INITIAL COMMENTS
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This report is a result of an on-site licensure renewal inspection conducted on July 12, 2006 by staff from the Division of Drug and Alcohol Program Licensure. The following deficiencies were identified during this inspection and a plan of correction is due on August 8, 2006.
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Plan of Correction
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704.11(a)(3) LICENSURE Training Feedback
704.11. Staff development program.
(a) Components. The project director shall develop a comprehensive staff development program for agency personnel including policies and procedures for the program indicating who is responsible and the time frames for completion of the following components:
(3) A mechanism to collect feedback on completed training.
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Observations
The facility failed to complete individual training plans for eleven of eleven personnel files reviewed.
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Plan of Correction
This facility does not file electronically, a Plan of Correction is on file with the Department of Health. |
709.28(c) LICENSURE Confidentiality
709.28. Confidentiality.
(c) The project shall obtain an informed and voluntary consent from the client for the disclosure of information contained in the client record. The consent shall be in writing and include, but not be limited to:
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Observations
1.) Of the five charts reviewed, there are no release of information forms signed that would allow the release of information to funding sources.
2.) One of the five charts reviewed (chart #2) included a release of information to Probation, that exceeded the limits of 255.5.
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Plan of Correction
This facility does not file electronically, a Plan of Correction is on file with the Department of Health. |