Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00263365 Renewal 03/11/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.151(a)Staff #2 did not complete a physical examination ever two years. Staff #2 completed a physical examination on 12/5/22 and did not complete another until 1/16/25. A staff person who comes into direct contact with the individuals or who prepares or serves food, for more than 5 days in a 6-month period, including temporary, substitute and volunteer staff, shall have a physical examination within 12 months prior to employment and every 2 years thereafter. Staff #2 will complete a physical examination, as outlined in policy, at least every two years, with correct and complete documentation of physical examination. 03/11/2025 Implemented
6400.151(c)(3)Staff #1 had a physical examination completed on 1/18/24. The physical examination did not include a signed statement that Staff #1 was free from communicable disease. The physical examination shall include: A signed statement that the staff person is free of communicable diseases or that the staff person has a communicable disease but is able to work in the home if specific precautions are taken that will prevent the spread of the disease to individuals. Staff #1 will check all documentation for correctness and completion prior to departing from appointments. 03/11/2025 Implemented
6400.165(a)Prescription medications are not prescribed by an authorized prescriber. A bottle of Pain Relief Menthol Topical Analgesic Roll on Gel was located in Individual #1's medication box. This was not prescribed by an authorized prescriber.A prescription medication shall be prescribed in writing by an authorized prescriber.Medications that were not prescribed have been removed from Individual #1¿s medication box. All medications that may be needed for Individual #1 will be prescribed by an authorized prescriber. 03/11/2025 Implemented
6400.166(b)Individual #1 is prescribed Azelastine HCL OP 0.05% Drop, Mucinex 120mg Guanfacine Extended Release, Pepto Bismol and Neosporin. These medications are available in the home; however they are not documented on the Medication Administration Record.The information in subsection (a)(12) and (13) shall be recorded in the medication record at the time the medication is administered.All medications available in home for Individual #1 have been documented properly on the Medication Administration Record 03/11/2025 Implemented
SIN-00201448 Renewal 04/05/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.51(b)(1)Staff #3 did not receive orientation training in the application of person-centered practices, community integration, individual choice and supporting individuals to develop and maintain relationships.The orientation must encompass the following areas: The application of person-centered practices, community integration, individual choice and supporting individuals to develop and maintain relationships.Nick's Home Orientation Syllabus is updated to reflect the additional missing trainings. The updated syllabus will be used henceforth for training new hires in Nick's Home. The Site Supervisor will ensure that new staff will be trained with the updated syllabus prior to working with the individual. The Program Supervisor and the CEO will review the completed New Employee Orientation syllabus prior to new employees working with the individual. 06/01/2022 Implemented
6400.52(c)(1)Staff #1, and Staff #4 did not receive annual training in supporting individuals to develop and maintain relationships. Staff #2 did not receive annual training in supporting individuals to develop and maintain relationships and individual choice.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.Nick's Home Annual Training Syllabus is updated to reflect the additional missing trainings. The updated syllabus will be used henceforth for all employees of Nick's Home. The Site Supervisor will ensure that new staff will be trained with the updated syllabus on an annual basis. The Program Supervisor and the CEO will review the completed annual training records quarterly to ensure that staff are on track to complete their annual training requirements and satisfy the requirements listed in the syllabus. 06/01/2022 Implemented
6400.166(a)(14)Individual #1 is prescribed Flonase Nasal Spray .50 mcg use two sprays in each nostril at 8AM and Azelastine Nasal Spray .15%, use two sprays in each nostril at 9PM only for congestion and nasal drainage from April 1, 2022, to October 31, 2022. The Medication Administration Record does not include the duration of treatment.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Duration of treatment, if applicable.Nick's Home MAR's will be updated by the pharmacy to indicate : A.) the medical condition for which the medication is prescribed B.) the duration for which the medication is prescribed if it is a PRN. The Program Specialist is will contact the prescribing physician to ensure that prescriptions contain the necessary information, and work with the pharmacy to see that the required information is included on the provided MAR's. The Site Supervisor will validate new MAR's monthly to verify that the required information is present and correct. 06/01/2022 Implemented
SIN-00185826 Renewal 04/05/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.21(a)Staff #1 was hired on 12/23/19. Staff #1 did not have a Pennsylvania State Police Criminal History check completed within five days of hire. The Pennsylvania State Police Criminal History check was not completed until February 5, 2020.An application for a Pennsylvania criminal history record check shall be submitted to the State Police for prospective employes of the home who will have direct contact with individuals, including part-time and temporary staff persons who will have direct contact with individuals, within 5 working days after the person's date of hire. Moving forward, Nick's Home will not accept an FBI Background Check in lieu of the required PSP Background check. 04/22/2021 Implemented
6400.52(c)(2)Annual training for Staff #1, Staff #2 and Staff #3 did not include the prevention, detection and reporting of abuse, suspected abuse and alleged abuse in accordance with the Older Adults Protective Services Act (35 P.S. §§ 10225.101-10225.5102). The child protective services law (23 Pa. C.S. §§ 6301-6386) the Adult Protective Services Act (35 P.S. §§ 10210.101 - 10210.704) and applicable protective services regulations.The annual training hours specified in subsections (a) and (b) must encompass the following areas: The prevention, detection and reporting of abuse, suspected abuse and alleged abuse in accordance with the Older Adults Protective Services Act (35 P.S. §§ 10225.101-10225.5102). The child protective services law (23 Pa. C.S. §§ 6301-6386) the Adult Protective Services Act (35 P.S. §§ 10210.101 - 10210.704) and applicable protective services regulations.Nick's Home will amend it's Training Syllabus and Orientation to include the prevention, detection and reporting of abuse, suspected abuse and alleged abuse in accordance with the Adult Protective Services Act. Staff will be required to complete these trainings every calendar year and will be tracked by individual staff on their Annual Training Record. 04/22/2021 Implemented
6400.52(c)(3)Annual training for Staff #1, Staff #2 and Staff #3 did not include training on individual rights.The annual training hours specified in subsections (a) and (b) must encompass the following areas: Individual rights.Nick's Home will amend it's Training Syllabus and Orientation to include Individual's Rights. Staff will be required to complete these trainings every calendar year and will be tracked by individual staff on their Annual Training Record. 04/22/2021 Implemented
6400.52(c)(4)Annual training for Staff #1, Staff #2 and Staff #3 did not include recognizing and reporting incidents.The annual training hours specified in subsections (a) and (b) must encompass the following areas: Recognizing and reporting incidents.Nick's Home will amend it's Training Syllabus and Orientation to include recognizing and reporting incidents. Staff will be required to complete these trainings every calendar year and will be tracked by individual staff on their Annual Training Record. 04/22/2021 Implemented
6400.52(c)(5)Annual training for Staff #1, Staff #2 and Staff #3 did not include the safe and appropriate use of behavior supports.The annual training hours specified in subsections (a) and (b) must encompass the following areas: The safe and appropriate use of behavior supports if the person works directly with an individual.Nick's Home will amend it's Training Syllabus and Orientation to include the safe and appropriate use of behavior supports. Staff will be required to complete these trainings every calendar year and will be tracked by individual staff on their Annual Training Record. 04/22/2021 Implemented
SIN-00170241 Renewal 02/06/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.141(c)(11)The section pertaining to health maintenance needs on Individual #1's physical form was left blank and not addressed elsewhere.The physical examination shall include: An assessment of the individual's health maintenance needs, medication regimen and the need for blood work at recommended intervals. After Individual #1 completes their annual physical exam, the attending staff will check the form to verify that all fields are complete before leaving the examining physicians office. ((Physician was contacted to obtain missing information -CH 3/3/20)) 02/19/2020 Implemented
6400.181(f)There is no documentation in Individual #1's file indicating that his assessment was provided to the SC or team members at least 30 days prior to the ISP meeting.The program specialist shall provide the assessment to the individual plan team members at least 30 calendar days prior to an individual plan meeting.Nick's Home will create a new format for the Assessment to comply with the new 6400 regulations, Part of the new format will include a title page that contains space for the SC and team members to sign and date the assessment to indicate that they have received a copy 30 days prior to the ISP meeting. 02/19/2020 Implemented
SIN-00150492 Renewal 02/21/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.163(c)Individual #1 is prescribed medication to treat the symptoms of a diagnosed psychiatric illness and did not have psychiatric medication reviews at least every 3 months. Psychiatric medication reviews occurred on 3/06/18 and 9/05/18. If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a review with documentation by a licensed physician at least every 3 months that includes the reason for prescribing the medication, the need to continue the medication and the necessary dosage.The Psychiatric visits for Individual #1 were completed on 03/06/18 and 09/05/18 and the Psychiatric Service Report which is used to document the visits and medication review were completed, but never placed in Individual #1's Documentation Binder. The Program Specialist responsible for setting up and documenting the visits contacted Individual #1's Psychiatrist and obtained copies from him of the Reports for the dates in question. They were placed the Documentation Binder. Going forward, the Program Specialist will insure that the documentation is received from the Psychiatrist at the time of the visit, and that it is placed in the Documentation Binder for Individual #1 as-soon-possible after the visit . The PS will also review the history visit prior to each visit and ensure that the documentation of the previous visits are in order. 03/04/2019 Implemented
SIN-00108240 Renewal 03/23/2017 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.106Annual furnace inspection was late. It was inspected 11/06/15, then not again until 11/28/16.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. What : A service contract has been secured with a local HVAC contractor to conduct biannual service and inspection of the facilities furnace. The service calls will occur in the Spring (April) and Fall (November) of each year. This will insure that the furnace is never more than 6 months without an inspection. Who : The CEO #2 is responsible for securing and maintaining the service contract. Plan : the HVAC vendor will call the CEO #2 to set-up appointments twice a year for the service calls. 04/20/2017 Implemented
6400.141(c)(14)There was no section on individual #1's physical addressing information pertinent to diagnosis and treatment in case of emergency.The physical examination shall include: Medical information pertinent to diagnosis and treatment in case of an emergency. What : A section has been added to the Individual #1 Annual Physical Examination form the requests the examining physician to address "Information pertinent to the patients' diagnosis and treatment in case of an emergency." A letter was obtained from Individual #1 physician that addresses the above and was added to Individual #1 Annual Physical Examination in the Program Documentation. Who : The Program Specialist #1 is responsible for this corrective action. Plan : The change to the Physical Examination form is a permanent one-time change. The form is reviewed annually after Individual #1 physical. 04/20/2017 Implemented
6400.151(a)Staff physicals for Staff #1 and Staff #2 were late. Staff #1 had a physical12/27/13, then not again until 02/08/16. Staff #2 had a physical on 12/20/13, then not again until 02/08/16. A staff person who comes into direct contact with the individuals or who prepares or serves food, for more than 5 days in a 6-month period, including temporary, substitute and volunteer staff, shall have a physical examination within 12 months prior to employment and every 2 years thereafter. What : Permanent reoccurring appointments for Physical Examinations have been set up with the PCP for the Program Specialist #1 and the CEO #2. The Staff's Healthcare Practitioners will notify the Staff of their impending appointments. Additionally, Staff have electronic reminders set up to notify them of impending appointments. Who : Both the Program Specialist # 1 and the CEO #2 were responsible for setting up the appointments with their respective Health Care Providers. Plan : Staff #1 and Staff #2 will review the status of their Physical Examinations during the Annual ISP Renewal for Individual #1. 04/20/2017 Implemented
6400.213(1)(i)Individual #1's file contained a photo, but it was not dated. Individual #1's record did not contain information pertaining to "Identifying marks" .Each individual's record must include the following information: Personal information including: (i) The name, sex, admission date, birthdate and social security number. (iii) The language or means of communication spoken or understood by the individual and the primary language used in the individual's natural home, if other than English. (ii) The race, height, weight, color of hair, color of eyes and identifying marks.(iv) The religious affiliation. (v) The next of kin. (vi) A current, dated photograph.What : A new photo of the Individual #1 has been taken and the date the photo was taken added to the photograph. It was printed and placed in the Individuals #1 Program Documentation. The old photo was destroyed. A section was added to Individual #1 Personal Identification Sheet that lists "Identifying Marks". Since Individual #1 has no identifying marks, the section was marked "None". The new Personal Information Sheet was printed and added to the Individual #1 program documentation. The old document was removed and destroyed. Who : The Program Specialist #2 is responsible for the above items. Plan : A new photograph of the Individual #1 will be taken annually around the time of his ISP renewal. The new photo will replace the old one. Since the information in the Personal Information Sheet for Individual #1 is reviewed annually during the ISP renewal, this information will be verified and updated. 04/20/2017 Implemented
SIN-00073545 Renewal 01/07/2015 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.181(a)Individual #1 had an assessment completed on 12/30/2013 only. The assessment for 2014 was not completed. 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. Sixty (60) days prior to the anniversary of the Annual Assessment, the CEO of Nick's Home (Joel Gilly) will ask the Program Specialist for the status of the upcoming Assessment. If the Annual Assessment is not complete, the CEO will make the inquiry to the PS every week thereafter until the Assessment is completed. Once the Assessment is completed, it will be reviewed and approved by the CEO, PS, and client r stakeholders, signed, then added to the clients documentation binder. 01/30/2015 Implemented
SIN-00055603 Renewal 12/05/2013 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.43(c)Staff #1, identified as the CEO, does not have the proper credentials(c) A chief executive officer shall have one of the following groups of qualifications: (1) A master's degree or above from an accredited college or university and 2 years work experience in administration or the human services field. (2) A bachelor's degree from an accredited college or university and 4 years work experience in administration or the human services field. The Request for Waiver of Regulation for CEO to be completed and submitted to PA DPW C&L on 23 December 2013. --Partially Implemented, Adequate Progress CH 1/6/14 12/23/2013 Implemented
6400.44(c)Staff #2, identified as the Program Specialist, does not have the proper credentials.(c) A program specialist shall have one of the following groups of qualifications: (1) A master's degree or above from an accredited college or university and 1 year work experience working directly with persons with mental retardation. (2) A bachelor's degree from an accredited college or university and 2 years work experience working directly with persons with mental retardation. (3) An associate's degree or 60 credit hours from an accredited college or university and 4 years work experience working directly with persons with mental retardation. The Request for Waiver of Regulation for PS to be completed and submitted to PA DPW C&L on 23 December 2013. --Partially Implemented, Adequate Progress CH 1/6/14 12/23/2013 Implemented
6400.167(a)Staff #3 administered the following medications: Concerta 36mg, Abilify 10mg, Clonidine 0.1mg, Depakote 125mg without completing medication training.(a) Prescription medications and injections of a substance not self-administered by individuals shall be administered by one of the following: (1) A licensed physician, licensed dentist, licensed physician's assistant, registered nurse or licensed practical nurse. (2) A graduate of an approved nursing program functioning under the direct supervision of a professional nurse who is present in the home. (3) A student nurse of an approved nursing program functioning under the direct supervision of a member of the nursing school faculty who is present in the home. (4) A staff person who meets the criteria specified in § 6400.168 (relating to medications administration training) for the administration of oral, topical and eye and ear drop prescriptions and insulin injections.Staff #3 was immediately prohibited from administering medications until the required additional Observations by 23 December 2013. Going forward, additional staff will have the required Observations and Practicums before being allowed to administer medications to individuals. Required observations completed 24 December 2013. --Fully Implemented CH 1/6/14 12/24/2013 Implemented
6400.186(b)Individual #1 did not sign the ISP Reviews dated 1/2013, 4/2013, 7/2013, and 10/2013.(b) The program specialist and individual shall sign and date the ISP review signature sheet upon review of the ISP. Individual #1 was read the Quarterly ISP reviews by the PS in short increments until completed. Individual #1 was then asked to affix his mark to the Reviews. Going forward, a block will be added ISP Review Template that includes an area for the Individual to refuse, or affix his Mark. --Fully Implemented CH 1/6/14 12/20/2013 Implemented
SIN-00241466 Renewal 03/07/2024 Compliant - Finalized
SIN-00220867 Renewal 03/07/2023 Compliant - Finalized
SIN-00129213 Renewal 02/22/2018 Compliant - Finalized
SIN-00088408 Renewal 02/11/2016 Compliant - Finalized