Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00260011 Renewal 01/21/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.106The furnace inspection was completed 6/9/23 and not again until 7/24/24.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. The provider has conducted a comprehensive review of the regulations and expectations with the vendor servicing this location, specifically addressing the requirement for annual furnace inspections to be completed on or before the date of the last inspection. 02/21/2025 Implemented
SIN-00218949 Renewal 02/07/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.81(k)(6)Individual #2's bedroom did not contain a mirror.In bedrooms, each individual shall have the following: A mirror. A mirror was placed in Individual #2's bedroom on 2/22.23 02/22/2023 Implemented
SIN-00199734 Renewal 01/31/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.151(c)(3)Staff #2's physical examination dated 10/3/21 does not include a signed statement that the staff person is free from communicable diseases. 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 staff has an appointment with their PCP on 3.7.2022 to have the physical form amended to indicate free from communicable disease 03/07/2022 Implemented
SIN-00107463 Renewal 01/25/2017 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.141(c)(11)The section pertaining to these areas on Individual #1's physical was left blank.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. Upon completion of the physical examination the program manager and or designee shall complete a thorough review of the physical examination form to ensure that each section of physical examination form is completed. In the event that this information has not been completed or left blank, the Program Manager and or designee will follow-up with the primary care physician to ensure that the incomplete or blank information is corrected. All Keystone Independent Living Program Managers and Program Coordinators will be trained on this expectation by 3/17/2017. All previously completed physicals will be reviewed for blank / incomplete information by 3/24/2017. Any incomplete physicals will be corrected by 4/14/2017. 04/14/2017 Implemented
6400.141(c)(12)The section pertaining to physical limitations was left blank on Individual #1's physical.The physical examination shall include: Physical limitations of the individual. Upon completion of the physical examination the program manager and or designee shall complete a thorough review of the physical examination form to ensure that each section of physical examination form is completed. In the event that this information has not been completed or left blank, the Program Manager and or designee will follow-up with the primary care physician to ensure that the incomplete or blank information is corrected. All Keystone Independent Living Program Managers and Program Coordinators will be trained on this expectation by 3/17/2017. All previously completed physicals will be reviewed for blank / incomplete information by 3/24/2017. Any incomplete physicals will be corrected by 4/14/2017. 04/14/2017 Implemented
6400.163(c)Individual #1's psychiatric medication reviews were not completed in the required timeframe. They were reviewed on 04/28/16 then not again until 08/16/16. 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.Psychiatric appointments will be scheduled to occur on or before they are due. If a circumstance arises that prohibits a psychiatric appointment to be completed on time, documentation will be requested from the treating psychiatrist identifying the reason for the late appointment. The program manager and program coordinator have reviewed this plan and are aware the psychiatric appointments need to be scheduled in advance along with the need for documentation from the treating psychiatrist if a situation arises that an appointment cannot be made / kept. 03/17/2017 Implemented
SIN-00087818 Renewal 01/13/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.71There were 2 cordless phones (upstairs; 1 downstairs). Neither phone had emergency telephone numbers posted near them. Telephone numbers of the nearest hospital, police department, fire department, ambulance and poison control center shall be on or by each telephone in the home with an outside line. Emergency stickers noting the telephone numbers of the hospital, fire department, ambulance and poison control center were placed by all cordless phones on 1/13/16. The Residential Coordinator will confirm emergency numbers are posted near the phones during routine program audits during the year. 01/13/2016 Implemented
SIN-00068489 Renewal 09/22/2014 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)The carpet in the front entrance near the door, approximately 4 feet in length, is stained black. The length of the hallway leading from the front entrance is badly stained and spattered black in several areas. I was informed that the carpet has been shampooed and cleaned many times but remains stained. Floors, walls, ceilings and other surfaces shall be in good repair. The carpeting will be removed and replaced with linoleum. Program Manager will continue to monitor to ensure future compliance. 11/13/2014 Implemented
SIN-00166009 Renewal 11/19/2019 Compliant - Finalized
SIN-00144668 Renewal 12/13/2018 Compliant - Finalized
SIN-00085902 Renewal 12/23/2015 Compliant - Finalized
SIN-00052841 Renewal 09/04/2013 Compliant - Finalized