Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00251411 Renewal 09/12/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(a)There was a black substance consistent with mold in both the main bathroom and in the individual's ensuite bathroom. (The one in ensuite bathroom was excessive.) There was a pile of grey dusty material between the screen and side door.Clean and sanitary conditions shall be maintained in the home. Both Bathrooms were thoroughly cleaned and recaulked on 9/16/24, See Attachment #10and #11. . Cleanliness and maintenance issues were reviewed with all managers on 9/13/24, See Attachment #2 and with direct care staff on 9/15/24, Attachment #7. 09/16/2020 Implemented
6400.65The exhaust fan in the kitchen was not operable. It was open but not on and with no screen would allow birds or insects into the home.Living areas, recreation areas, dining areas, individual bedrooms, kitchens and bathrooms shall be ventilated by at least one operable window or by mechanical ventilation. The exhaust fan was repaired on 9/19/24, Attachment #12. Follow up on maintenance request was reviewed with all managers on 9/13/24, See attachment #2. Maintenance issues were also reviewed with direct care staff on 9/15/24, Attachment #7 09/19/2024 Implemented
6400.67(b)There were tack strips along the walls in the basement that had been left when the carpet was removed. Staff stated that it was done about two months prior to the date of inspection. Floors, walls, ceilings and other surfaces shall be free of hazards.All Tacks were removed on 9/16/24, Attachment #13. Additional pictures taken of wall without tacks, Attachments #14 and #15. Follow up on maintenance issues was reviewed with all managers on 9/13/24,, See Attachment #2. Maintenance issues was also reviewed with direct care staff on 9/15/24, #7 09/16/2024 Implemented
6400.80(b)The deck on the back of the home needed repair. There were raised floorboards, and the handrail was lifted showing the nails beneath. The outside of the building and the yard or grounds shall be well maintained, in good repair and free from unsafe conditions.The handrail and deck were repaired on 9/17/24, Attachments #16 and 17. Follow up on maintenance issues was reviewed with all managers on 9/13/24. See Attachment #2, maintenance issues were also reviewed with direct care staff on 9/15/24, Attachment #7 09/17/2024 Implemented
6400.216(a)There were program records stored in the office which did not have a lock on the door. An individual's records shall be kept locked when unattended. Individual records were moved to a locked closet until the lock could be added on 9/17/24, Attachment #18 The locking up of records was reviewed with management on 9/13/24, Attachment #3 and with direct care staff on 9/15/24, Attachment #7 09/17/2024 Implemented
SIN-00211062 Renewal 09/12/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(a)There was a wet brown sludge built-up in the bottom of the dishwasher. {Repeated Non-Compliance 9/15/2021}Clean and sanitary conditions shall be maintained in the home. Upon inspection, Shared Values was non-compliant with code 6400.64a and there was a wet brown sludge built-up in the bottom of the dishwasher. Since the inspection, the items have been cleaned, and are now nonhazardous, and sanitized. The sanitization was completed by Shared Values maintenance 9/19/2022. Shared Values has also on-boarded an additional community manager. The community managers will be responsible for ensuring ongoing cleanliness and residential site repairs are reported and repaired in a timely manner to avoid any injuries and maintain compliance. Our community managers will be trained in utilization of the provider self-assessment to check for regulatory issues 10/25/2022. Staff will continue with protocols to contact a supervisor immediately in the event there is a residential repair needed or sanitization concerns arise. The program director and community mangers will complete scheduled residential site visits to follow-up on the status of all home's cleanliness. The compliance director will uphold compliance by completing site visits and completing the self-assessments of the homes and site inspection reports monthly. 10/15/2022. 09/19/2022 Implemented
6400.67(b)There is a substantial leak coming through the ceiling on the lower level/garage area. In two separate areas this leak caused the ceiling to crumble in onto the floor. The black and white tiles on the lower level of the home were peeling up or missing creating a tripping hazard on that area of the home. The landlord was contacted on 9/2/22 with a follow up on 9/9/22. It is unclear if they went out to begin to address the problem. Floors, walls, ceilings and other surfaces shall be free of hazards.Shared Values will ensure all homes are in free of hazards. Upon inspection there was a substantial leak coming through the ceiling on the lower level/garage area. In two separate areas this leak caused the ceiling to crumble in onto the floor. The landlord was contacted 9/13/2022 to follow-up on the status of repair for the leak. The landlord estimates the leak to be fixed by 10/19/2022. Maintenance has been tasked to complete a residential corrective action as a result of licensing inspection, and replace damaged floor tile by 10/30/2022. On October 27, 2022, Shared Values will be conducting a mandatory full staff meeting for all direct support staff. During this time, all employees will revisit the process on maintaining a hazard free residential program site. The facilitators will keep a sign-in sheet of all attendees. Employees who miss the meeting will be required to attend a follow-up meeting with their direct supervisor. A walkthrough was completed at all Shared Values residential programs to ensure hazard free conditions, including but not limited to identified leaks or structural damages 9/16/2022. On 10/17/2022 the program director and community mangers will complete scheduled residential site visits to follow-up on the status of hazard-free residential conditions. The compliance director will uphold compliance by completing site visits and completing the self-assessments of the homes and site inspection reports monthly. 10/30/2020. 10/30/2022 Implemented
6400.71There were no emergency phone numbers posted near kitchen phone. {Repeated Non-Compliance 9/15/2021}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. Shared Values will ensure emergency phone numbers are present and posted by the phones per 6400.71. The emergency contact document has been updated with the nearest hospital, police department, fire department, ambulance, and position control center and posted near the kitchen phone in the home 9/19/2022. Shared Values will ensure this information is continuously reviewed and updated. A new community manager has been secured for residential oversight. The community manager has revised the emergency phone numbers for all residential homes. The emergency contact numbers have been posted on-site by the phone. The information has been revised and approved by the Compliance director 9/19/2022. The community manager will be responsible for ongoing compliance with emergency phone numbers listed on-site. To ensure this is reviewed, the community manager will complete a provider self-assessment every three months. This will be submitted and reviewed by the program director. Completion Date 9/19/2022 09/19/2022 Implemented
6400.77(b)No Tweezers present in first aid kit or elsewhere in the home. {Repeated Non-Compliance 9/15/2021} 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. Shared Values has re-purchased a first aid kit for all homes. The first aid kits contain the following antiseptic, an assortment of adhesive bandages, sterile gauze pads, a thermometer, tweezers, tape, and scissors. New first aid kits were purchased for all homes on 9/14/2022. Upon inspection, the first aid kit did not contain tweezers as required per regulation code 6400.77b. A replacement first aid kit was purchased 9/13/2022. The kits, including tweezers, were delivered on 9/14/2022. The community managers will monitor First aid kits weekly, and will check for restock needs monthly during site self-assessment completion. 09/14/2022 Implemented
6400.82(e)No bathmat or non-slip surface present in hallway bathroom. {Repeated Non-Compliance 9/15/2021} Bathtubs and showers shall have a nonslip surface or mat. Shared Values will ensure all homes contain a bathmat or non-slip surface present in the homes' bathrooms. Since inspection, direct support staff have put replacement bathmats in the bathroom 9/13/2022. A community manager has been onboarded for the home. The community manager will be responsible for ensuring each bathroom maintains a clean non-slip surface. This shall be monitored on a regular ongoing basis. Direct support staff will still be responsible to ensure efficient non-slip surfaced are in the bathroom at all times. Shared Values will be conducting a mandatory full staff meeting for all direct support staff 10/27/2022. During this time, all employees will revisit the process on maintaining hazard-free residential conditions. The facilitators will keep a sign-in sheet of all attendees. Employees who miss the meeting will be required to attend a follow-up meeting with their direct supervisor. Community Managers have been tasked to complete a residential corrective action as a result of licensing inspection. All items needing repair or purchase must be completed by 10/16/2022. On 10/17/2022 the program director and community mangers will complete scheduled residential site visits to follow-up on the status of all housing needs. The compliance director will uphold compliance by completing site visits and completing the self-assessments of the homes and site inspection reports monthly. 10/16/2022 09/13/2022 Implemented
6400.110(a)The smoke detector on the lower level of the home was inoperable. A home shall have a minimum of one operable automatic smoke detector on each floor, including the basement and attic. Shared Values will ensure all homes have a minimum of one operable automatic smoke detector on each floor, including the basement and attic Since inspection, Maintenance has put replacement batteries in the smoke detector on the lower level of the home to render it operable 9/13/2022. A test of the smoke detector's operability was completed after new batteries were applied. A new community manager has been onboarded for the home. The community manager will be responsible for ensuring each level of the home maintains an operable smoke detector. This shall be monitored on a regular ongoing basis. Direct support staff will still be responsible to ensure smoke detectors are operable during monthly fire drill completion. Shared Values will be conducting a mandatory full staff meeting for all direct support staff 10/27/2022. During this time, all employees will revisit the process on maintaining hazard-free residential conditions. The facilitators will keep a sign-in sheet of all attendees. Employees who miss the meeting will be required to attend a follow-up meeting with their direct supervisor. Maintenance has been tasked to complete a residential corrective action as a result of licensing inspection. All items needing repair or purchase must be completed by 10/16/2022. On 10/17/2022 the program director and community mangers will complete scheduled residential site visits to follow-up on the status of all housing needs. The compliance director will uphold compliance by completing site visits and completing the self-assessments of the homes and site inspection reports monthly. 10/16/2022 09/13/2022 Implemented
6400.163(d)The medication closet was unlocked at the time of inspection. {Repeated Non-Compliance 9/15/2021}Prescription medications and syringes, with the exception of epinephrine and epinephrine auto-injectors, shall be kept in an area or container that is locked.Shared Values will ensure all homes contain Prescription medications and syringes in an area that is kept locked. Since inspection, direct support staff have monitored the medication closet to ensure it remains locked when not accessing medications 9/13/2022. A community manager has been onboarded for the home. The community manager will be responsible for ensuring all staff are equipped with operable keys that lock and unlock the medication closet, and that the key is kept on the staff's person. This shall be monitored on a regular ongoing basis. Direct support staff will still be responsible to ensure medication cabinets and closets are kept locked at all times 9/13/2022. Shared Values will be conducting a mandatory full staff meeting for all direct support staff 10/27/2022. During this time, all employees will revisit the process on securing medications in locked areas. The facilitators will keep a sign-in sheet of all attendees. Employees who miss the meeting will be required to attend a follow-up meeting with their direct supervisor. On 10/17/2022 the program director and community mangers will complete scheduled residential site visits to follow-up on the status secured medications and locked areas of all homes. The compliance director will uphold compliance by completing site visits and completing the self-assessments of the homes and site inspection reports monthly. 10/16/2022 09/13/2022 Implemented
SIN-00193965 Renewal 09/15/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.21(a)Criminal checks were not completed within the allowable time frames for staff members 3,4,5,6 and 7.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. 6400.21 (a): Criminal checks were not completed in the specified time frame for staff 3,4,5,6 and 7: Criminal background checks for staff hired after citation reflected the corrected hire date and background check date. Corrected 9/29/21. See attachment #:1 (Digital attachment). 09/29/2021 Implemented
6400.67(a)What appears to be insulation was seen exposed over pipe in basement and in need of repair. The carpet in living room appeared to be dirty and is in need of repair. A black substance in the shower consistent with dirt and or mold/mildew needs to be cleaned. The ceiling in basement shows water damage from a possible leak and is in need of repair.Floors, walls, ceilings and other surfaces shall be in good repair. 6400.67 (a): Exposed insulation on ceiling in garage. Maintenance sealed exposed insulation in garage. Corrected on 10/30. See attachment #: 2 09/30/2021 Implemented
6400.67(b)There was lint in dryer larger than the size of a golf ball which poses a fire hazard. The heating thermostat has exposed wires and is in need of repair as the exposed wires pose a hazard. Floors, walls, ceilings and other surfaces shall be free of hazards.6400.67 (b): Lint in dryer larger that golf ball which poses a fire hazard. Notice placed in front of dryer reminding staff to empty dryer lint compartment after each use. Corrected on 9/20/21. See attachment #: 3 09/20/2021 Implemented
6400.68(b)The water temperature in Individual #1 personal bathroom was 130 degree. The water temperature in the kitchen sink was measured at 124 degrees. The water temperature in the other bathroom was 124 degrees. Hot water temperatures in bathtubs and showers may not exceed 120°F. 4. 6400.68 (b): Water temperature in individual #1 bathroom was 130 and the temperature in the kitchen was 124: Maintenance adjusted the thermometer on the hot water tank. Corrected on 9/20. See attachment #: 4 09/20/2021 Implemented
6400.71No emergency numbers were posted next to telephone in kitchen.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. Updated contact list was placed in the home on 9/20/21. See attachment #: 5 09/20/2021 Implemented
6400.82(e)A nonslip mat was not found in the personal bathroom for Individual #1. Bathtubs and showers shall have a nonslip surface or mat. 6. 6400.82 (e): non-slip mat not found in personal bathroom of individual #1. Non-slip mat was purchased and placed in shower of individual #1. Completed 9/20/21. See attachment #: 6 09/20/2021 Implemented
6400.112(d)The fire drill completed on 8/10/21 indicated that it took 5 minutes to evacuate. 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. 6400.112(d) Fire drill took 5 minutes to complete: Program specialist and community manager trained all staff on proper fire drill procedures. Corrected on 10/7/21. See attachment #: 7 10/07/2021 Implemented
6400.141(c)(4)The record did not contain a detailed report of Individual #1 having, or needing, a hearing test or vision screening within the last twelve months.The physical examination shall include: Vision and hearing screening for individuals 18 years of age or older, as recommended by the physician. 6400.141 (c) (4): Record did not contain details on individual #1 needing or having a vision or hearing test: LPN contacted individual #1 PCP and got updated documentation reflecting the individual's need for hearing and vision tests. Corrected on 11/1. See attachment #: 8 11/01/2021 Implemented
6400.141(c)(10)Individual's #1 11/2/20 physical did not report his communicable disease status.The physical examination shall include: Specific precautions that must be taken if the individual has a communicable disease, to prevent spread of the disease to other individuals. 6400.141 (c) (10): Individual #1 11/2/20 physical did not report his communicable disease status: LPN contacted PCP and obtained records clearing the individual of any communicable diseases. Corrected on 11/1. See attachment #: 9 11/01/2021 Implemented
6400.142(a)Individual #1 record did not have a dental form signed by a licensed dentist or state that teeth cleaning, gums checked, follow up work as needed, was completed.An individual 17 years of age or younger shall have a dental examination performed by a licensed dentist semiannually. An individual 18 years of age or older shall have a dental examination performed by a licensed dentist annually. 10. 6400.142 (a): Record didn't have a dental form signed by a licensed dentist: LPN obtained dental form from the individual dentist. Corrected on 11/1. See attachment #: 10 11/01/2021 Implemented
6400.142(f)Individual #1 record did not have a written plan for dental hygiene, despite the 8/31/21 assessment reporting that there is tooth decay.An individual shall have a written plan for dental hygiene, unless the interdisciplinary team has documented in writing that the individual has achieved dental hygiene independence. 11. 6400.142 (f): No dental hygiene plan in individual #1 record despite 8/31/21 assessment reporting tooth decay: The LPN drafted and implemented a hygiene plan for individual #1. Corrected on 9/28. See attachment #: 11 09/28/2021 Implemented
6400.151(a)Physical exams for Staff members 1 and 2 were completed after they were hired and began employment. A staff person who comes into direct contact with the individuals or who prepares or serves food, for more than 5 days in a 6-month period, including temporary, substitute and volunteer staff, shall have a physical examination within 12 months prior to employment and every 2 years thereafter. 12. 6400.151 (a): Physical exams were completed for staff member 1 and 2 after they were hired and began employment: HR manager obtained updated physicals for staff 1 and 2 that reflected the corrected dates of physicals. Corrected on 9/22. See attachment #: 12 (digital attachment). 09/22/2021 Implemented
6400.217Individual's #! record did not have a signed consent for information release form.Written consent of the individual, or the individual's parent or guardian if the individual is 17 years of age or younger or legally incompetent, is required for the release of information, including photographs, to persons not otherwise authorized to receive it. Corrected on 9/14. See attachment #: 13. Packet was completed prior to inspection but got mixed up in other paperwork. 09/14/2021 Implemented
6400.34(b)A signed copy of rights was not found in the record of individual #1.The home shall keep a copy of the statement signed by the individual, or the individual's court-appointed legal guardian, acknowledging receipt of the information on individual rights.Corrected on 9/14. See attachment #: 13. Packet was completed prior to inspection but got mixed up in other paperwork. 09/14/2021 Implemented
6400.51(a)(1)Acceptable documentation that orientation trainings were completed for Staff Members 1 and 2 were not provided. The documents provided indicated they were completed prior to both dates of hires and also signed off that they were trained by an employee that was not employed at the time the trainings occurred. The records also indicated the full orientation was completed in one day although the training documents indicated the hours needed would exceed one business day.Prior to working alone with individuals, and within 30 days after hire, the following shall complete the orientation as described in subsection (b): Management, program, administrative and fiscal staff persons.15. 6400.51 (a) (1): Acceptable documentation that orientation training was completed for staff members 1 and 2 were not provided. The documentation provided indicated they were completed prior to both dates of hires and signed by an employee that wasn't hired at the time the trainings were completed. The records also indicated that the full orientation was completed in one day although the training document indicated that training needed would exceed one business day: HR redid trainings with staff 1 and 2 over a three-day period. Corrected on 9/27-10/1. See attachment #: 15 (digital attachment) 09/27/2021 Implemented
6400.51(a)(3)Acceptable documentation that orientation trainings were completed for Staff Members 1 and 2 were not provided. The documents provided indicated they were completed prior to both dates of hires and also signed off that they were trained by an employee that was not employed at the time the trainings occurred. The records also indicated the full orientation was completed in one day although the training documents indicated the hours needed would exceed one business day.Prior to working alone with individuals, and within 30 days after hire, the following shall complete the orientation as described in subsection (b): Direct service workers, including full-time and part-time staff persons.16. 6400.51 (a) (3): Acceptable documentation that orientation training was completed for staff members 1 and 2 were not provided. The documentation provided indicated they were completed prior to both dates of hires and signed by an employee that wasn't hired at the time the trainings were completed. The records also indicated that the full orientation was completed in one day although the training document indicated that training needed would exceed one business day: HR redid trainings with staff 1 and 2 over a three-day period. Corrected on 9/27-10/1. See attachment #: 15 (digital attachment). 09/27/2021 Implemented
6400.163(h)Expired fluconasian nose spray for Individual #1 was found in the medicine cabinet.Prescription medications that are discontinued or expired shall be destroyed in a safe manner according to Federal and State statutes and regulations.17. 6400.163 (h): Expired Fluconasian nasal spray for individual #1 was found in the medicine cabinet. Corrected on 9/20. Nasal spray was disposed of. 09/20/2021 Implemented
SIN-00230707 Renewal 09/12/2023 Compliant - Finalized