Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00260012 Renewal 01/21/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.106The furnace inspection was completed 6/1/23 and not again until 8/27/24.Furnaces shall be inspected and cleaned at least annually by a professional furnace cleaning company. Written documentation of the inspection and cleaning shall be kept. The provider has spoken with the vendor that services this location and reviewed the requirement for annual furnace inspections to be completed annually on or prior to the last completed inspection. 02/21/2025 Implemented
SIN-00199735 Renewal 01/31/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(a)Poisonous materials were not kept locked or made inaccessible to the individuals. There was a glade plug in air freshener was plugged in the kitchen above the stove. Instructions are to seek medical attention/advice.Poisonous materials shall be kept locked or made inaccessible to individuals. This was a violation to internal standards. The plug in was removed immediately. A staff meeting is being scheduled to address securing poisonous substances as well all items not permitted in the home. The Program Director will review Regulation 6400.62(a) with the Program Coordinator and the house staff during the staff meeting to ensure all employees are clear on this expectation. 04/01/2022 Implemented
6400.110(a)The attic of the home did not have an operable automatic smoke detector. A home shall have a minimum of one operable automatic smoke detector on each floor, including the basement and attic. The attic at this location will be sealed and inaccessible to staff and individuals. 04/01/2022 Implemented
6400.111(a)The attic of the home did not contain an operable fire extinguisher.There shall be at least one operable fire extinguisher with a minimum 2-A rating for each floor, including the basement and attic. The attic at this location will be sealed and inaccessible to staff and individuals. 04/01/2022 Implemented
SIN-00144669 Renewal 12/13/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.151(a)Staff #1 had a physical completed on 03-02-15, then not again until 10-25-17, which was seven months past when it was due to be completed.. A staff person who comes into direct contact with the individuals or who prepares or serves food, for more than 5 days in a 6-month period, including temporary, substitute and volunteer staff, shall have a physical examination within 12 months prior to employment and every 2 years thereafter. The Human Resources department has an auditing system in place to ensure staff are in compliance with the physical examination requirement. The oversight with this particular staff was most likely a clerical error. The Human Resources department will continue the process of auditing and notifying employees well in advance of their due date. Any employee that is out of compliance will be removed from the working schedule until compliance is achieved 12/27/2018 Implemented
6400.151(c)(2)Staff #1 has a chest x-ray from 2013 in his file after a supposed positive TB test, however, there is no record of that test or when he had the positive reading. The physical examination shall include: Tuberculin skin testing by Mantoux method with negative results every 2 years; or, if tuberculin skin test is positive, an initial chest x-ray with results noted. Tuberculin skin testing may be completed and certified in writing by a registered nurse or a licensed practical nurse instead of a licensed physician, licensed physician's assistant or certified nurse practitioner. The staff person from this sample has requested documentation from his Primary Care Physician indicating a positive tuberculin skin test result. Once obtained, this documentation will be retained in the employee file along with the results of the chest x-ray. Moving forward the Human Resources department will utilize an auditing process to ensure this documentation is present for any employee with a positive tuberculin skin test. 12/27/2018 Implemented
SIN-00126069 Renewal 12/19/2017 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.181(a)Individual #2 had an assessment done on 2/11/2016. He didn't have another assessment completed until 4/7/2017, which exceeds the annual requirement. Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the residential home and an updated assessment annually thereafter. The initial assessment must include an assessment of adaptive behavior and level of skills completed within 6 months prior to admission to the residential home. The agency has created a system that will track all required assessments. This system will be utilized by the case management (program specialist) department to track, review and ensure timely completion of all required assessments. This system tracks compliance dates compared to completion dates for this regulation and will be used by department directors to ensure program compliance. All program specialists will be trained and the new system will be fully implemented by 2/1/2018. The program specialists assigned to each identified KIL location will be responsible for ensuring timely completion of all required assessments. 02/01/2018 Implemented
6400.186(a)Individual #2 had ISP Reviews on 1/16/17, 4/5/17, 6/21/17, and 10/11/17. The timeframe between 6/21/17 and 10/11/17 exceeds the 3 month requirement.The program specialist shall complete an ISP review of the services and expected outcomes in the ISP specific to the residential home licensed under this chapter with the individual every 3 months or more frequently if the individual's needs change which impacts the services as specified in the current ISP. The agency has created a system that will track all required ISP reviews. This system will be utilized by the case management (program specialist) department to track, review and ensure timely completion of all ISP reviews. This system tracks compliance dates compared to completions dates for this regulation and will be used by department directors to ensure program compliance. All program specialists will be trained and the system will be fully implemented by 2/1/2018. The program specialist assigned to each identified KIL location will be responsible for ensuring timely completion of all ISP reviews. 02/01/2018 Implemented
6400.186(b)The ISP Review completed on 6/21/17 was not signed by Individual #2's Program Specialist.The program specialist and individual shall sign and date the ISP review signature sheet upon review of the ISP. The case management (program specialists) department will be trained on this regulation during the next scheduled staff meeting. All program specialists will be responsible for checking to ensure that their documentation needs to be clearly signed and dated. They will also be trained to double check that each document is appropriately signed and dated upon filing the document. The program specialist assigned to each identified KIL location will be responsible for ensuring that all ISP reviews are completed signed and dated as outlined in 6400 186 (b) 02/01/2018 Implemented
SIN-00087819 Renewal 01/13/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(a)In left side of the unlocked cabinet, under the kitchen sink the following poisons were founds: 30 fl. oz. of Clorox Disinfecting Bathroom Cleaner; 21 oz. Comet with Bleach Disinfectant cleanser; 32 fl. oz. spray bottle of Giant brand All Purposed Cleaner with Bleach; 16 fl. oz. of Weiman Lemon Oil; and 121 fl. oz. of Concentrated Bleach. Within the dining room, there is an unlocked closet that contains the washer and dryer. This closet has a shelf which contained a 24 pack of Swiffer Wet Sweeper Pads. Individual #2¿s ISP states the following: Individual #2 ¿has a history of ingesting poisonous substances. Poisons are locked at all times at both his residence and day program.¿ Poisonous materials shall be kept locked or made inaccessible to individuals. By 2-19-16, all Boulevard staff had received, reviewed and signed a Meeting Summary Note from their supervisor summarizing the violations and that all poisons are locked at all times due to the supervision needs outlined in a consumers¿ ISPs. The Residential Coordinator will confirm poisons are locked during routine on-site program audits during the year. 02/19/2016 Implemented
6400.62(d)Food and poisons are being stored in a locked closet in the basement. The following items were included in this closet: 1 gallon of Clorox Bleach; 1 gallon of Prestone De-Icer Windshield Washer Fluid; 6 Apple and Eve 100% juice boxes; 1 single serving bag of Dorito chips; 28 oz. bag of Oats & O¿s Honey & Nut cereal; 1 lb. and 4.5 oz. box of Lucky Charms cereal; and two 15 oz. bags of Middlewarth BBQ Potato chips. Poisonous materials shall be kept separate from food, food preparation surfaces and dining surfaces.By 2-19-16, all Boulevard staff had received, reviewed and signed a Meeting Summary Note from their supervisor summarizing the violation and that all poisonous materials shall be kept separate from food, food preparation surfaces and dining surfaces. The Residential Coordinator will confirm poisons are properly separated from food, food preparation surfaces and dining surfaces during routine on-site program audits during the year. 02/19/2016 Implemented
SIN-00068490 Renewal 09/22/2014 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)The second floor bathroom floor is missing large pieces of linoleum and the first floor bathroom ceiling is in need of reconditioning as the paint is peeling.Floors, walls, ceilings and other surfaces shall be in good repair. Existing floor will be replaced with epoxy flooring. The ceiling of the first floor bathroom has been repainted. Program Manager will continue to monitor to ensure future compliance. 11/13/2014 Implemented
SIN-00052842 Renewal 09/04/2013 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(a)Calcium Chloride Pellets were unlocked and accessible to the individuals. The label said " if swallowed seek medical attention". All individuals in this home are not safe to use or avoid poison.(a) Poisonous materials shall be kept locked or made inaccessible to individuals. Corrected at time of inspecition - the lid for the Calcium Chloride storage container has been properly secured to the base of the container and the chain with lock adjusted to ensure ensure it remains secure. 09/04/2013 Implemented
SIN-00218950 Renewal 02/07/2023 Compliant - Finalized
SIN-00183600 Renewal 02/23/2021 Compliant - Finalized
SIN-00107464 Renewal 01/25/2017 Compliant - Finalized
SIN-00085903 Renewal 12/23/2015 Compliant - Finalized