Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00253701 Renewal 10/11/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(e)On 10/11/24, at 3:19 pm, the basement trash can, measuring 22 inches in height, did not have a lid.Trash receptacles over 18 inches high shall have lids. Trash receptacles over 18 inches high will have a lid. 10/24/2024 Implemented
6400.101On 10/11/24 at 3:24PM the stairs to the basement, adjacent to the back family room, had a baby gate blocking the entry to the basement stairs. The basement door was locked, there is an egress located in the basement that exited to the garage where there is a fire exit.Stairways, halls, doorways, passageways and exits from rooms and from the building shall be unobstructed. Stairways, halls, doorways, passageways and exits from rooms and from the building will not be obstructed. 10/25/2024 Implemented
6400.141(c)(10)Individual #1 had a physical examination completed on 6/25/24 that did not address communicable disease. This section of the form was left blank.The physical examination shall include: Specific precautions that must be taken if the individual has a communicable disease, to prevent spread of the disease to other individuals. The physical exam will include: specific precautions that must be taken if the individual has a communicable disease, to prevent spread of disease to other individuals. 10/24/2024 Implemented
6400.141(c)(14)Individual #1 had a physical examination completed on 6/25/24 that did not address information pertinent to individual diagnoses and treatment in case of an emergency. This section of the form was left blank.The physical examination shall include: Medical information pertinent to diagnosis and treatment in case of an emergency. The physical exam will contain pertinent medical information needed for diagnosis and treatment in case of an emergency. 10/24/2024 Implemented
6400.151(c)(3)Direct Services Worker #1 had a physical examination completed on 6/18/24 that did not address communicable disease. This section of the form was left blank. 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. The physical exam will include a signed statement that the staff person is free of communicable disease or that the staff person has a communicable disease but is able to work in the home if specific prescautions are taken that will present spread of the disease to individuals. 10/24/2024 Implemented
SIN-00214121 Renewal 11/08/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.142(a)Individual #1, date of birth 2/21/64, had dental examinations completed 5/18/21 and then again 6/28/22.An individual 17 years of age or younger shall have a dental examination performed by a licensed dentist semiannually. An individual 18 years of age or older shall have a dental examination performed by a licensed dentist annually. Dental appointments with our provider can be made 3 months prior to needed date. Staff will call dental office 3 months prior to yearly dental date and schedule dental appointment. (This year as well as the last 2 years our dentist office has been difficult in making appointments as the have been back logged with trying to catch up with all the appointments that have been canceled.) 11/15/2022 Implemented
SIN-00196452 Renewal 11/09/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.181(a)Individual #1, date of admission 05/27/00, had an assessment completed on 12-1-19 and then again on 12-24-20. Individual #2, date of admission 03/01/19, had an assessment completed on 8-12-20 and then again on 9-29-21. 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. A spreadsheet was developed by the Program Director with each individuals name and yearly assessment date. this spreadsheet was sent to the Program Specialist. The Program Specialist will print out the spreadsheet and place each date on his calendar for reference. The Program Specialist will review his calendar at the first of each month for assessments 60 days out. Assessments will completed and submitted to Program Director 15 days prior to due date for review and signature. 11/30/2021 Implemented
SIN-00180206 Renewal 12/09/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.181(d)Individual #1's assessment, completed 7/01/2020 had the program specialist's name typed on the signature line. The document is not a secure file which would allow any person to type the program specialist's name on the signature line.The program specialist shall sign and date the assessment. Program director will sign the assessment to verify that the program specialist signed the form and did not just type name. The Program Specialist was informed of this on 12/22/2020 [Upon completion for at least one year, the CEO or designated management staff person, shall audit all individuals' current assessment to ensure accurate completion including that the program specialist signed and dated the assessment. Documentation of the audits shall be kept. (DPOC by AES,HSLS on 1/7/21)] 12/22/2020 Implemented
6400.34(a)Individual #1 and individual #2 were informed and explained their Individual Rights on 1/08/2020. The Individual Rights document did not include the following rights: 6400.32d, to be treated with dignity and respect; 6400.32e through 6400.32g, to choose, accept risks, refusal and control the individual's schedule, activities and services; 6400.32j, to voice concerns; 6400.32k, to participation in the development and implementation of the individual plan; and 6400.32r through 6400.32s; relating to locking doors in bedrooms and in the home.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.Individual rights form was updated and all individuals in this home signed new forms on 12/22/2020. The individual rights form will be read to and signed annually thereafter by each individual in this home. 12/22/2020 Implemented
6400.165(g)The reviews of medications prescribed to treat symptom of a psychiatric illness completed for Individual #1 on 2/26/2020, 3/17,2020, and 5/12/2020 do not include the reason for prescribing the Benztropine and Zyprexa.If a medication is prescribed to treat symptoms of a psychiatric illness, there shall be a review by a licensed physician at least every 3 months that includes to document the reason for prescribing the medication, the need to continue the medication and the necessary dosage.Program Director spoke with the psychiatric nurses who will be filling out the physician quarterly forms and explained the section listed "reason for prescribing section" and what is needed on that line as the psychiatrist is doing telepsych at the present. This was completed on 12/22/2020 when an individual had an appointment. [Upon completion of the medication reviews, the CEO or designee, educated in the requirements of medication review and certified to administer medications, shall audit the documentation to ensure all required information is included and all individuals are administered medications as prescribed. Documentation of the audits shall be kept. (DPOC by AES,HSLS on 1/7/20210] 12/22/2020 Implemented
SIN-00160648 Renewal 08/13/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.141(c)(6)Individual #1, date of admission 3/1/19, had a Tuberculin skin testing by Mantoux method with negative results completed 2/14/17 then again 6/7/19.The physical examination shall include: Tuberculin skin testing by Mantoux method with negative results every 2 years for individuals 1 year of age or older; or, if tuberculin skin test is positive, an initial chest x-ray with results noted. The ID Director typed an admissions checklist for new admissions which includes an up to date physical and all required vaccines (skin testing by Mantoux method). this will be used with each new admission. [Upon admission and upon completion of all individuals' physical examinations, the CEO or designee educated in the requirements of individual physical examinations shall audit all physical examinations to ensure all required information is included and completed timely. Documentation of the audits shall be kept. (DPOC by AES,HSLS on 9/10/19)] 08/27/2019 Implemented
6400.181(f)The program specialist provided Individual #2's assessment completed 7/2/19 to the plan team members on 8/10/18 for the Individual #2's s plan meeting on 9/6/18.The program specialist shall provide the assessment to the individual plan team members at least 30 calendar days prior to an individual plan meeting.The ID director typed up list of all individual previous ISP meetings and ISP review dates. This information was given to Program Specialist so as a visual for when the assessment package was due. ID Director will sign off on all assessment packages sent to confirm date falls in correct time frame. ID Director will track all dates as Director has copy of plan dates. The next assessment due will be due September 30 2019 as the meeting date should be scheduled for around November 21, 2019. This will be more than 30 days prior to meeting date. Approx. 41 days prior to next ISP meeting. 08/27/2019 Implemented
SIN-00102503 Renewal 10/19/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.163(c)Individual #2 is prescribed Clonazepam, Carbamazepine, Lithium ER, Lithium Carbonate, and Ativan to treat Bi Polar Disorder, Mood Disorder and Anxiety had medication reviews completed on 5/11/16 and then again on 8/31/16. 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.Quarterly medication review was found and will be sent for verification that it was complete. [Individual #1 had a psychiatric medication review completed on 7/20/16.Immediately, the executive director shall develop and implement policies and procedures to include a tracking system to ensure all individual have a psychiatric medication reviews to include all required information and timely completion. Within 30 days of receipt of the plan of correction, the Executive director shall train all staff in the policies and procedure and their responsibilities for ensuring timely completion of psychiatric medication reviews. At least quarterly for 1 year, the executive director shall review all psychiatric medication reviews to ensure timely completion with all required information. (AS 11/10/16)] 11/10/2016 Implemented
6400.186(a)The ISP reviews for Individual #1, dated 1/1/16, 3/31/16, 6/30/16 and 9/30/16 were completed by the house supervisor and reviewed and signed by the Program Specialist. The ISP reviews for Individual #2, dated 1/1/16, 3/31/16, 6/30/16, and 9/30/16 were completed by the house supervisor and reviewed and signed by the Program Specialist.The program specialist shall complete an ISP review of the services and expected outcomes in the ISP specific to the residential home licensed under this chapter with the individual every 3 months or more frequently if the individual's needs change which impacts the services as specified in the current ISP. Program Specialist will complete ISP review of services and expected outcomes in the ISP specific to the residential home licensed under 6400 regulations with the individual every 3 months beginning with next review which will be due January 2017. [Immediately, the Executive Director shall review the responsibilities of the program specialist as per 6400.44(b)(1)-(19) with the program specialist and sign and date. At least quarterly for 1 year, the executive director will review all completed ISP reviews to ensure completion by the program specialist. Documentation of reviews shall be kept. (AS 11/10/16)] 11/10/2016 Implemented
SIN-00079673 Renewal 09/01/2015 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.186(d)The program specialist did not provide the ISP review documentation dated 6/30/15, 3/31/15, 12/31/14, and 9/30/14 completed for Individual #1 to the SC and plan team members.The program specialist shall provide the ISP review documentation, including recommendations, if applicable, to the SC, as applicable, and plan team members within 30 calendar days after the ISP review meeting. Review documentation for the above quarterly dates with be given to SC and will have SC sign documentation stating the review documentation was received. 10/1/2015[As per converstation with PS on 10/7/15, PS developed a new form to have plan team members sign upon receiving the quarterly reviews, this form also includes the option to decline reviews. This will be done for all individuals in all community homes. (AS 10/7/15)] 10/03/2015 Implemented
6400.186(e)The program specialist did not notify the plan team members of the option to decline the ISP review documentation completed for Individual #1. The program specialist shall notify the plan team members of the option to decline the ISP review documentation. On residential sign in sheet will be a place for those attending to choose decline any ISP review documentation. Form is already in place. Began 9/9/2015[As per converstation with PS on 10/7/15, PS developed a new form to have plan team members sign upon receiving the quarterly reviews, this form also includes the option to decline reviews. This will be done for all individuals in all community homes. (AS 10/7/15)] 10/03/2015 Implemented
SIN-00060793 Renewal 08/28/2014 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.168(c)Staff Perons #1 completed the medication administration practicum reviews for Staff Person #2 and Staff Person #3 on 4/30/14. Staff Person #1's Medication Administration Trainer Certificate expired in December 2013. Medications administration training of a staff person shall be conducted by an instructor who has completed the Department's Medications Administration Course for trainers and is certified by the Department to train staff. All observations were completed prior 12/30/13. Corrective action: Medication trainer is in process of completing training course and will complete the course as soon as possible pending availability of face to face class time. Training will begin 6 months prior to expiration. Online training will be complete by September 19, 2014 if not before and then classroom training will occur as soon after as able to schedule. Certificate of completion to be mailed to you when complete. 09/03/2014 Implemented
SIN-00233050 Renewal 10/17/2023 Compliant - Finalized
SIN-00140140 Renewal 08/17/2018 Compliant - Finalized
SIN-00120362 Renewal 08/29/2017 Compliant - Finalized
SIN-00049702 Renewal 04/26/2013 Compliant - Finalized