 04/08/2024 Implemented
SIN-00220654 Renewal 03/14/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.71The phone in the upstairs empty bedroom did not have emergency numbers at the time of the inspection.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. The emergency phone number were immediately placed on the back of the phone. See attachment #5. 03/31/2023 Implemented
6400.112(g)In the past year, there were no fire drills conducted between the daytime hours of 6am-5pm. All of the drills were completed after 5pm, unless it was a sleep drill that was conducted between the hours of 12am-6am. Fire drills shall be held on different days of the week and at different times of the day and night. The Fire drills will now be submitted upon completion to the Residential Program Supervisor for review. A box at the end of the current fire drill Attachment #3 has been added for the Residential Program Supervisor to sign and date that the fire drill was reviewed for accuracy. All Team Leaders, Program Specialists, and the Residential Program Supervisor was trained on this new procedure by the Director of Residential Services see attachment #4 and 5. 03/31/2023 Implemented
SIN-00167438 Renewal 02/11/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.68(c)The coliform water testing was not completed with 90 days- - 7/25/19, missing Oct 2019, 1/2/2020.A home that is not connected to a public water system shall have a coliform water test by a Department of Environmental Resources¿ certified laboratory stating that the water is safe for drinking purposes at least every 3 months. Written certification of the water test shall be kept.The Maintenance Supervisor will be responsible to ensure that all of the applicable residential homes not connected to a public water system have a coliform water test by a Department of Environmental Resources certified laboratory stating that the water is safe for drinking purposes at least every 3 months from the date of the previous coliform water test. This calendar reminder has been attached. The Maintenance Supervisor has a reminder added to the company calendar that includes Crossroads CEO and Residential COO to ensure that the inspection is scheduled prior to the 3-month deadline. The Maintenance Supervisor will ensure that there is written certification of the water test. 03/05/2020 Implemented
6400.32(r)The bedroom doors for Individual #1 & #2 do not contain a locking mechanism for privacy.An individual has the right to lock the individual's bedroom door.The Maintenance Director has ensured that all residential bedroom doors have been equipped with locks even if the individual does not wish to lock his or her door unless they have clearly expresses that they do not want the door to be equipped with a lock. Bedroom door lock pictures have been attached to verify the correction to the violation. A bedroom door lock policy has been developed to review the individuals rights involving bedroom door locks and has been signed by the individual or guardian expressing if the person wishes to have a lock on their door or if they do not wish to have a lock on their bedroom door and expressing that they do not want their bedroom door to be equipped with a lock. The bedroom door lock policy form has been attached. The individual rights policy has been updated to reflect all of the rights in accordance with the 6100 regulations and has been attached. 03/03/2020 Implemented
6400.166(a)(12)The PRN medication Calc Antacid Chew 750mg -- Tums E-X chew 2 tablets for indigestion was initialed on December 16, 2019 as being administered, but there is no time of administration on the MAR for Individual #1.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Date and time of medication administration.CSI Medical Coordinator are Medication Administration Trainers. They have retrained all agency staff trained to pass medication on the proper procedure for passing and documenting PRN medication and utilizing agency codes to be utilized on the MAR to ensure consistency and understanding. The training charting for PRN medications and signature pages are attached. The CSI Medical Coordinator will be responsible for conducting quarterly MAR reviews to better identify any concerns or areas of correction needed. 03/02/2020 Implemented
6400.213(1)(i)Individual #1's record does not contain the information on Identifying marks. This section is left blank on the Individual Information Summary.Each individual's record must include the following information: Personal information, including: (i) The name, sex, admission date, birthdate and Social Security number.CSI Program Specialists overlooked the section on identifying marks and left it blank. CSI Program Specialists have reviewed all individual records and ensured that all identifying information is completed and recorded under content of records. The Program Specialists will be responsible to ensure that the content of records are updated when information changes or updates are needed. The Program Specialist will also conduct quarterly audits on the individual records and ensure that all areas of the record are complete. 03/02/2020 Implemented
SIN-00122999 Unannounced Monitoring 10/10/2017 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.71The telephone number to the nearest hospital was not located on or near any of the telephones in the house. 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. Immediately put emergency numbers on and/or near the telephones. If home supervisor notices numbers have gone missing from any telephone, immediately fix and/or replace numbers the same day. The home supervisor should complete daily checklists to check if the emergency numbers on by the telephones. The home supervisor should turn the daily checklists into their supervisor for review at least weekly. The home supervisor should document when the numbers are replaced. Program specialist shall review checklists of the home monthly and follow up within the same month to ensure all telephones have emergency numbers on the phone. The phone number list has been updated to include the local hospital. the new phone number list was put in the home on 10/25/17 as indicated on attachment #3. 11/02/2017 Implemented
6400.77(b)The first aid kit in the home was not equipped with a thermometer. A thermometer could not be located within the home. 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. Immediately put thermometer in first aid kit. If home supervisor notices the thermometer has gone missing, immediately fix the issue and replace thermometer the same day. The home supervisor should complete daily checklists to check if the first aid kit contains all the required contents. The home supervisor should turn the daily checklists into their supervisor for review at least weekly. The home supervisor should document when the thermometer or any missing item is replaced. Program specialist shall review checklists of the home monthly and follow up within the same month to ensure all missing contents have be added back to the first aid kit. The thermometer was placed in the first aid kit the day of the inspection. the supervisor will complete the daily checklist to ensure all parts of the first aid kit are on site. (attachment#2) if any items re not found in the first aid kit, the supervisor will immediately find the item and place it into the first aid kit. 11/02/2017 Implemented
SIN-00201244 Renewal 03/15/2022 Compliant - Finalized
SIN-00184836 Renewal 03/15/2021 Compliant - Finalized
SIN-00145605 Unannounced Monitoring 11/15/2018 Compliant - Finalized
SIN-00141775 Technical Assistance 09/19/2018 Compliant - Finalized
SIN-00120035 Technical Assistance 08/24/2017 Compliant - Finalized