Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00231978 Renewal 09/27/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.165(b)Lactulose 10GM/15ML, OTC Moisture Cream, Cortaid PRN medications were not present in the medication bin for Individual 1.A prescription order shall be kept current.The OTC moisture lotion was provided during the inspection, it is kept in the individuals room where it's used . The nurse placed the other PRN medications in the medication closet for each individual at the house. Attachment 1 09/29/2023 Implemented
SIN-00213224 Renewal 09/28/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.81(k)(6)There was no mirror in Individual 3's bedroom.In bedrooms, each individual shall have the following: A mirror. It has always been written in individual 3's ISP and assessment that he does not want a mirror since his admission 3/28/2016. 09/28/2022 Implemented
6400.141(c)(8)Individual 4's Prostate exam was last completed on 3/5/2020. The record did not include an updated exam.The physical examination shall include: A mammogram for women at least every 2 years for women 40 through 49 years of age and at least every year for women 50 years of age or older. Individual #4 did have a Prostate exam 3/16/2022 by his Urologist, we thought this report was provided, the date and specialist will be placed on the physical. 11/07/2022 Implemented
6400.151(c)(4)Staff 3's, direct support staff, 9/23/22 physical states that this staff has an inadequate immune status related to measles, mumps and/or rubella, but no follow up guidelines were provided to ensure that this staff does not pose a health risk to others.The physical examination shall include: Information of medical problems which might interfere with the health of the individuals.Staff 3's doctor checked in error a medical problem, thinking it was adequate immune system however it said inadequate immune system. We will continue to review physicals when they arrive and get explanations for medical problems, unfortunately we are not perfect and will miss something . We will strive for perfection to avoid this in the future when reviewing records 10/07/2022 Implemented
6400.195(b)Individual 4's BSP was not reviewed by the provider's HRC.The behavior support component of the individual plan shall be reviewed and revised as necessary by the human rights team, according to the time frame established by the team, not to exceed 6 months between reviews.The behavior support component of individual 4 will be noted that it was reviewed by the team at the monthly review meetings. 10/18/2022 Implemented
6400.213(1)(i)Individual 4's photo was not dated.Each individual's record must include the following information: Personal information, including: (i) The name, sex, admission date, birthdate and Social Security number.We will make sure the individuals photo has a date. 10/03/2022 Implemented
SIN-00193625 Renewal 09/28/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(a)There was a black substance on the floor of the shower consistent with mold.Clean and sanitary conditions shall be maintained in the home. The black substance was the grey color of the caulk, we did however re-caulk the shower with a white color. See attachment #9 09/30/2021 Implemented
6400.67(b)There were hoses and cords on the basement floor presenting a tripping hazard for those walking in that area. Floors, walls, ceilings and other surfaces shall be free of hazards.The dehumidifier was moved closer to the outlet so the cord would not be in the walking area. see attachment #10 09/30/2021 Implemented
6400.71There were no emergency numbers posted by the two phones located in the living room.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. The emergency phone list were replaced by the 2 phones in the living room.. See attachments 11and 12 09/29/2021 Implemented
6400.32(h)There was a chart on the refrigerator which included the names of individuals and their dietary needs.An individual has the right to privacy of person and possessions.The names were removed and replaced with just the initials of the individuals. see attachment #13 10/04/2021 Implemented
SIN-00176913 Renewal 09/24/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.141(c)(12)INDIVIDUAL #1's Annual Physical Exam Dated 09/24/2020 does not note the individual's physical limitations. There is a section of the form labeled "limitations or restrictions for activities (including work day, lifting, standing, and bending);" The boxes "Yes" and "No" next to this item and the comment line are blank. The physical must include this information.The physical examination shall include: Physical limitations of the individual. The attached #6 physical form was updated to include the limitations or restrictions for activities. The individual physical was the day of the inspection, when the physical was completed and taken to our office the form was handed directly to the licensing inspector prior to review by the company nurse. The other individual physical forms were reviewed and additions were made as needed. All physical forms are reviewed by company nurse prior to filing to avoid missed completions of sections. 09/25/2020 Implemented
6400.213(5)INDIVIDUAL #1's Individual Record does not contain a Dental Hygiene Plan.Each individual's record must include the following information: Dental hygiene plans. The dental hygiene plan information is included on the attached #7 oral hygiene section of the dysphagia plan it includes type of assistance, how often brushing is done, what is used(toothbrush, swab, toothpaste). All individuals have a completed dysphagia form which includes the oral(dental)hygiene plan. The company nurse will complete annually the dental hygiene plan. 09/30/2020 Implemented
6400.195(c)(4)INDIVIDUAL #1's Behavioral Support Plan, dated 12/20/2019, does not specify a target date to achieve the listed outcome.The behavior support component of the individual plan shall include: A target date to achieve the outcome.The attached #8 behavior support plan was updated with the target date to achieve the listed outcomes. The other individual plans were reviewed and dates were included were necessary. During the quarterly review behavior support plan target dates will be reviewed by the program specialist. 09/30/2020 Implemented
SIN-00106081 Renewal 12/01/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.181(c)Individual #3¿s annual assessment dated 5/11/16 does not indicate what instruments the assessment were based on. The assessment shall be based on assessment instruments, interviews, progress notes and observations. The form indicating what instruments the assessment was based on was placed with the assessment. The document listing the instruments of what the assessment was based on will be stapled to the assessment to avoid a non compliance. 12/06/2016 Implemented
6400.213(1)(i)Individual #3¿s record did not indicate eye color, hair color and identifying marks. Each individual's record must include the following information: Personal information including: (i) The name, sex, admission date, birthdate and social security number. (iii) The language or means of communication spoken or understood by the individual and the primary language used in the individual's natural home, if other than English. (ii) The race, height, weight, color of hair, color of eyes and identifying marks.(iv) The religious affiliation. (v) The next of kin. (vi) A current, dated photograph.The document with eye color, hair color and identifying marks was place with the record for individual #3. The document(client medical data sheet) will also be kept with the record to avoid future non compliance. It was only kept in a packet to be taken to the hospital in the case of emergency. 12/06/2016 Implemented
6400.217Individual #3¿s record did not contain a release of information. 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. The release of information form was signed by the individual. The release of information was added to the Client survey check sheet to avoid future non compliance. 12/06/2016 Implemented
SIN-00048160 Renewal 03/26/2013 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.34(b)(2)The Facility's Civil Rights Policy does not address physical accessibility issues.(2) Physical accessibility and accommodations for individuals with physical disabilities. That part of our Codes and Practices which covers the topic of physical accessabilty issues with the Civil Rights policy was not FAXED along with the rest of that portion that was FAXED ¿ ( namely , the top of page 26 in the Codes). Enclosed is a copy of this policy within our Civil Rights section of our Codes and practices. Effective 3/26/13 03/26/2013 Implemented
6400.186(a)The 90 day reviews of 6/12, 9/12, 11/12, and 01/13 did not report on progress and growth concerning recommendations in the assessment, specifically health care equipment and nebulizer.(a) The program specialist shall complete an ISP review of the services and expected outcomes in the ISP specific to the residential home licensed under this chapter with the individual every 3 months or more frequently if the individual's needs change which impacts the services as specified in the current ISP. We will continue to do our Quarterly ISP and ASSESSMENT reviews as we have been doing with the addition of a section devoted to specific progress on the recommendations, and outcomes listed in the Assessment and ISP for the quarter being reviewed. Effective March 2013 ...see enclosed additions to the quarterly reports for HM and LS. Done on 4/22/13. 04/22/2013 Implemented
SIN-00253196 Renewal 09/25/2024 Compliant - Finalized
SIN-00149521 Renewal 01/31/2019 Compliant - Finalized
SIN-00124617 Renewal 10/24/2017 Compliant - Finalized
SIN-00073653 Renewal 03/24/2015 Compliant - Finalized
SIN-00058537 Renewal 03/12/2014 Compliant - Finalized