Adelphoi Raphael House

Citation, complaint inspection : 55 Pa. Code § 3800.32.c Specific Rights

On , child A was not treated with respect by staff member A. Staff didn't intervene in the horseplay between child A and peers permitting them to .

Citation, renewal inspection : 55 Pa. Code § 3800.184.b Medication Log

The medication log for child A did not include a signature indicating that child A received on .

Citation, complaint inspection : 55 Pa. Code § 3800.32.b Specific Rights

On May 9th, 2023, staff A was seen picking up child A after jumped out of the transportation vehicle, and throwing onto the ground.

Citation : 55 Pa. Code § 3800.132.c

‘Tho fire dell record dated 4-9-2015 does nol Indicate the exit route used,

Citation, renewal inspection : 55 Pa. Code § 3800.51

Staff Member A was hired on 8/11/14 and his/her child abuse clearance was dated 2/12/15.

Citation, renewal inspection : 55 Pa. Code § 3800.143.d

Resident #'1’s health examination record dated 7/29/14 did not include the address of the examining pracillioner, Resident #'3’s health examinalion record dated 8/5/14 did not Include the address of the examining praciltloner.

Citation, renewal inspection : 55 Pa. Code § 3800.146.e

Resident #'1’s vision screening record dated 7/29/14 did not include the address of the {reating practitioner. Resident #'3's vision scraening record dated 8/5/14 did not include the address of the Ireating practitioner.

Citation, renewal inspection

Resident #'1’s hearlng screening record dated 7/29/14 did not include the address of the (reating practitioner. © Resident #'3's heating screening record dated 8/6/14 did not include the address of the treating praclilloner.

Citation, renewal inspection : 55 Pa. Code § 3800.84.d

The ash receptacte in the upstairs bathroom was uncovered on 03/07/13.

Citation, renewal inspection : 55 Pa. Code § 3800.88.b

Water temperature In the upstairs bathroom sink measured 125.2 degrees Fahrenheit on 03/07/13. 3. PLAN OF GORRECTION (POC) (Attach pages as necessary. Remember that you must sign and date any attached pages.) Include steps to correct the violation dascribad above and steps lo provent @ similar violation from occurring again. if staps cannot be completed immediately, include dates by which the steps will be completed. Please see attached Po. ge SA Signature of Legal Entity Repres¢ Required on EVE age Printed Name and Title of Legal entity Represe, {Required on EVERY Page) Pian of correction Implementation status as ot Sy 13 Aa < Fully Implemented Partially Implemented - Adequate Progress The above plan of correction was approved by oO Partially Implemented - Inadequate Progress (initials) oO Not Implemented RECEIVED MAR 28713 Page 4 of 4 WEST REGION | all! jcensing Inspection Summary: 42906 - 03/04/2013 - Rodack, Kristen Facility Name: RAPHAEL HOUSE

Citation, renewal inspection : 55 Pa. Code § 3800.144.b

Resident #1, admitted 12/20/41, had an Initial dental examination on 02/08/12.