| Regulation | LIS Non-Compliance Area | Correction Required | Plans of Correction | Correction Date | POC Status |
| 6400.15(a) | No self-assessment was done for the home. | The 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.
| The self assessment was completed once asked. |
12/04/2025
| Implemented |
| 6400.68(b) | The water temperature in the bathroom measured 123.1°F. | Hot water temperatures in bathtubs and showers may not exceed 120°F. | The heat and cooling personnel was contacted to immediately remedy the hot water being out of compliance on 12/04/2026. |
12/05/2025
| Implemented |
| 6400.70 | There was no working phone in the home. | A home shall have an operable, noncoin-operated telephone with an outside line that is easily accessible to individuals and staff persons.
| A phone was purchased immediately and connected at the home. |
12/08/2025
| Implemented |
| 6400.77(b) | The first aid kit on site did not contain a thermometer. | A first aid kit shall contain antiseptic, an assortment of adhesive bandages, sterile gauze pads, a thermometer, tweezers, tape, scissors and syrup of Ipecac, if an individual 4 years of age or younger, or an individual likely to ingest poisons, is served. | A thermometer was brought from extra supplies in the office immediately after the walk through on 12/04/2025. |
12/04/2025
| Implemented |
| 6400.106 | There was no furnace inspection for the home. | 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.
| A furnace inspection was conducted in November, we just did not have the invoice and summary. |
12/04/2025
| Implemented |