| Regulation | LIS Non-Compliance Area | Correction Required | Plans of Correction | Correction Date | POC Status |
| 2380.181(e)(7) | Individual #2's assessment, completed 3/7/2025, does not address the individual'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. This section was left blank. | The assessment must include the following information: The individual¿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. | ¿ A retraining session was conducted on 8/14/2025 by VP Programs for Director/Program Specialist regarding documenting all areas of the assessment and ensuring all information is included as required. Document attached.
¿ Individual #2¿s assessment was corrected, and heat sources assessed and documented. The corrected assessment was resent to ISP team. Document attached. |
08/14/2025
| Implemented |
| 2380.181(e)(9) | Individual #1's assessment, completed 1/28/2025, does not address documentation of the individual's disability, including functional and medical limitations. This section reads, "blank." | The assessment must include the following information: Documentation of the individual¿s disability, including functional and medical limitations. | ¿ A retraining session was conducted on 8/14/2025 by VP Programs for Director/Program Specialist regarding documenting all areas of the assessment and ensuring all information is included as required. Document attached.
¿ Individual #1¿s assessment was corrected, know disabilities including functional and medical limitations documented. The corrected assessment was resent to ISP team. Document attached. |
08/14/2025
| Implemented |
| 2380.182(c) | Individual #2's assessment, completed 3/7/2025, states that the individual can temper water independently. Individual #1's service plan, last updated 7/11/2025, reads, "[Individual #2] is unable to independently adjust his water temperature." | The individual plan shall be initially developed, revised annually and revised when an individual's needs change based upon a current assessment. | ¿ A retraining session was conducted on 8/14/2025 by VP Programs for Director/Program Specialist regarding documenting all areas of the assessment and ensuring all information matches ISP as required. Document attached.
¿ Individual #2¿s ISP was updated to match the individual documented ability in regard to water safety that is in annual assessment. Document attached. |
08/14/2025
| Implemented |