Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00221278 Renewal 03/14/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.17(b)Provider Self-Assessment, completed 1/31/2023, was conducted using the 6500 Self-Assessment Tool that was updated by the Department on 5/2018. This tool does not address all current regulations.The agency shall use the Department's licensing inspection instrument for this chapter to measure and record compliance.The Program Director will have the provider use the current/updated 6500 Self-Assessment Tool in order to measure and record compliance with all current regulations. 04/17/2023 Implemented
6500.125(a)No physical examination could be produced for Family Living Provider #1. Therefore, compliance could not be measured.Family members and persons living in the home shall have a physical examination within 12 months prior to the individual living in the home.Provider completed physical on 3/28/2023. Program Director has ensured accurate completion of physical form. 04/01/2023 Implemented
SIN-00203297 Renewal 04/05/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.48(b)(1)Family Living Provider #2 did not receive training in person-centered practices, rights, facilitating community integration, individual choice and supporting individuals to develop and maintain relationships during training year 7/1/20-6/30/21.The annual training hours specified in subsection (a) must encompass the following areas: The application of person-centered practices, rights, facilitating community integration, individual choice and supporting individuals to develop and maintain relationships.Provider completed training on person-centered practices and community integration as evidenced by Person Centered Planning for Individuals with Developmental Disabilities and People with Disabilities: Building Relationships and Community Membership trainings in Relias on 7/1/2021. Evidence viewed during inspection. 07/01/2021 Implemented
6500.48(b)(3)Family Living Provider #2 and Program Specialist #3 did not received training in Individual rights during training year 7/1/20-6/30/21.The annual training hours specified in subsection (a) must encompass the following areas: Individual rights.Provider completed training on consumer rights as evidenced by Rights of Individuals with IDD training in Relias on 2/13/2022. Evidence viewed during inspection. 02/13/2022 Implemented
6500.135(g)Individual #1 is prescribed Clonidine HCL, 0.1mg, two times per day and Lithium CR, 600 mg two time per day to treat symptoms of psychiatric diagnoses. Individual #1 had a review of the medication 8/31/21 and then again 12/21/21.If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a review by a licensed physician at least every 3 months to document the r reason for prescribing the medication, the need to continue the medication and the necessary dosage.Individual's 3-month psych med reviews were brought back into compliance as evidenced by review dates of 12/21/2021 and 3/8/2022. Evidence viewed during inspection. He is scheduled for another review on 6/7/2022 and will attend that appointment. 03/08/2022 Implemented
SIN-00143373 Renewal 10/11/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.108(a)The fire extinguisher in the basement of the home had a 1-A rating.There shall be at least one operable fire extinguisher with a minimum 2-A rating for each floor, including the basement and attic.The fire extinguisher in questions has been replaced with a fire extinguisher with a 2-A rating (supporting document #3). The Program Director completes a monitoring form each month when she visits the home. She has added a line item for fire extinguishers to this form (supporting document #2). During her regular monthly inspections, the Program Director will confirm that there is an appropriately rated fire extinguisher on each floor of the home, including the basement. The Operations Director will review the monthly monitoring form with the Program Director during regular supervision and at least quarterly to ensure regulatory standards are being met. The Program Director was retrained on this standard when meeting with the Compliance Manager on October 12, 2018. The Program Director retrained all Lifesharing providers on this standard when she met individually with them on October 23, 2018. 10/23/2018 Implemented
6500.121(c)(6)Individual #1's most recent Tuberculin skin testing on 09/06/16.Tuberculin skin testing by Mantoux method with negative results every 2 years for individuals 1 year of age or older; or, if a tuberculin skin test is positive, an initial chest x-ray with results noted.The Mantoux in question was completed on October 19, 2018 (supporting document #4). The Program Director completes a monitoring form each month when she visits the home. She notes the most recent Mantoux test date and the corresponding next due date. Each month, she reviews various regulatory standards with the Lifesharing provider, including approaching appointment dates. She will continue this process, and ensure that scheduling of Mantoux test dates occurs in advance of due dates. She will review documentation of every test result to ensure regulatory compliance. The Operations Director will review the monthly monitoring form and supporting documentation with the Program Director during regular supervision and at least quarterly to ensure regulatory standards are being met. The Program Director was retrained on this standard when meeting with the Compliance Manager on October 12, 2018. The Program Director retrained all Lifesharing providers on this standard when she met individually with them on October 23, 2018. 10/23/2018 Implemented
SIN-00123562 Renewal 10/19/2017 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.17(a)The agency completed a self-assessment of the home on 6/16/17. The agency's certificate of compliance had an expiration of 7/1/17.If an agency is the legal entity for the family living home, the agency shall complete a self-assessment of each home the agency is licensed to operate 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.The program specialist will ensure that the self-assessments are completed in a timely manner. These need to be completed anytime between January 1st and April 1st. Program Specialist will utilize the Outlook Calendar for reminders to complete. [Prior to 3 months of the expiration of the Certificate of Compliance the CEO shall review all self-assessment to ensure timely completion by the program specialist. (AS 11/17/17)] 11/10/2017 Implemented
6500.71The telephone numbers of the nearest police department, fire department, and ambulance were not on or by the telephones in the home.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.Program Specialist updated the telephone numbers to reflect the nearest police, fire, and ambulance in the Ulysses area. The numbers are posted in the home and will be updated as needed. Program Specialist will ensure compliance quarterly in the home. [Documentation of the program specialist audits shall be kept and reviewed by the CEO at least quarterly for 1 year. (AS 11/17/17)] 11/10/2017 Implemented
6500.122(a)Individual #1's most recent dental examination was completed on 4/25/16.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.LSP has an appointment scheduled for April 26, 2018. Program Specialist will monitor compliance with the yearly dental exam using the Outlook Calendar. Program Specialist and LSP will continue to discuss the importance of a yearly exam with the consumer on a quarterly basis to ease his fear of attending the dentist. [Aforementioned attempts to educate the individual about the need for dental appointments shall be documented in Individual #1's record as required per 6500.123(a). (AS 11/17/17)] 11/10/2017 Implemented
6500.133(c)Individual #1's prescribed psychiatric medication reviews completed on 2/7/17, 5/2/17, and 10/18/17 did not include the need to continue the medication. [Repeat violation 10/27/16]If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a review with documentation by a licensed physician at least every 3 months that includes the reason for prescribing the medication, the need to continue the medication and the necessary dosage.The program specialist has developed a new form to be used at appointments that includes the reason for prescribing the medication, the need to continue the medication, and the necessary dosage. LSP was trained on the requirements of the medication reviews. Program Specialist will monitor quarterly in the home. [Upon completion, the family living provider and the program specialist shall review the medication review documentation to ensure completion as required and to ensure Individual #1 is administered medications as prescribed. (AS 11/17/17)] 11/10/2017 Implemented
SIN-00102866 Renewal 10/27/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.31(b)The two most recent statements acknowledging receipt of the individuals rights were signed by Individual #1 on 9/15/15 and 10/27/16.A statement signed and dated by the individual, or the individual's parent, guardian or advocate if appropriate, acknowledging receipt of the information on individual rights upon admission and annually thereafter, shall be kept.The Program Specialist (PS) has produced a calendar (to be submitted as A) with reminder dates. LSP will utilize to ensure that the individuals rights are reviewed annually in the appropriate time frames as per regulations. PS will review calendar and upcoming annual signature dates during monthly monitoring visits to ensure timeliness of all reviews and signatures. PS will also utilize Monthly Monitoring tool (to be submitted as B) at each monitoring visit to ensure compliance. At least quarterly for one year, Chief Operations Officer (COO) will review PS's monitoring tool and corresponding documentation to ensure compliance, and these reviews will be documented. 11/11/2016 Implemented
6500.121(a)The two most recent physical examinations for Individual #1 were completed on 8/4/15 and 8/23/16. An individual shall have a physical examination within 12 months prior to living in the home and annually thereafter.The Program Specialist (PS) has produced a calendar (to be submitted as A) with reminder dates. LSP will utilize to ensure that annual physical exams occur in the appropriate time frames as per regulations. PS will review calendar and upcoming appointment dates during monthly monitoring visits to ensure timeliness of all appointments. PS will also utilize Monthly Monitoring tool (to be submitted as B) at each monitoring visit to ensure compliance. At least quarterly for one year, Chief Operations Officer (COO) will review PS's monitoring tool and corresponding documentation to ensure compliance, and these reviews will be documented. 11/11/2016 Implemented
6500.121(c)(6)The two most recent Tuberculin skin testing for Individual #1 were completed on 7/8/14 and 9/6/16.Tuberculin skin testing by Mantoux method with negative results every 2 years for individuals 1 year of age or older; or, if a tuberculin skin test is positive, an initial chest x-ray with results noted.The Program Specialist (PS) has produced a calendar (to be submitted as A) with reminder dates. LSP will utilize to ensure that Tuberculin skin testing occurs in the appropriate time frames as per regulations. PS will review calendar and upcoming appointment dates during monthly monitoring visits to ensure timeliness of all appointments. PS will also utilize Monthly Monitoring tool (to be submitted as B) at each monitoring visit to ensure compliance. At least quarterly for one year, Chief Operations Officer (COO) will review PS's monitoring tool and corresponding documentation to ensure compliance, and these reviews will be documented. 11/11/2016 Implemented
6500.133(c)The two most recent psychiatric medication reviews by a licensed physician for Individual #1 were completed 5/11/16 and 8/17/16.If a medication is prescribed to treat symptoms of a diagnosed psychiatric illness, there shall be a review with documentation by a licensed physician at least every 3 months that includes the reason for prescribing the medication, the need to continue the medication and the necessary dosage.The Program Specialist (PS) has produced a calendar (to be submitted as A) with reminder dates. LSP will utilize to ensure that 3-month reviews occur in the appropriate time frames as per regulations. PS will review calendar and upcoming appointment dates during monthly monitoring visits to ensure timeliness of all appointments. PS will also utilize Monthly Monitoring tool (to be submitted as B) at each monitoring visit to ensure compliance. At least quarterly for one year, Chief Operations Officer (COO) will review PS's monitoring tool and corresponding documentation to ensure compliance, and these reviews will be documented. 11/11/2016 Implemented
SIN-00242515 Renewal 03/05/2024 Compliant - Finalized
SIN-00182290 Renewal 01/29/2021 Compliant - Finalized
SIN-00163628 Renewal 10/02/2019 Compliant - Finalized