Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00259809 Renewal 02/27/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.62(c)At the time of inspection, there was a small, unlabeled, plastic food storage container located under the home's kitchen sink that contained a translucent, pinkish or orangish liquid that was consistent in appearance with hand or dish soap. This poisonous material was not kept in its original, labeled container.Poisonous materials shall be stored in their original, labeled containers. Substance in clear food storage bag was dumped down the drain at the time of licensing. 02/28/2025 Implemented
6400.64(a)Clean and sanitary conditions were not maintained throughout this home in three areas of the upstairs bathroom: 1. There was a half-dollar-sized wad of hair found in the bathtub drain. 2. There were whitish discolorations streaking down the majority of the walls of the bathtub that were consistent in appearance with hard water or lime stains. 3. The wooden surfaces of the window frame of the bathroom's single window were coated in a thick, fluffy layer of grey dust visible from a distance.Clean and sanitary conditions shall be maintained in the home. Hair was removed from the bathroom tub drain, bathtub was cleaned with CLR to remove water/lime stains, and the thick dust on the bathroom window frame was cleaned. Attachment # 23 and # 24 03/18/2025 Implemented
6400.67(a)There were two areas of the home's upstairs bathroom that were not in good repair. First, there was a half-dollar-sized hole in the linoleum floor near the bathtub, exposing the wooden flooring underneath and leaving it susceptible to water damage. Second, the bottom brim of the radiating heater unit next to the toilet was heavily covered in a flaky, brown discoloration consistent in appearance with rust or corrosion. In addition, one drop ceiling tile in the vacant bedroom on the home's lower level was brown and discolored in a water-drip pattern, causing it to bend and jut down out of the ceiling fixture.Floors, walls, ceilings and other surfaces shall be in good repair. Ceiling times were replaced; baseboard heater was cleaned and painted; floor was patched and sealed.. Attachment #25 and #26 03/18/2025 Implemented
6400.67(b)The lower interior surface of the home's kitchen oven was peppered with greyish and blackened flakes consistent in appearance with the burnt leavings of food. The presence of this substance in the oven increased the risk of a fire occurring in the home, constituting a hazard. Floors, walls, ceilings and other surfaces shall be free of hazards.Inside of oven was cleaned. Attachment # 27 03/25/2025 Implemented
6400.77(b)At the time of inspection, neither of the two thermometers found within the home's first aid kit could be made to function despite repeated attempts by staff on site. As both of these thermometers were broken, the home's first aid kit lacked a working thermometer. A first aid kit shall contain antiseptic, an assortment of adhesive bandages, sterile gauze pads, a thermometer, tweezers, tape, scissors and syrup of Ipecac, if an individual 4 years of age or younger, or an individual likely to ingest poisons, is served. A new working thermometer was placed in the first aid kit. Attachment # 28 03/18/2025 Implemented
6400.80(b)This home has two levels. As the home is built into a hillside, the ground level at the front of the home becomes the upper level at the rear of the home, with a wooden deck exiting off of the home's kitchen. The home's lower level has one exit leading to a stone patio underneath the wooden deck. A wooden staircase connects the upper deck to the lower patio. The home has a very large, fenced-in backyard that is multi-tiered, with wooden retention beams supporting the ground's tiered structure in areas. A staircase is structured into the hillside using wooden retention beams leads from the lower rear patio, down the hill into which it is carved, and into a large yard that is relatively flat but at a shallow downward grade. There were several very large, deciduous trees in the home's backyard and in the neighboring yards. Although it had been several months since autumn, the entirety of the home's backyard was covered in fallen leaves to the extent that the ground underneath could not be seen in most areas. There were numerous, small tree branches strewn throughout the yard as well as on the roof of the home. The home's roof was covered in moss, leaves, and broken and fallen branches. The gutters appeared to be filled with leaves and assorted detritus. There was a shed in the rear of the yard that was in a similar state---the roof of the shed coated in moss, leaves, and branches. The two thick, metal poles holding up the home's back deck were coated in peeling paint, exposing rusted or corroded metal underneath. The scene strongly suggested that this home's backyard was not maintained in any fashion for quite some time. The aforementioned wooden retention beams were rotted away, breaking, and disintegrating. Each of the beams was fastened down with metal rods driven through opposite ends of the beam. Due to the deteriorated state of the wood, the tops of the metal rods were protruding such that they would create a hazard either because they could be tripped over or---if someone were to trip nearby, on leaves or branches, for example---they could be fallen onto, resulting in a serious puncture wound. The fallen leaves, broken and fallen branches, rotting wooden beams, and protruding metal rods all contributed to unsafe conditions in the home's backyard. The outside of the building and the yard or grounds shall be well maintained, in good repair and free from unsafe conditions.Director of Maintenance is meeting with landscaper 3/28/2025 to remove debris and then grade in fill dirt that will eliminate any fall hazards. 04/30/2025 Implemented
SIN-00238325 Renewal 03/05/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.22(d)(1)The home shall keep an up-to-date financial and property record for each individual that includes the disbursements made to or for the individual. Individual #1 made a purchase at FYE with a receipt $46.60. Individual #1's January 2024 financial record for 1/9/24 documents a purchase of $46.90 at FYE. The amount logged on Individual #1's financial record from 1/9/24 was not the accurate amount from the FYE receipts as it was off by $0.30.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. Staff will be trained by 3/28/24 to ensure they can identify the total that was paid on the receipt and ensuring they are documenting the total on the monthly spending form. 03/20/2024 Implemented
6400.22(e)(3)Individual #1 is missing a receipt from 11/7/23 for $75.16 from Walmart. If the home assumes the responsibility of maintaining an individual's financial resources, the following shall be maintained for each individual: Documentation, by actual receipt or expense record, of each single purchase exceeding $15 made on behalf of the individual carried out by or in conjunction with a staff person. Threshold will reimburse Individual #1 $75.16 from the missing receipt from Walmart. Staff will be trained by 3/28/24 to ensure all receipts are logged after the activity and placed with the monthly spending form. Attachment #21 03/20/2024 Implemented
6400.165(c)A prescription medication shall be administered as prescribed. Individual #1 is prescribed Antiseptic Skin Cleanser 4%, apply half dollar amount to dry skin neck to toes 3 times a week allow to sit for 10 min prior to shower then rinse. The pharmacy label on the medication bottle had a refill date of 4/20/23, and the bottle was approximately more than ¾ of the way full of the medication. The medication is not being administered as prescribed. Individual #1 is prescribed Ketoconazole 2 % Shampoo, apply to dry scalp let sit then rinse in shower 3 times weekly. The pharmacy label on the medication bottle had a refill date of 8/15/23, when the licensing representative opened the top of the medication bottle the seal was still on the medication indicating that it has not been opened or used. The medication was documented as being administered to Individual #1 on 3/3/24.A prescription medication shall be administered as prescribed.A fax was sent on 3/6/24 to prescribing doctor of the antiseptic skin cleanser 4% and was discontinued and recommended OTC bodywash such as dial, Irish spring, etc. Attachment # 22 03/20/2024 Implemented
6400.165(g)Individual #1 is prescribed medication to treat symptoms of a diagnosed psychiatric illness. Individual #1 had 3 month medication reviews on 1/12/24 and 11/10/23 and the form used did not document or include the medication and the necessary dosage for both appointments (1/12/24 and 11/10/23).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.Medication list attached to appointment forms will ensure to include the diagnosis to the medications that are prescribed. Attachment # 24 03/20/2024 Implemented
6400.166(c)If an individual refuses to take a prescribed medication, the refusal shall be documented on the medication record. The refusal shall be reported to the prescriber as directed by the prescriber or if there is harm to the individual. Individual #1 is prescribed Antiseptic Skin Cleanser 4%, apply half dollar amount to dry skin neck to toes 3 times a week allow to sit for 10 min prior to shower then rinse. Individual #1 refused the medication on Individual #1 refused the medication on 2/1/24, 2/4/24, 2/6/27, 2/8/24, 2/11/24, 2/13/14, 2/15/24, 2/18/24, 2/20/24, 2/22/24, 2/25/24, 2/27/24, and 2/29/24. There is no documentation that the refusal was reported to the prescriber. Individual #1 is prescribed Ketoconazole 2 % Sham, apply to dry scalp let sit then rinse in shower 3 times weekly. Individual #1 refused the medication on 2/1/24, 2/4/24, 2/6/27, 2/8/24, 2/11/24, 2/13/14, 2/15/24, 2/18/24, 2/20/24, 2/22/24, 2/25/24, 2/27/24, and 2/29/24. There is no documentation that the refusal was reported to the prescriber.If an individual refuses to take a prescribed medication, the refusal shall be documented on the medication record. The refusal shall be reported to the prescriber as directed by the prescriber or if there is harm to the individual.A fax was sent on 3/6/24 to prescribing doctor of the antiseptic skin cleanser 4% and was discontinued and recommended OTC bodywash such as dial, Irish spring, etc. Attachment # 22 03/22/2024 Implemented
SIN-00166283 Renewal 12/03/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.15(a)The license for this chapter expires on 12/7/2019. The self-assessment was not dated so it couldn't be determined if it was completed 3-6 months prior to the license expiration.The agency shall complete a self-assessment of each home the agency operates serving eight or fewer individuals, within 3 to 6 months prior to the expiration date of the agency¿s certificate of compliance, to measure and record compliance with this chapter. Self-Assessment tool will be scheduled to be completed in July or August in 2020 and each successive year, which is within 3-6 months prior to the expiration date of the agency¿s certificate of compliance. This will be monitored by Martha Gonzalez, Director of IDD Residential Services. 12/21/2019 Implemented
SIN-00090968 Renewal 01/27/2016 Compliant - Finalized
SIN-00056110 Renewal 10/02/2013 Compliant - Finalized