INITIAL COMMENTS
|
This report is a result of an on-site licensure renewal inspection conducted on July 16, 2025 by staff from the Bureau of Program Licensure. Based on the findings of the on-site inspection H5Y06701 Nehemiah House was found to not be in compliance with the applicable chapters of 28 PA Code which pertain to the facility. Therefore, deficiencies were identified during this inspection and a plan of correction is required.
|
Plan of Correction
|
§ 717.19(b) LICENSURE Resident Rights
§ 717.19. Resident rights.
(b) The licensee shall obtain written acknowledgement by residents that they have received notice of their rights.
|
Observations
Based on review of the resident records the recovery house failed to have written acknowledgement by residents that they have received notice of their rights in 4 out of 6 records.
These findings were reviewed with the recovery house staff during the licensing process.
|
Plan of Correction
Acknowledgement of resident rights will be signed at time of admission. The house manager will ensure that this citation does not reoccur by checking records weekly to ensure that all
documentation is in the resident record. This was begun on July 20, 2025. |
§ 717.22(b)(1) LICENSURE Beginning of Residency
§ 717.22. Beginning of residency.
(b) The licensee shall complete the following documentation, which must be signed by the resident, within 24 hours of arrival:
(1) Disclosure to the resident of criteria for beginning and ending residency.
|
Observations
Based on review of the resident records, the recovery house failed to a residnet signature stating that they received orientation docoumentation within 24 hours of arrival.
These findings were reviewed with the recovery house staff during the licensing process.
|
Plan of Correction
The house manager will ensure that this citation does not reoccur by checking records weekly to ensure that all regulatory documentation is in the resident record. This will begin on July 22, 2025. |
§ 717.22(b)(2)(iii) LICENSURE Beginning of Residency
§ 717.22. Beginning of residency.
(b) The licensee shall complete the following documentation, which must be signed by the resident, within 24 hours of arrival:
(2) Resident orientation to the drug and alcohol recovery house which must include:
(iii) Supports provided by the drug and alcohol recovery house, as well as referrals to other essential services as needed.
|
Observations
Based on review of the resident records, the recovery house failed to document supports provided by the drug and alcohol recovery house, as well as referrals to other essential services as needed.
These findings were reviewed with the recovery house staff during the licensing process.
|
Plan of Correction
The house manager will ensure that this citation does not reoccur by documenting all supports provided each resident of the recovery house. This is be documents as soon as the referral is made. The house manager will review all files weekly, beginning July 22, 2025. |
§ 717.29(b)(1) LICENSURE Physical plant standards - Bldg-Exterior-Grnd
§ 717.29. Physical plant standards.
(b) Building interior, exterior and grounds. The licensee shall:
(1) Keep the interior, exterior, and grounds or yard of the drug and alcohol recovery house clean, safe, sanitary and in good repair and free of hazards at all times.
|
Observations
Based on review of the physical plant inspection the recovery house failed to keep the interior, exterior, and grounds or yard of the drug and alcohol recovery house clean, safe, sanitary and in good repair and free of hazards at all times. There are current and past residents belongings that are stored in the entrance which presents a hazard to the residents.
These findings were reviewed with the recovery house staff during the licensing process
|
Plan of Correction
The house manager, along with the church liaison, will inspect the interior, exterior, and grounds or yard of the drug and alcohol recovery house clean, safe, sanitary and in good repair and free of hazards at all times. This will be inspected weekly. This was discussed with the church liaison and began on 7/20/2025.
The house manager has instructed all residents to place any current belongings in bins and to discard any old or previous residents belongings. This was discuss with all residents on 7/20/2025.
|
§ 717.29(d)(1)(v)(B) LICENSURE Physical plant standards - Sleep accomodation
§ 717.29. Physical plant standards.
(d) Sleeping accommodations.
(1) Each drug and alcohol recovery house bedroom must have the following:
(v) At least 50 square feet of floor space per resident measured wall to wall in each shared bedroom with bunk beds. Bunk beds must:
(B) Be equipped with a securely attached ladder capable of supporting a resident.
|
Observations
Based on review of the physical plant the resident beds failed to have a securely attached ladder capable of supporting a resident on bunkbeds.
These findings were reviewed with the recovery house staff during the licensing process.
|
Plan of Correction
The house manager has instructed the church liaison to secure the attached ladder capable of supporting a resident on bunkbeds.
This will be completed by Sunday, July 27, 2025. |
§ 717.30(d)(3) LICENSURE Safety and emergency procedures -Extinguisher
§ 717.30. Safety and emergency procedures.
(d) Fire extinguishers. The licensee shall:
(3) Ensure fire extinguishers are inspected and approved annually by the local fire department or fire extinguisher company. The date of the inspection must be indicated on the extinguisher or inspection tag; the licensee shall replace or repair a fire extinguisher found to be inoperable within 48 hours.
|
Observations
Based on a review of the fire extinguishers located throughout that property, the recovery house failed to have fire extinguishers inspected and approved annually by the local fire department or fire extinguisher company.
These findings were reviewed with the recovery house staff during the licensing process.
|
Plan of Correction
The fire extinguishers located throughout that property will be inspected and approved annually by the local fire department or fire extinguisher company.
This is scheduled to take place on 7/30/25 and will be inspected annually. |