INITIAL COMMENTS
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This report is a result of an on-site inspection conducted for the approval to use a narcotic agent, specifically methadone and buprenorphine, in the treatment of narcotic addiction. This inspection was conducted on February 10-12, 2014 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, Coatesville Treatment Center was found not to be in compliance with the applicable chapters of 4 PA Code and 28 PA Code which pertain to the facility. The following deficiencies were identified during this inspection.
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Plan of Correction
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715.9(a)(4) LICENSURE Intake
(a) Prior to administration of an agent, a narcotic treatment program shall screen each individual to determine eligibility for admission. The narcotic treatment program shall:
(4) Have a narcotic treatment physician make a face-to-face determination of whether an individual is currently physiologically dependent upon a narcotic drug and has been physiologically dependent for at least 1 year prior to admission for maintenance treatment. The narcotic treatment physician shall document in the patient 's record the basis for the determination of current dependency and evidence of a 1 year history of addiction.
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Observations
Based on the review of clinical documentation, the facility, particularly the physician, failed to accurately document the basis for determining current dependency in one of ten patient records.
The findings include:
Twenty two patient records were reviewed February 10-12, 2014. Ten patient records were reviewed for physician documentation of the basis for determining current and one year history of dependency.
Patient # 10 was admitted January 22, 2014. The patient had been referred to the clinic from an inpatient treatment facility after being detoxified from opiates. The patient was opiate free for almost one month prior to admission to the narcotic treatment facility. There was no documentation by the physician addressing this issue, justifying the absence of current dependency upon admission.
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Plan of Correction
The annual physical form was updated after the last monitoring visit. Starting 2/13/2014, Medical Director will clearly document his recommendations for treatment and continued care on all physicals. Phycisian will evaluate all admissions and determine if they meet the requirements for medications assisted treatment. If there is is a case where a patient does not have opiates in their admission urine durg screen, Medical Director will perform a physical examination and completed the ASAM to determine eligibility and clearly document his treatment recommendation. If there was prior treatment, the documentation will be requested from previous treatment facility and maintained in the patients chart. The Physician will monitored this process by completing a review of each physical performed to ensure that the lanuage on the documentation clearly illustrates his recommendation. |
715.19(1) LICENSURE Psychotherapy services
A narcotic treatment program shall provide individualized psychotherapy services and shall meet the following requirements:
(1) A narcotic treatment program shall provide each patient an average of 2.5 hours of psychotherapy per month during the patient 's first 2 years, 1 hour of which shall be individual psychotherapy. Additional psychotherapy shall be provided as dictated by ongoing assessment of the patient.
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Observations
Based on a review of patient records, the facility failed to provide each patient an average of 2.5 hours of psychotherapy per month during the patient's first 2 years of treatment in five of seven patient records.
The findings include:
Twenty two patient records were reviewed February 10-12, 2014. Seven patient records were reviewed for psychotherapy hours during the first two years of treatment.
Patient # 8 was admitted December 17, 2013. Patient had only one hour of therapy total at the time of the inspection.
Patient # 11 was admitted October 15, 2013. There were no documented therapy hours at the time of the inspection.
Patient # 12 was admitted October 16, 2013. One hour of therapy was documented between August 8, 2013 and September 18, 2013 and then October 21, 2013.
Patient # 15 was admitted January 9, 2013. The patient received one hour of therapy in November 2013, one and one half hours therapy in December 2013 and one hour of therapy for January 2014.
Patient # 19 was admitted October 31, 2013. The patient had no therapy hours in November 2013, and one half hour January 2014.
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Plan of Correction
Training was conducted on 3/10/2014 with all Clinical staff regarding Counseling Hours. All Counselors must have contacted with their patients on the first of every month to ensure they are scheduled for individual and group counseling. All Counseling appointments are to be loaded in Tower. On the 15th and 30th of each month, Counselors are to submit their Counseling hours report from Tower for discussion and review with their supervisor. If a patient misses an appointment, they are to be met with the next day to reschedule. Patients with continuous non-compliance regarding counseling will have to meet with their counselor prior to medicated on the day of their appointment. |
715.23(b)(5) LICENSURE Patient records
(b) Each patient file shall include the following information:
(5) The results of all annual physical examinations given by the narcotic treatment program which includes an annual reevaluation by the narcotic treatment physician.
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Observations
Based on the review of patient records, the facility failed to complete the annual physical as required by the physician in three of six patient records reviewed.
The findings include:
Twenty two patient records were reviewed February 10-12, 2014. Six patient records required an annual physical be completed.
Patient # 16 was admitted October 13, 2011 and an annual physical was due to be completed by October 13, 2013. The annual physical exam was not completed at the time of the inspection.
Patient # 18 was admitted August 6, 2002. The annual physical exam was completed more than one month late, September 18, 2013.
Patient # 20 was admitted October 27, 2011. The annual physical exam was completed almost one month late, November 26, 2013.
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Plan of Correction
As of 02/13/2014, Director of Nursing will review monthly reports by the 15th of every month to ensure every patient receive an annual physicals. Patients that miss their appointments will be rescheduled within the same month and will not be able to medicate until after the physical is completed. Patients that have take home privileges or are eligible for take homes, loose the privileges if their physical is not completed. |