Based on the concerns arising from COVID-19, The Department of Drug and Alcohol Programs, Bureau of Quality Assurance for Prevention and Treatment, has implemented temporary procedures for conducting an annual renewal inspection. The inspection will be divided into two parts. 1, an abbreviated off-site inspection, will be conducted off site, and will require the submission of administrative information via email to a Licensing Specialist. 2, an abbreviated on-site inspection, will be conducted on-site, at a later date and will include a review of client/patient records, and a physical plant inspection.This report is a result of Part 1, an abbreviated off-site inspection, conducted on July 13, 2020 by staff from the Department of Drug and Alcohol Programs, Bureau of Quality Assurance for Prevention and Treatment. Not all regulations were reviewed, the remainder of the regulations, not reviewed during Part 1, will be reviewed at a later date.Based on the findings of Part 1, an abbreviated off-site inspection, Conewago-Pottsville was found not to be in compliance with the applicable chapters of 28 PA Code which pertain to the facility. The following deficiencies were identified during this inspection:
|
Plan of Correction
|
Observations
Based on a review of fire drills from July 2019 until June 2020, the facility failed to conduct fire drills on different days of the week as seven of the thirteen fire drills were conduct on the last few days of the month. These findings were discussed with facility staff during the inspection process. This is a repeat citation from previous inspection.
|
Plan of Correction
Beginning at time of this response, 8/11/2020, the Facility Director will ensure fire drills occur during varying weeks of the month from month to month.
Oversight of this process will be conducted monthly by the Facility Director and Corporate Compliance Officer.
.
|