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| Regulation | LIS Non-Compliance Area | Correction Required | Plans of Correction | Correction Date | POC Status |
| 6500.24(d)(1) | The agency is not Individual #1's representative payee. During interviews conducted on 5/28/26, the agency revealed that Individual #1's representative payee disburses $50-$100 approximately every month to the home for Individual #1's personal spending. Individual #1's current assessment, completed on 10/31/25, indicated that Individual #1 cannot follow a budget or manage spending money and that Individual #1 requires physical assistance to make purchases. In addition, Individual #1's Service Plan, last updated 5/19/26, explained that Individual #1 needs assistance in managing their money, as Individual #1 has no concept of money and that Individual #1 requires assistance in counting their money, as they do not know how much money should be tendered when making purchases. However, on 5/28/26, the home did not keep an up-to-date financial and property record for Individual #1 that includes the following: personal possessions and funds received by or deposited with the family or home. | An up-to-date financial and property record shall be kept for each indivudal that includes the personal possessions and funds received by or deposited with the family or agency. | Individual #1 now has a ledger in the home where the Lifesharing Provider will be keeping track of receipts on a record of expense sheet. The home will now keep an up to date financial and property record for individual #1 that includes the following personal possissions and funds received by or deposited with the family or home. Receipts will be kept and monies/record of expense sheets will be reviewed monthly by the Program Specialist. |
06/01/2026
| Implemented |
| 6500.24(d)(2) | The agency is not Individual #1's representative payee. During interviews conducted on 5/28/26, the agency revealed that Individual #1's representative payee disburses $50-$100 approximately every month to the home for Individual #1's personal spending. Individual #1's current assessment, completed on 10/31/25, indicated that Individual #1 cannot follow a budget or manage spending money and that Individual #1 requires physical assistance to make purchases. In addition, Individual #1's Service Plan, last updated 5/19/26, explained that Individual #1 needs assistance in managing their money, as Individual #1 has no concept of money and that Individual #1 requires assistance in counting their money, as they do not know how much money should be tendered when making purchases. However, on 5/28/26, the home did not keep an up-to-date financial and property record for Individual #1 that includes the following: disbursements made to or for Individual #1. | An up-to-date financial and property record shall be kept for each indivudal that includes the disbursements made to or for the individual. | Individual #1 now has a ledger in the home where the Lifesharing Provider will be keeping track of receipts on a record of expense sheet. The home will now keep an up to date financial and property record for individual #1 that includes the following personal possissions and funds received by or deposited with the family or home. Receipts will be kept and monies/record of expense sheets will be reviewed monthly by the Program Specialist. |
06/01/2026
| Implemented |
| 6500.121(a) | Individual #1 had annual physical examinations completed on 6/12/24, and then again on 8/14/25. This exceeds the annual requirement. [Repeated Violation-5/20/25, et al] | An individual shall have a physical examination within 12 months prior to living in the home and annually thereafter. | Individual #1 had a physical on 8/14/2025. The next annual physical was able to be scheduled at the earliest 8/20/2026 at 11am. |
06/18/2026
| Implemented |
| 6500.122(a) | Individual #1 had annual dental examinations completed on 6/14/24, and then again on 9/11/25. This exceeds teh annual requirement. | An individual 17 years of age or younger, shall have a dental examination performed by a licensed dentist semiannually. Each individual 18 years of age or older shall have a dental examination performed by a licensed dentist annually. | Individual #1 had a dental appointment on 9/11/2026. The next dental appointment is scheduled on 7/16/2026 to maintain annual compliance. |
06/18/2026
| Implemented |
| 6500.151(e)(12) | Individual #1's current assessment, completed on 10/31/25, did not include recommendations to foster skill growth with specific areas of training, programming, and services for implementation. The assessment's corresponding field only contained information regarding the requirements of 6500.151e13, reflecting Individual #1's current skill levels in the domains of health, motor and communication skills, activities of residential living, personal adjustment, socialization, recreation, financial independence, and community integration. | The assessment must include the following information: Recommendations for specific areas of training, programming and services. | "Individual #1's Assessment has been updated on 6/16/2026. This change now includes a training component in regards to the individuals current skill levels. The assessment now states Individual #1 WILL RECEIVE TRAINING DURING TRANSACTIONS. Individual #1 WILL FIRST ATTEMPT TO IDENTIFY THE CORRECT BILL COMBINATION AND THE LIFESHARING PROVIDER WILL THEN MODEL TO BETH THE CORRECT COMBINATION AND REVIEW THE VALUES OF THE BILLS.
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06/16/2026
| Implemented |
| 6500.152(c) | Individual #1's Service Plan, last updated 5/19/26, contained the following discrepancies between their current assessment, completed on 10/31/25, in the following health and safety skill domains: regarding medication administration, Individual #1's Service Plan, last updated 5/19/26, informed that Individual #1 requires monitoring with taking medications. In contrast, Individual #1's assessment, completed on 10/31/25, indicated Individual #1 can independently self-administer medications; regarding water safety, Individual #1's Service Plan, last updated 5/19/26, did not address their ability to swim and stated, rather, that Individual #1 "does not like to swim."; However, Individual #1's assessment, completed on 10/31/25, informed that Individual #1 cannot swim independently; regarding home supervision, Individual #1's Service Plan, last updated 5/19/26, explained that Individual #1 requires 23 hours of supervision daily and can be home alone for up to one hour and that Individual #1 can be left unsupervised in their bedroom for an unlimited period of time; In contrast, Individual #1's assessment, completed on 10/31/25, informed that Individual #1 requires no general supervision within the home but must remain within hearing distance when outside in the yard or on the porch; and regarding oral hygiene, Individual #1's Service Plan, last updated 5/19/26, explained that Individual #1 needs reminders to maintain hygiene, "specifically [with] brushing [their] teeth." In contrast, Individual #1's assessment, completed on 10/31/25, indicated that Individual #1 can independently brush their teeth. [Repeated Violation-5/20/25, et al.] | The individual plan shall be initially developed, revised annually and revised when an individual's needs change based upon a current assessment. | On 6/25/2026 Individual #1 has an annual quarterly scheduled. At this meeting Individual #1's Assessment and ISP will be reviewed entirely. The meeting will specifically address ensuring that the ISP and Assessment match in the follow areas: Aligning how the individual takes/administers her own medication, aligning the individuals ability to swim, aligning the individuals in home and community supervision, and aligning the individuals ability to brush their own teeth. After the meeting is complete UCIP Program Specialist will send an email overviewing the changes to ensure the ISP and assessment align. The Assessment will then be updated to reflect all changes to mirror the ISP. |
06/25/2026
| Implemented |
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| Regulation | LIS Non-Compliance Area | Correction Required | Plans of Correction | Correction Date | POC Status |
| 6500.65 | At 10:15 AM on 5/21/25, the mechanical exhaust fan in the full bathroom located off the kitchen on the home's main level was inoperable. This bathroom did not have an operable window for ventilation. | Living areas, dining areas, individual bedrooms, kitchens and bathrooms shall be ventilated by at least one operable window or by mechanical ventilation. | The mechanical exhaust fan in the full bathroom located off the kitchen on the home's main level will be replaced with an operable mechanical exhaust fan. |
06/30/2025
| Implemented |
| 6500.66 | There is an interior door from the basement to a vestibule area enclosed with Bilco doors leading to the outside. This egress serves as the only exterior exit from the basement. The vestibule area, measuring approximately three feet by six feet, has eight steps leading to the Bilco doors. At 10:19 AM on 5/21/25, this vestibule did not have a lighting fixture or any type of lighting source to adequately illuminate the area. | Rooms, hallways, interior stairways, outside steps, outside doorways, porches, ramps and fire escapes, that are used by individuals shall be lighted to assure safety and to avoid accidents. | A lighting fixture will be installed in the interior door from the basement to a vestibule area enclosed with Bilco doors leading to the outside. The lighting fixture will be a lighting source that adequately illuminates the area. |
06/30/2025
| Implemented |
| 6500.73 | There is an interior door from the basement to a vestibule area enclosed with Bilco doors leading to the outside. This egress serves as the only exterior exit from the basement. The vestibule area, measuring approximately three feet by six feet, has eight steps leading to the Bilco doors. At 10:19 AM on 5/21/25, these steps did not have a handrail. | An interior stairway exceeding two steps that is accessible to individuals, ramp and outside steps exceeding two steps, shall have a well-secured handrail. | The interior door from the basement to a vestibule area enclosed with Bilco doors leading to the outside will have a well-secured handrail installed due to the egress serving as the only exterior exit from the basement. |
06/30/2025
| Implemented |
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