Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00222858 Renewal 04/11/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.163(h)Individual 3 Prescribed Blistex Lip Ointment apply to irritated areas on lips 2 times a day as needed was not on the MAR, but the medication was still in the medication box. Staff at the home called and verified that the medication had been discontinued but was still in the medication box. The medication was removed at the time of the inspection.Prescription medications that are discontinued or expired shall be destroyed in a safe manner according to Federal and State statutes and regulations.The Blistex lip ointment was removed from the medication box on 4/12/23. A training will occur with all house staff and the assigned program specialist related to the proper disposal of discontinued medications and treatments. This training will be completed by the associate director by 5/8/23. 05/08/2023 Implemented
SIN-00186328 Renewal 04/15/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.72(b)The windows (3 total) located in individual#1's bedroom were not in good repair, once opened they would not remain open. Screens, windows and doors shall be in good repair. On 4/16/2021 the windows were repaired to ensure safety. On 4/19/2021 the windows were replaced. Program Specialist will train residential staff on the proper notification process to be followed to report maintenance issues. This training will be completed by 5/13/21. Documentation of training will be maintained in staff HR files. 05/13/2021 Implemented
6400.82(e)In bathroom #2 there was no nonslip surface or mat. Bathtubs and showers shall have a nonslip surface or mat. On 4/15/2021 a nonslip mat was placed in the shower. Program Specialist will train residential staff on the proper notification process to be followed to report maintenance issues. This training will be completed by 5/13/21. Documentation of training will be maintained in staff HR files. 05/13/2021 Implemented
6400.142(f)It could not be determined that individual#2 had a written dental hygiene plan in the record at time of inspection.An individual shall have a written plan for dental hygiene, unless the interdisciplinary team has documented in writing that the individual has achieved dental hygiene independence. A dental hygiene plan was created by the team on 4/16/21. Program Specialist will train residential staff on the dental hygiene plan by 5/3/21. Documentation of training will be maintained int staff HR files. Program Specialist level staff will complete 100% review of records to verify dental hygiene plans are in place. This review will be completed by 5/6/21. Documentation of this review will be sent the associate director for review. Associate Director will train Program Specialists on requirement to monitor the presence of and accuracy of dental hygiene plans monthly through the use of the Program Specialist Monthly Monitoring forms. This Process will begin May 2021. 05/06/2021 Implemented
6400.181(f)Individual#2's assessment was not shared with the team 30 days prior to the ISP meeting. The most recent ISP meeting was on 11/11/20; the assessment was shared with the team on 11/13/20The program specialist shall provide the assessment to the individual plan team members at least 30 calendar days prior to an individual plan meeting.The Program Specialist received performance related feedback regarding the monitoring of assessment due dates and the late mailing of the assessment. Beginning May 2021 Programs Specialists will monitor annual assessment due dates and mailing dates via a report from the agency¿s electronic records system. 05/03/2021 Implemented
SIN-00134330 Renewal 04/24/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.111(a)There was no fire extinguisher in the attic.There shall be at least one operable fire extinguisher with a minimum 2-A rating for each floor, including the basement and attic. On 4/26/18 a fire extinguisher was placed in the attic. On 5/3/18 the Associate Director conducted training with Residential Managers and Program Specialists in ensuring that at least one operable fire extinguisher, with a minimum 2A rating, is on each floor, including the basement and attic. The Residential Managers will complete a weekly check of all fire extinguishers on each floor level and will document and submit to the Program Specialist for review. In the case of facilities with three or more stories including the basement and attic, the Residential Manager and program specialist will ensure that all floor levels including the basements and attics are equipped with an operable fire extinguisher with a minimum 2A rating. If there is an absence of fire extinguisher noted on any of the aforementioned locations in a facility, the Facilities Manager will be notified immediately, and the Facilities Manager will ensure that the locations noted are equipped with fire extinguishers in a timely manner. 05/03/2018 Implemented
6400.112(h)The fire drill on 5/3/17 did not list a designated meeting place. Individuals shall evacuate to a designated meeting place outside the building or within the fire safe area during each fire drill.On 5/3/18 the Associate Director conducted training with Program Specialists and Residential Managers focused on ensuring the mandatory use of the electronic fire drill form, equipped with mandatory fields that ensure compliance to regulatory requirements, which includes identifying the designated meeting place outside the building. The Residential Manager will ensure the completion of the fire drill form using the electronic record system each month and will document on the monthly checklist and submit to the program specialist for review. The Program specialist will review the electronic records system to ensure the utilization of the electronic form and will maintain a tracking chart for that purpose. The Associate Director will complete a quarterly review of the tracking charts with the program specialists and will initial each month checked. 05/03/2018 Implemented
SIN-00067519 Renewal 09/22/2014 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6400.18(c)An incident occurred involving Individual #4 on 11-25-14 and it was not reported until 1-5-15.The home shall orally notify the county mental retardation program of the county in which the home is located, the funding agency and the appropriate regional office of mental retardation, within 24 hours after abuse or suspected abuse of an individual or an incident requiring the services of a fire department or law enforcement agency occurs. Staff who performed the inappropriate restraint resigned his position before we were aware of what happened. When we were notified of the restraint in December we notified the county and were instructed to include the restraint in another HCSIS report completed on the psychiatric hospitalization. We were later notified by the county that we needed to do a separate and an investigation. We initiated an investigation at that time. All remaining staff were retrained on the Agency policies on the use of restraints, Positive intervention techniques and Incident management procedures including timely reporting of incidents on 12/29/14 and on the individuals behavior plan on 1/6/15. See attached training sheet. The Incident Manager will monitor to ensure that all staff receive the necessary training and will follow up with appropriate disciplinary procedures if protocol is not followed. 01/06/2015 Implemented
6400.18(d)An incident occurred involving Individual #4 on 11-25-14 and it was not investigated until 1-5-15.The home shall initiate an investigation of the unusual incident and complete and send copies of an unusual incident report on a form specified by the Department to the county mental retardation program of the county in which the home is located, the funding agency and the appropriate regional office of mental retardation, within 72 hours after an unusual incident occurs. Staff who performed the inappropriate restraint resigned his position before we were aware of what happened. When we were notified of the restraint in December we notified the county and were instructed to include the restraint in another HCSIS report completed on the psychiatric hospitalization. We were later notified by the county that we needed to do a separate and an investigation. We initiated an investigation at that time. All remaining staff were retrained on the Agency policies on the use of restraints, Positive intervention techniques and Incident management procedures including timely reporting of incidents on 12/29/14 and on the individuals behavior plan on 1/6/15. See attached training sheet. The Incident Manager will monitor to ensure that all staff receive the necessary training and will follow up with appropriate disciplinary procedures if protocol is not followed. 01/06/2015 Implemented
6400.64(a)Individual #1's bedroom carpet had dark stains that were approximately 3 inches in diameter. The 1st floor shower room had mold on the wall. There were stains under the kitchen sink that were consistent with mold. Clean and sanitary conditions shall be maintained in the home. All staff, supervisors, maintenance personnel and management personnel have been retrained on ensuring that all areas of the home are in good repair and on timely reporting of any issues to the appropriate staff. See attached training sheets. Residential Managers will complete an outlined inspection of their sites on a monthly basis and submit checklist to their supervisor. Maintenance personnel will also complete an outlined inspection of their assigned sites monthly and submit the checklist to their supervisor. Please see attached checklists. Third Shift Supervisor has a revised nightly checklist to ensure all areas are checked thoroughly. Administrative staff conduct site inspections twice per month. See attached reports. The carpet was removed on 12/7/14. Mildew in shower and under kitchen sink was taken care of on 9/29/14 and then cabinets, sink and plumbing were replaced on 1/7/15.See attached work orders. 01/07/2015 Implemented
6400.168(a)Staff A who was hired on 9/12/11, administered medication during the month of September, yet has not completed the Department of Public Welfare's Medication Administration Training, In a home serving eight or fewer individuals, a staff person who has completed and passed the Department's Medications Administration Course is permitted to administer oral, topical and eye and ear drop prescription medications. The medication trainer was retrained by the Human Resources Manager on 9/30/14 to ensure that documentation of staff medication testing, trainings and observations are correctly and properly written on all forms and to ensure that staff names and dates are clearly written and accurate on all forms as the paperwork was missing the staff identifiers on some pages. See attached training sheet. The trainer will monitor all recall dates to ensure all staff are in compliance. The Human Resources Manager will monitor quarterly. 09/30/2014 Implemented
6400.186(a) Individual #4 ISP was dated 1/30/14; the most recent ISP review was dated 4/30/14.The program specialist shall complete an ISP review of the services and expected outcomes in the ISP specific to the residential home licensed under this chapter with the individual every 3 months or more frequently if the individual's needs change which impacts the services as specified in the current ISP. The Program Specialists were trained on 9/24/14 regarding completing an ISP review of the services and expected outcomes in the ISP every 3 months or more frequently if the individuals needs change. See attached training sheet. The Manager of Residential Services will monitor through a tracking system to ensure that quarterlies are completed as required. 09/24/2014 Implemented
6400.186(c)(3)Individual #4¿S ISP date 1/30/14 identifies residential supports, behavioral supports, social and recreation activities, as well as health and safety as needed outcomes. The monthly summaries from January 2014 through August 2014; does not indicate that progress has been made. However, there is no documentation to indicated that the program specialist made recommendation for modifications to the outcomes. The ISP review must include the following: The program specialist shall document a change in the individual's needs, if applicable.The Program Specialists were retrained on 9/24/14 regarding ensuring that all outcomes remain appropriate for the individual and ensuring that if no progress is being made that they initiate making changes to the individuals plan. The Program Specialists will monitor through review of Monthly progress notes and will document any need for changes to outcomes in their quarterly reviews and in an email to the supports coordinator. The Manager of Residential Services will monitor through review of monthly and quarterly notes. 09/24/2014 Implemented
6400.194(a)A restrictive procedure was utilized involing Individual #4 on 11-25-14 and there was not an approved restrictive plan as part of the record.If a restrictive procedure is used, there shall be a restrictive procedure review committee. Staff who performed the inappropriate restraint resigned his position before we were aware of what happened. When we were notified of the restraint in December we notified the county and were instructed to include the restraint in another HCSIS report completed on the psychiatric hospitalization. We were later notified by the county that we needed to do a separate and an investigation. We initiated an investigation at that time. All remaining staff were retrained on the Agency policies on the use of restraints, Positive intervention techniques and Incident management procedures including timely reporting of incidents on 12/29/14 and on the individuals behavior plan on 1/6/15. See attached training sheet. The Incident Manager will monitor to ensure that all staff receive the necessary training and will follow up with appropriate disciplinary procedures if protocol is not followed. 01/06/2015 Implemented
SIN-00264067 Renewal 04/07/2025 Compliant - Finalized
SIN-00158973 Renewal 07/18/2019 Compliant - Finalized