Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00268457 Renewal 07/14/2025 Needs Verification
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.121(c)(9)Individual #1 had completed a Prostate-Specific Antigen (PSA) test on 5/30/24 and not again until 7/7/25, which is outside of the annual time frame. The physical examination shall include: A prostate examination for men 40 years of age or older.Since the provider agency was not aware that the PSA is now a acceptable substitute for a prostate exam, this was not being tracked as an annual requirement. Life sharing provider was educated on this information by the life sharing specialist. 08/15/2025 Accepted
6500.20(b)(2)Individual #1 is prescribed Carvedilol 6.25 mg and it is to be taken 1 tablet twice a day. The individual was not administered the 8 pm dose of the medication 1/1/25-1/9/25 or 3/20/25-3/31/25. These medication errors were not reported as incidents in EIM.The agency and the home shall report the following incidents, alleged incidents and suspected incidents through the Department's information management system or on a form specified by the department within 72 hours of discovery by a staff person: A medication error as specified in § 6500.136 (relating to medication errors), if the medication was ordered by a health care practitioner.EIM reports were filed when this omission was discovered during licensing. This was not caught previously during routine audits and therefore was not filed at the time of the error. (HCSIS # 9658013 and 9658030) 07/25/2025 Accepted
6500.133(f)At the time of the inspection on 7/16/25, individual #1's medications, Ozempic and Cosentyx, were stored in an unlocked container in the refrigerator.Prescription medications stored in a refrigerator shall be kept in an area or container that is locked.This was an oversight by the life sharing provider, specialist, and agency. All parties reviewed regulation 133(f). Life sharing provider had a lockbox in their home and put the medications in the box inside the refrigerator. 07/24/2025 Accepted
6500.137(a)(1)Individual #1 is prescribed Carvedilol 6.25 mg and it is to be taken 1 tablet twice a day. The individual was not administered the 8 pm dose of the medication 1/1/25-1/9/25 or 3/20/25-3/31/25.Medication errors include the following: Failure to administer a medication.Since blister packs were empty when discarded, life sharing provider is certain these medications were administered as prescribed. This was a documentation error. Life sharing provider was re-educated on the importance of documenting immediately upon administering medications. 08/15/2025 Accepted
SIN-00229567 Renewal 09/06/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.125(b)Household member #5's 7/12/23 physical is not dated by the physician.The physical examination documentation shall be completed, signed and dated by a licensed physician, certified nurse practitioner or licensed physician's assistant.This physical has been returned to the physician to be dated. Awaiting call that it is complete. 09/30/2023 Implemented
6500.133(d)Individual #1's prescription medications are stored in a basket in an unlocked kitchen cabinet.Prescription medications and syringes, with the exception of epinephrine and epinephrine auto-injectors, shall be kept in an area or container that is locked.Individual's medications have been locked in a locked box. 09/30/2023 Implemented
6500.136(b)Individual #1's 8pm doses of Otezla from 7/27/23 through 7/31/23 were not documented as administered at the time of administration.The information in subsection (a)(12) and (13) shall be recorded in the medication record at the time the medication is administered.This was a documentation error. Life sharing provider was reminded to ensure that they must initial all medication administrations. Documentation of discussion placed in file. 09/30/2023 Implemented
6500.137(a)(4)Individual #1 has a PRN prescription for Hydroxyzine that is to be administered once daily at bedtime if needed for itching. On 8/1/23, 8/2/23, and 8/7/23 through 8/25/23, this medication was given at 8am instead of at bedtime as prescribed.Medication errors include the following: Failure to administer a medication at the prescribed time, which exceeds more than 1 hour before or after the prescribed time.The MAR was reviewed for accuracy and Life Sharing provider was instructed to ensure medications are given at the time stated on the label. The program specialist will consult the physician to see if medication can be given in the morning as requested by the individual. 10/15/2023 Implemented
6500.137(c)The errors described in 6500.137a4 were not reported in the department's incident management system.A medication error shall be reported as an incident as specified in § 6500.20(b) (relating to incident report and investigation).Upon discovery by licensing, medication error was reported in EIM. 10/15/2023 Implemented
SIN-00249060 Renewal 08/12/2024 Compliant - Finalized