Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00275694 Renewal 11/03/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.22(d)(1)(Repeat from 02/24/25) Individual #1 purchased a recliner on 04/03/25 from Young American Furniture for $1584.70. This purchase was not added to the individual's property record.The home shall keep an up-to-date financial and property record for each individual that includes the following: Personal possessions and funds received by or deposited with the home. Individual's recliner was added to the personal property inventory on11/5/25 by Program Specialist. (attachment #8). 11/24/2025 Implemented
6400.112(h)The fire drill held on 04/21/25 failed to indicate whether or not all individuals met at the designated meeting place. Individuals shall evacuate to a designated meeting place outside the building or within the fire safe area during each fire drill.Staff completing the fire drill on 4/21/25 verified that all individuals met at the designated meeting on 4/21/25 and Program Specialist noted the verification as a late entry on the fire drill log on 11/13/25 (Attachment #9). 11/24/2025 Implemented
6400.144(Repeat from 02/24/25) Individual #1 had a podiatry appointment on 11/12/24 and was scheduled for a follow-up on 02/13/25. The follow-up did not occur until 03/04/25. Individual #1 had another podiatry appointment on 03/04/25 and was scheduled for a follow-up on 06/05/25. The follow-up did not occur until 07/14/25. There was no documentation available as to why the follow-up appointments did not occur as originally scheduled.Health services, such as medical, nursing, pharmaceutical, dental, dietary and psychological services that are planned or prescribed for the individual shall be arranged for or provided. Individual #1 was seen by their podiatrist on 7/14/2025 and was to follow-up with their podiatrist on 10/6/2025. Individual #1 did attend the follow up appointment on 10/6/2025 and the next follow-up is scheduled for 12/22/2025. Program Specialist contacted the Podiatrist to inquire if individual #1 needed to be seen sooner, since the previous follow-up appointments were late and to ensure their healthcare needs were immediately being met. Podiatrist stated there were no concerns with follow up appointments being late and individual #1 is to continue with his current schedule for podiatry appointments. (Attachment #10) 11/24/2025 Implemented
6400.183(c)There is no record of who participated in the individual plan meeting held on 10/08/25. The 2024 individual plan meeting sign in sheet was also not available in the record.The list of persons who participated in the individual plan meeting shall be kept.Individual #1's ISP meeting signature sheets were obtained by DCQM on 11/6/25 from individual #1's supports coordinator via mail.(Attachment #11-2 pages) 11/24/2025 Implemented
SIN-00161449 Renewal 10/16/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(a)There were thick cobwebs in the window of the refinished basement living room and spread to the three figurines in the window. There were also cobwebs in the corners right outside of the individual's bedroom that was located off of the refinished basement living room.Clean and sanitary conditions shall be maintained in the home. The Cobwebs were removed on 10/17/19 by staff as instructed to do so by Program Director. The Program Director reviewed with staff both the requirement for adequate cleaning as well as the cleaning schedule. See Attachments #4b and #6. 10/29/2019 Implemented
6400.64(f)There was an outside garbage receptacle on the front porch and on the back porch, both without lids.Trash outside the home shall be kept in closed receptacles that prevent the penetration of insects and rodents.The lid was replaced on the garbage can by the front porch and the garbage can without a lid on the back porch was discarded on 10/22/19 by Program Supervisor. Staff were retrained by Program Director to keep lids on garbage cans. See Attachments #5a, #5b and #4b 10/29/2019 Implemented
6400.71The emergency phone numbers on the back of the portable phone in the living room were worn off and illegibleTelephone 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. Label on phone in living room with numbers worn off and illegible was replaced with a new label including telephone numbers of the nearest hospitals, police department, fire department, ambulance, and poison control center by Program Supervisor. Staff were trained by Program Director to check labels on all phones in the home when completing monthly Home Safety Check List via items 48, 49 and 50. See Attachments #4a, #4b and #2c 10/29/2019 Implemented
SIN-00119523 Renewal 08/15/2017 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)A ceiling tile in Individual #1's bedroom was warped and hanging lower then the rest of the ceiling tiles. Floors, walls, ceilings and other surfaces shall be in good repair. Ceiling tiles have been replaced in Individual #1's bedroom. See Attachment #51. 10/09/2017 Implemented
6400.74The stairs on the side deck off of the side door are not equipped with non-skid surfaces. Interior stairs and outside steps shall have a nonskid surface. Non-skid strips were applied to the stairs on the side of deck off the side door. See Attachment #50. 10/09/2017 Implemented
6400.145(1)The home did not have a written emergency medical plan that include the hospital or source of health care that will be used in an emergency. This was requested at the time of licensing. The home shall have a written emergency medical plan listing the following: The hospital or source of health care that will be used in an emergency. A written emergency medical plan that included the hospital that will be used in an emergency was written on 10/16/17 by program specialist for individual #1. The other individuals¿ residing in the home (not included in the sample) emergency medical plans were reviewed for the inclusion of the hospital that would be used. The hospital they use was present on their plans. This review was completed by Program Specialist on 10/16/17. 10/16/2017 Implemented
6400.145(2)The home did not have a written emergency medical plan that include the method of transportation that will be used in an emergency. This was requested at the time of licensing.The home shall have a written emergency medical plan listing the following: The method of transportation to be used. A written emergency medical plan that indicated the method of transportation to be used for individual #1 was written on 10/16/17 by program specialist. Other individuals¿ (not included in this sample) emergency medical plans were reviewed for including the method of transportation to be used in the case of an emergency. They did not include the method of transportation. These emergency medical plans were updated to include the method of transportation by the program specialist on 10/16/17. 10/16/2017 Implemented
6400.145(3)The home did not have a written emergency medical plan that include an emergency staffing plan that will be used in an emergency. This was requested at the time of licensing.The home shall have a written emergency medical plan listing the following: An emergency staffing plan.A written emergency medical plan that indicates an emergency staffing plan was completed by program specialist on 10/16/17. Other individuals¿ (not included in this sample) emergency medical plans were reviewed for including the emergency staffing plan to be used in the case of an emergency. They did not include the emergency staffing plan. These emergency medical plans were updated to include the emergency staffing plan by the program specialist on 10/16/17. 10/16/2017 Implemented
6400.216(a)Individual #2's record information was found unlocked and unattended in the staff room. The staff door was unlocked. An individual's records shall be kept locked when unattended. A training memo was created and sent to direct support professionals indicating the regulation of all individuals records need to be locked when not attended. An individual record shall be kept locked when unattended. The individual and the individual's parent, guardian or advocate shall have access to the records and to information in the records. If the interdisciplinary team documents that disclosure of specific information constitutes a substantial detriment to the individual or that disclosure of specific information will reveal the identity of another individual or breach the confidentiality of persons who have provided information upon an agreement to maintain their confidentiality, that specific information identified may be withheld. See Attachment #22 10/20/2017 Implemented
SIN-00068677 Renewal 10/20/2014 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.71Downstairs bedroom phone does not have emergency numbers on it. 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. Label noting police, fire, ambulance, hospital, crisis and poison control numbers was adhered to the phone in the downstairs bedroom. See attachments #23 (1) Label Sheet and #23 (2) Photo of phone with label adhered. 10/21/2014 Implemented
SIN-00223115 Renewal 05/01/2023 Compliant - Finalized
SIN-00204642 Renewal 05/10/2022 Compliant - Finalized
SIN-00179925 Renewal 08/26/2020 Compliant - Finalized