Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00238688 Renewal 01/30/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.22(e)(1)On 12/22/2023, staff assisted Individual #1 with purchasing a Nintendo Switch. The client expense voucher read, "$33.19 - staff paid as Christmas present." On 1/5/2024, $30.00 was withdrawn from Individual #1's cash on hand and documented as, "paid staff back." Staff interviews revealed that a direct service worker gave Individual #1 the money as a loan and later withdrew the money from Individual #1's funds. This transaction was not documented accurately. If the home assumes the responsibility of maintaining an individual's financial resources, the following shall be maintained for each individual: A separate record of financial resources, including the dates and amounts of deposits and withdrawals. On 12/22/2023, staff assisted Individual #1 with purchasing a Nintendo Switch. The client expense voucher read, "$33.19 - staff paid as Christmas present." On 1/5/2024, $30.00 was withdrawn from Individual #1's cash on hand and documented as, "paid staff back." Staff interviews revealed that a direct service worker gave Individual #1 the money as a loan and later withdrew the money from Individual #1's funds. This transaction was not documented accurately. On 2/19/2024, a review of current TTSR policy was reviewed and revised. The following was added to the current Client Financial Management Policy on 2/19/2024: ¿Client petty cash is to be used for client expenses only. Staff may not borrow money from client petty cash for any reason. Individual client money is not to be used for rewards or reinforcement. Furthermore, staff are not permitted to loan an individual any amount of money for any reason and expect to be reimbursed from the individuals funds.¿ Changes were made by TTSR Administrator and Compliance Officer on 2/19/2024. A review of this policy and its newly added contents took place with Site Supervisor on 2/19/2024. By signing the Attached document, Site Supervisor acknowledges that he has been retrained on the Client Financial Management policy and will adhere to agency policies and state regulations by no longer allowing clients to borrow money for their purchases in the future. 02/19/2024 Implemented
6400.64(a)On 1/31/24, at 11:08 AM, there were an inordinate amount of flies, both deceased and alive, on the floor, stairs and windows in the attic of the home.Clean and sanitary conditions shall be maintained in the home. During licensing inspection, it was found that in the attic space on the third floor of the home, there was an abundance of flies (both living and dead) found throughout the attic. TTSR maintenance Department arrived on site on 2/6/2024 and cleared the room of items in order to clean the room and rid the floors of the flies. First, TTSR Maintenance checked each window and sealed any openings in the windows and window frames to prevent entry from the outside as well as checked all screens on the windows to ensure that there were no holes in the screens (there were not). Next, TTSR Maintenance used fly swatters to kill the remaining living flies which were few in number. TTSR Maintenance then vacuumed the entire floor to ensure that all dead flies were removed. Attached are photos of the flooring in the attic space to show that all flies have been removed. 02/06/2024 Implemented
6400.72(a)On 1/31/24 there was no screen in the window in Individual #1's bedroomWindows, including windows in doors, shall be securely screened when windows or doors are open. During licensing inspection, it was found that one window in Individual#1¿s bedroom was missing from the window. TTSR Head of Maintenance located a screen that belonged to that window and inserted it securely on 1/31/2024. A review of regulation 72(a) took place on 2/8/2024 and the topic of discussion centered around the need for all windows, including windows in doors, shall be securely screened when windows and doors are open. 02/08/2024 Implemented
6400.74On 1/31/24, at 10:50 AM, three of the four exterior stairs leading to the side entrance of the home stairs did not have a nonskid surface. At 11:08 AM on 1/31/24, there was not a nonskid surface on the two sets of interior stairs leading to the attic of the home.Interior stairs and outside steps shall have a nonskid surface. During licensing inspection, it was found that the outside front porch stairs had non-skid that was in poor repair or was not present on some stairs. On 1/31/2024, TTSR Head of Maintenance replaced and put on new non-skid on each step of the front porch stairs (attached to POC is a photo of stairs). Moreover, Head of Maintenance placed non-skid on all stairs leading up to the attic area where previously there was no non-skid (photos attached(2)). Compliance will be assessed through routine monthly inspections by site staff, site supervisor, as well as TTSR Administrative staff (unannounced site inspections) as well as Head of Maintenance and TTSR will continue to ensure that all interior and exterior stairs have non-skid on them. A retrain on regulation 74 took place on 2/7/2024 with Site Supervisor as well as Head of Maintenance and the following was discussed: Interior stairs and outside steps shall have a nonskid surface and the definition of a non-skid surface which is a surface that is not slippery. Nonskid surfaces include carpeting, a nonskid wax, rubber, or metal strips on the edges of the stairs, or textured paint. Rough texture cement on outside stairs is nonskid. Wood and concrete steps may or may not be slippery depending on the finish of the surface. 02/07/2024 Implemented
SIN-00202185 Renewal 03/22/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.81(k)(6)On 3/23/22, there were no mirrors observed in the bedrooms of all four individuals.In bedrooms, each individual shall have the following: A mirror. A review of 55 PA Code Chapter 6400.81 (k)(6) took place with Site Supervisor who met with TTSR Assistant Director and TTSR Compliance Officer. This meeting took place on 3/31/2022 and the review consisted of the following: ¿ In bedrooms, each individual shall have a mirror Compliance will be measured during routine monthly checks of the site by site supervisor/ direct support professionals to ensure that standards identified under 55 Code are met and all regulations are adhered to and to ensure the needs of the individuals are met at all times. Site Supervisor also acknowledges that he will impart his knowledge of 55 PA Code Chapter 6400.81 (k)(6) to his staff to ensure that all staff present are aware of the requirement. Attached are photos of all bedrooms which show that mirrors are and will be present. Each bedroom is identified on the photo attached. Also, TTSR has attached the sign off sheet for the retrain on 55 PA Code Chapter 6400.81 (k)(6) which took place on 3/31/2022. 03/31/2022 Implemented
SIN-00043543 Renewal 10/16/2012 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.15(a)On 10/16/12, the agency self-assessment did not include the date the assessment was completed. None of the agency's self-assessments included a date. (Partially implemented-adequate progress 4/11/2013 CEM)(a) The agency shall complete a self-assessment of each home the agency operates serving eight or fewer individuals, within 3 to 6 months prior to the expiration date of the agency's certificate of compliance, to measure and record compliance with this chapter. Since Tammy Nelson, CEO, is the person responsible for the completion of each house assessment, she and the Program Manager as well as Compliance Officer for TTSR met on 3/20/2013 to discuss the protocol for completion of assessments. Attached is a copy of the signature sheet as well as the curriculum of topics discussed during this training meeting. In summary, the training involved the completion of the self-inspections as well as a review of the timelines and expectations of the CEO for TTSR in ensuring that the self-assessments for each home are completed thoroughly (INCLUDING ACTUAL DATES WRITTEN ON SCORESHEETS WHICH SHOW THE DATE OF INSPECTION)and in a timely manner (3 to 6 months prior to the expiration date of the agency¿s certificate of compliance). 03/11/2013 Implemented
6400.67(a)On 10/16/12, the two-door cabinet in the main floor bathroom had a missing door. (Fully implemented 4/11/2013 CEM)(a) Floors, walls, ceilings and other surfaces shall be in good repair. On 10/18/2012, the cabinet was transformed into a shelf (see attched). Attached to the Monitoring tool is a sign off sheet for those TTSR administrators who were trained on 3/11/2013 (curriculum attached). Attached is also a sign in sheet and curriculum for a 6400 Regulations/ restrictive procedure policy training which was held on 3/18/2013 which was held for all house supervisors. House supervisors will be responsible for implementing and monitoring of all policies and procedures pertaining to regulations associated with meeting the compliance set forth by 6400 regulations. TTSR administration will serve as oversight as the monthly inspectors to ensure that compliance standards are maintained. due to a house fire on 2/18/2013 and the damage sustained in the fire, TTSR will not be able to montior this home for a considerable amount of time (6 to 7 months at least). as evidenced by trainings listed above, all superivosory staff were trained and will maintain the compliance standards at the future homes. 03/11/2013 Implemented
6400.104On 10/15/12, there was no documentation to indicate that the local fire department was notified in writing of the exact location of Individual #1's bedroom. Individual #1's admission date is 8/7/12. (Fully implemented 4/11/2013 CEM)The home shall notify the local fire department in writing of the address of the home and the exact location of the bedrooms of individuals who need assistance evacuating in the event of an actual fire. The notification shall be kept current. Attached is a copy of the letter sent to the Knox Borough Fire Depratment, addressed to the Fire Chief that specifically states where TC is as well as other members of the home. The individual's move in date was 8/7/2012 and the letter was sent to the Fire Chief on 8/7/2013. TTSr secretary is responsible for ensuring that this letter is sent to the fire chief in a timely manner (at least day of arrival of individual). House supervisor attended (see attached)regulation training and was informed that not only is a fire drill necessary the day of arrival for any new individual as well as notification must be made to local fire department (as mentioned above) 03/11/2013 Implemented
6400.113(a)On 10/15/12, there was no documentation to indicate that Individual #1 was trained in his responsibilities during fire drills upon initial admission date of 8/17/12. Individual #1 attended an initial fire safety training on 8/17/12. (Fully implemented 4/11/2013 CEM)(a) An individual, including an individual 17 years of age or younger, shall be instructed in the individual's primary language or mode of communication, upon initial admission and reinstructed annually in general fire safety, evacuation procedures, responsibilities during fire drills, the designated meeting place outside the building or within the fire safe area in the event of an actual fire and smoking safety procedures if individuals smoke at the home. as requested by inspector, attached is a copy of the "Incipient Fire Training" which was held on January 2,3,and 4, 2013 as well as a copy of the letter which details the training for January 5, 2012. this document lists the curriculum discussed and was sent by the trainer, michael d. graham from atkinson fire safety inc. TTSR secretary will be responsible for ensuring that this document is maintained by TTSr administration on an annual basis. 03/11/2013 Implemented
6400.181(e)(1)On 10/15/12, the annual assessment for Individual #1, dated 8/22/12, did not include the preferences of the individual. (Fully implemented 4/11/2013 CEM)(e) The assessment must include the following information: (1) Functional strengths, needs and preferences of the individual. An updated assessment was completed for Individual #1 to reflect his preferences (see attached). Attached is a copy of the curriculum for the assessment training which was held on 11/1/2012. this training was held by the responsible person, josh altman who is the compliance officer for ttsr and will conduct reviews of the assessments with all house supervisors on an annual basis. Highlighted on the attachment is the house supervisor for this site who is responsible for filling out the assessment as well as their signature showing that he/ they attended the training on assessments with the compliance officer on 11/1/2012. The attachment gives specifics on what was discussed throughout the training and in Section 2 Part c shows that the Individual's strengths, needs, and preferences section was trained on and discussed with all house supervisor who are responsible for filling out the assessments for the individuals. 03/11/2013 Implemented
6400.195(a)On 10/15/12, documentation revealed that Individual #1 had been manually restrained once on 9/2/12 and once on 9/16/12 prior to a restrictive procedure plan being written. (Partially implemented-adequate progress 4/11/2013 CEM)(a) For each individual for whom restrictive procedures may be used, a restrictive procedure plan shall be written prior to use of restrictive procedures. On 10/23/2013, TTSR Program Specialist created a Restrictive Procedure Plan for Individual #1 (see attached). This program Specialist was taught on 10/23/2013 the regulations on the creation of Restrictive Procedures and the regulations associated with by Compliance Officer for TTSR (see attached signature page). Information on individuals coming to live with TTSR will be reviewed by Program Specialists and plans will be developed to ensure their safety in the home and community prior to coming to TTSR. All program specialists for TTSR will receive all incident reports for any incident involving restraint within 72 hours and will create necessary plans to reflect the needs of each individual and to ensure their health, safety, and well-being in the home and community. 03/11/2013 Implemented
SIN-00147192 Renewal 12/13/2018 Compliant - Finalized
SIN-00087538 Renewal 12/08/2015 Compliant - Finalized