INITIAL COMMENTS
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This report is a result of an on-site licensure renewal inspection and methadone monitoring inspection conducted on November 9, 2022 by staff from the Department of Drug and Alcohol Programs, Bureau of Program Licensure. Based on the findings of the on-site inspection, Pennsylvania Care LLC dba Miners Medical 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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704.7(b) LICENSURE Counselor Qualifications
704.7. Qualifications for the position of counselor.
(a) Drug and alcohol treatment projects shall be staffed by counselors proportionate to the staff/client and counselor/client ratios listed in 704.12 (relating to full-time equivalent (FTE) maximum client/staff and client/counselor ratios).
(b) Each counselor shall meet at least one of the following groups of qualifications:
(1) Current licensure in this Commonwealth as a physician.
(2) A Master's Degree or above from an accredited college with a major in chemical dependency, psychology, social work, counseling, nursing (with a clinical specialty in the human services) or other related field which includes a practicum in a health or human service agency, preferably in a drug and alcohol setting. If the practicum did not take place in a drug and alcohol setting, the individual's written training plan shall specifically address a plan to achieve counseling competency in chemical dependency issues.
(3) A Bachelor's Degree from an accredited college with a major in chemical dependency, psychology, social work, counseling, nursing (with a clinical specialty in the human services) or other related field and 1 year of clinical experience (a minimum of 1,820 hours) in a health or human service agency, preferably in a drug and alcohol setting. If a person's experience did not take place in a drug and alcohol setting, the individual's written training plan shall specifically address a plan to achieve counseling competency in chemical dependency issues.
(4) An Associate Degree from an accredited college with a major in chemical dependency, psychology, social work, counseling, nursing (with a clinical specialty in the human services) or other related field and 2 years of clinical experience (a minimum of 3,640 hours) in a health or human service agency, preferably in a drug and alcohol setting. If a person's experience was not in a drug and alcohol setting, the individual's written training plan shall specifically address a plan to achieve counseling competency in chemical dependency issues.
(5) Current licensure in this Commonwealth as a registered nurse and a degree from an accredited school of nursing and 1 year of counseling experience (a minimum of 1,820 hours) in a health or human service agency, preferably in a drug and alcohol setting. If a person's experience was not in a drug and alcohol setting, the individual's written training plan shall specifically address a plan to achieve counseling competency in chemical dependency issues.
(6) Full certification as an addictions counselor by a statewide certification body which is a member of a National certification body or certification by another state government's substance abuse counseling certification board.
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Observations
Based on one of nineteen employee personnel records reviewed, the facility failed to provide documentation of the qualification of counselors for employee # 10.
Employee # 10 was hired as a counselor on August 8, 2022 and was still in this position at the time of the inspection. Based on a review of employee # 10's personal record and resume, there was no documentation of at least one year of clinical experience with a bachelor's degree.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Plan of Correction:
Miners Medical Executive Director and
recruiting team will
review all resumes
prior to hire and
verify 1 year of
clinical experience to
place in the role of
counselor or identify
eligibility of counselor
assistant status prior
to onboarding in
accordance with 704.7
(b). Such will be
verified and
documented in staff
HR records. The current staff member will transition to counselor assistant, be provided weekly supervision for six months and be promoted to counselor after a year. |
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
Based on a review of the patient census for the weeks of July 31, 2022 through October 1, 2022, the facility failed to provide narcotic treatment physician services at least 1 hour per week onsite for every ten patients.
The week of August 7-13, 2022 had a patient census of 531. The required physician hours are 53.1. There were only 43.5 hours documented.
The week of September 18-24, 2022 had a patient census of 563. The required physician hours are 56.3. There were only 48.5 hours documented.
The week of September 25-October 1, 2022 had a patient census of 557. The required physician hours are 55.7. There were only 41.5 hours documented.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Miners Medical failed to comply with 715.6(d) LICENSURE Physician Staffing: Miners Medical Executive Director will monitor patient census and ensure accurate
physician staffing for at least 1 hour for every 10 patients. Executive Director will locate coverage in the absence of a provider or as needed. Miners Medical is in the process of hiring an additional medical doctor and nurse practitioner to accommodate the amount of patients and provided needed services. |
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
Based on a review of the patient census for the weeks of July 31, 2022 through October 1, 2022, the facility failed to provide narcotic treatment physician services at least one-third of the required physician time.
The week of August 7-13, 2022 had a patient census of 531. The required one-third physician time is 17.6. There were only 3.5 hours documented.
The week of September 18-24, 2022 had a patient census of 563. The required one-third physician time is 18.7. There were only 8.5 hours documented.
The week of September 25-October 1, 2022 had a patient census of 557. The required one-third physician time is 18.5. There were only 1.5 hours documented.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Miners Medical failed to comply with 715.6(e) LICENSURE
Physician Staffing: Miners Medical Executive Director will monitor census ongoing and ensure accurate physician
staffing/scheduling for at least one third of the required physician time. Executive Director will locate coverage in the absence of a provider or as needed.
Miners Medical is in the process of hiring an additional medical doctor and nurse practitioner to accommodate the need and provide services to the patients.
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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 one of eight patient records reviewed, the facility failed to provide documentation of a random drug-screening urinalysis for each patient at least monthly in patient record # 6.
Patient # 6 was admitted on March 20, 2019 and was discharged June 2, 2022. A random drug-screening urinalysis was completed for the month of March 2022.
The findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Miners Medical failed to comply with 715.14(a) LICENSURE Urine testing: Medical nursing staff and clinical supervisors will ensure each patient is provided at least monthly drugs screens using reports data to monitor and analysis through quality record reviews. Any patient missing a urine screen will be placed on hold and be required to complete one. |
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 two of four applicable patient records reviewed, the facility failed to provide documentation of an annual physical examinations given by the narcotic treatment program which includes an annual reevaluation by the narcotic treatment physician.
Patient # 1 was admitted on October 20, 2021 and was still active at the time of the inspection. An annual physical exam was due no later than October 20, 2022 however, no annual physical exam was documented in the patient record.
Patient # 5 was admitted on November 16, 2020 and was discharged February 9, 2022. An annual physical exam was due no later than November 16, 2021 however, no annual physical exam was documented in the patient record.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Miners Medical failed to comply with 715.23(b)(5) LICENSURE Patient records: Nursing staff members and Clinical Supervisors will utilize report data
monthly to ensure all patients are scheduled for and complete annual
physicals. Patient flags will be
utilized to schedule at least one month prior to annual due date to ensure timely receipt of services. Miners Medical is also in the process of hiring an additional medical doctor and nurse practitioner to ensure services are completed on-time. |
709.93(a)(11) LICENSURE Client records
709.93. Client records.
(a) There shall be a complete client record on an individual which includes information relative to the client's involvement with the project. This shall include, but not be limited to, the following:
(11) Follow-up information.
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Observations
Based on three of four applicable client records reviewed, the facility failed to provide documentation of follow-up information in accordance with the facility policy and procedure manual. The facility policy and procedure manual indicate a follow-up to the client occur by phone within set intervals. The first seven days, three months, and twelve months if not being referred to an outside resource.
Client # 5 was admitted on November 16, 2020 and discharged on February 9, 2022. There was no follow-up information documented in the client record.
Client # 7 was admitted on April 19, 2022 and discharged on September 22, 2022. There was no follow-up information documented in the client record.
Client # 8 was admitted on December 20, 2021 and discharged on July 22, 2022. There was no follow-up information documented in the client record.
These findings were reviewed with facility staff during the licensing process.
This is a repeat citation from the November 3, 2021 annual licensing inspection.
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Plan of Correction
Clinical supervisor will review with
clinical staff to ensure discharge follow up process and policy are
followed. Clinicians will utilize reports to ensure that follow- up calls
occur. An attempt will be made to follow-up the patient's progress
and status. This contact will be attempted by phone within set intervals 30 days and 60 days. The purpose of these contacts will be to offer continued therapeutic support and encouragement to the patient, to assess the patient's progress, and to suggest other services. |