INITIAL COMMENTS
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This report is a result of an onsite follow-up inspection pertaining to the plans of correction for the March 5 and march 6, 2012 methadone monitoring inspection. The follow-up inspection was conducted on December 26, 2012 by staff from the the Division of Drug and Alcohol Program Licensure. Based on the findings of the onsite follow-up inspection, Coatesville Treatment Center 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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715.9(c) LICENSURE Intake
(c) If a patient was previously discharged from treatment at another narcotic treatment program, the admitting narcotic treatment program, with patient consent, shall contact the previous facility for the treatment history.
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Observations
Based on the review of patient records, the facility failed to contact the previous narcotic treatment facility for the patient's treatment history in one of one patient record reviewed.
The findings include:
Ten patient records were reviewed December 26, 2012. One patient record required contact with the prior narcotic treatment facility for the patient's previous treatment history.
Patient record # 3 contained documentation that the patient reported a previous narcotic treatment experience at another narcotic treatment program. A review of patient record # 3 revealed that there was no documentation provided that specified the patient's previous narcotic treatment facility had been contacted for information.
This is a repeat citation.
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Plan of Correction
On 1/31/2013, a new release of information form was created by Clinic Supervisors along with a confirmation sheet that was added to the admission packet. The release will enable Coatesville Treatment Center to obtain prior treatment history from narcotic treatment facilities if patients report during their admission. The form will be included with the admission packet for the Admission Counselor to fax. The fax confirmation will be maintained in the patients' records and maintained by the Clinical Supervisor. The Clinical Supervisor will have direct oversight of this process. A training will be conducted by Clinical Supervisors on 2/4/2013 with Counselors to cover the new process as the new process will begin on 2/8/2013. |
715.14(a) LICENSURE Urine testing
(a) A narcotic treatment program shall complete an initial drug-screening urinalysis for each prospective patient and a random urinalysis at least monthly thereafter.
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Observations
Based on the review of patient records, the facility failed to ensure at least monthly random urinalysis in three of ten patient records.
The findings include:
Ten patient records were reviewed December 26, 2012. Ten records were reviewed for initial and at least monthly urine drug screens. In the review of these records, it was identified that three patients did not receive the required urinalysis on a monthly basis.
Patient # 2 did not have a urine drug screen for November 2012.
Patient # 9 did not have a urine drug screen for October 2012.
Patient # 10 did not have a urine drug screen for September 2012.
Nine of the ten still had not had a December urine drug screen at the time of the review, December 26, 2012.
This is a repeat citation.
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Plan of Correction
All urine drug screens were completed for the patients whose records were reviewed as documented in our patient system (Tower) and through Clinical Science Laboratory. By the 25th of each month, Counselors will go through their patient caseload to ensure that each urine drug screen has been filed. Clinical Supervisors will be responsible for monitoring this process as Counselors will need to submit verification that each of their patient charts have been reviewed to ensure that all Urine Drug Screens have been filed. This will begin on 2/18/2013. Counselors will be responsible for filing all urine drug screens. Clinical Supervisors will conduct a training on the new process on 2/11/2013 with Counselors. |
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 six of seven patient records.
The findings include:
Ten patient records were reviewed December 26, 2012. Seven patient records were reviewed for psychotherapy hours during the first two years of treatment. The months of September, October, November and December were reviewed for compliance.
Patient # 4 was admitted February 9, 2012. There were no psychotherapy hours documented for any dates between June 1, 2012 and September 30, 2012. There was no explanation for this documented within the patient record.
Patient # 6 was admitted July 31, 2012. There was one hour of therapy documented for September 2012; three hours of therapy documented for October 2012 and one hour of therapy documented for November 2012. The average therapy time since September 1, 2012 is 1.5 hours per month.
Patient # 7 was admitted July 31, 2012. There was one hour of therapy documented for September 2012; three hours of therapy documented for October 2012 and one hour of therapy documented for November 2012. The average therapy time since September 1, 2012 is 1.75 hours per month.
Patient #8 was admitted September 11, 2012. There was two hours of therapy documented for September 2012; three and one half hours of therapy documented for October 2012 and no therapy documented for November 2012. The average therapy time since September 1, 2012 is 2 hours per month.
Patient # 9 was admitted August 15, 2012. There was one half hour of therapy documented for September 2012; one and one half hours of therapy documented for October 2012 and no therapy documented for November 2012. The average therapy time since September 1, 2012 is .66 hours per month.
Patient # 10 was admitted August 31, 2012. There was two and a quarter hours of therapy documented for September 2012; one hour of therapy documented for October 2012 and one hour of therapy documented for November 2012. The average therapy time since September 1, 2012 is 1.3 hours per month.
This is a repeat citation.
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Plan of Correction
Beginning 02/11/2013, on the same day that a patient misses a counseling session the primary Counselor will flag the patient to see them the following day prior to being medicated. The patient will be scheduled for another counseling session and will need to attend the session prior to being medicated. If issues of non-compliance continues, patient will meet with primary counselor and Clinical Supervisor. Isssues of non-complaince will be documented. Counselors will also document all reasons for missed appointments. A training will be conducted by Clinical Supervisors on 2/4/2013 to go over this procedure. Clinical Supervisors will be responsible for running a report in the patient system on the 20th and 25th of every month to review patients that did not complete their counseling requirement. Clinical Supervisor will be responsible for ensuring that Counselors are meeting with patients in the first 2 years of treatment at a minimum of 2.5 hours per month. |
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 with a re-evaluation by the physician in six of eight patient record reviewed.
The findings include:
Ten patient records were reviewed December 26, 2012. Two required an annual physical exam with a re-evaluation by the narcotic treatment physician.
Patient # 1 was admitted August 13, 2009. The annual physical exam was completed on July 31, 2012 by the Certified Physician Assistant (PAc), but did not include a re-evaluation by the physician.
Patient # 2 was admitted October 13, 2010. The annual physical exam was completed on October 24, 2012 by the Certified Physician Assistant (PAc), but did not include a re-evaluation by the physician. Elsewhere in the patient record was a six month justification form completed by the clinician and signed by the physician, as well as the re-evaluation information on annual clinical evaluation, also signed by the physician. However, neither of these documents meet the requirements for the physician to complete a re-evaluation.
This is a repeat citation. .
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Plan of Correction
Based on previous audits, Medical Director currently reviews and signs off on all physicals completed by Physician Assistant. The Annual History & Physical form was updated on 2/5/2013 by Physician Assistant. There where check boxes added to the section that requires the Medical Director's signature and date, where the Medical Director will mark off whether the patient should continue in methadone maintenance or consider starting a taper to become abstinent. Physician Assistant will give all H&P's to Medical Director to Review. Medical Director will then return back to Physician Assistant once completed to track to ensure that the was reviewed and signed off on. Clinic Director will conduct a training with Medical Direcotr and Physician Assistant on 2/6/2013 to go over the new process. The new process will begin on 2/7/2013. |