Observations
Based on a review of eight personnel record, the facility failed to ensure that four counselor assistants were counseling clients under the supervision of a trained counselor or clinical supervisor based on their education.Employee #4 was hired on April 25, 2022 as a bachelor ' s degree-qualifying counselor assistant and then promoted to a counselor on April 25, 2023. While a counselor assistant, the employee was required to receive close supervision for the first six months in the counselor assistant position. There is no documentation in the record indicating close supervision was provided during those first six months in the position.Employee #6 was hired on January 10, 2023 as a counselor assistant and was still employed at the time of the inspection. Employee #6 has a bachelor ' s degree with no experience and may counsel clients only under close supervision of a trained counselor or clinical supervisor for the first six months of employment. There is no documentation in the record indicating close supervision was provided during those first six months in the position.Employee #7 was hired on February 20, 2023 as a counselor assistant and was still employed at the time of the inspection. Employee #7 has an associate degree with no experience and may counsel clients only under close supervision of a trained counselor or clinical supervisor for the first nine months of employment. There is no documentation in the record indicating close supervision was provided during those first nine months in the position.Employee #8 was hired on February 20, 2023 as a counselor assistant and was still employed at the time of the inspection. Employee #8 has a bachelor ' s degree with no experience and may counsel clients only under close supervision of a trained counselor or clinical supervisor for the first six months of employment. There is no documentation in the record indicating close supervision was provided during those first six months in the position.Close supervision is defined by regulation as follows: " Formal documented case review and an additional hour of direct observation by a supervising counselor or a clinical supervisor once a week ". The fully qualified clinical supervisor or counselor is then responsible for weekly supervision notes relating to the counselor assistant. Clear documentation in the weekly notes and in the pertinent client charts must also demonstrate that direct observation is occurring. These findings were reviewed with facility staff during the licensing process..
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Plan of Correction
Clinical Supervisor received DDAP regulations regarding the counselor assistant requirements on 07/14/2023. These regulations were then reviewed in the Clinical Supervisor's monthly supervision with Corporate Clinical Director to clarify expectations and requirements for the supervision of counselor assistants. Staff who are identified as counselor assistants will be supervised weekly by a full-time supervisor or counselor for the required length of time based on the counselor assistant's degree. A counselor assistant with a Master's degree will receive 3 months of weekly close supervision, a counselor assistant with a Bachelor's degree will receive 6 months of weekly close supervision, and a counselor assistant with an Associate's degree will receive 9 months of weekly close supervision. Close supervision will align with DDAP regulations regarding weekly direct observation and weekly case review. Supervision notes will document a weekly case review which includes client initials or identifying number and an hour of direct observation. The hour of direct observation will then be referenced in the chart of the client with whom it is conducted. The Clinical Supervisor completing the clinical supervision sheet will observe and document the counselor assistant's interaction and intervention with the client(s), noting counselor performance and effectiveness, utilizing stated criteria specified on supervision sheets. The Clinical Supervision Sheet has been updated to present these requirements with more clarity. Supervision sessions will review the counselor assistant's clinical skills, strengths, and areas for improvement. Counselor assistants currently employed will start following this protocol immediately. The Clinical Supervisor will forward counselor assistant supervision sheets, fully completed with signatures, to the Corporate Clinical Director and the Facility Director by end of business day each Friday to ensure compliance with these regulations. The Corporate Clinical Director will review the supervision sheets to ensure compliance with the regulations and to ensure that supervision is happening as appropriate. The Corporate Clinical Director, Facility Director, and Clinical Supervisor will meet between 10/23/2023 and 10/27/2023 to determine if these will continue to be received on a weekly basis, or if the supervision sheets can be received once monthly moving forward. Signed supervision sheets for counselors will be submitted to the Corporate Clinical Director and Facility Director by the last Friday of the month. |