Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00243038 Renewal 04/09/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.77(b)The first aid kit was missing the tweezers, thermometer, and scissors. 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. On 4/10/24 tweezers, thermometer, and scissors were placed in the First Aid kit. The Residential Supervisor will conduct training with group home staff regarding the review of First Aid kits and the process to request items if any are noted to be missing. Training will be completed by 5/31/2024. Documentation will be maintained in staff HR files. 05/31/2024 Implemented
6400.77(c)The first aid kit did not contain a first aid manual A first aid manual shall be kept with the first aid kit.On 4/10/24 a first aid manual was placed in the First Aid kit. The Residential Supervisor will conduct training with group home staff regarding the review of First Aid kits and the process to request items if any are noted to be missing. Training will be completed by 5/31/2024. Documentation will be maintained in staff HR files. 05/31/2024 Implemented
6400.80(b)The outside wood ramp has excessive large paint chipping on the entire surface and is need of repair. The outside of the building and the yard or grounds shall be well maintained, in good repair and free from unsafe conditions.On 4/11/24 a work order for repairs to the ramp was placed. Contracted maintenance staff will complete repairs by 7/1/2024. Beginning May 2024 the Residential Supervisor will complete a monthly site monitoring form. This form will be sent to the Associate Director for review. Issue noted will be sent to the Manager of Facilities for follow up. 07/01/2024 Implemented
6400.110(f)Individual #1 requires a bed shaker and strobe lights for fire safety due to being hearing/visually impaired. The bed shaker was unable to detect the sound from the fire alarm and therefore was inoperable after 3 attempts to get it to work. A person with a body device and or pillow (for use when sleeping) that vibrates when the alarms sound, thus did not occur for the device currently being used. If one or more individuals or staff persons are not able to hear the smoke detector or fire alarm system, all smoke detectors and fire alarms shall be equipped so that each person with a hearing impairment will be alerted in the event of a fire. On 4/10/24 the bed shaker was repaired and tested to ensure proper functioning. The Residential Supervisor will conduct training with group home staff on reporting issues related to adaptive equipment. Training will be completed by 5/31/2024. Documentation will be maintained in staff HR files. 05/31/2024 Implemented
6400.112(a)There was no fire drill documented for the month of December 2023. An unannounced fire drill shall be held at least once a month. The Residential Supervisor will conduct training with Lead DSPs regarding the process for conducting monthly fire drills. Training will be completed by 5/31/2024. Documentation will be maintained in staff HR files. The Associate Director will conduct training with Program Specialists regarding the process for verifying that monthly fire drills have been completed in compliance with regulatory requirements. Training will be completed by 5/31/2024. Documentation will be maintained in staff HR files. 05/31/2024 Implemented
6400.141(c)(7)Individual #1 has not had an OBGYN appt in a several years. It is stated in their record that her family does not want her to have an exam however they would need POA/Guardianship in order to make that determination.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 Associate Director will conduct training with Nursing regarding the regulatory requirements for medical appointments and documentation for individuals on their caseloads. Training will be completed by 5/31/24. Documentation will be maintained in staff HR files. On 4/9/24 the program received correspondence from Individual #1¿s physician recommended deferring the gynecological exam indefinitely unless a problem presents that would require a GYN examination. A team meeting has been scheduled for 5/17/24 to review the physician¿s recommendations. 05/31/2024 Implemented
6400.142(a)On 6/2/23 individual #1 had a dental appointment, however this appointment was unsuccessful and no cleaning occurred. The individual was then referred to special smiles and has not yet been seen or scheduled which resulted in greater that 1 year between successful annual dental cleanings/exams.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. The Associate Director will conduct training with Nursing regarding the regulatory requirements for dental appointments. Training will be completed by 5/17/24. Documentation will be maintained in staff HR files. On 4/9/2024 Individual #1 `s PCP provided clearance for a dental appointment at Special Smiles. Pre sedation lab work was completed on 4/9/24, and an EKG is scheduled for 5/4/2024. Following the EKG, Special Smiles will schedule the dental appointment. 05/17/2024 Implemented
6400.144The 10/23/23 Annual Physical Exam for individual #1 recommends seeing an ENT, this appointment had not yet occurred or been scheduled.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 has an ENT appointment scheduled for 5/31/2024. The Associate Director will conduct training with Nursing on ensuring all components of the physical exam are completed in a timely manner including physicians¿ recommendations. Training will be completed by 5/17/24. Documentation will be maintained in staff HR files. 05/17/2024 Implemented
SIN-00096470 Renewal 01/28/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.76(a)Individual # 1 had a knob missing from the top left side drawer of their dresser. Furniture and equipment shall be nonhazardous, clean and sturdy. The knob was replaced on 2/4/16. The Manager of Residential Services will conduct retraining with Program Specialists and Residential Managers on ensuring that that furniture and equipment are non-hazardous, clean and in good state of repair by 7/21/16. The Program Specialists will conduct weekly site visits and will record in their reports any furniture/equipment that need to be repaired or replaced. If repairs or replacement are needed, a maintenance request will be sent to the Facilities Manager. The Facilities Manager will then inspect the equipment/furniture to determine the need for repair or replacement. If replacement is needed, a purchase order will be submitted by the Residential Manager and the furniture/equipment will be replaced. If repairs are needed the Manager of Facilities will monitor completion of work orders /repairs through weekly inspection report. 07/21/2016 Implemented
6400.77(b)The first aid kit did not contain tweezers. 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. On 2/18/06 Program Specialists and the Residential Managers were retrained to ensure that the first aid kit contains all required items, including tweezers. All residential group home first aid kits have been inspected to ensure that they contain all required items. The Residential Manager will review the first aid kit monthly to ensure that there are no missing items and submit the checklist to the Program Specialist for review. The program specialist will also check the first aid kit monthly. 02/18/2016 Implemented
SIN-00158970 Renewal 07/18/2019 Compliant - Finalized
SIN-00134327 Renewal 04/24/2018 Compliant - Finalized
SIN-00067516 Renewal 09/22/2014 Compliant - Finalized