Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00291086 Renewal 07/01/2026 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2390.151(e)(4)Individual #1s assessment, dated 12/16/2025, states "[Individual] currently receives 1:3 of supervision to ensure her safety. [Individual] has had prior incidents of tripping in her work area. [Individual] needs to have the work area checked that there are no tripping hazards before she walks through to get to the hall. She could be vulnerable to victimization. Individual #1s Individual Service Plan (ISP), last updated 6/10/2026, states "[Individual] will now be receiving 1:1 support at Lifeswork due to recent choking and falls. Staff will transition with her to reduce fall risk and ensure she is sitting in her designated chair with arms to increase stability. Staff will sit next to her at meals and snack to ensure her food is cut appropriately and to provide verbal prompts to eat slowly and set her fork down between bites." Interview on 7/1/2026 with Staff Program Specialist reveal that the Individual should be assessed as 1:3 while at facility, however should be 1:1 while transferring to/from Work Station and while Eating due to recent choking incident. The assessment is incorrectly assessing the individuals supervision needs. The assessment must include the following information: The client's need for supervision.The Program Specialist reassessed the individual with both 1:2-3 ratio and a 1:1 ratio. The assessment was completed at the 1:2-3 while she was working at the table with her peers. The 1:1 ratio was reassessed while she was transitioning to a sitting position in a chair with arms, and during times she eats at the program. The Assessment was completed on 7/7/26 and reviewed with the individual and sent to all ISP team members via email. 07/07/2026 Implemented
2390.151(e)(7)Individual #2s assessment, dated 3/25/2026; and Individual #3s assessment, dated 2/1/2026, does not address the individuals knowledge of the danger of heat sources and ability to sense and move away quickly. The Assessment documents, "There are no heat sources in [Individuals] work area that exceed 120 Degrees".The assessment must include the following information: The client's knowledge of the danger of heat sources and ability to sense and move away quickly from heat sources which exceed 120° F and are not insulated.The individual #2 Assessment plan was updated with the following information. The individual's mother states that he has to be reminded to avoid hot surfaces. The family focused specifically on the stove and hot curling irons. Individual #3 Assessment plan was updated with the following information. Individual family was interviewed and they report that he needs reminders to avoid hot surfaces. He is able to regulate his own bath water. 07/07/2026 Implemented
2390.151(e)(8)Individual #2s assessment, dated 3/25/2026; and Individual #3s assessment, dated 2/1/2026, does not address the individuals knowledge to evacuate in the event of the fire. The Assessment documents only the dates of fire training. Individual #2 Individual Service Plan, last updated 6/8/2026, states " [Individual] reports that he knows to evacuate if there is a fire but may require prompting to do so", indicating they may need prompting to evacuate, which needs to be addressed within the assessment. The assessment must include the following information: The client's ability to evacuate in the event of a fire.The individual #2 Assessment plan was updated with the following information. Individual participated in in a mock fire drill and he was able to stand and sought out DSP staff to evacuate to the nearest exit. Our DSP staff pointed to the nearest exit. This individual was able to walk to the safe meeting place without further direction. The individual #3 Assessment was updated with the following information. Individual participated in in a mock fire drill and he was able to stand and sought out DSP staff to evacuate to the nearest exit. Our DSP staff pointed to the nearest exit. This individual was verbally prompted to walk to the safe meeting place. 07/07/2026 Implemented
2390.152(c)Individual #1s assessment, dated 12/16/2025, states "[Individual] currently receives 1:3 of supervision to ensure her safety. [Individual] has had prior incidents of tripping in her work area. [Individual] needs to have the work area checked that there are no tripping hazards before she walks through to get to the hall. She could be vulnerable to victimization. Individual #1s Individual Service Plan (ISP), last updated 6/10/2026, states "[Individual] will now be receiving 1:1 support at Lifeswork due to recent choking and falls. Staff will transition with her to reduce fall risk and ensure she is sitting in her designated chair with arms to increase stability. Staff will sit next to her at meals and snack to ensure her food is cut appropriately and to provide verbal prompts to eat slowly and set her fork down between bites." Interview on 7/1/2026 with Staff Program Specialist reveal that the Individual should be assessed as 1:3 while at facility, however should be 1:1 while transferring to/from Work Station and while Eating due to recent choking incident.The Individual plan shall be initially developed, revised annually and revised when a client's needs change based upon a current assessment.The annual assessment originally dated 12/16/25 did not include the new ratio of 1:1. This ratio was added from discussions at her ISP in February that included new ways to ensure health and safety. The Program specialist updated the assessment to include the new 1:1 ratio in the ISP. This assessment was sent to the ISP team on 7/7/26. 07/07/2026 Implemented
SIN-00215053 Renewal 11/21/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2390.151(a)Individual #1 had an assessment completed 10/1/21 then again 11/3/22.Each client 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.This Provider developed a spreadsheet documenting all individuals assessment dates to assure regulatory compliance. 12/07/2022 Implemented
2390.49(c)(1)Direct Service Worker #1 was not trained in the application of person-centered practices, including community integration, client choice and supporting clients to develop and maintain relationships in the training year, from July 1, 2021 to June 30, 2022.The annual training hours specified in subsections (a) and (b) must encompass the following areas: The application of person-centered practices, community integration, client choice and supporting clients to develop and maintain relationships.Provide documentation of completed training in the following topics: The application of person-centered practices, community integration, client choice and supporting clients to develop and maintain relationships by direct service #1. 12/07/2022 Implemented
2390.49(c)(2)Direct Service Worker #1 was not trained in the prevention, detection and reporting of abuse, suspected abuse and alleged abuse, in the training year, from July 1, 2021 to June 30, 2022..The annual training hours specified in subsections (a) and (b) 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.Provide documentation of completed training in the following topics: The prevention, detection and reporting of abuse, suspected abuse and alleged abuse in accordance with the Older Adults Protective Services Act by direct service #1. 12/07/2022 Implemented
2390.49(c)(3)Direct Service Worker #1 was not trained in client rights, in the training year, from July 1, 2021 to June 30, 2022.The annual training hours specified in subsections (a) and (b) must encompass the following areas: Client rights.Provide documentation of completed training in the following topic: client rights by direct service #1. 12/07/2022 Implemented
2390.151(f)The program specialist provided Individual #1's assessment, completed 11/3/22 to plan team members on 11/3/22 for the individual plan meeting on 11/10/22.The program specialist shall provide the assessment to the individual plan team members at least 30 calendar days prior to the individual meeting.This Provider developed a spreadsheet documenting all individuals assessment dates to assure regulatory compliance. 12/07/2022 Implemented
SIN-00274630 Renewal 09/29/2025 Compliant - Finalized
SIN-00252857 Renewal 10/01/2024 Compliant - Finalized
SIN-00232779 Renewal 10/12/2023 Compliant - Finalized
SIN-00197911 Initial review 12/22/2021 Compliant - Finalized