Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00291633 Renewal 07/09/2026 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.103The furnace was inspected on 7/16/24 and not again until 8/21/25. This exceeds the requirement.Furnaces shall be cleaned at least annually. Written documentation of the cleaning shall be kept.The Program Specialist/AVP retrained the Life share provider on the regulation and requirements for the furnace. 07/23/2026 Implemented
6500.123(a)Individual #1's record documents that on 8/22/25 Individual #1 refused to attend an eye exam for many years-he is blind, and at the bottom the form it noted date of 1st attempt 8/22/25, date of 2ndt attempt 12/16/25, date of 3rd attempt 3/20/26. There is no record or documentation of Individual #1 being trained on the importance of attending an eye appointment. Individual #1's record documents that on 8/22/25 Individual #1 refused to have dental work-last dental exam was in 2015.and at the bottom the form it noted date of 1st attempt 8/22/25, date of 2ndt attempt 12/16/25, date of 3rd attempt 3/20/26. There is no record or documentation of Individual #1 being trained on the importance of attending a dental appointment.If an individual refuses routine medical or dental examination or treatment, the refusal and continued attempts to train the individual about the need for health care shall be documented in the individual's record.Fitzmaurice updated the medical appointment refusal form to include a section for training and education for the individual. 08/05/1926 Implemented
6500.124Individual #1 had a neurology appointment in 4/15/26, and Individual #1 refused the appointment, and the appointment was rescheduled for June 2026. There is no record or documentation that the appointment occurred for Individual #1. Individual #1 had an ENT appointment on 9/3/25, and the form noted for the date of the next appointment 3-4 months 1/9/26 @ 2:15. There is no record or documentation that is appointment occurred for Individual #1 as the next ENT appointment in the record occurred on 3/30/26. Individual #1 had a podiatry appointment on 8/26/25 and noted for the date of the next appointment 4 months, and the next appointment in Individual #1 record occurred on 3/6/26 which is over the prescribed 4 months. Individual #1 had a urology appointment on 8/2/23 and the appointment form noted to return annually and there is no record or documentation of any urology appointments occurring since. Individual #1 is prescribed Clozapine ODT 5 mg Tab, take 0.5-1 mg tablets (2.5-5 mg total) by mouth daily as needed agitation/restlessness. The June 2026 Medication Administration Record (MAR) documented that the medication was administered to Individual #1 on 6/2/26,6/6/26, 6/9/26, 6/12/26, 6/19/26, 6/21/26, 6/22/26, and 6/29/26. There was no documentation in the file for the specific symptoms of agitation/restlessness displayed by Individual #1 for staff to administer the PRN medication.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.The program specialist/AVP will provide the lifeshare provider with upcoming dates for appointments and due dates for requirements at each monthly monitoring and offer assistance if needed for scheduling the appointments. At the time of licensing, A PVR for the neurology appointment wasn't scanned. James attended a neurology appt on 6/2/26. During monthly monitoring the PS/AVP will review all paperwork and documentation of completed appointments with the life share provider and ensure all follow up and scheduled appointments are attended. AVP/PS will also provide the dates of upcoming appointments, trainings, necessary documentation and events for the following month. AVP/PS will review all medication bottles and the MAR for accuracy. 07/23/2026 Implemented
6500.135(g)Individual #1 is prescribed medications to treat the symptoms of a diagnosed psychiatric illness and had a medication review on 6/2/25, 8/18/25, 12/15/25, and 2/26/25. The forms used for each of these appointments did not include the medication and the necessary dosage under the current psych medications section it noted "see attached", however there was nothing further included or uploaded in the electronic file/record.If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a review by a licensed physician at least every 3 months to document the r reason for prescribing the medication, the need to continue the medication and the necessary dosage.Managers and Program Specialist were retrained on 7/30/26 on "see attached" on Physician visit forms. Program specialist and managers were trained if they are writing see attached then the documents need to be attached when scanned. James ' last psych medication review was 5/26/26. The medications were listed on this form and a current medication list from the June 23, 2026 monitoring was also attached. James ' last psych medication review was 5/26/26. The medications were listed on this form and a current medication list from the June 23, 2026 monitoring was also attached. See attached documentation. Managers and PS were retrained on 7/30/26 on "see attached on Physician forms visit forms. Program Specialist and managers were trained if they are writing "see attached" then the documents need to be attached when scanned. 07/30/2026 Implemented
6500.136(a)(7)Individual #1 is prescribed Clozapine ODT 5 mg Tab, take 0.5-1 mg tablets 2.5-5 mg total) by mouth daily as needed agitation/restlessness. Individual #1's Medication Administration Record (MAR) documented the same for Individual #1 however the dose of the medication is not specific for the amount to be administered.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Dose of medication.Program Specialist had the lifeshare provider contact the individual's prescribing doctor to obtain a script with an exact dosage to be administered to the individual. Upon receipt the MAR was updated to reflect the dosage amount. 07/23/2026 Implemented
6500.139(a)Lifesharing providers who administer medications require bi-annually Modified Medication Administration Training. Staff #1 completed the Modified Medication Administration Training on 4/15/24, and not again until 5/4/26. Staff medication administration training is not being conducted as prescribed by the medication administration training course.A staff person who has successfully completed a Department-approved medications administration course, including the course renewal requirements may administer medications, injections, procedures and treatments as specified in § 6500.132 (relating to medication administration).The program specialist/AVP will provide the lifeshare provider with upcoming dates for appointments, trainings and due dates for requirements at each monthly monitoring and offer assistance if needed for scheduling the appointments. 07/23/2026 Implemented
SIN-00130042 Renewal 01/17/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.121(c)(6)Individual #1 had a TB test on 04/08/14, then not again until 08/09/16.Tuberculin skin testing by Mantoux method with negative results every 2 years for individuals 1 year of age or older; or, if a tuberculin skin test is positive, an initial chest x-ray with results noted.The physician's office did not have the Mantoux medication to administer when it was due. When it was available, it was administered. see attached note to file. 01/18/2018 Implemented
6500.151(a)Individual #1's assessment was late. One was completed 04/05/16, then not again until 05/11/17.Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the family living 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 family living home.The reminder to complete the Assessment annually has been inputted into the Program Specialists Outlook Calendar. 02/01/2018 Implemented
6500.151(e)(13)(i)Individual #1's assessment 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.The Assessment has been updated and the new Assessment requires that progress be explained. See attached new Assessment form 01/18/2018 Implemented
6500.151(e)(13)(ii)Individual #1's assessment did not document progress and growth in the area of motor and communication skills.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Motor and communication skills.The Assessment was revised to indicate progress- see attached updated assessment. The Assessment form used by FCS has been revised and asks specifically to describe progress. See attached new Assessment 01/18/2018 Implemented
6500.151(e)(13)(iii)Individual #1's assessment did not document progress and growth in the area of activities of residential living. The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Activities of residential living.The assessment was revised to indicate progress - see attached. The Assessment that FCS now uses specifically asks to describe progress in this area. See attached assessment form 01/18/2018 Implemented
6500.151(e)(13)(iv)Individual #1's assessment did not document progress and growth in the area of personal adjustment. The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Personal adjustment.The assessment was revised to indicate progress in this area - see attached assessment. FCS now uses a new Assessment and it specifically asks to describe progress in this area. See attached 01/18/2018 Implemented
6500.151(e)(13)(v)Individual #1's assessment 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.The Assessment was revised to indicate progress- see attached updated assessment. The Assessment form used by FCS has been revised and asks specifically to describe progress. See attached new Assessment 01/18/2018 Implemented
6500.151(e)(13)(vi)Individual #1's assessment 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.The Assessment was revised to indicate progress- see attached updated assessment. The Assessment form used by FCS has been revised and asks specifically to describe progress. See attached new Assessment 01/18/2018 Implemented
6500.151(e)(13)(vii)Individual #1's assessment did not document progress and growth in the area of financial independence. The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Financial independence.The Assessment was revised to indicate progress- see attached updated assessment. The Assessment form used by FCS has been revised and asks specifically to describe progress. See attached new Assessment 01/18/2018 Implemented
6500.151(e)(13)(viii)Individual #1's assessment did not document progress and growth in the area of managing 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.The Assessment was revised to indicate progress- see attached updated assessment. The Assessment form used by FCS has been revised and asks specifically to describe progress. See attached new Assessment 01/18/2018 Implemented
6500.151(e)(13)(ix)Individual #1's assessment did not document progress and growth in the area of community integration. The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Community integration.The Assessment was revised to indicate progress- see attached updated assessment. The Assessment form used by FCS has been revised and asks specifically to describe progress. See attached new Assessment 01/18/2018 Implemented
6500.182(c)(1)(ii)The record for Individual #1 did not document the individual's identifying marks. Each individual's record must include the following information: Personal information, including: The race, height, weight, color of hair, color of eyes and identifying marks.Identifying marks were added during licensing. Going forward, the Administrative Assistant will input that information when added the individual into our electronic files 01/18/2018 Implemented
6500.182(c)(1)(iv)Individual #1's file did not document his religious affiliation.Each individual's record must include the following information: Personal information, including: The religious affiliation.The religious affiliation was added at licensing. See attached. The Department's Administrative Assistant will input this information into our electronic record when adding this individual to our system 01/18/2018 Implemented
SIN-00163462 Renewal 10/28/2019 Compliant - Finalized