Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00209644 Renewal 08/15/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2390.82(a)REPEAT from 8/30/21 annual inspection: The written emergency evacuation plan states, in case of a fire all employees are evacuated across the road to the camco building using the established staff responsibilities for building evacuation as the staffing plan. However, the staff responsibilities are not included in the plan.Written emergency evacuation procedures including at a minimum client and staff responsibilities, means of transportation in an emergency, emergency shelter location and an evacuation diagram specifying directions for egress in the event of an emergency shall be posted in work areas.In order to comply with 2390.82(a), additional clarification has been added to the evacuation policy stating what that staff are responsible for evacuating listed areas. Document 1a 08/31/2022 Implemented
2390.151(e)(8)REPEAT from 8/30/21 annual inspection: Individual #1's current, 6/15/22 assessment does not include their ability to evacuate the facility. The assessment states "at this time Individual #1 hasn't participated in a fire drill at the facility yet but according to their ISP evacuated independently at home." As of 8/17/22, the individual hasn't had an assessment completed that assesses their ability to evacuate the facility. The assessment must include the following information: The client's ability to evacuate in the event of a fire.Ability to evacuate the building in the case of an emergency was assessed and documented in accordance with 2390.151(e)(8) in the annual assessment. Document 2a 09/30/2022 Implemented
2390.21(u)Individual #1's individual rights reviewed with them on 5/25/22 did not include a review of their rights defined in 2380.21(a), (b), (d)-(f), and (s). Individual #2's individual rights reviewed with them on 5/14/22 did not include a review of their rights defined in 2380.21(a), (b), (d)-(f), and (s). Additionally, the agency did not produce records that individual's rights were reviewed with the individual in 2021.The facility shall inform and explain client rights and the process to report a rights violation to the individual, and persons designated by the client, upon admission to the facility and annually thereafter.Client rights form has been updated to include 2390.21(a), (b), (d-f), and (s). This form will be distributed, reviewed, and signed by each client to come into compliance with the regulation. Document 3a 09/30/2022 Implemented
SIN-00191401 Renewal 08/30/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2390.83(b)-1There are no records maintained that Staff person #4, who is checking the facility's fire alarm system monthly, is trained in the operation of the fire alarm equipment.An employe trained in the operation of the equipment shall check the fire alarm monthly. Staff responsible for completing monthly fire alarm checks were trained using the manual from the fire alarm system. Training sheet completed 09/13/2021 Implemented
2390.103The written emergency medical plan did not include the staffing plan to be used during the emergency.A facility shall have a written emergency medical plan listing the following:(1)The hospital or source of health care that will be used in an emergency. (2) The method of transportation to be used.(3) Written consent from the client, parent or guardian for emergency medical treatment.(4) The staffing plan during the emergency.The written emergency medical plan has been revised to include a staffing plan to be used in the case of an emergency in the facility or during community participation supports. 09/23/2021 Implemented
2390.40(a)The training records for staff do not include the specific training content reviewed or provided to staff. For example, Staff person #3's 1/9/2020 training record only stated "program activities, management and supervision of activities" training was provided to staff but did not include the content of each topic discussed.Records or orientation and training, including the training source, content, dates, length of training, copies of certificates received and persons attending, shall be kept.Provider's plan of correction is to document more specific, detailed information on the training material covered. 09/08/2021 Implemented
2390.151(f)There are no records maintained that Individual #1's 4/20/21 assessment was sent to themselves and their individual support plan team.The program specialist shall provide the assessment to the individual plan team members at least 30 calendar days prior to the individual meeting.Provider's plan of correction is to document #1's annual assessment was sent to the individual and the individual's support plan team. 09/02/2021 Implemented