| Regulation | LIS Non-Compliance Area | Correction Required | Plans of Correction | Correction Date | POC Status |
| 6400.64(a) | There was baked on grime in the oven. | Clean and sanitary conditions shall be maintained in the home. | The oven will be cleaned daily by staff on shift. |
08/05/2024
| Implemented |
| 6400.64(b) | The kitchen cabinet over the sink was dirty and had a dead insect in it. | There may not be evidence of infestation of insects or rodents in the home. | Olalus staff will clean and maintain sanitary conditions in the home on every shift. |
08/05/2024
| Implemented |
| 6400.67(a) | The sliding door in the closet of individual #1 bedroom came off of its tracks when opened and closed. | Floors, walls, ceilings and other surfaces shall be in good repair. | The sliding door in the closet of individual #1 was repaired to stay on its track. |
08/06/2024
| Implemented |
| 6400.110(c) | The basement smoke detector was in a utility closet where the furnace was located. There was a door closing the space in. | The smoke detectors specified in subsections (a) and (b) shall be located in common areas or hallways. | A smoke detector was added in the common area in the basement. |
08/05/2024
| Implemented |
| 6400.32(r) | Individual #1: There is no statement on the individual rights form stating an individual has the right to lock the individual's bedroom door. | An individual has the right to lock the individual's bedroom door. | Individual #1 requested to have a lock on individual's bedroom door. A lock was installed on individual #1-bedroom door as requested. |
08/06/2024
| Implemented |
| 6400.166(a)(2) | The name of the prescriber for any of the medications was not on the MAR. | A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Name of the prescriber. | The name of the prescribing physician, along with the phone number, has been added onto the MAR. |
08/05/2024
| Implemented |
| 6400.167(a)(1) | Carbamazepine 200 MG for 11 PM was not administered on 08/04/24 for individual #1
Clonazepam 0.5 mg for 11 PM was not administered on 08/04/24 for individual #1
Desmopressin 0.2 mg for 8 PM was not administered on 08/02/24 & 08/03/24 for individual #1
Prazosin 2 mg AT 11 pm was not administered on 8/04/24 for individual #1
Quetiapine 300 MG AT 11 pm was not administered on 8/04/24 for individual #1
Senna 806 mg at 11 PM was not administered on 8/04/24 for individual #1
Trazadone 50 mg for 8 PM was not administered on 8/02/24 for individual #1. | Medication errors include the following: Failure to administer a medication. | All documentation of medication administered as well as not administered were done. All staff were trained on medication documentation. |
08/15/2024
| Implemented |