Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00268476 Renewal 06/05/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.67(a)Drawer with no handles in individual 9's room. Baseboard heater is broken beneath front window.Floors, walls, ceilings and other surfaces shall be in good repair. The individual received a new dresser and the baseboard heater has been repaired 06/16/2025 Implemented
6400.141(c)(14)The Annual Physical Examination dated 7/10/24 for individual 8 does not address information pertinent to diagnosis in case of emergency.The physical examination shall include: Medical information pertinent to diagnosis and treatment in case of an emergency. JEVS has been working on new processes for nursing and wellness. JEVS will utilize new processes for ensuring compliance and make sure all staff is trained on these processes, which includes making sure forms are complete. 07/17/2025 Implemented
6400.181(a)Individual 8's date of admission is 4/24/24. The individual did not have an initial assessment until 7/12/24 which is greater than 60 days after admission. Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the residential 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 residential home. The program specialist was counseled in this. She knows the regulations for completing timely assessments and this was an oversight on her part that should not be repeated 06/13/2025 Implemented
6400.32(r)There were no locks on any of the individuals' rooms in the home, however there was no documentation reflecting this.An individual has the right to lock the individual's bedroom door.JEVS does not agree that this individual should have a lock on their bedroom door for safety reasons. JEVS is holding team meetings about this issue. JEVS and the SC shall document the outcome in the ISP and assessment as this person cannot safely evacuate in an emergency if her bedroom door is locked When it is determined that an individual can safely have a locked bedroom door, we will attempt to utilize keypad locks which do not require a key. This is a safer option. All team meetings and lock installations when requested will be completed by December 31, 2025. 07/01/2025 Implemented
6400.34(a)The signed individual rights statement for individual 8 did not include all of the rights outlined in the 6400 regulations.The home shall inform and explain individual rights and the process to report a rights violation to the individual, and persons designated by the individual, upon admission to the home and annually thereafter.JEVS revised the individual rights form to include the list of rights as outlined in the 6400 regulations and trained all management staff on the use of the new form. 06/16/2025 Implemented
6400.165(f)Individual 8 is prescribed psychiatric medications, however he does not have a SEEP plan or BSP in Place.If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a written protocol as part of the individual plan to address the social, emotional and environmental needs of the individual related to the symptoms of the psychiatric illness.The behavior specialist was counseled on this issue and has since written the SEEP. 06/20/2025 Implemented
6400.167(c)Individual 8 did not receive their prescribed Polyethylene Glycol 3350 Powder for the dates 6/2/25 through 6/5/25 and there was no medication error entered for this medication.A medication error shall be reported as an incident as specified in § 6400.18(b) (relating to incident report and investigation).A medication error was put in EIM for this incident. Incident number is 9662512 08/14/2025 Implemented
6400.181(f)The annual assessment for individual 8 was sent to the team on 8/27/24 however the ISP meeting was scheduled for 8/29/24 which is less than 30 days time.The program specialist shall provide the assessment to the individual plan team members at least 30 calendar days prior to an individual plan meeting.The program specialist was counseled on this. She is aware of the regulations concerning assessments and this should not be repeated 06/16/2025 Implemented
SIN-00225823 Renewal 06/06/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.71There were no emergency numbers located on or near the telephone in the staff office.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. this was corrected on 6/7/23. Emergency numbers were posted as required 06/07/2023 Implemented
6400.163(d)Medications were not double locked for the individuals in the home who take supraoptic medications.Prescription medications and syringes, with the exception of epinephrine and epinephrine auto-injectors, shall be kept in an area or container that is locked.This was corrected on 6/8/2023. The controlled substances are now in a locked box inside of a locked closet 06/08/2023 Implemented
SIN-00165052 Renewal 10/08/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.64(a)The Second floor bathroom had brown/black stains on the shower floor which appeared to be dirt.Clean and sanitary conditions shall be maintained in the home. This was corrected during the inspection. House supervisors and program directors will review physical site concerns more regularly to ensure compliance with regulations. 10/09/2019 Implemented
SIN-00044862 Renewal 12/05/2012 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.34(b)(2)The home's civil rights policy does not include mention of physical accessibility and accomodation for individuals.(2) Physical accessibility and accommodations for individuals with physical disabilities. The Civil Rights/Nondiscrimiation Policy was updated in June 2011. However, for the preinspection, the old policy was sent by mistake. All staff were informed of the new policy and copies made available. All policy manuals were reviewed to ensure the updated policy which includes language related to physcial accessiblity are in place. 12/07/2012 Implemented
6400.46(g)Staff # 1 did not have on record annual fire safety training.(g) Program specialists and direct service workers shall be trained annually by a fire safety expert in the training areas specified in subsection (f). Staff #1 received Fire Safety Training on 12/11/12.JEVS implemented an annual training plan to ensure all required training occurs in an assigned month. All training is tracked in a tickler system for training compliance. 12/11/2012 Implemented
6400.46(i)Staff # 1 did not have current CPR training on record.(i) 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 trainer by a hospital or other recognized health care organization, in first aid, Heimlich techniques and cardio-pulmonary resuscitation. Staff #1 received CPR Training on 12/13/12. JEVS implemented an annual training plan to ensure all required training occurs in an assigned month. All training is tracked in a tickler system for training compliance. 12/13/2012 Implemented
6400.103The homes' emergency evacuation procedures does not clearly define individual and staff responsibilities nor does it address the method of transportation.There shall be written emergency evacuation procedures that include individual and staff responsibilities, means of transportation and an emergency shelter location. The emergency evacuation procedure includes individual and staff respnsibilities with the method of transportation and the emergency shelter location. 12/05/2012 Implemented
6400.151(c)(2)Staff # 1 did not have on record updated TB testing.(2) 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. Staff #1 completed TB testing on 12/5/12. A physical, including the TB test, tickler system has been implemented. The Administrative Secretary will monitor and send alerts to staff and director when the staff member is due for a physical to ensure compliance. 12/05/2012 Implemented
SIN-00104163 Renewal 03/03/2016 Compliant - Finalized