Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00262718 Renewal 03/18/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.113(a)Individual #1, date of admission 12/27/2024, was instructed in fire safety on 12/28/2024. 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. All Program Specialists will ensure that the Individual is instructed on fire safety upon admission and annually thereafter. The Individual Orientation Checklist was updated, and forms packets were prepared for new admissions 04/24/2025 Implemented
6400.181(a)Individual #1, date of admission 12/27/2024, had an initial assessment completed on 3/4/2025. 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. Program Specialists will ensure that the Initial Annual Assessment is completed within 6 months prior to or 60 calendar days after admission and annually thereafter. The Individual Orientation Checklist was updated, and forms packets were prepared for new admissions. 04/24/2025 Implemented
6400.34(a)Individual #1, date of admission 12/27/2024, was informed and explained the individual rights and the process to report a rights violation on 12/28/2024. [Repeated violation: 3/19/2024 et al]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.All Program Specialists will ensure that the Individual Rights Statement is reviewed and signed by the Individual upon admission and annually thereafter. The Individual Orientation Checklist was updated, and forms packets were prepared for new admissions. 04/24/2025 Implemented
6400.163(d)On 3/19/25 at 12:04PM the following medications prescribed to Individual #3 were unlocked in the bedroom closet: Loperamide 1 mg/7.5mL, Bausch + Lomb Advanced Eye Relief Lubricant Eye Drops, and Magnesium Citrate Saline Laxative.Prescription medications and syringes, with the exception of epinephrine and epinephrine auto-injectors, shall be kept in an area or container that is locked.All prescription medications and syringes, with the exception of epinephrine and epinephrine auto-injectors, shall be kept in an area or container that is locked. All staff will be retrained on the Medication Storage Policy by 4-25-25. 04/25/2025 Implemented
6400.163(h)On 3/19/25 at 12:04PM the following medications prescribed to Individual #3 were unlocked in the bedroom closet: Loperamide 1 mg/7.5mL, Bausch + Lomb Advanced Eye Relief Lubricant Eye Drops, and Magnesium Citrate Saline Laxative. Individual #3 died on 1/11/2025.Prescription medications that are discontinued or expired shall be destroyed in a safe manner according to Federal and State statutes and regulations.All prescription medications and syringes, with the exception of epinephrine and epinephrine auto-injectors, shall be kept in an area or container that is locked. All staff will be retrained on the Medication Disposal Policy by 4-25-25 04/25/2025 Implemented
SIN-00171473 Renewal 02/19/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.181(e)(14)Individual #1's assessment completed on 1/21/2020 did not include the individual's knowledge of water safety and ability to swim. This section of the assessment was marked "NA".The assessment must include the following information:The individual's progress over the last 365 calendar days and current level in the following areas: The individual's knowledge of water safety and ability to swim. Individual #1¿s assessment will be edited via the electronic health record form to include Individual #1¿s knowledge of water safety and ability to swim by 3-20-2020. The edited assessment will be sent to all plan team members as evidenced by a completed critical exchange form. All Program Specialists will be retrained to ensure that they understand that N/A is not an acceptable response on the Assessment for areas requiring assessment. This training will be completed and documented by 3-24-2020. All Program Specialists will complete a review of all Assessments within 30 days (by 4-23-2020) to ensure that there are no other Assessments marked N/A for areas requiring assessment. During these reviews, any areas marked N/A will be assessed and edited in the electronic health record. Any changes to the Assessment forms will be sent to all team members. 04/23/2020 Implemented
SIN-00059399 Renewal 01/22/2014 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.31(b)The rights form signed by individual #1 on 1/2/14, did not state the full rights per regulations 33(g) regarding visitors and 33(k) regarding religion. Per 6400. 33(g), An individual has the right to receive scheduled and unscheduled visitors, communicate,associate and meet privately with family and persons of the individual's own choice." Individual #1's signed statement included that, "I have the right to have visitors in my home and talk to people I want unless my health or safety is at risk." Per 6400. 33(k), An individual has the right to practice the religion or faith of the individual's choice." Individual #1's signed statement included that, "I have the right to attend religious services of my choice."(b) Statements signed and dated by the individual, or the individual's parent, guardian or advocate, if appropriate, acknowledging receipt of the information on rights upon admission and annually thereafter, shall be kept. the individual rights statement form was revised to reflect the exact wording of state regulation 6400.31(b)33(g), 33(k)the individual#1 reviewed signed a new rights statment on 03/21/2014, attachment A. All other individuals will sigh the revised statement by 4/30/14. The program specialist is responsible for the completion of this corrective action. All agency ID services residential staff will be trained on the changes to the form by 04/30/2014. The program specialist is responsible for ensuring completion of the staff training. 04/30/2014 Implemented
SIN-00222370 Renewal 04/04/2023 Compliant - Finalized
SIN-00112648 Renewal 04/20/2017 Compliant - Finalized