Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00249235 Renewal 08/06/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(a)Antibacterial soap (a poison) was found in the first-floor bathroom. The soap was replaced with a non-poisonous soap during the inspection.Poisonous materials shall be kept locked or made inaccessible to individuals. As noted, the soap was replaced during the inspection. 08/19/2024 Implemented
6400.64(a)The bottom kitchen cabinets to the opposite of the oven were dirty and grimy.Clean and sanitary conditions shall be maintained in the home. The cabinet was cleaned. Attachment 3. 08/19/2024 Implemented
6400.82(f)There were no individual clean paper or cloth towels in the first-floor bathroom.Each bathroom and toilet area that is used shall have a sink, wall mirror, soap, toilet paper, individual clean paper or cloth towels and trash receptacle. Papertowels were placed in the bathroom. 08/19/2024 Implemented
6400.216(a)Personal records of the individuals were kept in unlocked cabinets. An individual's records shall be kept locked when unattended. All records (books) were moved to the office on the second floor of the home and placed in the closet, which locks. Attachment 1, 2, 4. 08/19/2024 Implemented
6400.167(a)(1)Debrox 6.5% eye drops for 8 PM was not administered on 08/02/24 for individual 2.Medication errors include the following: Failure to administer a medication.Incident report was written for this medication error for Individual 2. The medication was given but was not signed for so it is noted as a documentation error not an omission of a medication. Attachment 14. 08/19/2024 Implemented
SIN-00209797 Renewal 08/09/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.141(c)(14)Individual #2's physical dated 10/11/21 did not indicate information pertinent to diagnosis in case of emergency. The space on the form was left blank.The physical examination shall include: Medical information pertinent to diagnosis and treatment in case of an emergency. The physician who completed the individual's physical has left the practice and can not be contacted to request the information be provided. His next physical is scheduled for 10/12/2022 and staff accompanying him to the appointment will insure the information is provided. 09/16/2022 Implemented
6400.141(c)(15)Individual #2's physical dated 10/11/21 did not indicate dietary instructions. The space on the form was left blank.The physical examination shall include:Special instructions for the individual's diet. The physician who completed the individual's physical has left the practice and can not be contacted to request the information be provided. A wellness appointment with a new primary care physician on 6/2/22 the physician documented diet instruction for "no added salt" His next physical is scheduled for 10/12/2022 and staff accompanying him to the appointment will insure the information is provided. 09/16/2022 Implemented
SIN-00171608 Renewal 02/26/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.76(a)Individual #1's Mattress cover was and needs to be replace. Individual#1's bedroom drawer was coming apart when opened it should be replaced. Furniture and equipment shall be nonhazardous, clean and sturdy. The mattress pad was replaced and the drawer was repaired. In the future, the Program Director will insure that a physical site monitoring is conducted monthly and includes examining the mattresses and bedroom furniture. 03/02/2020 Implemented
6400.81(k)(2)Individual #1 and #2's bedroom mattress springs were protruding through the mattresses, both mattresses need to be replaced.In bedrooms, each individual shall have the following: A clean, comfortable mattress and solid foundation. The protruding springs were cut the day of the licensing inspection to avoid discomfort or possible injury. New mattresses were ordered but have not yet been delivered due to CoVID 19 limitations. Examination of mattresses was added to the physical site monitorings that the Program Director will insure are completed at least monthly. 02/27/2020 Implemented
SIN-00120540 Renewal 09/13/2017 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.141(c)(14)Individual #1's physical examination dated 9/13/17 did not include information pertinent to diagnosis and treatment in case of an emergency.The physical examination shall include: Medical information pertinent to diagnosis and treatment in case of an emergency. The physician wrote "no". The Physical and the lifetime medical history accompany individuals to all appointments and emergency room visits to insure proper treatment. We will request physicians put additional information in that section. Physicals were reviewed and Program Coordinator's were informed to request all sections of the physical be completed thoroughly. 09/22/2017 Implemented
6400.181(e)(13)(i)Individual #1's annual assessment dated 8/9/17 did not document progress and growth in the area of health.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Health. Individual #1's assessment was updated to better reflect progress in the area of health. The Assessment form was updated with a "Progress" area in each section. The other two program specialists were already using a form with this feature, so only one program specialist needed to revise his forms. 10/03/2017 Implemented
6400.181(e)(13)(v)Individual #1's annual assessment dated 8/9/17 did not document progress and growth in the area of socialization.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Socialization. Individual #1's assessment was updated to better reflect progress in the area of socialization. The Assessment form was updated with a "Progress" area in each section. The other two program specialists were already using a form with this feature, so only one program specialist needed to revise his forms. 10/03/2017 Implemented
6400.181(e)(13)(vi)Individual #1's annual assessment dated 8/9/17 did not document progress and growth in the area of recreation.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Recreation. Individual #1's assessment was updated to better reflect progress in the area of recreation. The Assessment form was updated with a "Progress" area in each section. The other two program specialists were already using a form with this feature, so only one program specialist needed to revise his forms. 10/03/2017 Implemented
6400.181(e)(13)(viii)Individual #1's annual assessment dated 8/9/17 did not document progress and growth in the area of mamaging personal property.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Managing personal property. Individual #1's assessment was updated to better reflect progress in the area of managing personal property. The Assessment form was updated with a "Progress" area in each section. The other two program specialists were already using a form with this feature, so only one program specialist needed to revise his forms. 10/03/2017 Implemented
SIN-00075628 Renewal 03/02/2015 Compliant - Finalized