Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00295630 Renewal 07/28/2026 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2380.58(a)The women's bathroom in the facility had a metal grab bar next to the toilet. There was an area approximately 6-8 inches long, brown and orange in color, that extended from the bottom of the bar towards the floor. The discolored area appeared to be rust. The cinder block wall next to the toilet in this same bathroom had two small areas of chipping and loose paint surrounded by bubbled paint. The bathroom wall was not in good repair.Floors, walls, ceilings and other surfaces shall be in good repair.Administrator has hired a contractor to come into the building to repair the chipped paint on the walls and repaint any areas that are not in good repair. 09/25/2026 Implemented
2380.58(b)The floor in the main program area of the building had three large areas, approximately 4 x 5 each, that were covered with a black rubber sheet and held down with black tape. Additional strips of black tape were found on seams in the flooring of this area. There were approximately 15 strips of tape on the floor seams. The large, covered areas are a potential tripping hazard. Floors shall be free of hazards. REPEAT VIOLATION 10/29/25Floors, walls, ceilings and other surfaces shall be free of hazards.Administrator is in the process of recieving quotes from local floor companies to come into the building to completly replace the flooring. All areas will be free of hazards 10/06/2026 Implemented
2380.68Limited space for hanging hats and coats was available to the Individual's. There were no areas for the Individuals to store their personal belongings.Space shall be provided for hanging hats and coats and storing personal belongings.There is a locker coat rack in the back of the program area along with a coat rack that the individuals utilize for hanging hats and coats. In the bathrooms there are individual plastic bins used for storage individual's personal belongings. Pictures are attached. 09/25/2026 Implemented
2380.113(c)(3)Staff #2 had a physical completed on 11/17/25. The Yes/No question of being free from communicable disease was answered "No." There was no additional information of specific precautions that are needed to be taken that will prevent spread of disease to individuals. Staff #3 had an annual physical completed on 10/29/25. There was no statement that Staff #3 was free from communicable disease as required.The physical examination shall include: A signed statement that the person is free of serious communicable diseases as defined in 28 Pa. Code §  27.2 (relating to specific identified reportable diseases, infections and conditions) to the extent that confidentiality laws permit reporting, or that the person has a serious communicable disease as defined in §  27.2 to the extent that confidentiality laws permit reporting, but is able to work in the facility if specific precautions are taken that will prevent spread of disease to individuals.Staff #2 is reaching out to her provider as she is free of communicable disease. She will have a signed statement completed or a new physical completed. She is not working with the indivduals until these documents are received. Staff # 3 does have her physical completed and signed by a MD stating she is free of communicable diseases along with her medical history filled out. Physical attached for proof 09/25/2026 Implemented
2380.113(c)(3)Staff #3 had an annual physical completed on 10/29/25. There was no Information of medical problems which might interfere with the safety or health of the individuals as required.The physical examination shall include: A signed statement that the person is free of serious communicable diseases as defined in 28 Pa. Code §  27.2 (relating to specific identified reportable diseases, infections and conditions) to the extent that confidentiality laws permit reporting, or that the person has a serious communicable disease as defined in §  27.2 to the extent that confidentiality laws permit reporting, but is able to work in the facility if specific precautions are taken that will prevent spread of disease to individuals.Staff # 3 does have her physical completed and signed by a MD stating she is free of communicable diseases along with her medical history filled out. Physical attached for proof 09/25/2026 Implemented
2380.172(b)The Program Assessment Tool for Individual #3 was dated 7/2/26, at an undetermined time and by an undetermined staff member. The date on multiple sections of the form and next to signatures, had been altered to be 6/20/26 making the 6 difficult to read. The correction and new entry into the Individuals record was not dated and signed by the person making the entry as required.Entries in an individual¿s record shall be legible, dated and signed by the person making the entry.Administrator will review all records which will also include program assessment tools to ensure that any entry that is completed is legible, dated and signed by the person making the entry. 09/25/2026 Implemented
2380.181(a)Individual #2 was admitted into the program on 5/4/26. At the time of inspection on 7/28/26 no assessment had been completed. Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission.Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the facility and an updated assessment annually thereafter.A checklist has been created for the program specialist to include the individuals name, individual admit date to the center and the date of initial assessment and the date of the individuals annual assessment to ensure this compliance is met. 09/25/2026 Implemented
2380.21(u)Individual #1's rights were reviewed with them on 1/3/25 then again on 1/11/26. Rights are to be completed annually.The facility 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 facility and annually thereafter.A spreadsheet has been created with individuals name, previous year of review and current year of review to ensure the residents rights are reviewed annually as per regulation. 09/25/2026 Implemented
2380.33(a)The "Annual Inspection Preparation List" submitted by Staff #5 listed Staff #1 as the Program Specialist for all Individuals documented as attending the program. The list of Individuals totaled 31. Staff #1's caseload exceeds the regulated number of 30.At least 1 program specialist shall be assigned for every 30 individuals, regardless of whether they meet the definition of individual in 2380.3 (relating to definitions).The documentation that was submitted was done in error. Keystone Adult Day Care currently has 2 program specialist that are employed. The word document that was created deleted the other program specialist name. Administrator has submitted a new list of current individuals with the names of each program specialist. 09/25/2026 Implemented
2380.37(a)The orientation checklists for Staff #3 and Staff #4 did not record the length of the training as required.Records or orientation and training, including the training source, content, dates, length of training, copies of certificates received and persons attending, shall be kept.The orientation training sheet has been updated to include the training source, content, dates, length of training, copies of certificates and person attending as per the regulation. 09/25/2026 Implemented
SIN-00276974 Renewal 10/29/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2380.58(b)Surfaces shall be free of hazards. A wooden storage cabinet located to the left side door of the facility which is used to store games and other activities had a broken edge on the front right side that was sharp to the touch.Floors, walls, ceilings and other surfaces shall be free of hazards.The cabinet has been repaired and no longer has broken sharp edges. 11/03/2025 Implemented
2380.111(c)(5)Individual #3 was admitted on 8/26/2025 and had an admission physical examination on 6/09/2025 which did not include tuberculin testing. A radiology report for a chest x-ray completed on 7/21/2025 accompanied the physical examination and the reason documented on the report for the x-ray was "unable to get PPD test." A chest x-ray is not an acceptable alternative to a tuberculin test. Individuals are required to have tuberculin testing prior to admission; a chest x-ray is only required or accepted if the individual had a positive reaction to the tuberculin test or a history of positive reactions.The physical examination shall include: Tuberculin skin testing with negative results every 2 years; or, if the tuberculin skin test is positvie, an initial chest X-ray with results noted.Any individual who is being admitted to the day program will be required to complete a Tuberculin skin test. If the individual is unable to obtain the skin test then the individual will not be permitted to start services at the day program until completed. 11/03/2025 Implemented
2380.173(1)(iv)The record for Individual #3 did not identify the individual's religious affiliation. An area to record religious affiliation on the individual's intake record was blank.Each individual¿s record must include the following information: Personal information including: Religious affiliation.All records were audited to ensure personal information including religious affiliation is completed. 11/03/2025 Implemented
2380.36(b)Staff #1 most recently received training by a fire safety expert on 11/08/2023. Training by a fire safety expert was held on 11/08/2024 but Staff #1 did not attend that training as they were out on parental leave at the time. The staff has returned to work but has not been trained by a fire safety expert since 11/08/2023.Program specialists and direct service workers shall be trained annually by a fire safety expert in the training areas specified in subsection (a).All program specialist and direct service workers will be trained annually by the fire safety expert. If they are not available for the training on the day that is scheduled, administrator will then schedule an additional training with the fire expert to ensure all staff are trained as required by the regvualtion. 11/03/2025 Implemented
2380.181(f)Individual #1's current assessment was completed on 4/25/2025 and was provided to the Individual's team members on that date which was not at least 30 days prior to the annual meeting held on 4/29/2025. Individual #2's current assessment was provided to the Individual's team members on the day of the annual meeting on 10/22/2024 which was not at least 30 days prior to the annual meeting.The program specialist shall provide the assessment to the individual plan team members at least 30 calendar days prior to the individual plan meeting.All assessments will be completed by program specialist 30 days prior to ISP meeting. The assessment will be scanned and emailed to the team to ensure of this compliance. Once emailed a copy of the email will be kept in the induvial record. 11/03/2025 Implemented
SIN-00255193 Renewal 11/18/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2380.53(a)Poisonous materials are not locked and inaccessible to individuals when not in use. There was a bottle of Dial antibacterial hand soap located under the sink in the staff bathroom. The bottle stated to contact poison control. The bathroom is not locked and was accessible to individuals.Poisonous materials shall be kept locked or made inaccessible to individuals, when not in use.The bottle of hand soap was disposed of during the inspection. All poisonous materials will be locked in a cabinet that is not accessible to the individuals. 12/05/2024 Implemented
2380.89(c)Fire drill records do not indicate when problems occur during fire drills. Individual #2, per staff report frequently refuses to leave the building during fire drills. This was observed during the onsite inspection when the fire alarm was tested. All fire drills that were reviewed from November 2023-November 2024 all indicated that no problems were encountered during any of the fire drills.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 was operative.Fire drill records will be updated with the required information as per the regulation. 12/09/2024 Implemented
2380.21(l)Individual #1, Individual #2, Individual #3 and Individual #4''s right to make choices and accept risks was violated. Individual #1's, Individual #2, Individual #3 and Individual #4's individual record did not include conversations relating to the Individual's preferred community participation and activities as required by ODP announcement 24-061.An individual has the right to make choices and accept risks.A form was created to be completed by the program manager to have a conversation quarterly with all individual's in regards to their preferred community participation and activities . If a individual is unable to communicated their preferred community participation and activities a conversation will be held with a member of the individuals team. 12/09/2024 Implemented
2380.21(u)Individual #1 was not informed of the Individual's rights on an annual basis. Individual #1 was informed of the individual's rights on 1/9/23 and was not informed again until 1/24/24. Individual #3 was not informed of the Individual's rights on an annual basis. Individual #1 was informed of the individual's rights on 12/28/22 and was not informed again until 1/24/24.The facility 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 facility and annually thereafter.A form has been created to ensure all individuals rights are reviewed with the individual and the persons designated to the individual upon admission and annually there after. 12/09/2024 Implemented
2380.125(f)Individual #3 is prescribed Clonazepam 1mg tablet 4times daily to treat symptoms of psychiatric illness. Individual #3 does not have a SEEP plan to address the use of this medication.If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a written protocol as part of the individual plan to address the social, emotional and environmental needs of the individual related to the symptoms of the psychiatric illness.A SEEP plan has been created for the individual and any individual who is prescribed a medication for a psychiatric illness. 12/09/2024 Implemented
SIN-00235245 Renewal 11/29/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2380.53(a)Poisonous materials shall be kept locked or made inaccessible to individuals, when not in use. There was a large container of liquid antibacterial hand sanitizer on 2 of the program area tables. The back of this container recommends contacting poison control if ingested.Poisonous materials shall be kept locked or made inaccessible to individuals, when not in use.Hand sanitizers were removed immediately from both areas. All poisonous materials will be locked and made inaccessible to the individuals. All hand sanitizer labels will be checked to ensure it is not a poisonous material. 12/08/2023 Implemented
2380.89(g)Individuals shall evacuate to a designated meeting place outside the building or within the fire safe area during each fire drill. At the time of the inspection the fire alarm was sounded, and all individuals and staff evacuated the building. All staff and individuals crowded outside the one exit door. I questioned staff where the meeting place was. The meeting place was said to be up by the tree as they pointed to a little further up the road. No staff or individuals evacuated to what was reported to be their meeting place. Staff said they did not go to that spot due to the cold weather.Individuals shall evacuate to a designated meeting place outside the building or within the fire safe area during each fire drill.Individuals and staff members will evacuate to the designated meeting place outside the building during each fire drill or when the alarm sounds. 12/08/2023 Implemented
2380.111(c)(5)According to records provided, Individual had a TB test with negative results completed on 1/16/2020 and not again until 9/8/22. This exceeds the two-year time requirement.The physical examination shall include: Tuberculin skin testing with negative results every 2 years; or, if the tuberculin skin test is positvie, an initial chest X-ray with results noted.Individuals started Keystone Adult Day Care on 10/11/2021. She received the required TB test on 8/27/2021 and again on 9/6/2022. The individual is not due again for her next TB until 9/6/2024. See attached documents. 12/08/2023 Implemented
2380.111(c)(11)This individual #1 physical dated 4/26/23 reflects that he has no limitations or restrictions for a diet. However, his assessment reflects that he is a choking risk and requires his food to be cut into bite size pieces and requires supervision at meals. The assessment and ISP also reflect that he is on a low sodium diet. The physical does not reflect any of this information.The physical examination shall include: Special instructions for an individual's diet.Administration reached out to the program specialist of the group home in regards to the physical, received an email (see attached) that the individual had a swallow study completed in 2022 with no findings. The individual is not a choking risk or on any dietary restrictions. Reached out to the caseworker to update the individuals ISP as the information is not accurate. Program Specialist from KADC was directed not follow the individuals ISP for assessment and only follow what is on the physical. 12/08/2023 Implemented
2380.181(a)Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the facility and an updated assessment annually thereafter. Individual #2 had an annual assessment dated 9/15/22 and an up to date assessment has not yet been completed. This exceeds the annual time requirement.Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the facility and an updated assessment annually thereafter.A spreadsheet has been created for the program specialist to ensure all assessments are completed 60days after admissions and updated annually there after. All dated were added a calendar to keep track of the dates. Form is attached. 12/08/2023 Implemented
2380.181(e)(13)(i)Individual #2 had an annual assessment dated 9/15/22. Individual #3 had an annual assessment dated 12/1/22. Neither of these assessments address the progress and growth in the area of health.The assessment must include the following information: The individual¿s progress over the last 365 calendar days and current level in the following areas: Health.A new assessment form has been created to ensure all areas of the assessment especially the progress and growth of the individuals health is updated as required. New assessment form attached, 12/08/2023 Implemented
2380.181(e)(13)(ii)Individual #2 had an annual assessment dated 9/15/22. Individual #3 had an annual assessment dated 12/1/22. Neither of these assessments address the progress and growth in the area of motor and communication skills.The assessment must include the following information: The individual¿s progress over the last 365 calendar days and current level in the following areas:  Motor and communication skills.A new assessment form has been created to ensure all areas of the assessment especially the progress and growth of the individuals motor and communication skills are updated as required. 12/08/2023 Implemented
2380.181(e)(13)(iii)Individual #2 had an annual assessment dated 9/15/22. Individual #3 had an annual assessment dated 12/1/22. Neither of these assessments address the progress and growth in the area of personal adjustment.The assessment must include the following information: The individual¿s progress over the last 365 calendar days and current level in the following areas: Personal adjustment.A new assessment form has been created to ensure all areas of the assessment is completed especially the progress and growth of the individuals personal adjustment is update as required. 12/08/2023 Implemented
2380.181(e)(13)(iv)Individual #2 had an annual assessment dated 9/15/22. Individual #3 had an annual assessment dated 12/1/22. Neither of these assessments address the progress and growth in the area of socialization.The assessment must include the following information: The individual¿s progress over the last 365 calendar days and current level in the following areas: Socialization.A new assessment form has been created to ensure all areas of the assessment especially progress and growth of the individuals socialization is updated as required. 12/08/2023 Implemented
2380.181(e)(13)(v)Individual #2 had an annual assessment dated 9/15/22. Individual #3 had an annual assessment dated 12/1/22. Neither of these assessments address the progress and growth in the area of recreation.The assessment must include the following information: The individual¿s progress over the last 365 calendar days and current level in the following areas: Recreation.A new assessment form has been created to ensure all areas of the assessment especially progress and growth of the individuals socialization is updated as required. 12/08/2023 Implemented
2380.181(e)(13)(vi)Individual #2 had an annual assessment dated 9/15/22. Individual #3 had an annual assessment dated 12/1/22. Neither of these assessments address the progress and growth in the area of community integration.The assessment must include the following information: The individual¿s progress over the last 365 calendar days and current level in the following areas: Community-integration.A new assessment form has been created to ensure all areas of the assessment especially progress and growth of the individuals recreation is updated as required. 12/08/2023 Implemented
2380.38(b)(1)The staff shall have orientation prior to working with individuals alone and with in 30 days of hire in the area of application of person-centered practices, community integration, individual choice and supporting individuals to develop and maintain relationships. Staff original hire date was 10/13/2017. Agency reports that staff was out on medical leave for the years of 2021 and 2022. Agency reports that staff returned to work as of 1/1/2023. The staff did not have annual training on these topics during the time frame of 2021-2022. The staff did not have new orientation on these topics prior to her new start date of 1/1/2023. Staff had a training on Person Centered Practices on 2/6/23 and a training on Individual choice on 7/2023.The orientation must encompass the following areas: The application of person-centered practices, community integration, individual choice and supporting individuals to develop and maintain relationships.Any new or existing staff who take a leave of absence will have all required orientation prior to working with the individuals on all required training topics. 12/08/2023 Implemented
2380.38(b)(2)The staff shall have orientation prior to working with individuals alone and with in 30 days of hire in the area of The prevention, detection and reporting of abuse, suspected abuse and alleged abuse in accordance with the Older Adults Protective Services Act (35 P.S. § § 10225.101---10225.5102), the Child Protective Services Law (23 Pa.C.S. § § 6301---6386), the Adult Protective Services Act (35 P.S. § § 10210.101---10210.704) and applicable protective services regulations. Staff original hire date was 10/13/2017. Agency reports that staff was out on medical leave for the years of 2021 and 2022. Agency reports that staff returned to work as of 1/1/2023. The staff did not have annual training on this topic during the time frame of 2021-2022. The staff did not have new orientation on this topic prior to her new start date of 1/1/2023. Staff had a training on abuse on 3/16/23. This exceeds the time frame.The orientation must encompass the following areas: The prevention, detection and reporting of abuse, suspected abuse and alleged abuse in accordance with the Older Adults Protective Services Act (35 P.S. §§ 10225.101 - 10225.5102), the child protective services law (23 Pa. C.S. §§ 6301 - 6386), the Adult Protective Services Act (35 P.S. §§ 10210.101 - 10210.704) and applicable protective services regulations.Any new or existing staff member shall be orientated to the prevention. detection and reporting of abuse, suspected abuse and alleged abuse in accordance with the Older Adult Protective Services act prior to working with any of the individuals. 12/08/2023 Implemented
2380.38(b)(4)The staff shall have orientation prior to working with individuals alone and within 30 days of hire in the area of Recognizing and reporting incidents. Staff original hire date was 10/13/2017. Agency reports that staff was out on medical leave for the years of 2021 and 2022. Agency reports that staff returned to work as of 1/1/2023. The staff did not have annual training on this topic during the time frame of 2021-2022. The staff did not have new orientation on this topic prior to her new start date of 1/1/2023. Staff had a training on recognizing and reporting incidents on 4/13/23.The orientation must encompass the following areas: Recognizing and reporting incident.Any new or existing staff member on a leave of absence shall be orientated to recognizing and reporting a incident prior to working with any of the individuals. 12/08/2023 Implemented
SIN-00216669 Renewal 12/16/2022 Compliant - Finalized
SIN-00199373 Initial review 12/10/2021 Compliant - Finalized