Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00088302 Renewal 03/14/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.15(a)A properly completed self-assessment made between 3 to 6 months before the expiration of the license was not availableThe agency shall complete a self-assessment of each home the agency operates serving eight or fewer individuals, within 3 to 6 months prior to the expiration date of the agency¿s certificate of compliance, to measure and record compliance with this chapter. A self Assessment was completed by the Service Director on September 21, 2016. In the future the Assistant Executive Director will keep track of the date for the Self-Assessment and make sure that it is completed 3 to 6 months prior to the expiration date of the agency's certificate of compliance. 09/21/2016 Implemented
6400.106Documentation that the furnace was inspected and cleaned was not availableFurnaces shall be inspected and cleaned at least annually by a professional furnace cleaning company. Written documentation of the inspection and cleaning shall be kept. The furnace was inspected and cleaned on March 16, 2016. Going forward the Maintenance Supervisor will make sure that the Furnace is inspected and cleaned Annually, and documentation will be kept in a file in the Administrative office. 03/16/2016 Implemented
SIN-00072631 Renewal 01/15/2015 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.21(a)Staff #1's was hired on 8/21/14, and the criminal history check was completed on 8/28/14. 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. The Assistant Executive Director will review all potential new hire applicant's paperwork and make sure that all applications for a Pennsylvania criminical history record check is submitted to the State Police before they are officially hired. 02/13/2015 Implemented
6400.31(b)Individual #1's signed rights were last completed on 1/13/12.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 Service Director will be responsible for making sure that all individual signed rights are completed, signed and dated annually. The Service Director or designee will audit all individuals records to ensure that the rights have been signed for 2014 and annual thereafter. The Service Director or designee will develop a tracking tool to ensure that all rights are signed on an annual basis, starting within 30 days of receipt of this plan of correction. [SW 2.12.15] 02/13/2015 Implemented
6400.112(c)The fire drill completed on 9/29/14 did not document the exit route.A written fire drill record shall be kept of the date, time, the amount of time it took for evacuation, the exit route used, problems encountered and whether the fire alarm or smoke detector was operative. The person conducting the fire drill will be retrained on how to complete the fire drill forms and will be double checked by the administrative assistant or designee to make sure the form is filled out correctly before the form is submitted and filed. The Program Director will conduct periodic checks of the fire drill records to ensure all required elements are noted on the form. 02/13/2015 Implemented
6400.112(d)The fire drill completed on 9/29/14 took 2 minutes and 40 seconds, which exceeded 2 ½ minutes. Individuals shall be able to evacuate the entire building, or to a fire safe area designated in writing within the past year by a fire safety expert, within 2 1/2 minutes or within the period of time specified in writing within the past year by a fire safety expert. The fire safety expert may not be an employe of the home or agency. Staff assistance shall be provided to an individual only if staff persons are always present at the home while the individual is at the home. Management will speak to the Fire Marshal about extending the time for the fire drills. A second drill was held and it was completed within the 2.5 minute frame. We have one individual that refuses to leave the building sometimes because she states, "this is not a real fire, I an not going outside." The Director or designee will conduct a fire safety training with both staff and residents within 30 days of receipt of this plan of correction. In addition, when fire drill evacuations exceed 2.5 minutes, the home will conduct a second unannounced drill within the same month to ensure that all individuals evacuate. The individual that continues to refuse to participate bedroom should be located closest to the door to ensure that they can evacuate timely and to meet with the individual plus their supports coordinator to explain the importance of evacuating during a drill. 02/13/2015 Implemented
6400.141(a)Individual #1's current physical dated 9/30/14, and previous physical was completed on 9/4/13. An individual shall have a physical examination within 12 months prior to admission and annually thereafter. The Nursing Supervisor will make monthly reviews of each individual's med book and make sure all doctor's appointments are scheduled and completed at the appropriate times. The nursing supervisor will conduct an audit of all participants annual physicals to ensure that they are completed timely. In addition, a tracking tool will be developed by the nursing supervisor to ensure that all physical examinations are conducted timely. 02/13/2015 Implemented
6400.141(c)(7)Individual #2's gynecological exam on 1/28/14 did not include a pap, which was last completed on 1/10/12. The physical examination shall include: A gynecological examination including a breast examination and a Pap test for women 18 years of age or older, unless there is documentation from a licensed physician recommending no or less frequent gynecological examinations. The individual refused the Pap test. Nursing Supervisor will make sure that when an individual refuses an examination the doctor writes documentation that it is alright for the individual to have less frequent gynecological examinations. The nursing supervisor will develop a refusal plan for Individual #2 and recommendations on how to encourage the individual to participate in the pap examination. 02/13/2015 Implemented
6400.181(f)Individual #2's assessment dated 7/2/14 was not sent to the supports coordinator 30 days prior to the meeting on 8/22/14. (f) The program specialist shall provide the assessment to the SC, as applicable, and plan team members at least 30 calendar days prior to an ISP meeting for the development, annual update and revision of the ISP under § § 2380.182, 2390.152, 6400.182 and 6500.152 (relating to development, annual update and revision of the ISP). The office staff will mail or staff will hand the assessment to the supports coordinator with a receipt form that will be signed by the supports coordinator. If the assessment is emailed, a copy of the email will be used as receipt. The Program Specialist will receive training on the importance of submitting the assessment 30 days prior to the ISP meeting. 02/13/2015 Implemented
SIN-00058755 Renewal 01/02/2014 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)The bedroom tile floor for Individual # 1 has rust marks. The men's bathroom on the lower level has a rusted radiator cover in a corner stall and also a rusted radiator cover in the shower room.(a) Floors, walls, ceilings and other surfaces shall be in good repair. The rust marks on the bedroom tile floor for individual #1 was stripped, sanded and waxed. The marks are gone, this was completed on 1/17/14. The radiator cover in a corner stall, in the men's bathroom on the lower level and the rusted radiator cover in the shower room on the same level were removed and replaced wit new baseboard covers and the nedw covers were painted with a high gloss paint, today 1/22/14. To ensure floors, walls, ceilings and other surfaces are in good repair at all times the Operations/Maintenance team will conduct monthly inspections and address any items needing repair. This process will be documented using an inspection check list which will be reviewed and signed by Administrative staff. The inspection checkist form is being drafted and will be implemented no later than 1/26/14 01/26/2014 Implemented
6400.76(a)There are large blue floor mats with frayed surfaces located in bedroom 719 and in the 2nd floor general living area.(a) Furniture and equipment shall be nonhazardous, clean and sturdy. The large blue floor mats with frayed surface located in the bedroom 719 and in the 2nd floor general living area were immediately removed and disposed of. New mats from Florig Hall were moved to Lion Hall to replace the frayed mats. New mats were ordered online to replace the mats moved from Florig Hall to Lion Hall. To ensure furniture and equipment is nonhazardous, clean and sturdy, the Operations/Maintenance team will conduct monthly inspections, documenting any need for replacement of furniture or equipment using an inspection check list form which will be reviewed and signed by Administrative staff. This check list inspection form will be drafted and implimented no later than 1/26/14. 01/26/2014 Implemented
6400.240(b)The facility uses a sanitizer "Clean Force" in its mechanical dishwasher. Documentation that this sanitizer is approved by the National Sanitation Foundation was not available.(b) A mechanical dishwasher shall use hot water temperatures exceeding 140°F in the wash cycle and 180°F in the final rinse cycle or shall be of a chemical sanitizing type approved by the National Sanitation Foundation. A picture of the data plate which is permanently attached to the bottom of the dishwasher table was taken documenting the temperaturesa and sanitizing agents require for the dishwasher. The Agency requested the MSDS sheet of the leasor of the dishwasher, U.S. Foods, the documents demonstrate the sanatizing type is approved by NSF. The documents have been posted by the dishwasher. 01/22/2014 Implemented
SIN-00045513 Renewal 02/01/2013 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.11The agency is not in compliance with section 1007 of the Pennsylvania's Public Welfare Code, as it has not complied with the provisions of the Older Adult Protective Services Act. Specifically, one agency staff did not have criminal history checks submitted prior to employment with the agency. The requirements specified in Chapter 20 (relating to licensure or approval of facilities and agencies) shall be met.The company noted this and the company will ensure this does not happen again. No one will begin employment until criminal history checks are submitted and recived. to ensure this does not happen again a check list was created of all clearences required. Before anyone begins employment the Administrative Assistant willfill out the new hire check list and the Executive Director or their designee will sign the form and verify clearences have been recieved before employment begins. This check list was implimented 3/21/13. 04/02/2013 Implemented
6400.82(d)Basement boys bathroom shower #2 did not have a curtain. (d) Privacy shall be provided for toilets, showers and bathtubs by partitions or doors. Curtains are acceptable dividers if the bathroom is used only by one sex or only by individuals 9 years of age or younger. The shower curtain for bathroom #2 was put up while inspectors were on site. The inspector returned to the bathroom to see that the shower curtain was in place. To ensore this does not happen again staff will be assigned on a daily basis to check and make sure all shower curtains are in place. This duty assignement is written on the staff daily planner and will be effective 3/22/13. 04/02/2013 Implemented
6400.141(c)(4)Indidvidual #1 did not have a hearing screening on their physical. (4) Vision and hearing screening for individuals 18 years of age or older, as recommended by the physician. A hearing screening appointment for Individua #1 was doen on 3/7/13. To ensure this does not happen again the Nurse Supervisor will review all annual physicals of all individuals and schedule all follow up appointments. 04/02/2013 Implemented
6400.186(b)Individual #2's ISP reviews for 1/8/13, 10/8/12, 7/8/12 were not dated. (b) The program specialist and individual shall sign and date the ISP review signature sheet upon review of the ISP. This was an oversight. All ISP reviews will be signed and dated. All reports will be checked by the Program Specialist and reviewed by the Administartive Assistant on a monthly basis to make sure all reports are signed and dated. This practice is effective immediately. 04/02/2013 Implemented
6400.241(a)In the freezer there were unsealed bags of waffles, chicken tenders, hot dogs, and chicken chunks. (a) Food shall be stored in covered containers. On 2/11/13 management met with kitchen saff to review proper food storage. Staff were instructed to store food in covered sealed containers. A checklist was creaed and impliented effective 3/22/13 for the Dietary manager to check all supplies and all food in the freezer on a weekly basis and initial the check list verifying the review was completed. 04/02/2013 Implemented