| Regulation | LIS Non-Compliance Area | Correction Required | Plans of Correction | Correction Date | POC Status |
| 6400.22(d)(1) | At the time of the inspection, there was no tracking being done for individual #1's spending money or EBT card. The individual's ability to handle these independently is unclear from both the assessment and ISP.
The 6/12/25 assessment does not fully describe the individual's ability to handle finances. The assessment states that it is unknown if the individual can balance a checkbook, the individual does not always know the correct values for items and needs someone to protect their asset level for consolidated waiver eligibility. The individual is currently given $75-$100/month by their representative payee. The individual is managing this money independently despite the assessment not reflecting this or supporting their ability to do so. The individual's ISP is also unclear as it states the individual can allocate weekly spending money but makes no mention of the individual being able to handle a monthly amount. The individual also has an EBT card and is receiving monthly deposits onto this. The individual has not been thoroughly assessed as to their ability to use this card independently and it reportedly has not been used at all since, they were admitted to cares in April 2025. | The home shall keep an up-to-date financial and property record for each individual that includes the following: Personal possessions and funds received by or deposited with the home. | Individual 1's rep payee was notified that the EBT card with food stamps needs to be closed out immediately. This notification occurred on 08/07/2025 (Attachment 2). |
08/07/2025
| Implemented |
| 6400.144 | At the time of the inspection on 8/6/25 there were several PRN medications listed on the MAR that were not available in the home. The missing medications are as followed:
· Anti Itch Lotion 0.5% (equivalent to Sarna)
· Phenylephrine 10mg
· Pramoxine HCL 1% (not a steroid like hydrocortisone, topical anesthetic)
· Stopain 8% Spray | 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 Lead DSP reviewed the MARs after the inspection. As suspected, the 4 above listed medications were not current medications when the individual moved into the home. The pharmacy who generates and sends CARES the MARs has been notified of this repeatedly, but they continue to send the MARs with incorrect information. Additionally, the above 2 medications Pramoxine HCL 1% (not a steroid like hydrocortisone, topical anesthetic) and Anti Itch Lotion 0.5% (equivalent to Sarna) are the same medication (Attachment 9). The Stopain 8% Spray prescription expired on 09/07/2024 prior to individual 1 moving into the CARES home (Attachment 10) and has never been on this med since moving into CARES. The pharmacy has been and will continue to be notified of this. Phenylephrine 10mg is on individual 1's MAR from the pharmacy however this med is not on the MARs from the previous provider, not in the ISP, not on the med lists, not in the Oasis portal (psych), and not in the Geisinger portal (PCP). It is unknown to CARES why this med is on the MAR generated from the pharmacy. The pharmacy has been and will continue to be notified of this. |
08/19/2025
| Implemented |
| 6400.181(e)(13)(vii) | The individual's 6/12/25 assessment does not fully assess their ability to handle their finances independently. It does not address if they are able to independently manage any amount of spending money however they are being given lumpsums of $75-100 per month by the representative payee. This section of the assessment was copied from the financial management section of the individual's ISP and it does not appear that a true assessment of the individual's ability regarding finances was conducted. | 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.
| Individual #1 is unable to manage their own bank account and has a rep payee, who helps them maintain their waiver eligibility. The rep payee sends Individual #1 $75-$100 per week, in the form of a check. Individual #1 is able to go to the bank and cash the check without support from staff. They demonstrate an understanding of how much the money is worth and when the money runs out. The individual demonstrates an ability to identify all coins and bills, though they prefer to put their money on a reloadable card because it is easier to carry. They recognize what they can and cannot afford independently, however if the individual does need help, they will ask their staff for assistance. Individual #1 also has access to $300 per month in petty cash for outings or other supplies as needed. Although Individual #1 does not handle this money (staff handle this money), the individual works with staff to budget throughout the month. Since moving in in April, they have shown impulsivity with their spending habits but ultimately understands the value of a dollar and is understanding of why it runs out so quickly. Individual #1 moved into the group home with CARES of Central PA in April 2025. The progress in this area will continue to be monitored and changes to his support in this area will be made accordingly. The assessment was updated to reflect this information. For the $300 that Individual #1 does not independently maintain, staff will keep track of all transactions and keep receipts over $15. |
08/22/2025
| Implemented |
| 6400.165(g) | Individual #1 had a psychotropic medication review completed on 7/16/25. The medications, dosages, and reason for prescribing these medications was not identified on the paperwork. It says "see list" on the form but there is no medication list or any additional documentation attached. | If a medication is prescribed to treat symptoms of a psychiatric illness, there shall be a review by a licensed physician at least every 3 months that includes to document the reason for prescribing the medication, the need to continue the medication and the necessary dosage. | On 08/19/2025 CARES reached out to obtain the med list from the doctor's office who held the psych med review appointment on 07/16/2025. A voicemail was left on the phone, and a message was sent in the portal requesting the med list referenced on the appointment form (Attachment 8). |
08/19/2025
| Implemented |
| 6400.166(a)(2) | The MAR's for May 2025 through August 2025 do not include the prescriber for any of the prescribed medications. | A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Name of the prescriber. | A list of all medications for each month, including prescriber for the prescribed daily medications, is included on the list (Attachment 6) has been created and added to the respective MARs. |
08/19/2025
| Implemented |
| 6400.166(a)(11) | The MAR's for May 2025 through August 2025 did not include any diagnoses for the prescribed daily medications. Only the PRN medications had diagnoses listed. | 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. | A list of all medications for each month, including diagnoses for the prescribed daily medications, is included on the list (Attachment 6) has been created and added to the respective MARs. |
08/19/2025
| Implemented |
| 6400.167(a)(1) | Per the June 2025 MAR, the 5:30pm dose of Gs Clearlax powder was not given on 6/30/25. | Medication errors include the following: Failure to administer a medication. | This med error was not an actual omission but rather an error in documentation as this med was refused. Upon realizing there was a error in documentation during the inspection, a incident was filed (EIM#9671427 on 08/07/2025). |
08/19/2025
| Implemented |
| 6400.207(4)(I) | Individual #1 is prescribed Perphenazine 4mg tablet as take one tablet by mouth daily as needed for agitation. In order for a psychotropic medication to be given as a PRN, the following are required per ODP Bulletin 00-02-09:
1. Confirmed documentation by a physician or medical practitioner of the individual's mental illness diagnosis shall be present in the individual's record.
2. Written instructions by a physician or medical practitioner listing the individual's specific mental illness symptoms that would warrant the use of a PRN psychotropic medication shall be included in the physician's prescription of the medication.
3. Prescribed directions on the pharmacy label shall include frequency (dose and allowable rate of recurrence of dosage) for administration of the PRN.
4. Authorization by the CEO or CEO's designee for each instance of administration of a PRN psychotropic medication shall be documented in the applicable medication log.
5. Monitoring as indicated by a physician or medical professional and as directed on the pharmacy label of the actual response to medication each time a PRN is administered shall be documented in the individual's record.
Individual #1 does have a confirmed mental health diagnosis however the prescriber of the psychotropic PRN did not provide written instruction regarding what specific symptoms would warrant the use of this PRN. The individual was administered this medication on 5/1/25, 5/8/25, 5/12, 5/18, 5/19, 5/27, 5/29, 6/5, 6/15, 6/20, and 6/22. Furthermore, the administration of a psychotropic PRN requires authorization by the CEO or CEO Designee for each instance of the administration of a PRN psychotropic medication. There was no CEO/CEO Designee authorization for any instance of the administration of this medication. | A chemical restraint, defined as use of a drug for the specific and exclusive purpose of controlling acute or episodic aggressive behavior. A chemical restraint does not include a drug ordered by a health care practitioner or dentist for the following use or event: Treatment of the symptoms of a specific mental, emotional or behavioral condition. | On 08/08/2025 individual 1's doctor wrote an order stating that they are to receive their PRN upon request. (Attachment 4). |
08/19/2025
| Implemented |