| 6400.32(r) | Individual #1 - Individual right's does not include the right to lock the individual's bedroom door. | An individual has the right to lock the individual's bedroom door. | In accordance with 55 PA Code Chapter 6400.32(r), the CFO has updated the individual rights form indicate that the individual was informed of the choice to not have a lock on their bedroom door. The new form with the updated right has been added to the agency¿s residential admission packet effective 3/1/2025. |
03/01/2025
| Implemented |
| 6400.166(b) | Individual#1 - medication record indicates medications are being administered; however, the times & staff initials are not being consistently documented at the occurrence of administration. | The information in subsection (a)(12) and (13) shall be recorded in the medication record at the time the medication is administered. | In accordance with 55 PA Code Chapter 6400.144, the agency's CFO has arranged to contract with Honest Elite Caregivers, a PA home health agency, to provide LPN's to administer medications to all residents. The agency CFO has also contracted with an ODP approved medication administration trainer to train all staff including the CFO and Program Specialist appropriately. Both the CFO and Program Specialist have begun the medication administration training as of 1/29/25, and all staff have been enrolled in the course as of 1/29/25. an LPN, has agreed to administer all 8pm medications on 1/29/25, and the home health agency nurses will begin administering for all medication times on 1/30/25. The CFO, and Program Specialist will be appropriately trained and certified to administer medication by 2/15/25. Moreover, the Program Specialist will ensure that at least ¼ (OR 5) of DSP¿s employed by the agency are also medication administration trained and certified by 3/1/12025 |
03/01/2025
| Implemented |