Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00216822 Renewal 12/15/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.21(a)Staff #1 Date of Hire: 11/7/2022 Background Check 12/7/2022 Staff #2 Date of Hire: 11/7/2022 Background Check 12/7/2022 Staff #3 Dare of Hire: 10/24/2022 Background Check 12/7/2022 Staff #4 Date of Hire: 1/3/2022 Background Check 12/13/2022An application for a Pennsylvania criminal history record check shall be submitted to the State Police for prospective employes of the home who will have direct contact with individuals, including part-time and temporary staff persons who will have direct contact with individuals, within 5 working days after the person's date of hire. 6400.21(a) was reviewed with onboarding team; going forward criminal background checks for new employees will be completed per the regulation timeline 01/31/2023 Implemented
6400.151(a)No physical exam is in the record for Staff #8 and Staff #5 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. List of last employee physical dates was requested from Occupational Health to know which employees will need their physical in 2023; those who did not receive it in 2022 will be on the list as well 12/31/2022 Implemented
6400.151(c)(2)For Staff #10, No TB test on physical dated 12/8/2022; physical indicated PPD was differed The physical examination shall include: Tuberculin skin testing by Mantoux method with negative results every 2 years; or, if tuberculin skin test is positive, an initial chest x-ray with results noted. Tuberculin skin testing may be completed and certified in writing by a registered nurse or a licensed practical nurse instead of a licensed physician, licensed physician's assistant or certified nurse practitioner. List of last employee PPD test was requested from Occupational Health to know which employees will need PPD test or chest xray submission in 2023; those who did not receive it in 2022 will be on the list as well 12/31/2022 Implemented
6400.46(a)Current fire safety certificate is not in the record for Staff #3,5.6,7,8,9,10Program specialists and direct service workers shall be trained before working with individuals in general fire safety, evacuation procedures, responsibilities during fire drills, the designated meeting place outside the building or within the fire safe area in the event of an actual fire, smoking safety procedures if individuals or staff persons smoke at the home, the use of fire extinguishers, smoke detectors and fire alarms, and notification of the local fire department as soon as possible after a fire is discovered.ODL Team and Office Admin scheduled meeting with Fire Expert for ¿train the trainer¿ and will be certified to issue certificates of completion for Fire Safety training provided by Fire Expert 01/25/2023 Implemented
6400.169(d)There were no Medication course requirements on file for staff #169d including the practicumA record of the training shall be kept, including the person trained, the date, source, name of trainer and documentation that the course was successfully completed.Medication Administration training is being scheduled for staff including Practical Observations and updated system of filing/tracking for all certifications and observation paperwork 06/30/2023 Implemented
SIN-00196390 Unannounced Monitoring 11/18/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(a)The Hallway Bathroom adjacent to the bedrooms on the first floor had a build up of dirt and toothpaste in each of the sinks, the bathtub and corners of the tub had dirt and mildew build up throughout. The kitchen cabinet knobs had residue consistent with grease and dirt and the stovetop was observed to have puddles of grease settling on the right rear burner. The second-floor bathroom bathtub and sink had residue consistent with dirt and mildew built up throughout.Clean and sanitary conditions shall be maintained in the home. Program manager reviewed this violation with the team and reminded the staff team about the daily cleaning checklist. The program manager also cleaned the home with the staff members after the 11/18/21 unannounced visit. The program manager walked the staff through the home in order for the staff team to observe the expectation of the level of cleanliness of each area of the home, as well as the expected maintenance of the cleanliness of the home. 11/26/2021 Implemented
6400.64(c)The vacant bedroom on the first floor had a buildup of item that were no longer in use.Trash shall be removed from the premises at least once per week. Program manager reviewed this violation with the team and reminded the staff team about the daily cleaning checklist. The program manager also cleaned the home with the staff members after the 11/18/21 unannounced visit. The program manager walked the staff through the home in order for the staff team to observe the expectation of the level of cleanliness of each area of the home, as well as the expected maintenance of the cleanliness of the home. The excess trash/buildup was removed. 11/26/2021 Implemented
6400.67(a)The refrigerator door handle was loose and the faucet fixtures in the hallway bathroom were loose and leaked when they were turned on. Individual #2's bedroom door had an approximate 6-inch by 12-inch hole on the upper right side of the door. Individuals light switch plate was also damaged.Floors, walls, ceilings and other surfaces shall be in good repair. The refrigerator handle and faucets fixtures have been repaired. 01/07/2022 Implemented
6400.67(b)Dryer lint larger than a golf ball amount was discovered in the dryer at the time of inspection Floors, walls, ceilings and other surfaces shall be free of hazards.Program manager reviewed this violation with the team and reminded the staff team about the daily cleaning checklist. The program manager also cleaned the home with the staff members after the 11/18/21 unannounced visit. The program manager walked the staff through the home in order for the staff team to observe the expectation of the level of cleanliness of each area of the home, as well as the expected maintenance of the cleanliness of the home. This included a review of the need to clean the dryer lint trap after every use. The lint has been removed. 11/26/2021 Implemented
6400.82(f)There were no hand towels, paper towels and toilet paper in the hallway bathroom adjacent to the bedrooms.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. Program manager reviewed this violation with the team and reminded the staff team about the daily cleaning checklist which includes ensuring that supplies are available. The paper towels and toilet paper were replaced. 11/26/2021 Implemented
6400.101The Basement door had a chain lock and a push pin deadbolt lock on the first-floor side of the room, preventing immediate escape from basement level.Stairways, halls, doorways, passageways and exits from rooms and from the building shall be unobstructed. The basement is secured with the added locks to secure the home from possible intruders entering through the basement. 01/14/2022 Implemented
6400.163(g)There was an expired tube of SF 5000 toothpaste discovered in individual #1's medication box. The expiration date on the prescribed tube read 12/13/2019.Prescription medications shall be stored in an organized manner under proper conditions of sanitation, temperature, moisture and light and in accordance with the manufacturer's instructions.The expired toothpaste was removed and replaced. The program manager will complete a weekly MAR and medication audit. 01/14/2022 Implemented
6400.166(b)Ziprasidone capsule 6mg prescribed to individual #1 was not logged immediately after administration on 11/1/2021. The field for initials was left blank. Clonezapam .5mg prescribed to individual #1 to be taken three times daily was not logged for the 1pm Dose on 11/1/2021.The information in subsection (a)(12) and (13) shall be recorded in the medication record at the time the medication is administered.The program manager will retrain the staff team on MAR documentation. The program manager will complete weekly MAR reviews. 01/21/2022 Implemented
SIN-00155718 Renewal 04/11/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.15(b)The self-assessment for this home did not complete pages 4,5, and 6.The agency shall use the Department's licensing inspection instrument for the community homes for people with intellectual disability regulations to measure and record compliance. All Management staff of the appropriate departments have been retrained on the 6400 Self Assessment tool. This was completed on 5/6/2019. Going forward, all new management staff will also be trained on the Self Assessment Tool. 05/06/2019 Implemented
SIN-00109601 Renewal 02/09/2017 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)There was a dresser in individual #3's bedroom that was missing knobs. There was a dresser in individual #3's bedroom that was missing knobs. Individual #4's bedroom had a broken heater cover. Floors, walls, ceilings and other surfaces shall be in good repair. A repair request was submitted to Bancroft¿s Facilities department to replace the missing knobs on individual #3¿s dresser as well as to repair the broken heater cover in individual #4¿s bedroom. These repairs were completed. 04/03/2017 Implemented
6400.68(b)The water temperature in the home was tested and found to be 129 degrees Fahrenheit. Hot water temperatures in bathtubs and showers may not exceed 120°F. A repair request was submitted to Bancroft¿s Facilities department to adjust the temperature of the water in the home. This repair request was completed. Staff will continue to take water temperatures on a daily basis. 04/03/2017 Implemented
6400.71There were no emergency numbers listed by the phone in the kitchen. Telephone numbers of the nearest hospital, police department, fire department, ambulance and poison control center shall be on or by each telephone in the home with an outside line. Emergency numbers including the nearest hospital, police department, fire department, ambulance and poison control center have been posted next to the phone in the kitchen. Please see Attachment number 13 for supporting documentation. 04/03/2017 Implemented
6400.111(f)There was a fire extinguisher in the second floor hallway that did not have an inspection tag. A fire extinguisher shall be inspected and approved annually by a fire safety expert. The date of the inspection shall be on the extinguisher. An inspection tag has been attached to the fire extinguisher with the annual inspection date. 04/03/2017 Implemented
6400.181(d)Individual #3's annual assessment dated 10/20/16 was not signed by the program specialist. The program specialist shall sign and date the assessment. Individual #3¿s annual assessment has been updated to include the Program Manager/Specialist¿s signature. Please see attachment number 12 for supporting documentation. 04/03/2017 Implemented
6400.181(e)(8)Individual #3's annual assessment dated 10/20/16 did not include the ability to evacuate in the event of a fire. The assessment must include the following information: The individual's ability to evacuate in the event of a fire. Individual #3¿s annual assessment has been updated. Going forward, the Program Managers/Specialists are responsible to update their specific individual¿s assessments and ensure that all necessary components of the annual assessment are included; specifically, the ability to evacuate in the event of a fire. Please see attachment number 12 for supporting documentation. 04/03/2017 Implemented
6400.181(e)(13)(ii)Individual #'s annual assessment dated 10/20/16 did not include progress and growth in the area of motor and communication.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. Individual #3¿s annual assessment has been updated. Going forward, the Program Managers/Specialists are responsible to update their specific individual¿s assessments and ensure that all necessary components of the annual assessment are included; specifically, progress and growth. Please see attachment number 12 for supporting documentation. 04/03/2017 Implemented
6400.181(e)(13)(iii)Individual #'s annual assessment dated 10/20/16 did not include progress and growth in the area of activities of residential livingThe 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. Individual #3¿s annual assessment has been updated. Going forward, the Program Managers/Specialists are responsible to update their specific individual¿s assessments and ensure that all necessary components of the annual assessment are included; specifically, progress and growth. Please see attachment number 12 for supporting documentation. 04/03/2017 Implemented
6400.181(e)(13)(iv)Individual #'s annual assessment dated 10/20/16 did not include 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. Individual #3¿s annual assessment has been updated. Going forward, the Program Managers/Specialists are responsible to update their specific individual¿s assessments and ensure that all necessary components of the annual assessment are included; specifically, progress and growth. Please see attachment number 12 for supporting documentation. 04/03/2017 Implemented
6400.181(e)(13)(v)Individual #'s annual assessment dated 10/20/16 did not include 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 #3¿s annual assessment has been updated. Going forward, the Program Managers/Specialists are responsible to update their specific individual¿s assessments and ensure that all necessary components of the annual assessment are included; specifically, progress and growth. Please see attachment number 12 for supporting documentation. 04/03/2017 Implemented
6400.181(e)(13)(vi)Individual #'s annual assessment dated 10/20/16 did not include progress and growth in the area of recreationThe 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 #3¿s annual assessment has been updated. Going forward, the Program Managers/Specialists are responsible to update their specific individual¿s assessments and ensure that all necessary components of the annual assessment are included; specifically, progress and growth. Please see attachment number 12 for supporting documentation. 04/03/2017 Implemented
6400.181(e)(13)(vii)Individual #'s annual assessment dated 10/20/16 did not include progress and growth in the area of financial independenceThe 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 #3¿s annual assessment has been updated. Going forward, the Program Managers/Specialists are responsible to update their specific individual¿s assessments and ensure that all necessary components of the annual assessment are included; specifically, progress and growth. Please see attachment number 12 for supporting documentation. 04/03/2017 Implemented
6400.181(e)(13)(viii)Individual #'s annual assessment dated 10/20/16 did not include progress and growth in the area of managing personal propertyThe 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 #3¿s annual assessment has been updated. Going forward, the Program Managers/Specialists are responsible to update their specific individual¿s assessments and ensure that all necessary components of the annual assessment are included; specifically, progress and growth. Please see attachment number 12 for supporting documentation. 04/03/2017 Implemented
6400.181(e)(13)(ix)Individual #'s annual assessment dated 10/20/16 did not include 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.Individual #3¿s annual assessment has been updated. Going forward, the Program Managers/Specialists are responsible to update their specific individual¿s assessments and ensure that all necessary components of the annual assessment are included; specifically, progress and growth. Please see attachment number 12 for supporting documentation. 04/03/2017 Implemented
6400.181(e)(14)Individual #'s annual assessment dated 10/20/16 did not include progress and growth in the area of water safety and ability to swimThe assessment must include the following information:The individual's progress over the last 365 calendar days and current level in the following areas: The individual's knowledge of water safety and ability to swim. Individual #3¿s annual assessment has been updated. Going forward, the Program Managers/Specialists are responsible to update their specific individual¿s assessments and ensure that all necessary components of the annual assessment are included; specifically, progress and growth. Please see attachment number 12 for supporting documentation. 04/03/2017 Implemented
6400.183(3)Individual #3's annaul ISP dated 2/15/16 did not have a method to evaluate the progress towards outcomes.The ISP, including annual updates and revisions under § 6400.186 (relating to ISP review and revision), must include the following: Current status in relation to an outcome and method of evaluation used to determine progress toward that expected outcome. The Program Manager/Specialist is responsible to update the Progress Note each month. There is a specific section on each Monthly Progress Note designated to explaining the method of evaluating progress towards the outcome goals. As of 2/17, Program Managers/Specialists have been trained on properly completing this Monthly Progress Note. Please see Attachment number 8 for supporting documentation. 04/03/2017 Implemented
6400.213(1)(i)Individual #3's record did not list their religious affiliationEach individual's record must include the following information: Personal information including: (i) The name, sex, admission date, birthdate and social security number. (iii) The language or means of communication spoken or understood by the individual and the primary language used in the individual's natural home, if other than English. (ii) The race, height, weight, color of hair, color of eyes and identifying marks.(iv) The religious affiliation. (v) The next of kin. (vi) A current, dated photograph.Individual #3¿s record has been updated to include her religious affiliation. 04/03/2017 Implemented