Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00216819 Renewal 12/15/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.80(b)Two of the posts on the outside ramp of the home are broken and several are wobbly and need to be repaired or replaced. The outside of the building and the yard or grounds shall be well maintained, in good repair and free from unsafe conditions.A maintenance request was placed on 12/15/22. A stronger epoxy was used for the repair. 01/13/2023 Implemented
6400.112(e)Greater than 6 months between sleep drills: No overnight sleep drills were conducted from the start of December 2021 to June 4, 2022A fire drill shall be held during sleeping hours at least every 6 months. Last overnight drill held September 2022. Next overnight drill to be held by March 2023. Overnight drills will be conducted at least every six months. 01/13/2023 Implemented
6400.166(b)On the Medication Administration Log of Individual #1 the Clonidine .1 MG Tab was not signed as administered on MAR on 12/14/22 for 1 PM.The information in subsection (a)(12) and (13) shall be recorded in the medication record at the time the medication is administered.The back of the MAR was documented that the medication was given but not signed for 01/04/2023 Implemented
SIN-00196353 Unannounced Monitoring 11/18/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(b)The exhaust cover over the stove in the kitchen had peeling paint on it which could flake off and get into food being cooked. Floors, walls, ceilings and other surfaces shall be free of hazards.The range hood was replaced on 11/19/21. 11/19/2021 Implemented
SIN-00180925 Renewal 12/21/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)The tub in the main bathroom of the house was not able to be used. The shower was operable.Floors, walls, ceilings and other surfaces shall be in good repair. The individuals do not choose use the tub feature of this bathroom; therefore this was overlooked. A facilities request was submitted immediately after the inspection the facilities department went to the home on 12/22/20 to fix the tub faucet. It was discovered that because the individuals do not use the tub faucet, it had become stuck. Facilities lubricated the lever to make it work. Staff complete a facilities request when items found that are not in good repair. The facilities department then goes to the home to repair or replace the item. In addition, staff will complete a monthly health and safety checklist which includes ensuring that floors, walls, ceilings and other surfaces are in good repair. A facilities request can be submitted with the form should staff find an item that is not in good repair. See attachment #1 12/22/2020 Implemented
6400.112(a)An unannounced fire drill was not completed for the month(s) of 11/2019 and 12/2019. An unannounced fire drill shall be held at least once a month. Post inspection, the program manager found the 12/19 fire drill in the drill book. Documentation of the 11/19 was not found. Going forward, Program Managers will schedule fire drills on the monthly staff calendar. See attachment #2 02/01/2021 Implemented
SIN-00130369 Renewal 02/20/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(a)In the bathroom there was mildew present at base of the shower.Clean and sanitary conditions shall be maintained in the home. The bathroom shower has been cleaned and is now free of mold. Staff have been retrained on mold prevention. 03/12/2018 Implemented
6400.67(a)There was one cabinet hinge loose in the kitchen. In the office room the floor is worn by the entrance door. In the bathroom the toilet seat was broken and loose. Individual #1's bathroom was missing caulk around the sink.Floors, walls, ceilings and other surfaces shall be in good repair. The cabinet hinge has been repaired by facilities. The toilet seat has been replaced with a new one and the caulk at the bathroom sink has been filled in by facilities. 02/26/2018 Implemented
6400.76(a)There were several knobs loose on the kitchen cabinets. Individual #1's bedroom had a loose knob in dresser. Individual #2's bedroom chair covering is cracked. Individual #3's chair has a torn cover. The third floor armchair is broken in half. Furniture and equipment shall be nonhazardous, clean and sturdy. The facilities department has tightened all loose knobs (including individual #1 bedroom dresser) and the kitchen cabinet. Individuals #2 & #3 chairs have been replaced with new furniture. 02/23/2018 Implemented
6400.112(a)The fire drill log for 10/14/17 did not indicate time of drill. An unannounced fire drill shall be held at least once a month. The staff member that conducted the October 2017 fire drill has been retrained on how to properly run and document a fire drill. 03/01/2018 Implemented
6400.141(c)(11)Individual #2's physical dated 1/3/18 did not include health maintenance needs.The physical examination shall include: An assessment of the individual's health maintenance needs, medication regimen and the need for blood work at recommended intervals. The Program Nurse contacted the physician and the physical form has been updated to include health maintenance needs. Please see attachment #6 for the updated physical consult form. 03/14/2018 Implemented
6400.141(c)(15)Individual #2's physical dated 1/3/18 did not include special instructions for the individual's diet.The physical examination shall include:Special instructions for the individual's diet. The Program Nurse contacted the physician and the physical form has been updated to include special instructions for the individual's diet. Please see attachment #6 for the updated physical consult form. 03/14/2018 Implemented
6400.181(e)(6)Individual #2's assessment dated 10/1/17 did not include the ability to safely use or avoid poisonous materials.The assessment must include the following information: The individual's ability to safely use or avoid poisonous materials, when in the presence of poisonous materials. Individual #2 has been observed and assessed on her current ability to use poisonous materials. Current 2017-2018 document has been updated with this information. Please see attachment #5 for the updated assessment. 03/01/2018 Implemented
SIN-00109584 Renewal 02/09/2017 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.141(c)(14)Individual #1's annual physical examination, dated 12/21/16, did not indicate information pertainent to diagnosis. The physical examination shall include: Medical information pertinent to diagnosis and treatment in case of an emergency. Individual #1¿s annual physical has been updated. The Nurse and/or Health Care Coordinator is responsible for ensuring that the appropriate physical form is taken and completed in its entirety at each annual physical and will be reviewed within 48 hours of the physical examination. Please see Attachment number 3 for supporting documentation 04/03/2017 Implemented
6400.143(a)Individual #1 refused treatment on several appointments and there was no documentation to show that a desensitization plan was followed. If an individual refuses routine medical or dental examination or treatment, the refusal and continued attempts to train the individual about the need for health care shall be documented in the individual's record. Individual #1 has changed to a new dentist, Special Smiles. She attended an appointment on 3/23/17 with no issues. Since switching dental providers, the team has determined that Individual #1 no longer requires a desensitization plan. Going forward, if Individual #1 continually refuses medical appointments, a new desensitization plan will be formulated by the team and put into place. Please see Attachment number 2 for supporting documentation. 04/03/2017 Implemented
6400.181(e)(13)(vii)Individual #1's annual assessment dated 10/1/16 did not show progress and growth in the area of financial independenceThe assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Financial independence. Individual #1¿s annual assessment has been updated. Going forward, the Program Managers/Specialists are responsible to update their specific individual¿s assessments and ensure that all necessary components of the annual assessment are included; specifically, progress and growth. Please see attachment number 1 for supporting documentation. 04/03/2017 Implemented
6400.181(e)(13)(viii)Individual #1's annual assessment date 10/1/16 did not show progress and growth in the area of managing personal property. The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Managing personal property. Individual #1¿s annual assessment has been updated. Going forward, the Program Managers/Specialists are responsible to update their specific individual¿s assessments and ensure that all necessary components of the annual assessment are included; specifically, progress and growth. Please see attachment number 1 for supporting documentation. 04/03/2017 Implemented
SIN-00095179 Renewal 12/22/2015 Compliant - Finalized