Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00266627 Renewal 05/20/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.17(b)Licensing Inspection Instrument completed on 11/20/24 was not on the Department's licensing inspection instrument for this chapter to measure and record compliance. The home utilized an old, obsolete Licensing Inspection Instrument that did not address all of the current regulations.The agency shall use the Department's licensing inspection instrument for this chapter to measure and record compliance.All old versions of the Licensing Inspection Instruments (LIIs) were disposed of on 5-21-25. The correct version of the LII was used for all self-assessments completed in April/May 2025, and will be used moving forward. 06/06/2025 Implemented
SIN-00246033 Renewal 06/03/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.122(a)Individual #1's most recent dental examination was completed on 3/20/23.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.A letter from the dental office was shown to the licensing person on 6-3-24 showing that an appointment scheduled with the dental office on 9-23-23 was cancelled by the dental office due to the doctor having a family emergency. The letter also indicated that when the Life sharing Provider called back to reschedule the earliest available appointment was scheduled for 8-23-24.Individual #1 dental appointment will be completed at that time. 06/20/2024 Implemented
6500.152(c)Individual #1's assessment, completed 10/25/23 states that Individual #1 evacuates independently. The individual #1's Individual plan, last updated 1/10/24 reads, "[Individual #1] requires total assistance to evacuate."The individual plan shall be initially developed, revised annually and revised when an individual's needs change based upon a current assessment.The Life Sharing Program Specialist contacted Individual #1¿s Supports Coordinator on 6-20-24 via email with the information regarding the Individual¿s ability to evacuate the home independently and requested that the ISP be updated based upon the assessment. 06/20/2024 Implemented
SIN-00208591 Renewal 07/21/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.121(c)(6)Individual #1 had a Tuberculin skin testing by Mantoux method on 01/09/20, and then again on 02/04/22.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.Individual # 1¿s TB skin testing by Mantoux method completed on 2-4-22 is current now. 09/02/2022 Implemented
SIN-00154676 Renewal 05/01/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.109(d)The fire drill records from January 2018 to April 2019 do not include problems encountered during fire drills. This section of the form was left blank.A written fire drill record shall be kept of the date, time, the amount of time it took for evacuation, the exit route used, problems encountered and whether the smoke detector was operative.The blank on the Fire Drill form for documenting problems encountered will be completed by 6-7-19. The fire drill log was amended to include a check box for each drill to indicate problems encountered during the fire drill. On the form it will indicate a yes or no answer. If a problem is encountered an explanation will be written on the back of the fire drill log, and will include corrective action taken. All Lifesharing Providers and Specialists will be trained on the changes to the form by 6-24-19. Documentation of the training completion will be kept. 06/24/2019 Implemented
SIN-00115092 Renewal 05/22/2017 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.121(c)(13)Individual #1's physical examination completed on 1/19/17 did not include allergies or contraindicated medications. This section was left blank. The physical examination shall include: Allergies or contraindicated medications.Immediately, the Lifesharing Program Specialists shall review all individuals `current physical examinations to ensure all required areas are completed and there are not any required areas left blank. At least quarterly for one year, the Lifesharing Coordinator shall review all physical examinations to ensure aforementioned process is working and that all required areas of the physical examinations are completed for the health and safety of the individuals. The Lifesharing Coordinator reviewed regulation 6500.121 (c) (13) as reflected in Policy 6.06.02 with the Lifesharing Program Specialists on 6/7/2017 as evidenced by the attached signature page, and corrected form. [Individual #1's physical examination was updated to include allergies and contraindicated medications. Documentation of aforementioned reviews and trainings shall be kept. (AS 6/30/17)] 06/15/2017 Implemented
6500.182(c)(1)(ii)The record for Individual #1 did not include identifying marks. Each individual's record must include the following information: Personal information, including: The race, height, weight, color of hair, color of eyes and identifying marks.All Lifesharing Residential Individual Information Sheets have been reviewed for completeness as of 5-24-17 and corrected to reflect identifying marks. The Lifesharing Program Specialists will review the individual information sheet to ensure all areas are completed as updates occur. The Lifesharing Coordinator will review all information sheets once every three months for one year to ensure all required areas are completed and there are no required areas left blank. The Lifesharing Coordinator reviewed regulations 182(c) through 182(c)(1)(vi), with all Lifesharing Specialist as reflected in Policy 6.03 and as evidenced by the attached signature page dated 6/7/2017 and by the corrected form. [Individual #1's record was update to include "distinguishing features." Documentation of reviews shall be kept. (AS 6/30/17)] 06/15/2017 Implemented
SIN-00079061 Renewal 05/05/2015 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.151(f)The assessment for Individual #1 dated 10-24-14 was not sent to the entire team.The program specialist shall provide the assessment to the SC, as applicable, and plan team members at least 30 calendar days prior to an ISP meeting for the development of the ISP, the annual update, and revision of the ISP under § §  2380.182, 2390.152, 6400.182 and 6500.152 (relating to development, annual update and revision of the ISP).The Lifesharing Specialists will submit each Individual's Assessment to all team members at least 30 calendar days prior to an ISP meeting for the development of the ISP, the annual update, and revision of the ISP. This will be evidenced by the completion of Mercy's critical exchange form or by e-mail/fax confirmation. All Lifesharing Specialist will review regulation 6500.151(f) as evidenced by a signed certificate. [The Lifesharing Specialist will review ISP/ISP documentation to determine who is on the team and ensure all team members receive the assessment. (AS 6/10/15)] 06/08/2015 Implemented
SIN-00281343 Renewal 01/13/2026 Compliant - Finalized
SIN-00191656 Renewal 08/18/2021 Compliant - Finalized
SIN-00176588 Renewal 09/15/2020 Compliant - Finalized
SIN-00064476 Renewal 06/12/2014 Compliant - Finalized