Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00273581 Renewal 09/03/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.14(a)The agency did not possess a valid certificate of occupancy for any of its homes or an applicable letter from the corresponding municipality or township, indicating that a certificate of occupancy is not required.If the home is located outside Philadelphia, Scranton or Pittsburgh and serves four or more individuals or if the home is located in a multiple family dwelling, the home shall have a valid fire safety occupancy permit listing the appropriate type of occupancy from the Department of Labor and Industry or the Department of Health. If the home is located in Philadelphia, Scranton or Pittsburgh, the home shall have a valid fire safety occupancy permit from the Department of Health or the Department of Public Safety of the city of Pittsburgh, the Department of Licensing and Inspection of the city of Philadelphia or the Department of Community Development of the city of Scranton, if required by State law or regulation or local codes. Source: Records.The Provider will contact the homeowner of this residence and assist in any way in obtaining an occupancy permit from Smithton Borough officials or any other Borough governmental entity. 10/24/2025 Implemented
6400.64(a)At 10:27 AM on 9/4/25, the center interior base of the oven was coated with blackened grease and several charred food particles. At 11:00 AM, the base of the walk-in shower stall located in the home's basement was lined throughout its entirety with debris, pinkish-colored water stains, and a multitude of dead insects. The interior sink adjacent to the shower stall located in the home's basement was coated with a black substance in a large area surrounding its drain, appearing to be mold and/ or mildew. At 11:10 AM, in the full bathroom located on the home's main level, the caulking surrounding the entire walk-in shower base as well as the caulking applied to its adjoining walls was covered significantly in several portions with a blackish substance, appearing to be mold and/or mildew.Clean and sanitary conditions shall be maintained in the home. The Site monitor, DSP staff will clean the oven after each prepared meal to ensure that it remains clean. The Site Monitor and DSP staff will clean and sanitize the unused basement bathroom in its' entirety and adding the basement bathroom to the scheduled house cleaning. The Site Monitor contacted the Landlord and he agreed to make the caulking repairs to remove blackish substance appearing to be mold or mildew. 10/24/2025 Implemented
6400.67(b)At 10:53 AM on 9/4/25, located at the bottom of the basement steps, was a dryer exhaust vent pipe extending six inches inward towards the basement from the wall, with exposed, sharp metal edges. The dryer exhaust vent pipe was stuffed with a cloth rag to prevent the basement from exposure to outside elements. At 11:18 AM, the carpet in the area in front of Individual #3's dresser was frayed, exposing carpet padding in an area measuring two feet by one and one-half inches. This section of carpeting was also creased and raised from the rest of the level flooring in seven areas, each measuring in lengths of two feet, one foot, four feet, one and one-half feet, four and one-half feet, and two and one-half feet, respectively, posing as tripping hazards. Floors, walls, ceilings and other surfaces shall be free of hazards.The Provider contacted the landlord. The landlord agreed to make the repairs, but to cut and cap the exposed interior dryer vent. Site Monitor contacted Landlord; Landlord agreed to replace the flooring in accordance with regulations. 10/24/2025 Implemented
6400.80(a)At 10:44 AM on 9/4/25, the top step of the set of three, leading from the basement to the exterior sidewalk adjacent to the detached garage, was missing a large piece of structural concrete in an area measuring approximately two feet in length. This broken step area missing concrete structure was outlined on both sides with jagged edges of remaining concrete, posing a tripping hazard. Outside walkways shall be free from ice, snow, obstructions and other hazards. The Provider has contacted the owner of this residence and has been given preliminary approval to complete these tasks. The Director has made contact with our agency contractor and will meet with him on September 24, 2025, at 10:00 a.m. to develop a plan to address these issues. 10/31/2025 Implemented
6400.101At 10:50 AM on 9/4/25, the interior basement door leading to the attached garage was equipped with a deadbolt lock, requiring a key to disengage it from the garage side. The attached garage did not have an exterior swing door to prevent entrapment.Stairways, halls, doorways, passageways and exits from rooms and from the building shall be unobstructed. DHS currently rents the Smithton home, and we have contacted the owner. We have addressed the issue with the door and the deadbolt lock. A swing door will be provided for our individuals, or the dead bolt will be removed to ensure that there is no entrapment. 10/31/2025 Implemented
6400.111(a)At 11:00 AM on 9/4/25, there was no operable fire extinguisher with a minimum 2-A rating on the home's basement level.There shall be at least one operable fire extinguisher with a minimum 2-A rating for each floor, including the basement and attic. The Provider will have a minimum 2-A-rated Fire Extinguisher located and accessible in the basement. 10/31/2025 Implemented
6400.112(c)According to the written fire drill record submitted from 11/16/24 to 8/21/25, the drill conducted on 8/21/25 did not document the time that it took place, as the corresponding field was left blank. [Repeated Violation-11/13/24, et al]A written fire drill record shall be kept of the date, time, the amount of time it took for evacuation, the exit route used, problems encountered and whether the fire alarm or smoke detector was operative. The fire drill trainings will be monitored and documented correctly by DHS staff to ensure the training is completed in its entirety. 10/31/2025 Implemented
6400.151(a)Director/ Chief Executive Officer Designee #1's date-of-hire to this position is 8/22/25. Through interviews conducted on 9/3/25, Director/ Chief Executive Officer Designee #1 revealed that they have contact with the individuals for more than five days in a six-month period. Director/ Chief Executive Officer Designee #1's content of records included only a physical examination completed on 9/4/25, as there was no documentation of a prior physical examination having been completed before their appointment to this position on 8/22/25. 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. The Director completed his physical examination on September 4, 2025. In the future, the Director will remain in compliance by having a physical exam completed well within the two-year limit. 10/31/2025 Implemented
6400.171At 10:35 AM on 9/4/25, the following perishable food items in the refrigerator were unprotected from contamination: a 22-ounce package of Member's Mark Rotisserie Season Chicken Breast Lunch Meat with a best-if-used-by-date of 7/22/25; a 22-ounce package of Member's Mark Seasoned Angus Roast Beef Lunch Meat with a best-if-used-by-date of 7/2/25; and a 22-ounce package of Member's Mark Uncured Honey Ham Lunch Meat with a best-if-used-by-date of 7/9/25.Food shall be protected from contamination while being stored, prepared, transported and served. All perishable food will be wrapped and labeled with a use-by date. Additionally, Staff will place food in see-through containers to ensure that we can better prevent contamination. 10/31/2025 Implemented
6400.214(b)At 10:10 AM on 9/4/25, neither hard nor electronic copies of the following regarding Individual #1's most current records were kept at the home: an assessment, an applicable social, emotional, and environmental needs plan, which was dated 5/14/23, and incident reports. The most current copies of record information required in § 6400.213(2)¿(14) shall be kept at the residential home. The Provider will confirm that the necessary paperwork is current and up to date on all of our individuals and that incident reports are completed in their entirety and available in hard and electronic copies. 10/31/2025 Implemented
6400.216(a)At 10:05 AM on 9/4/25, the following of Individual #1's and former resident, Individual #2's records were unlocked and in plain view on an open shelf in the staff office area located on the home's main level: a blue binder, entitled, "[Individual #2]---Medical Documentation Papers," containing demographic information, medical appointments dating from 6/22/16 to 6/1/20, and physician orders; a black binder entitled, "[Individual #2] and [Individual #1] goals," containing Individual Support Plan outcome goals for Individual #2 dating from 12/16/22 to 7/15/23, several receipts for purchases by Individual #2 made in 2022, Individual Support Plan outcome goals for Individual #1 dating from 1/16/23 to 10/15/23; and a black binder, entitled, "[Individual #1]---Medical Documentation," containing demographic information, medical appointments dating from 3/23/16 to 7/28/20 as well as a Health Risk Screening Tool completed on 12/28/19. An individual's records shall be kept locked when unattended. All individual documentation will be secured in a locked box and placed in an additional locked container to ensure it's confidentiality. To further ensure compliance, these documents will be removed from common areas and put in a secure, designated area. 10/31/2025 Implemented
6400.15(b)The agency used the Department's licensing inspection instrument modified in June 2018 to complete the self-assessment for this home. The current licensing inspection summary instrument for the community homes regarding individuals with intellectual disability or autism regulations was promulgated in February 2020.(b) The agency shall use the Department's licensing inspection instrument for the community homes for individuals with an intellectual disability or autism regulations to measure and record compliance.DH S has begun to use the Department's Licensing inspection form for 2020. 10/31/2025 Implemented
6400.18(g)Enterprise Incident Management #: 9657592 for exploitation, involving theft/ misuse of funds, was discovered on 7/15/25 at 12:00 AM and reported on 7/16/25 at 4:16 PM. The agency assigned Certified Investigator #2 on 7/15/25 at 9:00 AM. However, Certified Investigator #2's first witness statement was not gathered until 7/17/25 at 10:00 AM with the testimony of Individual #1's relative. Furthermore, Certified Investigator #2 did not make a notation in the Certified Investigator's Report about the reason for this delay in capturing testimonial evidence under the corresponding filed entitled, "Summary of Relevant Information from Witness and Attempts at Interview."The home shall initiate an investigation of an incident, alleged incident or suspected incident within 24 hours of discovery by a staff person.DHS has trained CLA staff to conduct these investigations within the 24-hour timeframe. In addition, we will be using a binder and cataloging the time and date of any incident, and the confirmation of the certified investigator beginning the process within these 24 hours 10/31/2025 Implemented
6400.20(b)The agency did not review, analyze, conduct, and document a trend analysis of incidents at least every three months for its homes during the following time periods: 7/1/24 to 1/31/25 and 6/1/25 to 9/3/25.The home shall review and analyze incidents and conduct and document a trend analysis at least every 3 months.The Provider will complete quarterly data reports on incidents to ensure that these target dates are met and that we can easily access the necessary information. 10/31/2025 Implemented
6400.32(r)(1)At 11:17 AM on 9/4/25, Individual #3's bedroom door was equipped with a privacy lock having a pop button on the interior and a thumbnail, straight-edge access point on the exterior. This locking assembly does not provide Individual #3 with a unique mechanism in which to lock and unlock their bedroom door. At 11:26 AM on 9/4/25, Individual #1's bedroom door was equipped with a privacy lock having a pop button on the interior and a thumbnail, straight-edge access point on the exterior. This locking assembly does not provide Individual #1 with a unique mechanism in which to lock and unlock their bedroom door.Locking may be provided by a key, access card, keypad code or other entry mechanism accessible to the individual to permit the individual to lock and unlock the door.The Provider will review the Individual and Basic Rights to confirm whether they want a lock on the door. Additionally, staff will change the locks if the individual chooses to have locks installed on the door. We will also be discussing this matter with the homeowner, as DHS does not own this home. 10/31/2025 Implemented
6400.32(r)(4)At 11:17 AM on 9/4/25, Individual #3's bedroom door was equipped with a privacy lock having a pop button on the interior and a thumbnail, straight-edge access point on the exterior. This bedroom door lock mechanism does not allow easy and immediate access by the individual and staff persons in the event of an emergency. At 11:26 AM on 9/4/25, Individual #1's bedroom door was equipped with a privacy lock having a pop button on the interior and a thumbnail, straight-edge access point on the exterior. This bedroom door lock mechanism does not allow easy and immediate access by the individual and staff persons in the event of an emergency.The locking mechanism shall allow easy and immediate access by the individual and staff persons in the event of an emergency.The Provider will inquire with the individuals to confirm if they want locks on their doors. If, in fact, the individual wishes to have a lock, we will change the locks to comply with regulatory standards. 10/31/2025 Implemented
6400.51(b)(4)Program Specialist #3's date-of-hire is 11/11/24. Program Specialist #3's orientation record did not include required training on recognizing and reporting incidents.The orientation must encompass the following areas: recognizing and reporting incidents.New hires will complete the necessary training within the first week of employment. The employee will have a checklist in their respective employee file that needs to be signed off on by their direct supervisor. 10/31/2025 Implemented
6400.51(b)(5)Program Specialist #3's date-of-hire is 11/11/24. Program Specialist #3's orientation record did not include all job-related knowledge and skills.The orientation must encompass the following areas: Job-related knowledge and skills.The Provider will have all new hires complete their orientation packets in their entirety. DHS will add any relevant paperwork to these documents, including job-related skills and knowledge. 10/31/2025 Implemented
6400.163(d)At 10:00 AM on 9/4/25, the home's first aid kit included the following unlocked, accessible over-the-counter medications: seven packets of Antacid, each containing two 420 MG tablets; two packets of Aspirin, each containing two 325 MG tablets; and two packets of Ibuprofen, each containing two 200 MG tablets.Prescription medications and syringes, with the exception of epinephrine and epinephrine auto-injectors, shall be kept in an area or container that is locked.All unnecessary medications and syringes will be removed from the first aid kits and be placed in locked containers. 10/31/2025 Implemented
SIN-00217012 Renewal 01/04/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(f)On 1/5/23 at 9:35AM, there were two outdoor trash receptacles in the front of the home overflowing with trash in bags causing the lids not to fully close.Trash outside the home shall be kept in closed receptacles that prevent the penetration of insects and rodents.An additional outdoor trash receptacle with closing lid was purchased for the Smithton home to ensure that there are no occasions in which the lid is not able to close completely. Each site was contacted on 1/12/2023 to ensure that there are no occasions in which their trash receptacle could not close due to excessive amounts of garbage or other related issues. It was confirmed that all other community living arrangements have trash receptacles that are large enough to accommodate the amount of trash that they produce. 01/12/2023 Implemented
6400.141(c)(9)Individual #1, date of birth 2/19/58, who was admitted on 2/12/85, had a prostate examination on 7/27/22. There was not a record of the previous prostate examination; therefore, compliance could not be measured.The physical examination shall include: A prostate examination for men 40 years of age or older. A tracking spreadsheet for medical exams was created on 1/30/2023, and includes tracking the dates of each individual's prostate exam to allow the program specialist to monitor the completion of a prostate exam. 01/30/2023 Implemented
6400.142(a)Individual #1 had a dental examination on 3/15/19 and then again 1/3/22.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. A tracking spreadsheet for medical exams was created on 1/30/2023, and includes tracking the dates of each individual's dental exam to allow the program specialist to monitor the completion of a dental exam. 01/30/2023 Implemented
6400.171On 1/5/23 at 10:08AM, there was a small block of cheese with what appears to be mold and a package of partially used "deli" meat with a best use by date of 10/1/22 in the refrigerator in the kitchen of the home.Food shall be protected from contamination while being stored, prepared, transported and served. A checklist of duties for overnight or other designated staff was created on 1/31/2023. Site monitors and program specialist will be trained on the proper completion of the checklist during a meeting scheduled for 2/17/2023. This checklist includes checking the refrigerator for expired or unlabeled food. 02/17/2023 Implemented
6400.15(b)The agency used a Department's licensing inspection instrument modified in June 2018. The current licensing inspection summary instrument for the community homes for individuals with intellectual disability or autism regulations was promulgated in February 2020.(b) The agency shall use the Department's licensing inspection instrument for the community homes for individuals with an intellectual disability or autism regulations to measure and record compliance.The internal policy for self-assessment was updated on 1/25/2023 to include the current Provider self-assessment tool, and previously used forms were replaced on the shared drive with the correct form on the same date. The form was forwarded via email to the Chief Executive Officer and Program Specialist on 1/6/2023 with direction that this form should be utilized moving forward per inspection. 01/25/2023 Implemented
6400.20(b)The home is not reviewing and analyzing incidents and conducting and documenting a trend analysis for at least the prior year.The home shall review and analyze incidents and conduct and document a trend analysis at least every 3 months.The agency will implement the use of an incident review committee consisting of a minimum of two members of the management team. The incident review committee will complete and document trend analysis for incidents occurring in each residential home individually and across the board. Documentation of data and trend analysis will be kept by an employee qualifying as program specialist. The first committee meeting will occur on February 17, 2023. 02/17/2023 Implemented
6400.34(b)Individual #1 signed a statement acknowledging receipt of the information on individual rights on 1/1/20 then again 1/1/22.The home shall keep a copy of the statement signed by the individual, or the individual's court-appointed legal guardian, acknowledging receipt of the information on individual rights.Program Specialists will continue with its current process of having the individual rights page reviewed and signed by all individuals served in the community living arrangements on January 1st of each calendar year. However, should an individual plan to not be in the care of the program during this time (January 1st) an individual rights form will be reviewed and signed by the individual or the individual¿s court appointed guardian prior to their departure. A training of regulatory standards for individual rights documentation will be completed with site monitors and program specialist in February 17, 2023. 02/17/2023 Implemented
6400.52(b)(1)Chief Executive Officer #1 completed 7.5 hours of annual training in the training year from January 1, 2022 to December 31, 2022.The following shall complete 12 hours of training each year: Management, program, administrative and fiscal staff persons.A tracking spreadsheet was created on 1/31/2023 to monitor the Chief Executive Officer¿s training hours and added to the shared folder where tracking spreadsheets for monitoring the training hours of program specialists and direct support staff are saved. The Chief Executive Officer will schedule and complete 12 hours of training per calendar year. The next measurement period is January 1, 2023 ¿ December 31, 2023. 01/31/2023 Implemented
6400.52(c)(1)Chief Executive Officer #1's training for the training year from January 1, 2022 to December 31, 2022, did not include the application of person-centered practices, community integration, individual choice, and supporting individuals to develop and maintain relationships.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.The Chief Executive Officer will attend the online, self-paced Person Centered Practices training provided by the Office of Developmental Programs by February 28, 2023. Completion of this training will be evidenced by retention of a training certificate. A tracking spreadsheet was created on 1/31/2023 to monitor the Chief Executive Officer¿s training hours and added to the shared folder where tracking spreadsheets for monitoring the training hours of program specialists and direct support staff are saved. 02/28/2023 Implemented
6400.52(c)(2)Chief Executive Officer #1's training for the training year from January 1, 2022 to December 31, 2022, did not include the prevention, detection, and reporting of abuse, and alleged abuse.The annual training hours specified in subsections (a) and (b) must encompass the following areas: The prevention, detection and reporting of abuse, suspected abuse and alleged abuse in accordance with the Older Adults Protective Services Act (35 P.S. §§ 10225.101-10225.5102). The child protective services law (23 Pa. C.S. §§ 6301-6386) the Adult Protective Services Act (35 P.S. §§ 10210.101 - 10210.704) and applicable protective services regulations.The Chief Executive Officer will attend the online, self-paced Abuse: Detection, Reporting, and Prevention of Abuse and Alleged Abuse training provided by the Office of Developmental Programs by February 28, 2023. Completion of this training will be evidenced by retention of a training certificate. A tracking spreadsheet was created on 1/31/2023 to monitor the Chief Executive Officer¿s training hours and added to the shared folder where tracking spreadsheets for monitoring the training hours of program specialists and direct support staff are saved. 02/28/2023 Implemented
6400.52(c)(3)Chief Executive Officer #1's training for the training year from January 1, 2022 to December 31, 2022, did not include Individual Rights.The annual training hours specified in subsections (a) and (b) must encompass the following areas: Individual rights.The Chief Executive Officer will attend the online, self-paced Individual Rights training provided by the Office of Developmental Programs by February 28, 2023. Completion of this training will be evidenced by retention of a training certificate. A tracking spreadsheet was created on 1/31/2023 to monitor the Chief Executive Officer¿s training hours and added to the shared folder where tracking spreadsheets for monitoring the training hours of program specialists and direct support staff are saved. 02/28/2023 Implemented
6400.52(c)(4)Chief Executive Officer #1's training for the training year from January 1, 2022 to December 31, 2022, did not include Recognizing and reporting incidents.The annual training hours specified in subsections (a) and (b) must encompass the following areas: Recognizing and reporting incidents.The Chief Executive Officer will attend the online, self-paced Recognizing and Reporting Incidents training provided by the Office of Developmental Programs by February 28, 2023. Completion of this training will be evidenced by retention of a training certificate. A tracking spreadsheet was created on 1/31/2023 to monitor the Chief Executive Officer¿s training hours and added to the shared folder where tracking spreadsheets for monitoring the training hours of program specialists and direct support staff are saved. 02/28/2023 Implemented
6400.166(a)(5)Individual #1 is prescribed Refresh Celluvisc Op 1%, instill one drop into both eyes 6 times daily. Individual #1's January 2023 Medication Administration Record for this medication had Refresh Tears 0.5% Eye drop apply 1 drop to eye 6 times per day.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Strength of medication.A checklist of weekly duties for overnight or other designated staff was created on 1/31/2023. Site monitors and program specialist will be trained on the proper completion of the checklist during a meeting scheduled for 2/17/2023. This checklist includes ensuring that all medication labels match the MAR and include the medication strength. A training on regulatory standards for medication will be completed with site monitors and program specialist in a meeting scheduled for 2/17/2023. 02/17/2023 Implemented
6400.166(a)(7)Individual #1 is prescribed Refresh Celluvisc Op 1%, instill one drop into both eyes 6 times daily. Individual #1's January 2023 Medication Administration Record reads Refresh Tears 0.5% Eye drop, apply 1 drop to eye 6 times per day. The medication administration record does not indicate to apply to both eyes.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Dose of medication.A checklist of weekly duties for overnight or other designated staff was created on 1/31/2023. Site monitors and program specialist will be trained on the proper completion of the checklist during a meeting scheduled for 2/17/2023. This checklist includes ensuring that all medication labels match the MAR and include the medication strength. A training on regulatory standards for medication will be completed with site monitors and program specialist in a meeting scheduled for 2/17/2023. 02/17/2023 Implemented
6400.166(a)(11)Individual #1's January 2023 Medication Administration Record does not include the diagnosis or purpose for Refresh Celluvisc Op 1% eye drops.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Diagnosis or purpose for the medication, including pro re nata.Upon receipt of a new medication and/or MAR the site monitor or on site employee is responsible for ensuring that the medication label includes all required items and matches the MAR. In order to ensure this step is being completed, a checklist of weekly duties for overnight or other designated staff was created on 1/31/2023. Site monitors and program specialist will be trained on the proper completion of the checklist during a meeting scheduled for 2/17/2023. This checklist includes ensuring that all medication labels match the MAR and include the medication purpose. A training on regulatory standards for medication will be completed with site monitors and program specialist in a meeting scheduled for 2/17/2023. 02/17/2023 Implemented
SIN-00071534 Renewal 01/21/2015 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.106The most recent furnace inspections were completed on 3/20/13 and 4/11/14.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. Agency developed tracking chart for annual furnace inspections and procedure for annual furnace inspections to be scheduled and confirmed once completed. Program supervisors are responsible for scheduling annual inspections to be done within a 12 month period and site monitors are responsible for confirming appointments, advising supervisors when inspection is complete, and forwarding copy of inspection invoice to program director. All 2015 inspections are scheduled. 02/10/2015 Implemented
SIN-00057918 Renewal 12/20/2013 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.33(e)The bathrooms in the home do not have window coverings that cover the windows to allow for privacy during personal care. (e) An individual has the right to privacy in bedrooms, bathrooms and during personal care. Blinds were purchased and put on bathroom windows to ensure privacy. [All windown coverings will be checked in all community homes to ensure that they allow for privacy in bedrooms, bathrooms and during personal care by the program specialist by 2/28/14. (CHG 1/10/14)] 12/30/2013 Implemented
SIN-00184351 Renewal 03/08/2021 Compliant - Finalized
SIN-00169211 Renewal 01/14/2020 Compliant - Finalized
SIN-00129079 Renewal 02/09/2018 Compliant - Finalized
SIN-00088650 Renewal 01/21/2016 Compliant - Finalized