Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00176589 Renewal 09/15/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.109(d)The written fire drill records for the fire drills held on 1/20/20, 2/14/20, 3/14/20, 4/19/20, 5/23/20, 6/05/20, 6/06/20, 7/11/20, 8/08/20 do not include the exit route used. This section 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 Lifesharing Provider was retrained on 10-6-20 on the requirements of PM Polciy 7.01.04 (Fire Drills) and was retrained on the need to complete all areas of the Fire Drill Form as evidenced by the training verification form. The Lifesharing Program Specialists will complete a fire drill checklist at all homes to verify that all necessary information is on the fire drill form. The checklist will be completed monthly during home visits effective immediately as evidenced by the completed checklist. All completed checklists will be submitted to the Lifesharing Coordinator on a monthly basis for review.[Aforementioned checklist of fire drill documentation check list was completed for each home between 10/7/20 and 10/19/20. Copies were provided to the Department on 10/19/20. (AES, HSLS on 10/19/20)] 10/06/2020 Implemented
6500.151(e)(1)Individual #1's assessment dated 7/05/20 did not include functional strengths, needs, and preferences of the individual.The assessment must include the following information: Functional strengths, needs and preferences of the individual.The Lifesharing Program Specialist updated the Assessment to include the strengths, needs and preferences of the individual. Updates were completed on 9/15/2020. The Lifesharing Program specialist will ensure that functional strengths, needs and preferences of the individual will be included on all new admissions, and current individuals, as evidenced by the signed training certificate. The Lifesharing Coordinator will complete reivews of at least 25% of the Assessments over the next year to ensure that all areas have been completed. 10/06/2020 Implemented
6500.151(e)(2)Individual #1's assessment dated 7/05/20 did not include the likes, dislikes, and interest of the individual.The assessment must include the following information: The likes, dislikes and interest of the individual.The Lifesharing Program Specialist updated the Assessment to include the likes, dislikes, and interest of the individual immediately. This is evidenced by the updated Assessment completed on 9/15/2020. The Lifesharing Program specialist will ensure that Likes, dislikes and interest of the individual will be included on all new admissions, and current individuals, as evidenced by the signed training certificate. The Lifesharing Coordinator will complete reivews of at least 25% of the Assessments over the next year to ensure that all areas have been completed. 10/06/2020 Implemented
6500.151(e)(10)Individual #1's assessment dated 7/05/20 did not include a lifetime medical history.The assessment must include the following information: A lifetime medical history.A Lifetime Medical History was completed on 9/16/2020 by Machelle DeCarlo, RN as evidenced by the completed form in the electronic health record. The Lifesharing Program Specialists were retrained on the Medical History Summary Policy on 10-6-20 as evidenced by the training verification form. The Lifesharing Program Coordinator will ensure that any future assessments will be completed within 60 days of admission as per PM policy #6.06.02.01 (Medical History Summary) by reviewing a 25 % sample of assessments over the next year. 10/06/2020 Implemented
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