Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00228625 Renewal 08/02/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)- One of the drawers in the kitchen was missing a handle. - In the second story restroom one of the sinks was missing the knob for the hot water.Floors, walls, ceilings and other surfaces shall be in good repair. A maintenance request was submitted on 09/06/2023. (maintenance request) to repair kitchen drawer missing a handle and second story restroom knob for the hot water. 09/30/2023 Implemented
6400.72(b)The window in the second story bathroom would not hold itself up and would fall back down once opened. Screens, windows and doors shall be in good repair. A maintenance request was submitted on 09/06/2023. (maintenance request) to fix the window. 09/30/2023 Implemented
SIN-00172445 Renewal 03/10/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(a)There was a sticky substance consistent with grease in, on and around the oven.Clean and sanitary conditions shall be maintained in the home. 1. On 03/11/20 the grease on around the stove was cleaned and removed. (Attachment #15) 2. Direct support professionals will be re-trained on daily and weekly responsibilities regarding the cleaning and sanitary upkeep in all homes. The training will be completed by the Team Facilitator or designee. 3. On a weekly basis, the Cluster Lead staff (newly created position) will complete the Weekly Quality Assurance checklist (PA-QA) to ensure compliance with the requirements of clean and sanitary conditions. (PA-QA Attachment #1) 4. The monthly Quality Assurance checklist will be completed by the Team Facilitator or designee assigned to the cluster. (Attachment #2) 5. All Lead Staff, Team Facilitators and Program Specialists will be re-trained on following the new guidelines/expectations to ensure compliance regarding environmental checks. This training will be completed by the Associate Residential Directors. 6. This training will be completed by July 31, 2020. 07/31/2020 Implemented
6400.67(a)The toilet seat in the main bathroom was broken and coming off the toilet.Floors, walls, ceilings and other surfaces shall be in good repair. 1. On 03/24/20 the toilet seat in the main bathroom was replaced. (Attachment #14) 2. Direct support professionals will be re-trained on daily and weekly responsibilities regarding the cleaning, sanitary upkeep and the need to have everything in good repair; as well as reporting to the Team Facilitator when anything is broken. The training will be completed by the Team Facilitator or designee. 3. On a weekly basis, the Cluster Lead staff (newly created position) will complete the Weekly Quality Assurance checklist (PA-QA) to ensure compliance that everything in the home is in good repair. (PA-QA Attachment #1) 4. The Monthly Quality Assurance checklist will be completed by the Team Facilitator or designee assigned to the cluster. (Attachment #2) 5. All Lead Staff, Team Facilitators and Program Specialists will be re-trained on following the new guidelines/expectations to ensure compliance regarding environmental checks. This training will be completed by the Associate Residential Directors. 6. This training will be completed by July 31, 2020. 07/31/2020 Implemented
6400.80(b)The deck on the back of the home had floor boards that were lifting up from the surface, rails that came off with a slight pull, and warped wood in many places. The outside of the building and the yard or grounds shall be well maintained, in good repair and free from unsafe conditions.Plan of Correction: 1. The deck was repaired on 03/30/20. (Attachment #13) (The Deck was not repaired, but an order to replace was made). 2. The work to repair the deck will require an outside vendor to complete; all areas of non-compliance will be completed by July 31 2020. The Director of Maintenance will be responsible for ensuring compliance. 3. On a weekly basis, the Cluster Lead staff (newly created position) will complete the Weekly Quality Assurance checklist (PA-QA) to ensure compliance with environment checks under the supervision of the cluster Team Facilitator. (PA-QA Attachment #1) 4. The monthly Quality Assurance checklist will be completed by the Team Facilitator or designee assigned to the cluster. (Attachment #2) 5. If an area of non-compliance is identified, a Maintenance request will be completed by the lead staff, Team Facilitator or designee. 6. All Lead Staff, Team Facilitators and Program Specialists will be re-trained on following the new guidelines/expectations to ensure compliance regarding environmental checks. This training will be completed by the Associate Residential Directors. 7. This training will be completed by July 31, 2020. 07/31/2020 Implemented
6400.151(a)Staff #1 did not have a physical at the time of the inspection. 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. 1. The biennial physical was found in HR files and placed were all training records are kept. 2. The HR department is now ensuring that the most current biennial physical is placed in the training record of all employees to maintain all records in one file. 3. Every 6 months the Director of HR or designee will run reports and ensure compliance. 07/31/2020 Implemented
6400.181(e)(9)Documentation of the individual #4's disability, including functional and medical limitation was not listed on the annual assessment dated 02/04/2020.The assessment must include the following information: Documentation of the individual's disability, including functional and medical limitations. 1. On 3/30/2020 individual¿s disability, including functional and medical limitations was documented and revised on the assessment. (Attachment #12) 2. All Program Specialist will be retrained on utilizing the Residential quarterly assessment tool which covers the area of non-compliance in this citation. 3. This training will be completed by the Associate Director who will ensure the guidelines are followed. 4. The training will be completed by July 31st 2020. 07/31/2020 Implemented
6400.165(c)Individual #4's medication Listerine and Ammonium Lactate 12% was not signed for on 2/16/2020.A prescription medication shall be administered as prescribed.1. Individual #4 whose records were reviewed self-administers medications. 2. Individual #4 was reevaluated for medication self-administration 04/08/20 (Attachment #11) 3. All admins and DSP¿s working in the home, as well as other C.I. homes where individuals are self-administering; will be retrained on how to monitor individuals who self-medicate including how they document. 4. Senior program specialists for all the clusters will conduct the training. 5. The training on Self-Administration will be completed by 7/31/2020. 07/31/2020 Implemented
SIN-00113366 Renewal 12/06/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.15(a)The self-assessment was completed on 09/17/2015 and the certificate of compliance expired on 03/30/2016The 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. Cluster Administrators and Associate Director for oversight will initiate the self-assessment tool 6 months prior to the expiration date of the license and document date on the self- assessment check list. 12/07/2016 Implemented
SIN-00057827 Renewal 02/24/2014 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.141(c)(4)Individual #1 previous hearing screening was 5/23/12 and the next hearing screening was not completed until 10/23/13.(4) Vision and hearing screening for individuals 18 years of age or older, as recommended by the physician. An electronic tracking data base for all medical appointments will be instituted by the Healthcare Department. The agency LPNs will be responsible for tracking all medical appointments on an ongoing basis and assuring compliancy for these appointments in coordination with the assigned Cluster Administrator. 06/30/2014 Implemented
6400.181(a)The annual assessment for individual #1 was last completed 2/7/13. (a) 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 Program Specialist will ensure that the assessment is prepared 60 calendar days prior to the Individuals annual ISP end date. The Program Specialist and Assistant Residential Director will then review the assessment and include any updates, corrections or propose any questions related to the individual. The assessment will then be reviewed and submitted to the Support Coordinator 30 calendar days prior to the ISP meeting for the development, annual update and revision of the ISP. 06/30/2014 Implemented
6400.183(4)Individual #1 has two hours of unsupervised time at home and thirty minutes while in the community. There was no plan to address the unsupervised time.(4) A protocol and schedule outlining specified periods of time for the individual to be without direct supervision, if the individual's current assessment states the individual may be without direct supervision and if the individual's ISP includes an expected outcome which requires the achievement of a higher level of independence. The protocol must include the current level of independence and the method of evaluation used to determine progress toward the expected outcome to achieve the higher level of independence. A written Supervision Plan of support will be created for each individual whose ISP states that they are able to utilize unsupervised time. The plan will be completed, reviewed or updated for the annual ISP by the Program Specialist. 06/30/2014 Implemented
6400.188(c)Individual #1 ISP dated 5/8/13 identifies residential supports and volunteering at the library. There was no protocol developed to determine how these outcomes would be implemented.(c) The residential home shall provide services to the individual as specified in the individual's ISP. Moving forward, all ISP Outcomes will be added into the computer based Therap ISP-data system. It will list step by step instructions on how these outcomes are to be achieved. Progress will be measured through the Monthly Progress Reports, Quarterly Reports and Assessment Tools by the assigned Cluster Administrator and the Program Specialist. 06/30/2014 Implemented