INITIAL COMMENTS
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This report is a result of an on-site complaint investigation conducted on May 29-31, 2019 by staff from the Department of Drug and Alcohol Programs, Bureau of Quality Assurance for Prevention & Treatment. Based on the findings of the on-site inspection, Echo Treatment Center, LLC was found not to be in compliance with the applicable chapters of 28 PA Code which pertain to the facility.
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Plan of Correction
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704.6(c) LICENSURE Core Curriculum - Supervisor Training
704.6. Qualifications for the position of clinical supervisor.
(c) Clinical supervisors and lead counselors who have not functioned for 2 years as supervisors in the provision of clinical services shall complete a core curriculum in clinical supervision. Training not provided by the Department shall receive prior approval from the Department.
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Observations
The facility failed to document that a lead counselor had the required core curriculum in clinical supervision at the time of hire.
Employee #1 was hired as a lead counselor on 10/15/18 but did not have 2 years of supervisory experience; the core curriculum was required by April 30, 2019 but was not documented at the time of the investigation.
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Plan of Correction
Lead counselor will register and attend the Core Curriculum in Clinical Supervision. If the training is not hosted by the Department of Drug and Alcohol Programs, director will submit the core course syllabus and and acquire prior approval of the Department of Drug and Alcohol Programs prior to lead counselor attending the training. Lead counselor will attend a Department of Drug and Alcohol Programs approved Core Curriculum Course in Clinical Supervision within 90 days. Lead counselor will provide director with a certificate of completion and a feedback form for the training upon completion. |
704.9(c) LICENSURE Supervised Period
704.9. Supervision of counselor assistant.
(c) Supervised period.
(1) A counselor assistant with a Master's Degree as set forth in 704.8 (a)(1) (relating to qualifications for the position of counselor assistant) may counsel clients only under the close supervision of a trained counselor or clinical supervisor for at least the first 3 months of employment.
(2) A counselor assistant with a Bachelor's Degree as set forth in 704.8 (a)(2) may counsel clients only under the close supervision of a trained counselor or clinical supervisor for at least the first 6 months of employment.
(3) A registered nurse as set forth in 704.8 (a)(3) may counsel clients only under the close supervision of a trained counselor or clinical supervisor for at least the first 6 months of employment.
(4) A counselor assistant with an Associate Degree as set forth in 704.8 (a)(4) may counsel clients only under the close supervision of a trained counselor or clinical supervisor for at least the first 9 months of employment.
(5) A counselor assistant with a high school diploma or GED equivalent as set forth in 704.8 (a)(5) may counsel clients only under the direct observation of a trained counselor or clinical supervisor for the first 3 months of employment. For the next 9 months, the counselor assistant may counsel clients only under the close supervision of a lead counselor or a clinical supervisor.
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Observations
The facility failed to document that all counselor assistants received the required supervision.
Employee #2 was hired as a counselor assistant on 10/29/18 with a High School diploma; supervision notes were documented for employee #2 but these did not reflect the required direct observation for the first 3 months.
This information was reviewed with the facility staff to allow them to begin increased supervision and remediate potential quality of care issues.
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Plan of Correction
Director has reviewed the 704.9 regulations and standards of supervision of a counselor assistant with lead counselor and all clinical staff. Director has reviewed the standard of 704.8 (a) (5) with lead counselor and all clinical staff as it pertains to 90 days of direct observation of a counselor assistant with a high school diploma or GED equivalent followed by 9 months of close supervision. Lead counselor will provide director with a weekly report verifying that all daily sessions performed by a counselor assistant requiring direct observation have been directly observed by the lead counselor/clinical supervisor/ or a qualified counselor for 90 days and an evaluation has been performed by lead counselor stating that counselor assistant can service a full caseload under the close supervision by the lead counselor for an additional 9 months. Lead counselor will provide director with weekly reports on the close supervision of all counselor assistants and their progress. |
709.24 (a) (3) LICENSURE Treatment/rehabilitation management.
§ 709.24. Treatment/rehabilitation management.
(a) The governing body shall adopt a written plan for the coordination of client treatment and rehabilitation services which includes, but is not limited to:
(3) Written procedures for the management of treatment/rehabilitation services for clients.
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Observations
The facility failed to adhere to procedures for treatment and rehabilitation management.
*Facility policy states that a Urine Drug Screen (UDS) will be performed on any patient suspected of using illegal drugs or abusing prescription medication. Patient #1 admitted to their counselor that they had used illegal drugs but no UDS was performed.
Facility staff acknowledged that the policy and procedure was not followed in this case.
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Plan of Correction
On 6/5/2019 all staff were retrained by director on the proper procedures of Echo Treatment
Center's facility policy on Urine Drug Screening (UDS). Policy states that a urine drug screen (UDS) will be immediately administered to any patient suspected of using illegal drugs or abusing prescription medication. All clinical and medical staff have been directed to administer a urine drug screen (UDS) to any patient who appears intoxicated or has admitted illegal drug use or abusing a prescription medication. Any patient that admits to a staff member to recent illegal drug use or abusing prescription medication or appears intoxicated will immediately consult with lead counselor/clinical supervisor or physician for further instruction or orders issued on the further treatment of the patient. |
715.23(b)(11) LICENSURE Patient records
(b) Each patient file shall include the following information:
(11) Counselor notes regarding patient progress and status.
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Observations
The facility failed to document progress notes for individual sessions that accurately depicted the progress and status of patient #1.
Patient #1 was admitted on 11/30/15 and was an active client at the time of the investigation. Progress notes were documented for individual sessions on 5/2/19 and 5/8/19; the ' Data ' section of both notes were identical and stated that patient #1 had " reported using 10 bags of heroin " during the prior week, however the ' Assessment ' section of the notes stated this patient " was making good progress " and the ' Plan ' section advised that " take-homes " should continue.
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Plan of Correction
Counselor assistant responsible for the inaccurate progress notes has had case load reduced and is receiving additional direct observation and increased supervision by lead counselor. Lead counselor has reviewed and retrained counselor assistant on all operating policies and procedures including the proper and accurate documentation of a patient's progress and status in the progress notes. Lead counselor will submit a weekly report on the direct observation and close supervision of counselor assistant to the director for review. lead counselor will review all progress notes documented by counselor assistant for 60 days for accuracy and to ensure that all polices and procedures of the facility have been adhered to by the counselor assistant. Lead counselor will perform a written evaluation of counselor assistants performance after 60 days. Counselor assistant will only be assigned a full case load upon a positive written evaluation by lead counselor and received and approved by the director. |