Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00237643 Renewal 01/23/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.142(a)- An individual shall have dental exam performed annually. The individual had a dental exam on 3/7/22 and not another exam until 7/20/23. This exceeds the annual time frame.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. Individual has since been seen by her Dental Provider for follow up care in August 2023. She has had a routine appointment completed on January 23, 2024 and is scheduled to return for a routine visit on July 25, 2024. Program Director will train Program Manager and Program Coordinator on regulation 6400.142(a) by February 28, 2024. 02/28/2024 Implemented
6400.142(e)The individual had a dental exam on 3/2/22 with a follow up appointment scheduled on 9/15/22, there was no follow up documentation that the individual attended this appointment.Follow-up dental work indicated by the examination, such as treatment of cavities, shall be completed.Individual has since been seen by her Dental Provider for follow up care in August 2023. She has had a routine appointment completed on January 23, 2024 and is scheduled to return for a routine visit on July 25, 2024. Program Director will train Program Manager and Program Coordinator on regulation 6400.142(a) by February 28, 2024. 02/28/2024 Implemented
6400.144The individual had a vision exam on 2/22/22 with a recommendation to see a retina specialist on 3/11/22 for alternating esotropia. There was no documentation that reflects the individual seen the specialist as recommended by the doctor. This individual also had a gastroenterology appointment on 8/2/22 with a follow up on 12/23/22. There was no documentation that reflects the individual attended the 12/23/22 appointment. Health services, including medical appointments shall be arranged for or provided by the agency.Health services, such as medical, nursing, pharmaceutical, dental, dietary and psychological services that are planned or prescribed for the individual shall be arranged for or provided. Individual is scheduled to see the retina specialist on June 6, 2024. This individual is also scheduled to see the gastroenterologist on April 12, 2024. Program Director will train Program Manager and Program Coordinator on regulation 6400.144 by February 28, 2024. 02/28/2024 Implemented
SIN-00199738 Renewal 01/31/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(a)The cabinet in the kitchen next to the kitchen sink contained poisons, microban spray, Lysol wipes and Clorox multipurpose cleaner which all say contact poison control if ingested and the lock on the cabinet was broken and the poisonous materials were not locked or inaccessible to the individuals in the home. The cabinet in the laundry room above the washer contained poisons and the lock was broken. The drawer in the first bathroom contained poisons, ie., potpourri toilet spray which stated seek medical attention/advise, the drawer was not locked and inaccessible to individuals. The first aid kit stored in the kitchen in the cabinet next to the sink contained poisons, ie., packets of aspirin. The aspirin indicates contact poison center or doctor/pharmacy.Poisonous materials shall be kept locked or made inaccessible to individuals. This was a violation to internal standards. All poisons were removed immediately and a work order was submitted to fix the lock. A staff meeting is being scheduled to address the process for identifying and reporting maintenance concerns and securing poisonous substances. 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
6400.64(a)Clean and sanitary conditions were not maintained in the home. The washer hoses in the laundry room were covered in a thick layer of dust. The vent in the second bathroom contained a thick layer of dust.Clean and sanitary conditions shall be maintained in the home. The washer hose was cleaned that day. A staff meeting is being scheduled to review the chore checklist and the expectation of completion of chores with all staff members. The Program Director will review Regulation 6400.64(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
6400.67(a)The cabinet in the kitchen under the stove was not in good repair, the door on the left side was missing a handle.Floors, walls, ceilings and other surfaces shall be in good repair. Work order was submitted that day to repair. A staff meeting is being scheduled to address the process for identifying and reporting maintenance concerns. The Program Director will review Regulation 6400.67(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
6400.80(a)The back deck left side of the home and the driveway where individuals access the home's vehicle were not free from ice and snow. Outside walkways shall be free from ice, snow, obstructions and other hazards. Walkways were cleared that day. A staff meeting is being scheduled to address the process for identifying and reporting maintenance concerns as well as the need to ensure walkways are clear of ice, snow, obstructions, and other hazards. The Program Director will review Regulation 6400.80(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
SIN-00087822 Renewal 01/12/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.68(b)The water temperature in the home was 125. 6 degrees. When taken a second time with a different thermometer, it was 126.9 degrees. Hot water temperatures in bathtubs and showers may not exceed 120°F. On 1/13/2016 the Keystone Independent Living maintenance department lowered the temperature on the hot water heater. The temperature was taken again and was below 120°F. Water temperature is monitored monthly for all occupied, licensed homes. 01/13/2016 Implemented
6400.80(a)The first step of the wooden stairs to the back porch was hazardous to walk on due to weathering, extreme weakness and bowing. Outside walkways shall be free from ice, snow, obstructions and other hazards. On 1/13/2016 the Keystone Independent Living maintenance department removed the first step off of the wooden stairs and replaced it with a new step. 01/13/2016 Implemented
6400.106The furnace inspection was completed by Ace-Robins, Inc on 11/13/2014. 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. Ace Robbins (oil/heat company) completed a boiler inspection and cleaning on 1/13/2016. Upon completion Ace Robbins supplied Keystone Independent Living with documentation of the inspection and condition of the boiler. This documentation will be retained at the group home location. The provider will assure that furnace inspection and cleaning occurs annually. 01/13/2016 Implemented
SIN-00166013 Renewal 11/19/2019 Compliant - Finalized
SIN-00126071 Renewal 12/19/2017 Compliant - Finalized