INITIAL COMMENTS
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This report is a result of an on-site licensure renewal inspection conducted on December 4-6, 2018 by staff from the Department of Drug and Alcohol Programs, Bureau of Quality Assurance for Prevention & Treatment with the inspection also conducted for the approval to use Methadone and Buprenorphine in the treatment of narcotic addiction. Based on the findings of the on-site inspection, Habit OPCO, Inc. - Allentown 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:
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Plan of Correction
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704.9(c) LICENSURE Supervised Period
704.9. Supervision of counselor assistant.
(c) Supervised period.
(1) A counselor assistant with a Master's Degree as set forth in 704.8 (a)(1) (relating to qualifications for the position of counselor assistant) may counsel clients only under the close supervision of a trained counselor or clinical supervisor for at least the first 3 months of employment.
(2) A counselor assistant with a Bachelor's Degree as set forth in 704.8 (a)(2) may counsel clients only under the close supervision of a trained counselor or clinical supervisor for at least the first 6 months of employment.
(3) A registered nurse as set forth in 704.8 (a)(3) may counsel clients only under the close supervision of a trained counselor or clinical supervisor for at least the first 6 months of employment.
(4) A counselor assistant with an Associate Degree as set forth in 704.8 (a)(4) may counsel clients only under the close supervision of a trained counselor or clinical supervisor for at least the first 9 months of employment.
(5) A counselor assistant with a high school diploma or GED equivalent as set forth in 704.8 (a)(5) may counsel clients only under the direct observation of a trained counselor or clinical supervisor for the first 3 months of employment. For the next 9 months, the counselor assistant may counsel clients only under the close supervision of a lead counselor or a clinical supervisor.
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Observations
One personnel record was reviewed for the counselor assistant position, during the licensing renewal inspection conducted on December 4-6, 2018. The facility failed to fully document the provision of direct observation and close supervision for employee record # 9.
Employee # 9 was hired by the facility on July 12, 2018 as a bachelor's degree level counselor assistant. The employee requires close supervision, to include direct observation, for the first 6 months of employment in the counselor assistant position. Weekly supervision notes were reviewed for the period of July 13, 2018 - November 29, 2018. Supervision notes were not documented for the weeks of October 14, 2018 and November 25, 2018. The facility also failed to fully demonstrate in both the supervision notes and the pertinent client charts that weekly close supervision included at least 1 hour of direct observation per week.
This finding was reviewed with facility staff during the licensing inspection.
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Plan of Correction
Clinical Supervisor will conduct weekly supervision for all Counseling Assistants and document accordingly in supervision notes. Close supervision, inclusive of direct observation, will be documented in the patient chart by the Counselor Assistant and in the weekly supervision notes by the Clinical Supervisor. The Clinic Director will meet monthly with the CS to review the status of Counselor Assistant supervisions. |
704.12(a)(6) LICENSURE OutPatient Caseload
704.12. Full-time equivalent (FTE) maximum client/staff and client/counselor ratios.
(a) General requirements. Projects shall be required to comply with the client/staff and client/counselor ratios in paragraphs (1)-(6) during primary care hours. These ratios refer to the total number of clients being treated including clients with diagnoses other than drug and alcohol addiction served in other facets of the project. Family units may be counted as one client.
(6) Outpatients. FTE counselor caseload for counseling in outpatient programs may not exceed 35 active clients.
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Observations
A licensing renewal inspection was conducted on December 4-6, 2018. Based on a review of the finalized Staffing Requirements Facility Summary Report submitted by the facility during the licensing process, the facility failed to ensure that all FTE counselor caseloads remained at or under 35:1.
Based on the total number of hours per week devoted to clients, and the standard work week of 35 hours, employees # 4 and 5 exceeded the allowable maximum 35:1 caseload.
The actual client caseload is determined by dividing the Full-Time Equivalent (FTE) into the actual number of clients. The FTE is determined by dividing the number of hours devoted to the clients' treatment by a standard work week of 35 hours.
reported on the Staffing Requirements Facility Summary Report, the number of hours per week devoted by Employee # 4 to outpatient client treatment was 37.5 hours per week. As of October 26, 2018, the employee had 39 active clients who were receiving counseling services at a frequency of at least twice per month.
- Employee # 4 (37.5/35 = 1.0714 FTE *** 39 clients/1.0714 FTE = 37/1 caseload)
reported on the Staffing Requirements Facility Summary Report, the number of hours per week devoted by Employee # 5 to outpatient client treatment was 37.5 hours per week. The employee had 38 active clients who were receiving counseling services at a frequency of at least twice per month.
- Employee # 5 (37.5/35 = 1.0714 FTE *** 38 clients/1.0714 FTE = 36/1 caseload)
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Based on the current census and those who meet the criteria of licensure alert 01-14, the facility will meet the 35:1 requirement. The Clinical Supervisor will monitor ratio and assess for appropriateness of patients meeting licensure alert 01-14 weekly, when assigning new admissions to counselors. The Facility Director will monitor census weekly to ensure compliance with this regulation and hire additional staff as needed. |
705.10 (d) (2) LICENSURE Fire safety.
705.10. Fire safety.
(d) Fire drills. The residential facility shall:
(2) Conduct fire drills during normal staffing conditions.
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Observations
The facility's fire drill records were reviewed on December 6, 2018, for the period of December 2017 - November 2018. The following deficiencies were found during this review:
-The facility failed to fully demonstrate that monthly fire drills are routinely conducted during normal staffing conditions. As of April 15, 2018, the facility no longer operates on Sundays. The facility provided documentation of a fire drill that was conducted on Sunday, May 20, 2018. Facility staff confirmed that the Sunday facility closure would have been in effect on that date.
-The facility failed to document whether the fire alarm or smoke detector was operative during fire drills conducted on January 11, 2018 and June 8, 2018.
-The facility failed to document the number of people in the facility during the fire drill conducted on June 8, 2018.
These findings were reviewed with facility staff during the licensing inspection.
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Plan of Correction
The Clinic Director will ensure all fire drills are conducted monthly by review of the drill forms beginning January 2019. The CD will review for accuracy prior to signing the form for each month. The documentation will clearly indicate whether the fire alarm or smoke detector was operative during the drill and will consistently indicate the number of participants monthly. |
705.23 (3) LICENSURE Counseling or activity areas and office space
705.23. Counseling or activity areas and office space.
The nonresidential facility shall:
(3) Ensure privacy so that counseling sessions cannot be seen or heard outside the counseling room. Counseling room walls shall extend from the floor to the ceiling.
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Observations
A physical plant inspection was conducted on December 6, 2018, during the licensing renewal inspection. In a large group counseling room located on the first floor, an exterior door was located in the rear of the room. This door had glass panels that were uncovered, allowing full visibility into the room.
This finding was reviewed with facility staff during the licensing inspection.
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Plan of Correction
The Clinic Director has accommodated for the exposed window on the door in the rear of the group room. The relocation of this facility is scheduled for 2/9/19. |
705.26 (2) LICENSURE Heating and cooling.
705.26. Heating and cooling.
The nonresidential facility:
(2) May not permit in the facility heaters that are not permanently mounted or installed.
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Observations
A physical plant inspection was conducted on December 6, 2018, during the licensing renewal inspection. An unmounted space heater was found in a storage closet located within a counseling office.
This finding was reviewed with facility staff during the licensing inspection.
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Plan of Correction
The Clinic Director will ensure that the facility will not have any space heaters on site, regardless of being in a storage location. This will be completed through the monitoring of monthly Health and Safety checks. |
709.28 (b) LICENSURE Confidentiality
§ 709.28. Confidentiality.
(b) The project shall secure hard copy client records within locked storage containers. Electronic records must be stored on secure, password protected data bases.
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Observations
A physical plant inspection was conducted on December 6, 2018, at approximately 1:00 pm, during the licensing renewal inspection. The following deficiencies were noted during the physical plant inspection:
-Filing cabinets containing client records were stored in the facility's copy room. At the time of the physical plant inspection, the door to the copy room was unlocked, and the filing cabinets were unlocked.
- Client records were also stored in filing cabinets located in the reception area. At the time of the physical plant inspection, the reception area was unattended, and the filing cabinets were unlocked.
This finding was reviewed with facility staff during the licensing inspection.
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Plan of Correction
Immediately following inspection the patient records were relocated to the allocated file room. The files were locked in the cabinet and the file room door was then locked appropriately.
Facility Director to ensure all client records are stored and locked in the appropriate file room.
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715.6(d) LICENSURE Physician Staffing
(d) A narcotic treatment program shall provide narcotic treatment physician services at least 1 hour per week onsite for every ten patients
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Observations
Weekly physician time sheets and client census reports were reviewed on December 4-6, 2018 for the period of July 1, 2018 through October 27, 2018. Based on a review of this documentation, the facility failed to provide at least one hour of physician services per week on site for each week within the reviewed time period.
For the week of July 29, 2018, the patient census was 226. The facility was required to provide at least 22.6 onsite physician hours. There were 19 onsite physician hours documented for this week.
For the week of August 19, 2018, the patient census was 222. The facility was required to provide at least 22.2 onsite physician hours. There were 17 onsite physician hours documented for this week.
For the week of September 2, 2018, the patient census was 219. The facility was required to provide at least 21.9 onsite physician hours. There were 14 onsite physician hours documented for this week.
For the week of September 23, 2018, the patient census was 220. The facility was required to provide at least 22.0 onsite physician hours. There were 21 onsite physician hours documented for this week.
This was a repeat citation from the November 28, 2017 inspection.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
The Clinic Director, together with the Regional Director and Regional Medical Director, is actively pursuing the development of a 'physician team' to ensure compliance with regulations. The Clinic Director will review the census weekly and monitor the physician schedule to ensure adequate coverage is provided. |
715.6(e) LICENSURE Physician Staffing
(e) A physician assistant or certified registered nurse practitioner may perform functions of a narcotic treatment physician in a narcotic treatment program if authorized by Federal, State and local laws and regulations, and if these functions are delegated to the physician assistant or certified registered nurse practitioner by the medical director, and records are properly countersigned by the medical director or a narcotic treatment physician. One-third of all required narcotic treatment physician time shall be provided by a narcotic treatment physician. Time provided by a physician assistant or certified registered nurse practitioner may not exceed two-thirds of the required narcotic treatment physician time.
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Observations
Weekly physician time sheets and client census reports were reviewed on December 4-6, 2018, for the period of July 1, 2018 through October 27, 2018. The facility failed to ensure that at least one-third of all required narcotic treatment physician time was provided by the narcotic treatment physician.
For the week of July 8, 2018, the facility was required to provide at least 7.29 hours by the narcotic treatment physician. There were 7 hours documented for the narcotic treatment physician for this week.
For the week of July 29, 2018, the facility was required to provide at least 7.45 hours by the narcotic treatment physician. There were 5 hours documented for the narcotic treatment physician for this week.
For the week of September 2, 2018, the facility was required to provide at least 7.3 hours by the narcotic treatment physician. There were 0 hours documented for the narcotic treatment physician.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
The Clinic Director, together with the Regional Director and Regional Medical Director, is actively pursuing the development of a 'physician team' to ensure compliance with regulations.
The CTC Director will monitor the Physician schedule and census to ensure compliance with the regulation and adjust physician/physician assistant hours appropriately. |
715.9(a)(1) 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:
(1) Verify that the individual has reached 18 years of age.
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Observations
Eight client records were reviewed for the use of Methadone and Buprenorphine in the outpatient treatment activity on December 4-6, 2018. For client records # 1 and 8, the facility failed to document verification that the client had reached 18 years of age.
Client #1 was admitted on February 14, 2018 and was still active at the time of inspection. An initial dose of Methadone was administered to the client on February 23, 2018. The facility failed to document their verification of the client's age prior to administering Methadone.
Client #8 was admitted on August 9, 2018 and was discharged on November 26, 2018. The client received a prescription for Buprenorphine on August 10, 2018, authorized by the narcotic treatment physician. The facility failed to document their verification of the client's age prior to providing the initial Buprenorphine prescription.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Upon admission, verification of age will be documented via an acceptable form of ID as identified in licensing alert 01-2018. This documentation will be reviewed by the admissions team, inclusive of the Administrative Assistant and the Assistant Director, then uploaded into the EMR for future verification as needed.
The Clinical Supervisor and Counselors will review upon monthly chart reviews. |
715.9(a)(2) 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:
(2) Verify the individual 's identity, including name, address, date of birth, emergency contact and other identifying data.
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Observations
Eight client records were reviewed for the use of Methadone and Buprenorphine in the outpatient treatment activity on December 4-6, 2018. For client records # 1 and 8, the facility failed to document verification of the individual's identity, including name, address, and date of birth.
Client #1 was admitted on February 14, 2018 and was still active at the time of inspection. An initial dose of Methadone was administered to the client on February 23, 2018. The facility failed to document their verification of the client's identity prior to administering Methadone.
Client #8 was admitted on August 9, 2018 and was discharged on November 26, 2018. The client received a prescription for Buprenorphine on August 10, 2018, authorized by the narcotic treatment physician. The facility failed to document their verification of the client's identity prior to providing the initial Buprenorphine prescription.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Upon admission, verification of identity, inclusive of name, address and DOB, will be documented via an acceptable form of ID as identified in licensing alert 01-2018. This documentation will be reviewed by the admissions team, inclusive of the Administrative Assistant and Assistant Director, then uploaded into the EMR for future verification as needed.
The Clinical Supervisor and Counseling team will monitor during monthly chart reviews. |
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
Eight client records were reviewed for the use of Methadone and Buprenorphine in the outpatient treatment activity on December 4-6, 2018. For client record # 8, the facility failed to provide documentation of the physician's determination of current dependency on a narcotic drug and evidence of a 1-year history of addiction.
Client # 8 was admitted on August 9, 2018 and was discharged on November 26, 2018. The client received a prescription for Buprenorphine on August 10, 2018, authorized by the narcotic treatment physician. The client's record did not contain any intake documentation pertaining to the physician's determination of current dependency and history of addiction.
This finding was reviewed with facility staff during the licensing process.
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Plan of Correction
The MD will complete the initial physical and document the all physician admission information in the EMR accordingly. The facility is moving to a full EMR system, which will ensure the documentation remains intact when moving from department to department. |
715.12(1-5) LICENSURE Informed patient consent
A narcotic treatment program shall obtain an informed, voluntary, written consent before an agent may be administered to the patient for either maintenance or detoxification treatment. The following shall appear on the patient consent form:
(1) That methadone and LAAM are narcotic drugs which can be harmful if taken without medical supervision.
(2) That methadone and LAAM are addictive medications and may, like other drugs used in medical practices, produce adverse results.
(3) That alternative methods of treatment exist.
(4) That the possible risks and complications of treatment have been explained to the patient.
(5) That methadone is transmitted to the unborn child and will cause physical dependence.
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Observations
Eight client records were reviewed for the use of Methadone and Buprenorphine in the outpatient treatment activity on December 4-6, 2018. The facility failed to obtain an informed, voluntary, written consent prior to the administration of a narcotic agent for client record # 8.
Client #8 was admitted on August 9, 2018 and was discharged on November 26, 2018. The client received a prescription for Suboxone on August 10, 2018, authorized by the narcotic treatment physician.
This finding was reviewed with facility staff during the licensing process.
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Plan of Correction
The informed consent to treat will be completed upon intake. This consent form is located in the medical forms section of the EMR. MD will ensure this form is signed accordingly during each admission process. |
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
Eight client records were reviewed for the use of Methadone and Buprenorphine in the outpatient treatment activity on December 4-6, 2018. For client records # 1, 2, 3, 4, 6, and 8, the facility failed to provide each patient with an average of 2.5 hours of psychotherapy per month during the patient's first 2 years, 1 hour of which was required to be individual psychotherapy.
Client #1 was admitted into treatment on February 14, 2018 and was still active at the time of the inspection. Documentation in the client's record indicated that the client received less
than 2.5 hours of psychotherapy for the month November 2018. In addition, the client received less than 1 hour of individual psychotherapy for the months of October 2018 and November 2018.
Client #2 was admitted on January 15, 2018 and was active at the time of the inspection. Documentation in the client's record indicated that the client received less than 2.5 hours of psychotherapy, and less than 1 hour of individual psychotherapy, for the months of October 2018 and November 2018.
Client #3 was admitted on March 9, 2018 and was active at the time of the inspection. Documentation in the client's record indicated that the client received less than 2.5 hours of psychotherapy, and less than 1 hour of individual psychotherapy, for the month of September 2018.
Client #4 was admitted on January 10, 2017and was active at the time of the inspection. Documentation in the client's record indicated that the client received less than 2.5 hours of psychotherapy for the months of September 2018, October 2018, and November 2018. In addition, the client received less than 1 hour of individual psychotherapy for the months of September 2018 and November 2018.
Client #6 was admitted on September 9, 2013 and was discharged on October 16, 2018. Documentation in the client's record indicated that the client received less than 1 hour of individual psychotherapy for the months of July 2018, August 2018, and September 2018.
Client #8 was admitted on August 9, 2018 and was discharged on November 26, 2018. Documentation in the client's record indicated that the client received less than 2.5 hours of psychotherapy, and less than 1 hour of individual psychotherapy, for the months of August 2018, September 2018, October 2018, and November 2018.
These findings were reviewed with the facility staff during the licensing process.
This was a repeat citation. The facility was cited for non-compliance of this regulation during the previous licensing renewal inspection, completed on November 28, 2017.
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Plan of Correction
Clinical Supervisor will be responsible for monitoring counseling hours week over week. The Clinical Supervisor will pull the Direct Service Analysis report weekly to review compliance with required counseling hours. The clinical supervisor will review the report in individual and group supervision. Patients that missed counseling will be held to meet with a member of the clinical team prior to medicating to address issues of counseling non-compliance. Continued issues of counseling non-compliance after multiple intervention attempts will be moved to administrative taper. |
715.20(1) LICENSURE Patient transfers
A narcotic treatment program shall develop written transfer policies and procedures which shall require that the narcotic treatment program transfer a patient to another narcotic treatment program for continued maintenance, detoxification or another treatment activity within 7 days of the request of the patient.
(1) The transferring narcotic treatment program shall transfer patient files which include admission date, medical and psychosocial summaries, dosage level, urinalysis reports or summary, exception requests, and current status of the patient, and shall contain the written consent of the patient.
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Observations
Eight client records were reviewed for the use of Methadone and Buprenorphine in the outpatient treatment activity on December 4-6, 2018. As a referring narcotic treatment program, the facility failed to document the transfer of required patient files to a receiving narcotic treatment program, for client record # 5.
Client # 5 was admitted on March 24, 2016 and was discharged on February 2, 2018, upon transferring to another narcotic treatment program. The client's record did not contain documentation verifying the transfer of required patient files to the receiving narcotic treatment program.
This finding was reviewed with facility staff during the licensing process.
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Plan of Correction
The CTC Director will provide a training on 1/17/2019 to review the transfer policy and regulations which require documentation in writing that we notified the narcotic treatment program the patient is transferring to of the patients admission date, medical and psychosocial summaries, dosage level, urinalysis reports/summary, exception requests, current status of the patient, and a copy of the release of information signed by the patient.
The Clinical Supervisor will complete monthly chart reviews of all patients that transfer in and out of the CTC to ensure the documentation is in the patient record under scanned documents
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715.23(b)(4) LICENSURE Patient records
(b) Each patient file shall include the following information:
(4) The results of an initial intake physical examination.
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Observations
Eight client records were reviewed for the use of Methadone and Buprenorphine in the outpatient treatment activity on December 4-6, 2018. For client record # 2, the facility failed to provide documentation of an initial physical examination conducted by a physician.
Client #2 was admitted on January 15, 2018 and was active at the time of the inspection. The client's record contained documentation of an initial physical examination conducted by a registered nurse on January 18, 2018. However, documentation of an initial physical examination conducted by a physician was not found in the client's record.
This finding was reviewed with facility staff during the licensing process.
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Plan of Correction
An initial Comprehensive Physical Examination will be documented in the EMR using the Division approved template for all patients admitted to the CTC.
All Admission documentation including the comprehensive physical will be reviewed by the Nursing Supervisor and Clinical Supervisor as part of the admission chart audit within 7 days of the admission date. Documentation that is unacceptable will discussed with the responsible staff member.
Continued non-compliance in this area will be documented in writing and EIP's will be presented if warranted
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709.91(b)(7) LICENSURE Intake and admission
709.91. Intake and admission.
(b) Intake procedures shall include documentation of:
(7) Preliminary treatment and rehabilitation plan.
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Observations
The facility failed to complete preliminary treatment plans in three out of eight clients.
Client number one was admitted on February 14, 2018 and was still active at the time of the inspection. Client number one had a treatment plan dated March 14, 2018 but it was not signed by the client or counselor until May 10, 2018.
Client number three was admitted on March 9, 2018 and did not have a treatment plan until May 2, 2018. The treatment plan on May 2, 2018 did not have type or frequency of services listed on it.
Client number eight was admitted on August 9, 2018 and was discharged on November 26, 2018. Client number eight did not have a preliminary treatment plan completed.
These findings were reviewed with the facility staff during the licensing process.
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Plan of Correction
All initial treatment plans will be completed by the intake counselor on the day of admission. A comprehensive treatment plan will then be completed by the assigned counselor within 30 days of admission and will be used to guide the next 20 days of treatment.
All Admission documentation including the initial treatment plan will be reviewed by Clinical Supervisor as part of the admission chart audit within 7 days of the admission date. Documentation that is unacceptable will discussed with the responsible staff member.
Continued non-compliance in this area will be documented in writing and EIP's will be presented if warranted
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709.92(b) LICENSURE Treatment and rehabilitation services
709.92. Treatment and rehabilitation services.
(b) Treatment and rehabilitation plans shall be reviewed and updated at least every 60 days.
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Observations
The facility failed to update treatment plans every sixty days.
Client number one was admitted on February 14, 2018 and was still active at the time of the inspection. Client number one had a treatment plan on May 10, 2018 with the next being due no later than July 10, 2018, however one was not completed until August 9, 2018. The following treatment plan was dated September 17, 2018 with the next being due no later than November 17, 2018, however one was not completed until December 3, 2018.
Client number three was admitted on March 9, 2018 and was still current at the time of the inspection. Client number three had treatment plans dated May 2, 2018 and May 7, 2018 with the next being due no later than July 7, 2918, however one was not completed until August 1, 2018. There were no subsequent treatment plans as of the date of the inspection.
Client number 4 was admitted on January 1, 2018 and was still current at the time of the inspection. The client had a treatment plan dated March 9, 2018 with the next being due no later than May 9, 2018, however one was not completed until May 24, 2018. The following treatment plan should have been completed no later than July 24, 2018, however was completed on July 30, 2018. The next treatment plan was completed on September 19, 2018 with the next being due no later than November 19, 2018, however there was not one completed as of the date of inspection.
Client number eight was admitted on August 9, 2018 and discharged on November 26, 2018. Client eight had no treatment plan or treatment plan updates as of the date of inspection.
This is a repeat citation from the November 11, 2017 inspection.
These findings were reviewed with the facility staff during the licensing process.
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Plan of Correction
Treatment plan updates will be completed a minimum of every 60 days. The Clinical Supervisor will review the services due report in SMART monthly and address non-compliance in Clinical Supervision. Further, compliance in this area will also be reviewed by the Clinical Supervisor during all chart audits. Non-compliance in this area will be documented in writing and EIP's will be presented if warranted. |