Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00274076 Renewal 08/26/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.141(a)The pre-admission physicals completed on 5/12/2025 and 7/31/2025 for Individual #3 were both incomplete.An individual shall have a physical examination within 12 months prior to admission and annually thereafter. We will ensure that when admitting a new individual that all documentation is completed on appropriate forms, as per policy and requirements. 12/23/2025 Implemented
6400.34(a)Individual Rights were signed on 8/12/2025 despite an admission date of 8/4/2025 for Individual #3.The home shall inform and explain individual rights and the process to report a rights violation to the individual, and persons designated by the individual, upon admission to the home and annually thereafter.We have a checklist of documents and paperwork that is required to be completed upon admission of a new individual. The rights were signed on the day that Individual #3 moved into the home, however, it was not dated that day and when the forms were being reviewed on 8/12/25 and this was noted the person reviewing dated the form with the review date. We reviewed the requirements with the program supervisor. 10/16/2025 Implemented
6400.52(c)(1)Staff Member #1 & #2 did not complete training for the application of person-centered practices, community integration, individual choice and supporting individuals to develop and maintain relationships in the 2024 training year.The annual training hours specified in subsections (a) and (b) must encompass the following areas: The application of person-centered practices, community integration, individual choice and supporting individuals to develop and maintain relationships.Staff training requirements were reviewed with both Staff # 1 and #2 and going forward all required trainings will be completed annually. 12/23/2025 Implemented
6400.52(c)(3)Staff Member #1 & #2 did not complete training on individual rights in the 2024 training year.The annual training hours specified in subsections (a) and (b) must encompass the following areas: Individual rights.Staff training requirements were reviewed with both Staff # 1 and #2 and going forward all required trainings will be completed annually. 12/23/2025 Implemented
6400.52(c)(4)Staff Member #1 did not complete training on recognizing and reporting incidents in the 2024 training year.The annual training hours specified in subsections (a) and (b) must encompass the following areas: Recognizing and reporting incidents.Staff training requirements were reviewed with Staff # 1 and going forward all required trainings will be completed annually. 12/23/2025 Implemented
SIN-00171607 Renewal 02/26/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(b)Both bathrooms and the kitchen have an electrical outlet with an unfinished exposed surface behind them, creating a potential electrical hazard. Floors, walls, ceilings and other surfaces shall be free of hazards.Large switch plates were installed to cover the exposed surfaces. An electrician was contacted but has not yet been to the home due to CoVID 19. In the future, the Program Director will insure that a physical site monitoring is completed at least monthly and any surfaces needing maintenance will be addressed. 03/12/2020 Implemented
SIN-00075624 Renewal 03/02/2015 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.141(c)(8)Individual #2's date of birth is 04/23/1939; the previous mammogram was on 07/09/2013 and the most recent mammogram was on 09/16/2014.The physical examination shall include: A mammogram for women at least every 2 years for women 40 through 49 years of age and at least every year for women 50 years of age or older. Program Coordinators have been trained to maintain an Annual Medical Appointment Calendar which is to be kept in each individual's medical file. This calendar will track medical appointments and their follow up requirements. This calendar will be monitored monthly by the Program Specialist and quarterly by nursing staff in order to insure all appointments are completed as needed 04/16/2015 Implemented
6400.142(a)Individual #2's previous dental examination was on 10/01/2013 and the most recent dental examination was on 01/20/2015.An individual 17 years of age or younger shall have a dental examination performed by a licensed dentist semiannually. An individual 18 years of age or older shall have a dental examination performed by a licensed dentist annually. Program Coordinators have been trained to maintain an Annual Medical Appointment Calendar which is to be kept in each individual's medical file. This calendar will track medical appointments and their follow up requirements. This calendar will be monitored monthly by the Program Specialist and quarterly by nursing staff in order to insure all appointments are completed as needed. 04/16/2015 Implemented
SIN-00209796 Renewal 08/09/2022 Compliant - Finalized