| Regulation | LIS Non-Compliance Area | Correction Required | Plans of Correction | Correction Date | POC Status |
| 6400.66 | On 1/5/23 at 1:02PM, there was not a source of outside light at the side exit of the home. | Rooms, hallways, interior stairways, outside steps, outside doorways, porches, ramps and fire escapes shall be lighted to assure safety and to avoid accidents.
| On January 11, 2023 a light was installed for the side exit of the home. |
01/11/2023
| 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 |
| 6400.46(d) | Direct Service Worker #1, date of hire 12/16/21, completed initial first aid, Heimlich techniques and cardio-pulmonary resuscitation training on 11/2/22. | Program specialists, direct service workers and drivers of and aides in vehicles shall be trained within 6 months after the day of initial employment and annually thereafter, by an individual certified as a training by a hospital or other recognized health care organization, in first aid, Heimlich techniques and cardio-pulmonary resuscitation. | All employees needing CPR in 2023 were signed up for a CPR course being held a minimum of 1 month prior to the expiration date of their CPR card. A document containing training dates was provided to site monitors and program specialists at a meeting on 1/19/2023. These were distributed to all other employees the same day via on site mailbox. |
02/01/2023
| Implemented |