Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00275549 Renewal 10/15/2025 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.64(a)At the time of the inspection, the bathroom located downstairs where the Individuals shower had multiple cobwebs from the shower head to the light fixture in the ceiling. This same shower head had a build-up of grime on it. The metal shower rod in this same bathroom had multiple areas all over it with what appeared to be rust.Clean conditions shall be maintained in all areas of the home.The shower head was cleaned, and a new shower bar was purchased. The host was retrained on the requirements. Photo attached. 10/27/2025 Implemented
6500.79(d)At the time of the inspection, Individual #1 did not have drapes, curtains, shades, blinds, or shutters in their bedroom window.Bedroom windows shall have drapes, curtains, shades, blinds or shutters.Curtains were purchased and hung in the bedroom. The host was retrained on the requirements. Photo attached. 10/27/2025 Implemented
SIN-00253413 Renewal 10/29/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.109(d)Documentation of fire drills completed on 1/28/23, 6/28/23, 1/28/24 and 7/19/24 all listed an evacuation time of 60 seconds. The recorded evacuation times are not accurate.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 host family had a fire drill on 11/17/2024 and recorded the exact evacuation time in minutes and seconds. Documentation of the date and time of the evacuation was sent to the LifeSharing Coordinator. 11/17/2024 Implemented
SIN-00232488 Renewal 10/11/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.72(b)Screens, windows and doors shall be in good repair. At the time of inspection, the screen located on the window to the left of the garage was ripped in the left corner approximately and 5 inches long and 3 inches wide. The screen located in the window in the attic at the top of the steps as ripped at the bottom approximately 14 inches long and 10 inches wide.Screens, windows and doors shall be in good repair.The Life Share provider has been tasked with repairing the two window screens by the next physical site visit conducted by the Life Share Specialist in November. 11/30/2023 Implemented
6500.101Stairways, halls, doorways and exits from rooms and from the home shall be unobstructed. The door going up to the attic had a turn lock on the door. When the door is locked an individual would not be able to exit from the attic as you would be locked in the attic.Stairways, halls, doorways and exits from rooms and from the home shall be unobstructed.The Life Share provider has been tasked with replacing the locking doorknob leading to the attic with a non-locking knob by the next physical site visit conducted by the Life Share Specialist in November. 11/30/2023 Implemented
6500.121(c)(10)Individual #1's physical examination dated 1/17/23 did not include if the individual was free from communicable disease or Specific precautions that must be taken if the individual has a communicable disease, to prevent spread of the disease to other individuals. The physical examination shall include: Specific precautions that must be taken if the individual has a communicable disease, to prevent spread of the disease to other individuals.The Life Share Provider was given the approved physical evaluation form to update their master documentation binder provided by the Life Share Specialist which contains all approved documents needed for program operation. 10/31/2023 Implemented
6500.121(c)(11)Individual #1's physical examination dated 1/17/23 did not include or address an assessment of the individual's health maintenance needs, medication regimen and the need for blood work at recommended intervals. The physical examination shall include: An assessment of the individual's health maintenance needs, medication regimen and the need for blood work at recommended intervals.The Life Share Provider was given the approved physical evaluation form to update their master documentation binder provided by the Life Share Specialist which contains all approved documents needed for program operation 10/31/2023 Implemented
6500.121(c)(13)Individual #1's physical examination dated 1/17/23 did not include allergies or contraindicated medications as this section of the examination was left blank. The physical examination shall include: Allergies or contraindicated medications.The Life Share Provider was given the approved physical evaluation form to update their master documentation binder provided by the Life Share Specialist which contains all approved documents needed for program operation. 10/31/2023 Implemented
6500.121(c)(14)Individual #1's physical examination dated 1/17/23 did not include or address medical information pertinent to diagnosis and treatment in case of an emergency. The physical examination shall include: Medical information pertinent to diagnosis and treatment in case of an emergency.The Life Share Provider was given the approved physical evaluation form to update their master documentation binder provided by the Life Share Specialist which contains all approved documents needed for program operation. 10/31/2023 Implemented
6500.124Health 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 is prescribed Invega ER 6 MG tablet, take 1 tablet by mouth once daily at 8pm. The medication bottle had a discard after date of 12/29/22 on the pharmacy label and Staff #1 has been administering the medication to Individual #1 from the expired medication bottle. Pharmaceutical services are not being planned or followed.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.The Life share Provider has disposed of expired/discontinued meds at their local pharmacy. Current medications also reviewed to document future expiration dates. 10/31/2023 Implemented
6500.133(d)Prescription medications shall be kept in an area or container that is locked. At the time of the inspection, Staff #1 obtained Individual #1's additional/extra medications (Paliperidone ER 6 mg, Invega ER 3 mg, Invega 6 mg, Midodrine HCL 5 mg, and pro re nata medications (CVS Senna Plus and Acetaminophen) that were stored in a wooden unlocked cabinet/bench.Prescription medications and syringes, with the exception of epinephrine and epinephrine auto-injectors, shall be kept in an area or container that is locked.The Life Share Provider has discarded the medications that were unlocked and has ensured and confirmed that all medication are all locked in their identified area. 10/31/2023 Implemented
6500.133(h)Prescription medications that are discontinued or expired shall be destroyed in a safe manner. Individual #1 is prescribed Acetaminophen 325mg tablet, take 2 tablets every 3 hours as needed for pain or fever over 99. Call MD after 5 days if still sick. The bottle had a discard date of 9/10/21 on the pharmacy label. Individual #1's is prescribed Invega ER 6 MG tablet, take 1 tablet by mouth once daily at 8pm. There were two bottles of the medication in the home. One of the b unopened with a discard after date of 12/29/22 on the pharmacy label. Invega ER 3 mg, take 1 tablet by mouth at bedtime and the discard date on the pharmacy label on medication bottle was 8/7/23. Midodrine HCL 5 mg tablet, take 1 tablet by mouth twice a day at 8am and 8pm. The bottle of medication in the home had discard after 10/4/23 on the pharmacy label. CVS Purelax Powder, take one capful (17 grams) in liquid at 8pm every day by mouth. The pharmacy label had date filled of 2/19/21 for the medication. Benefiber Powder, take 2 tablespoonsful by mouth at 8am with breakfast and 5pm with dinner daily. The date filled on the pharmacy label was 2/10/21. These medications remained in the home and have not been disposed of properly.Prescription medications that are discontinued or expired shall be destroyed in a safe manner according to Federal and State statutes and regulations.The Life share Provider has disposed of expired/discontinued meds at their local pharmacy. Current medications also reviewed to document future expiration dates 10/31/2023 Implemented
6500.135(g)Individual #1 is prescribed medications to treat symptoms of a diagnosed psychiatric illness. Individual #1 had a 3 month psychiatric medication reviews on 3/27/23, 5/18/23, and 8/7/23 and the form used did not include the reason for prescribing the medication.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.Life Share Specialist have been trained on documentation of medication within the center¿s new electronic health record on 11/09/2023. All medications noted as active for individuals have been updated to reflect reason medication is prescribed. 10/31/2023 Implemented
SIN-00193318 Renewal 09/14/2021 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.24(c)A Kohl's receipt dated 5/20/21 in the amount of $107.98 was presented as items purchased for Individual #1. Staff #1 used Staff #1's reward membership when making the purchase with Individual #1 and gained $20 in Kohl's cash to be used as cash for a future purchase. Individual #1's money was used to gain the reward, therefore the $20 in Kohl's cash should have been used for Individual #1's benefit. No record of Individual #1 having access to or using the Kohl's cash was produced. An Individual's funds and property shall be used for the individual's benefit.An individual's funds and property shall be used for the individual's benefit.Provider was retrained in proper finance procedures. 10/15/2021 Implemented
6500.109(f)Fire drills dated 12/18/20, 1/21/21 and 6/10/21 all listed garage or garage/kitchen as the exit used during the drills. Alternate exit routes must be used. Additional drills in 2020 listed the same exit. Additional exits are available in the home.Alternate exit routes shall be used during fire drills.Providers received re-training on 6500.109 regarding fire drills on 10/8/21. 10/08/2021 Implemented
6500.109(g)Fire drills dated 12/18/20, 1/21/21 and 6/10/21 were all noted to be sleep drills during the evening hours at 7:44pm, 8:30pm and 9:30pm. Fire drills are to be conducted at different times of the day and night. A fire drill shall be held during the day to ensure compliance.Fire drills shall be held on different days of the week and at different times of the day and night.Providers received re-training on 6500.109 regarding fire drills on 10/8/21. 10/08/2021 Implemented
6500.121(c)(4)The physical dated 1/4/21 for Individual #1 did not include an assessment of vision or hearing. The vision and hearing sections of the physical were not checked as being assessed and the "Comments" section was blank. No other vision or hearing screenings occurred throughout the year. The physical examination shall include: Vision and hearing screening for individuals 18 years of age or older, as recommended by the physician.Vision and hearing screening and will be conducted 10/31/21 due to appointment availability. 10/30/2021 Implemented
6500.48(b)(4)There was no documentation to support that training on recognizing and reporting incidents occurred for Staff #1.The annual training hours specified in subsection (a) must encompass the following areas: Recognizing and reporting incidents.Provider completed the required APS & OAPS trainings on 10/14/2021 10/14/2021 Implemented
6500.136(a)(2)The September 2021 Medication Administration Record (MAR) for Individual #1 did not list the name of the prescriber for medications listed.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Name of the prescriber.The program¿s nursing department has reviewed all MARs vs. current prescriptions to ensure physician medication orders are being correctly documented. 10/08/2021 Implemented
6500.136(a)(3)The September 2021 Medication Administration Record (MAR) for Individual #1 did not list allergies or lack thereof. The allergies section of the MAR was blank.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Drug allergies.The program¿s nursing department has reviewed all MARs vs. current prescriptions to ensure physician medication orders are being correctly documented. 10/08/2021 Implemented
6500.136(a)(4)The September 2021 Medication Administration Record (MAR) for Individual #1 listed "Apriso 0.7gm Grams Give 4 capsules by mouth twice a day." Apriso was not the medication being administered to Individual #1. Staff #1 indicated that Mesalamine, a generic form of Apriso, was being administered per label directions but not logged. Label instruction for Mesalamine: Mesalamine 0.375g Take 4 capsules by mouth daily. There were no entries for Mesalamine on the MAR. The name of the medication is required on the MAR.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Name of medication.The program¿s nursing department has reviewed all MARs vs. current prescriptions to ensure physician medication orders are being correctly documented 10/08/2021 Implemented
6500.136(a)(5)The September 2021 Medication Administration Record (MAR) for Individual #1 listed "Apriso 0.7gm Grams Give 4 capsules by mouth twice a day." Apriso was not the medication being administered to Individual #1. Staff #1 indicated that Mesalamine, a generic form of Apriso, was being administered per label directions but not logged. Label instruction for Mesalamine: Mesalamine 0.375g Take 4 capsules by mouth daily. There were no entries for Mesalamine on the MAR. The strength of Mesalamine was not included on the MAR.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Strength of medication.The program¿s nursing department has reviewed all MARs vs. current prescriptions to ensure physician medication orders are being correctly documented 10/08/2021 Implemented
6500.136(a)(9)The September 2021 Medication Administration Record (MAR) for Individual #1 listed "Apriso 0.7gm Grams Give 4 capsules by mouth twice a day." Apriso was not the medication being administered to Individual #1. Staff #1 indicated that Mesalamine, a generic form of Apriso, was being administered per label directions but not logged. Label instruction for Mesalamine: Mesalamine 0.375g Take 4 capsules by mouth daily. There were no entries for Mesalamine on the MAR. The frequency of admiration for the Mesalamine was not included on the MAR.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Frequency of administration.The program¿s nursing department has reviewed all MARs vs. current prescriptions to ensure physician medication orders are being correctly documented. 10/08/2021 Implemented
6500.136(a)(10)The September 2021 Medication Administration Record (MAR) for Individual #1 listed "Apriso 0.7gm Grams Give 4 capsules by mouth twice a day." Apriso was not the medication being administered to Individual #1. Staff #1 indicated that Mesalamine, a generic form of Apriso, was being administered per label directions but not logged. Label instruction for Mesalamine: Mesalamine 0.375g Take 4 capsules by mouth daily. There were no entries for Mesalamine on the MAR. The administration times for the Mesalamine was not included on the MAR.A medication record shall be kept, including the following for each individual for whom a prescription medication is administered: Administration times.The program¿s nursing department has reviewed all MARs vs. current prescriptions to ensure physician medication orders are being correctly documented. 10/08/2021 Implemented
SIN-00179466 Renewal 11/12/2020 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.122(e)Individual #3's dental exam on 1/21/2020 documented a recall for 6 months, and the next dental appointment occurred on 10/20/2020.Follow-up dental work indicated by the examination, such as treatment of cavities, shall be completed.On-going FLP¿s will ensure individuals medical appointments are scheduled within the timeframe mandated through 6500 regulations or by medical professional recommendations for follow-up. During the COVID-10 pandemic Devereux will continue to use the Level of Community Transmission information provided by ODP in conjunction with CDC guidance to make informed choices about protecting the health and safety of individuals and staff as well as their families. In the event routine appointments must be postponed due to Covid-19, all attempts to reschedule appointments will be made when community transmission has decreased to levels the minimize risk for the individual. All cancelled appointments will be documented in the individual file with the reason for cancellation and rescheduled date, if applicable. 12/04/2020 Implemented
SIN-00135563 Renewal 07/10/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
6500.62(d)Food items were found stored with cleaning products in the laundry closet off the kitchen.Poisonous materials shall be kept separate from food, food preparation surfaces and dining surfaces.Food was removed immediately and procedure was reviewed with Life Share Provider. Physical site review of food and poisons will be added to monthly visit form by 9/1/18. Monthly site visit by Program Specialist will include a physical site review of food and poisons and immediate feedback on needed corrections. 09/01/2018 Implemented
SIN-00214366 Renewal 10/20/2022 Compliant - Finalized
SIN-00158609 Renewal 07/09/2019 Compliant - Finalized
SIN-00121518 Renewal 08/21/2017 Compliant - Finalized
SIN-00099720 Renewal 07/06/2016 Compliant - Finalized