Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00275153 Renewal 10/03/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.112(e)Only one sleep hour drill between the hours of 11pm to 7am was conducted since the last inspection date that occurred on 10/25/24: -11/19/24: 7-3 shift -12/14/24: 3-11 shift -1/29/25: 3-11 shift -1/30/25: 7-3 shift -2/25/25: 3-11 shift -3/19/25: 7-3 shift -4/24/25: 3-11 shift -5/16/25: 3-11 shift -6/25/25: 3-11 shift -7/30/25: 7-3 shift -8/28/25: 3-11 shift -9/13/25: shift listed as 11:00pm, drill time listed as 11:10pmA fire drill shall be held during sleeping hours at least every 6 months. 1. Corrective Action Taken: The provider conducted a sleep-hour fire drill on 11/09/2025 to ensure compliance with the regulation. Staff and individual(s) participated and demonstrated appropriate evacuation procedures. Documentation of this drill has been completed and filed. 2. Person Responsible: Program Manager 3. Completion Date:11/10/2025 11/10/2025 Implemented
6400.113(a)Individual #1 received fire safety training upon admission on 2/26/24 and then again on 5/2/25. The timeframe between these two training dates exceeds the annual requirement. An individual, including an individual 17 years of age or younger, shall be instructed in the individual's primary language or mode of communication, upon initial admission and reinstructed annually in general fire safety, evacuation procedures, responsibilities during fire drills, the designated meeting place outside the building or within the fire safe area in the event of an actual fire and smoking safety procedures if individuals smoke at the home. 1. Corrective Action Taken: Individual #1 was re-instructed in fire safety, evacuation procedures on 05/02/2025. Documentation of the training has been completed and placed in the individual's record. The Program Director has made a schedule to ensure compliance with yearly required training moving forward. 2. Person Responsible: Program Director/ Fire Safety Specialist 3. Completion Date: 11/10/2025 11/10/2025 Implemented
6400.34(a)The consumer bill of rights form which reviews individual rights for individual #1 was reviewed with and signed by the individual's legal guardian upon admission on 2/26/24. This form was not reviewed and signed annually as required by regulation.The home shall inform and explain individual rights and the process to report a rights violation to the individual, and persons designated by the individual, upon admission to the home and annually thereafter.The Consumer Bill of Rights was reviewed with Individual #1 and their legal guardian on 02/15/2025. Documentation has been placed in the individual's record. Person Responsible: Program Director 3. Completion Date: 11/10/25 11/10/2025 Implemented
SIN-00254518 Renewal 10/25/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.151(a)Staff member #1 physical examination was completed 09/27/2024, which was after date of hire 02/29/2024. 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. WHO: Program Director. The Program Director has reviewed the employee`s file. What: The employee has completed and submitted a physical exam dated 09/27/2024 When and How: A new physical exam was completed and submitted by the employee 11/01/2024 Implemented
6400.166(a)(4)Individual #1 PRN medication Acetaminophen 650mg tablets were not listed on the MAR. During the visit, the MAR was updated by staff to include this medication.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Name of medication.WHO: The Agency Nurse updated the MAR and entered the PRN right there, which the auditor verified before he left. What: The MAR was updated with the PRN When and How: The MAR was updated on the audit day- 10/25/2024. 11/01/2024 Implemented
SIN-00233499 Renewal 10/16/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.72(b)The window screen near the kitchen needs to be replaced as it is damaged with holes throughout. Screens, windows and doors shall be in good repair. a. WHO : The Program Director- The window screen near the kitchen was replaced on 10/23/2023, and pictures were emailed to the inspector Program Director will be responsible b. WHAT will be corrected: The Window screen near the kitchen- Has been fixed c. WHEN and HOW: Was replaced on 10/23/2023, We removed and replaced the damaged window screen 11/12/2023 Implemented
6400.111(f)The fire extinguisher in the kitchen was not tagged or inspected and approved by a fire safety expert. A fire extinguisher shall be inspected and approved annually by a fire safety expert. The date of the inspection shall be on the extinguisher. a. WHO: The program director- The fire extinguisher has been inspected by CINTAS Fire Protection Company and tagged. The pictures were emailed to the inspector on 10/23/2023 b. WHAT: The fire extinguisher c. WHEN and HOW: Was corrected on 10/23/2023, We took the fire extinguisher to CINTAS and got it inspected and tagged. 11/12/2023 Implemented
SIN-00213194 Initial review 10/13/2022 Compliant - Finalized