Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00263882 Renewal 04/21/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.141(c)(3)(Repeat from the 4/29/24 renewal inspection) The Td/Tdap immunization for Individual #1 was administered 10/30/14, and not again until 12/31/24; this immunization was administered outside of the 10-year time year that it should be administered.The physical examination shall include: Immunizations for individuals 18 years of age or older as recommended by the United States Public Health Service, Centers for Disease Control, Atlanta, Georgia 30333. The Program Specialist and Residential Coordinator will be trained on Regulation 6400.141(c)(3) by the Director of Quality Assurance no later than 5/31/2025 and will be sent as Attachment #4. 05/31/2025 Implemented
6400.141(c)(7)Individual #1 did not have a gynecological examination since 1/3/22. An examination needs to be completed annually unless there is documentation from a licensed physician recommending no or less frequent gynecological examinations, with a reason for the deferment.The physical examination shall include: A gynecological examination including a breast examination and a Pap test for women 18 years of age or older, unless there is documentation from a licensed physician recommending no or less frequent gynecological examinations. The Residential Program Specialist messaged Individual #1's physician requesting the reason as to why individual #1 did not need a gynecological exam, for the physician's response see Attachment #8. Residential Program Specialist and Residential Coordinator will be trained on regulation 6400.141(c)(7) by the Director of Quality Assurance no later than 5/31/2025 and will be sent as Attachment #9. Residential Program Specialist and Residential Coordinator will be trained on discussion points of the RCG for regulation 6400.141 by the Director of Quality Assurance no later than 5/31/2025 and will be sent as Attachment #10. 05/31/2025 Implemented
6400.141(c)(8)(Repeat from 4/29/24 renewal inspection) Individual #1 had a mammogram on 10/2/23 and not again until 2/19/25, which is outside of the annual timeframe for an individual 50 years of age or older.The physical examination shall include: A mammogram for women at least every 2 years for women 40 through 49 years of age and at least every year for women 50 years of age or older. The Residential Program Specialist and Residential Coordinator will be trained on Regulation 6400.141(c)(8) by the Director of Quality Assurance no later than 5/31/2025 and will be sent as Attachment #12. 05/31/2025 Implemented
6400.141(c)(14)The 12/17/24 physical for Individual #1 does not identify information pertinent to diagnosis and treatment in case of an emergency, as it was left blank.The physical examination shall include: Medical information pertinent to diagnosis and treatment in case of an emergency. The Residential Program Specialist messaged Individual #1's physician requesting, information pertinent to diagnosis and treatment in case of an emergency, for the physician's response see Attachment #13. 05/31/2025 Implemented
6400.181(a)The new admission assessment for Individual #1 was completed on 11/12/24 which was not completed within 60 days on the individual's date of admission on 9/12/24. 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 Residential Program Specialist went by the month to account for the 60 days in error instead of counting out the actual days. The Residential Program Specialist will be trained on Regulation 6500.181(a) no later than 5/31/2025 by the Director of Quality Assurance and will be sent as Attachment #17. 05/31/2025 Implemented
6400.181(e)(9)The assessment on 11/12/24 for Individual #1 does not identify the individual's functional and medical limitations.The assessment must include the following information: Documentation of the individual's disability, including functional and medical limitations. The Residential Program specialist only listed the diagnosis instead of addressing any medical or functional limitations. The Residential Program Specialist wrote an addendum to the Assessment for Individual #1 to include the medical and functional limitations on 4/28/2025, see Attachment #18. 05/31/2025 Implemented
6400.181(e)(11)The assessment on 11/12/24 for Individual #1 does not addresses if a psychological evaluation had been completed.The assessment must include the following information: Psychological evaluations, if applicable. The Residential Program Specialist wrote an addendum to the Assessment for Individual #1 to include information related to the psychological evaluation on 4/23/2025, see Attachment #18. 05/31/2025 Implemented
6400.211(b)(1)On the face sheet for Individual #1, the name, address, and phone number of who to contact for emergency's was not documented.Emergency information for each individual shall include the following: The name, address, telephone number and relationship of a designated person to be contacted in case of an emergency. The Residential Program Specialist updated the Face Sheet to include the name, phone number, and address of the person to contact in case of an emergency, see Attachment #21. 05/31/2025 Implemented
6400.211(b)(3)On the face sheet for Individual #1, the name, address, and phone number for who to contact for medical consent was not documented.Emergency information for each individual shall include the following: The name, address and telephone number of the person able to give consent for emergency medical treatment, if applicable. The Residential Program Specialist updated the Face Sheet to include the name, phone number and address of the person to give consent in case of an emergency, see Attachment #21. 05/31/2025 Implemented
6400.166(a)(11)For the September 2024 MAR, the following medications did not have the diagnosis or purpose for the medications for: Levothyroxine 50, Levothyroxine 75 mcg, Omeprazole 40 mg, Quetiapine Fumarate ER 24 HR 150 mg, Divalproex Sodium 500 mg, and Mirtazapine 15 mg. For the November 2024 MAR, the following medications did not have the diagnosis or purpose for the medications for: Azithromycin 200 mg/5 ml, Prednisolone 15 mg/ 5 ml, and Ibuprofen 800 mg.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.Individual #1's MAR shows diagnosis listed with each medication, see Attachment #24. The Residential Program Specialist and Residential Coordinator will be trained on Regulation 6500.166(a)(11) no later than 5/31/2025 by the Director of Quality Assurance and will be sent as Attachment #25. A Process for checking MARs to the pharmacy label was developed and All Residential Coordinators will be trained no later than 5/31/2025 by the Director of Quality Assurance and will be sent as Attachment #26. 05/31/2025 Implemented
6400.213(1)(i)213 (1) (vi) The photograph for Individual #1 is not a current, dated picture, as it was taken 2/14/24.213 (1)(vi) Each individual's record must include the following information: A current, dated photograph.A current picture of individual #1 was taken on 4/29/2025, and placed in the file see Attachment #27. 05/31/2025 Implemented
SIN-00242802 Renewal 04/29/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.66At the time of the inspection, there was no lighting located at the door leading out of the sunroom to the outside.Rooms, hallways, interior stairways, outside steps, outside doorways, porches, ramps and fire escapes shall be lighted to assure safety and to avoid accidents. The Residential Coordinator was trained on 5/15/2024 on Regulation 6400.66 by Director of Quality Assurance, see Attachment #1. The Director of Quality Assurance developed a maintenance request form on 5/1/2024 to be used for reporting and tracking progress for all maintenance needs of the home. The new maintenance request form was completed for the missing light fixture and submitted to the CEO on 5/3/2024 as attachment # 2. The CEO has contacted the property owner via email on 5/7/2024 and requested for a light to be added to the outside exit of the back porch that leads out to the ramp as attachment # 3. If the property does not complete the work by 6/30/2024 then the agency will purchase and install a dusk `til dawn light no later than 7/2/2024. Once the work is complete, a picture will be taken of the work and sent in as attachment # 4. 07/02/2024 Implemented
6400.67(b)At the time of the inspection, there was a tennis ball sized amount of lint located in the dryer. Floors, walls, ceilings and other surfaces shall be free of hazards.The lint was removed from the trap at the time of the inspection. The Residential Coordinator was trained on 5/15/2024 on Regulation 6400.67(b) by Director of Quality Assurance, see Attachment #7. 05/25/2024 Implemented
6400.104(Repeat from 5/1/23 Inspection) The fire department notification letter dated 2/23/24 does not include the exact location of the individual bedrooms and a description of the mobility needs of the individual served.The home shall notify the local fire department in writing of the address of the home and the exact location of the bedrooms of individuals who need assistance evacuating in the event of an actual fire. The notification shall be kept current. Residential Program Specialist and Residential Coordinator were trained on regulation 6400.104 on 5/15/24 and 5/17/2024 by the Director of Quality Assurance, see Attachment # 9. Director of Quality Assurance developed a layout for each home showing the exact location of areas of the home including the individual(s) bedroom along with a photo of the home itself. The floor plan was developed on 5/7/2024 along with the picture of the home. Program Specialist updated the fire department letters on 5/6/2024. The fire department letter, floor plan and picture of the home was sent to the fire department on 5/7/2024, see Attachment # 10. 05/07/2024 Implemented
6400.111(f)The fire extinguishers were inspected on 6/20/22 and not again until 6/28/23. A fire extinguisher shall be inspected and approved annually by a fire safety expert. The date of the inspection shall be on the extinguisher. The Residential Director and Residential Coordinator were trained on Regulation 6400.111(f) on 5/15/2024 by the Director of Quality Assurance as Attachment # 11. 05/15/2024 Implemented
SIN-00223240 Renewal 05/01/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.15(a)The Self-Assessment was completed on 2/24/23. The time frame for the self-assessment to be completed was from 11/1/22 to 2/3/23.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.Due to lack of knowledge of the regulation, assessors did not take into account both month and day when completing self-assessments. They were trained on Regulation 6400.15(a) on 5/17/2023. Attachment #1. 05/24/2023 Implemented
6400.103(Repeat from Inspection completed on 5/3/22) The written evacuation procedure developed did not identify the means of transportation or emergency shelter that would be used in the event of an emergency evacuation.There shall be written emergency evacuation procedures that include individual and staff responsibilities, means of transportation and an emergency shelter location. The Program Specialist misunderstood the regulation. New Evacuation procedures were written to include all required information. Individuals and staff of the home were trained on the evacuation procedures as of 5/17/2023. Attachment #22. 05/17/2023 Implemented
6400.144At the time of the 5/3/23 inspection, the "Tylenol Extra Strength" and "NYSTOP 100,000/GM Power" Pro Re Nata Prescriptions were not available in the home.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 agency was unaware that PRNs needed to be present in the home. Tylenol Extra Strength and NYSTOP 100,000/GM were obtained from the pharmacy on 5/12/2023 and are now present in the home and kept with other medication locked. Picture taken to show compliance. Attachment #23a, #23b & #23c 05/24/2023 Implemented
6400.181(e)(7)The description in the "knowledge of heat sources and the ability to sense and move away quickly" is not clear in the 12/09/22 annual Assessment for Individual #1; the form states that Individual #1 "understands the word "hot"", but the Assessment doesn't address if Individual #1 can identify the heat source independently.The assessment must include the following information: The individual's knowledge of the danger of heat sources and ability to sense and move away quickly from heat sources which exceed 120° F and are not insulated. The Program Specialist did not word the Assessment to clearly meet the regulation. An addendum was completed to address Individual #1's knowledge of the dangers of heat sources and the ability to sense and move away quickly on 5/4/2023 by the Program Specialist. Attachment #25. It was also emailed to all team members. Attachment #26. 05/17/2023 Implemented
6400.181(e)(14)The water safety evaluation states that Individual #1 is not able to temper water anywhere except for at home, because the water temperature never exceeds 120 degrees Fahrenheit. That temperature is not guaranteed, nor is it appropriate to believe that Individual #1 is comfortable taking a 120-degree temperature bath or shower.The 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. Program Specialist error. An addendum was completed to address Individual #1's knowledge of the dangers of heat sources and the ability to sense and move away quickly on 5/4/2023 by the Program Specialist. Attachment #25. It was also emailed to all team members. Attachment #26. 05/17/2023 Implemented
6400.166(a)(11)Individual #1's March 2023 Medication Administration Record (MAR) does not include a diagnosis for the "Desitin Rapid Relief 13% Cream".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.The diagnosis for Individual #1's Desitin Rapid Relief was not typed on the MAR and was handwritten in each month, as a result it was missed on March 2023 MAR. The diagnosis for Desitin is now typed on the MAR to ensure it will be on all MARs. 05/24/2023 Implemented
SIN-00204538 Renewal 05/03/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.71The emergency numbers were not on or near the telephone in the living room.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. A copy of the emergency numbers were placed on the phone in the living room on 5/12/2022. A picture was taken and sent as Attachments #22a & 22b. 05/24/2022 Implemented
6400.80(b)The roof to the screened in porch was leaking during the inspection on 5/4/22. The agency did respond to this by notifying the landlord on 5/4/22 after the inspection who agreed to have it repaired. The outside of the building and the yard or grounds shall be well maintained, in good repair and free from unsafe conditions.CEO was notified of the leaking porch on 5/4/2022, he sent an email to the landlord on 5/4/2022 as Attachment#24, we received verification from the landlord that it was scheduled for 5/24/2022 as Attachment #25. Work order showing completion will send once obtained as Attachment #26 05/24/2022 Implemented
SIN-00189593 Renewal 06/29/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.15(a)A self-assessment was to be completed between October 2020 and February 2021. No self-assessments were completed during that time frame.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. A process was developed to show that all self-assessments of the residential group homes are to be completed between the months of October of the previous year and February of the current year in order to maintain compliance. Please see Attachment # 1. All responsible parties (Program Specialist/home supervisors/verifiers) will be trained on this process no later than 8/30/2021. A copy of the training sheet will be sent as Attachment # 2 once completed. All parties will be trained on regulation 6400.15 (a) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 3. 08/30/2021 Implemented
6400.22(e)(1)Individual #1's September 2020 Personal Ledger had an ending balance of 7.45 after the ledger was reconciled. The beginning balance for October 2020, was $8 (the amount before the ledger was reconciled). The March 2021 Personal ledger for Individual #1 has a transaction amount of 71.45 on 3/26/21. The receipt is only for $71.39. If the home assumes the responsibility of maintaining an individual's financial resources, the following shall be maintained for each individual: A separate record of financial resources, including the dates and amounts of deposits and withdrawals. A procedure was developed to address the requirements and responsibilities for house account ledgers. A copy of the procedure is being sent as Attachment # 24. Residential oversight designee, home supervisors and PS will be trained on the new procedure no later than 8/30/2021. A copy of the training sheet signed by will be sent as Attachment # 25. Residential staff will be trained on the procedure and sent no later than 10/30/2021 as attachment # 26. Home supervisors and PS will be trained on regulation 6400.22 (e) (1) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 27. A copy of Individual # 1's November Ledger will be reviewed by home supervisor to ensure all receipts are accounted for and balance is accurate as well. Copies of the Novembers house account ledger along with required receipts will be sent as Attachment # 28 no later than 12/5/2021. 12/05/2021 Implemented
6400.112(e)A sleep drill was held on 10/17/20 and not again since.A fire drill shall be held during sleeping hours at least every 6 months. An overnight sleep drill was attempted at Water Street on 7/31/2021 and again on 8/5/2021, both drills were not successful due to refusals from one of the clients.He has not been feeling well and was diagnosed with a sinus infection which could be playing a factor into the refusals due to lack of sleep and aggression he has been showing. Continued attempts will occur for an overnight fire drill in August until successful or a plan of support will be implemented following guidance from the RCG for this regulation. This will be sent as Attachment # 30. Home supervisors will be trained on regulation 6400.112 (e) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 19. 08/30/2021 Implemented
6400.113(c)The annual fire safety training curriculum does not include identifying the designated meeting place. A written record of fire safety training, including the content of the training and a list of the individuals attending, shall be kept.Fire Safety Emergency Evacuation procedure was developed as an attachment to the Individual Fire Safety Training Content. This procedure contains basic information for staff and individuals in regards to evacuations procedures and clearly states where the meetings places are located for each residential home. This procedure will be reviewed with each individual and no later than 8/30/2021 and a copy of their signed procedure will be obtained and sent as Attachment # 31. Home supervisors and PS will be trained on regulation 6400.113 (c) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 8. 08/30/2021 Implemented
6400.141(c)(6)Individual #1 had a TB test on 8/19/18 and not again until 11/23/20, outside of the bi-annual time frame.The physical examination shall include: Tuberculin skin testing by Mantoux method with negative results every 2 years for individuals 1 year of age or older; or, if tuberculin skin test is positive, an initial chest x-ray with results noted. Director of Quality Assurance will meet with PS to help her develop a tracking mechanism for all medical appointments to ensure that individuals are receiving necessary appointments, immunizations, and screening done within their required time frames. A completed tracking chart will be completed and sent as Attachment # 32 no later than 8/30/2021. Home supervisors and PS will be trained on regulation 6400.141 (c) (6) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 33. 08/30/2021 Implemented
6400.141(c)(9)Individual #1 did not have a prostate exam completed. No deferment letter was in the record.The physical examination shall include: A prostate examination for men 40 years of age or older. Individual #1 deferment letter dated 7/31/2021 was obtained. Please see Attachment # 34. Home supervisors and PS will be trained on regulation 6400.141 (c) (9) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 33. 08/30/2021 Implemented
6400.141(c)(11)Individual #1's most recent annual physical completed 11/19/20 had the health maintenance needs section blank.The physical examination shall include: An assessment of the individual's health maintenance needs, medication regimen and the need for blood work at recommended intervals. Received new annual physical on 7/30/2021 where the individuals health maintenance needs, medication regimen and the needs for blood work at recommended interval was completed by the physician. Please see Attachment # 35. Home supervisors and PS will be trained on regulation 6400.141 (c) (11) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 33. 08/30/2021 Implemented
6400.141(c)(12)Individual #1's most recent annual physical dated 11/19/20 did not have the physical limitations section listed on it at all.The physical examination shall include: Physical limitations of the individual. received new annual physical on 7/30/2021 where the physical limitations of the individual was reviewed by the physician. Please see Attachment # 35. Home supervisors and PS will be trained on regulation 6400.141 (c) (12) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 33. 08/30/2021 Implemented
6400.141(c)(14)Individual #1's most recent annual physical completed 11/19/20 had the section addressing information pertinent to treat/diagnose in the event of an emergency blank.The physical examination shall include: Medical information pertinent to diagnosis and treatment in case of an emergency. Received new annual physical on 7/30/2021 where the medical information pertinent to diagnosis and treatment in case of an emergency was reviewed by the physician. Please see Attachment # 35. Home supervisors and PS will be trained on regulation 6400.141 (c) (14) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 33. 08/30/2021 Implemented
6400.141(c)(15)Individual #1's most recent annual physical completed 11/19/20 had the section addressing special diet blank.The physical examination shall include:Special instructions for the individual's diet. Received new annual physical on 7/30/2021 where special instructions for the individuals diet was reviewed by the physician. Please see Attachment # 35. Home supervisors and PS will be trained on regulation 6400.141 (c) (15) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 33. 08/30/2021 Implemented
6400.142(a)Individual #1 was to have a dental exam on 11/23/20. It was canceled due to Covid. As of 7/1/21, the appointment has not been rescheduled.An individual 17 years of age or younger shall have a dental examination performed by a licensed dentist semiannually. An individual 18 years of age or older shall have a dental examination performed by a licensed dentist annually. PS emailed Individual #1s dentist to schedule an appointment, it is in the process of getting scheduled in late October. Reason for the longer time frame is due to the fact that needs sedation for all dentistry and his travel cannot be too far from his home due to his medical issues and care needs. Please see Attachment # 36. Director of Quality Assurance will meet with PS to help her develop a tracking mechanism for all medical appointments to ensure that individuals are receiving necessary appointments, immunizations, and screening done within their required time frames. A completed tracking chart will be completed and sent as Attachment # 32 no later than 8/30/2021. Home supervisors and PS will be trained on regulation 6400.142 (a) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 37. 08/30/2021 Implemented
6400.144Individual #1 has a bowel movement protocol that if Individual #1 has no bowel movement in 3 days, milk of magnesia is to be administered. If Individual #1 has no bowel movement in 4 days, a suppository must be administered. If Individual #1 has no bowel movement in 5 days, Individual #1's PCP is to be called. Individual #1 had no bowel movement documented from 11/23/20 to 11/27/20. No milk of magnesia was given. No suppository was administered. No bowel movement was documented from 12/22/20 to 12/24/20. No milk of magnesia was given. No bowel movement was documented from 1/3/21 to 1/6/21. No milk of magnesia was given. No suppository was administered. No bowel movement was documented from 1/8/21 to 1/10/21. No milk of magnesia was given. No bowel movement was documented from 1/21/21 to 1/23/21. No milk of magnesia was given. No bowel movement was documented from 1/27/21 to 1/30/21. No milk of magnesia was given. No suppository was administered. No bowel movement was documented from 2/1/21 to 2/5/21. No milk of magnesia was given. No suppository was administered. No bowel movement was documented from 2/16/21 to 2/19/21. No milk of magnesia was given. No suppository was administered. No bowel movement was documented from 2/27/21 to 3/1/21. No milk of magnesia was given. No bowel movement was documented from 3/15/21 to 3/19/21. No milk of magnesia was given. No suppository was administered. No bowel movement was documented from 4/1/21 to 4/7/21. No milk of magnesia was given. No suppository was administered. Primary Care Physician was not called. No bowel movement was documented from 4/28/21 to 4/30/21. No milk of magnesia was given. Individual #1 is to be checked on every two hours. Individual #1 was not checked on every two hours on 11/2/20 and from 5/27/21 to 5/29/21.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. Individual # 1 did not have a BM tracking sheet to cover all shifts and required checks. Individual #1's 2 hours checks clearly showed a section for tracking whether Individual #1 had a BM during those time frames. However, Individual #1's overnight paperwork (30 minute checks) did not have a space for tracking whether they had a BM or not so it is unclear if had a BM during overnight shifts and that is why his MAR shows that he wasnt receiving the MOM or suppositories. Home supervisors and PS will be trained on regulation 6400.144 and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 38. All staff need to be retrained of Plan of Support for constipation. This will be completed by 8/30/2021 and sent as Attachment # 39. Individual #1 was not in our care 5/27/2021 thru 5/29/2021 due to hospitalization for his hernia surgery, the following documentation: Attendance Record is being sent as Attachment #40 to verify this. Documentation is missing from 2:30pm-8:00pm for Individual #1's 2 hours checks. It is unclear if the checks were completed and not signed off on or if they even occurred. 09/15/2021 Implemented
6400.181(a)Individual #1's date of admission was 9/1/2020. Individual #1's initial assessment was not completed until 3/6/21. 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. Director of Quality Assurance will meet with the Program Specialist to help them develop a tracking mechanism for all dates as required for 6400 regulations. A tracking chart will be completed and sent as Attachment # 44 no later than 8/30/2021. Program Specialists will be trained on regulation 6400.181 (a) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 45. 11/15/2021 Implemented
6400.211(b)(2)Physician's contact information is not included in Individual #1's record content. Emergency information for each individual shall include the following: The name, address and telephone number of the individual's physician or source of health care.Updated face sheet to include the name, address and telephone number of the individual's physician for individual #1. A copy of the face sheet is being sent in as Attachment # 46. Program Specialist will receive training for regulation 6500.211 (b) (2) no later than 8/30/2021, signature sheet will be sent as Attachment # 47. 11/15/2021 Implemented
6400.32(r)Individual #1 was not offered the option to have a lock on Individual #1's bedroom door.An individual has the right to lock the individual's bedroom door.Information has been added to ISP. Please see attachment # 53. 11/15/2021 Implemented
6400.52(c)(6)Individual #1 has a seizure protocol dated 9/1/20. Staff #1 has not received this training. Individual #1 has an NPO protocol, a monthly weight protocol, a Gerd protocol, a dental hygiene protocol, a Bi-pap protocol, and a G-tube protocol all dated 9/1/20. Staff #2 has not received any of these trainings. Individual #1 has a Constipation/BM protocol and a Range of Motion Protocol dated 9/1/20. Staff #3, Staff #4, and Staff #5 did not have these trainings. Staff were to receive the following trainings for Individual #1 after hospitalizations and ER visits: 9/16/20-EIM states staff were to be trained on what to look for regarding issues with g-tube. On 9/25/20 the EIM states staff were to be trained on what to look for when suspecting aspiration and pneumonia. And on, 11/21/20, EIM states staff were to be trained on what to do and what to look for if bleeding from ostomy site would occur again. No documentation was provided that any staff received these three trainings.The annual training hours specified in subsections (a) and (b) must encompass the following areas: Implementation of the individual plan if the person works directly with an individual.Staff #1, #2, #, #4 & #5 will be trained on Individual #1 POS no later than 8/30/21. Signatures of the trainings will be sent as Attachment # 56. Staff will be provided with training in regards to all follow up information from Individual #1s ER visits on 9/25/2020 and 11/21/2020 no later than 9/30/2021. Copies of training records will be sent as attachment # 57. Residential oversight designee, home supervisor and PS will receive training for regulation 6500.52 (c) (6) no later than 8/30/2021, signature sheet will be sent as Attachment # 58. 09/30/2021 Implemented
6400.162(a)Individual #1 receives medications via a G-Tube. Staff administering the medications to Individual #1 via the G-Tube have not been trained by a medical professional.A home whose staff persons or others are qualified to administer medications as specified in subsection (b) may provide medication administration for an individual who is unable to self-administer the individual's prescribed medication.Individual #1s PCP provided guidance as to the type of preferred medical professional that could train staff. Please see documentation to this affect as attachment # 50. An LPN will be obtained to train all staff that work directly with Individual #1 and will be providing medication to the individual via their G-Tube. Once all staff are trained, the signature sheet from the training will be sent as Attachment # 51. Residential oversight designee, home supervisors and program specialists, will receive training for regulation 6500.162 (a) no later than 8/30/2021, signature sheet will be sent as Attachment # 52. 08/30/2021 Implemented
6400.165(c)Individual #1's is prescribed milk of magnesia and a suppository when Individual #1 goes three and four days consecutively with no bowel movement. The milk of magnesia and suppository are not being administered as prescribed.A prescription medication shall be administered as prescribed.Individual # 1 did not have a BM tracking sheet to cover all shifts and required checks. Individual #1's 2 hour checks clearly showed a section for tracking whether the individual had a BM during those time frames. However, the overnight paperwork (30 minute checks) did not have a space for tracking whether the individual had a BM or not so it is unclear if the individual had a BM during overnight shifts and that is why the MAR shows that the individual wasn't receiving the MOM or suppositories. Home supervisors and Program Specialists will be trained on regulation 6400.165 (c) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 61. All staff need to be retrained on Individual #1's Plan of Support for constipation. This will be completed by 8/30/2021 and sent as Attachment # 39. 09/15/2021 Implemented
6400.166(a)(1)No documentation was provided verifying Individual #1 had medication records from 9/2020 to 12/2020, or from 2/2021.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Individual's name.At this time MARs for individual #1 have not been able to be obtained. Home supervisors will be trained on Regulation 6400.166 (a) (1) and will be sent as Attachment # A no later than 8/30/2021. 11/15/2021 Implemented
6400.181(f)Individual #1's assessment was sent to the team on 3/6/21. The team meeting for ISP was held on 3/10/21.The program specialist shall provide the assessment to the individual plan team members at least 30 calendar days prior to an individual plan meeting.Director of Quality Assurance will meet with PS to help them develop a tracking mechanism for all dates as required for 6400 regulations. A tracking chart will be completed and sent as Attachment # 44 no later than 8/30/2021. Program Specialist will be trained on regulation 6400.181 (f) and it will be sent no later than 8/30/2021, signature sheet will be sent as Attachment # 45. 11/15/2021 Implemented
6400.213(1)(i)Individual #1's record does not identify next of kin.Each individual's record must include the following information: Next of KinUpdated face sheet to include next of kin. A copy of his face sheet is being sent in as Attachment # 46. PS will receive training for regulation 6500.213 (1) (v) no later than 8/30/2021, signature sheet will be sent as Attachment # 60. 11/15/2021 Implemented
6400.213(1)(i)Individual #1's Religious Affiliation section is blank in the record. If Individual #1 has no religious affiliation, please indicate so.Each individual's record must include the following information: Religious AffiiliationUpdated face sheet to include religious affiliation. A copy of his face sheet is being sent in as Attachment # 46. PS will receive training for regulation 6500.213 (1) (iv) no later than 8/30/2021, signature sheet will be sent as Attachment # 60. 11/15/2021 Implemented