INITIAL COMMENTS
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This report is a result of an on-site, provisional follow-up inspection conducted on November 15, 2022 by staff from the Department of Drug and Alcohol Programs, Bureau of Program Licensure. Based on the findings of the on-site inspection, Fayette Treatment Center, LLC d/b/a Greene 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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715.17(b) LICENSURE Medication control
(b) A narcotic treatment program shall develop policies and procedures regarding verbal medication orders, including the issuing and receiving of orders, identifying circumstances when orders are appropriate and documenting orders, in accordance with applicable Federal and State statutes and regulations.
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Observations
Based on a review of the policy and procedure and patient records, the Certified Registered Nurse Practitioner (CRNP) issued verbal orders and written orders for methadone dose and schedule changes in violation of Federal and State statutes and regulations.
The plan of correction indicated the policy would be in compliance by 4/11/2022. As of the date of the inspection, the policy and procedure were not revised, and the CRNP continued to issue verbal and written orders for methadone.
Two of seven patient records reviewed documented the CRNP issued verbal and written orders for methadone.
Patient # 3 was admitted on April 9, 2022 and transferred out to another facility on August 10, 2022. A medication order was written as a Verbal Order and signed by the CRNP on May 17, 2022, June 21, 2022 and June 27, 2022.
Patient #5 was admitted on December 19, 2019 and transferred out to another facility on October 11, 2022. A medication order was written as a Verbal Order and signed by the CRNP on May 5, 2022, May 18, 2022, June 3, 2022, June 24, 2022, and August 11, 2022.
The findings were reviewed with facility staff during the licensing process.
This is a repeat citation from the annual licensing and methadone monitoring inspection conducted on March 17, 2022.
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Plan of Correction
The facility updated the policy and procedure regarding verbal medication orders, including the issuing and receiving orders, in accordance with applicable Federal and State statutes and regulations.
This policy has gone into effect as of 11/12/2022. Medical Director, CRNP, and nursing department have been provided with the regulations and reviewed in a staff meeting.
Medical Director is the only person permitted to write orders or give verbal orders.
Smart system was also updated so CRNP can meet with patients, but Medical Director will have to review and sign off on requested orders. |
715.17(c)(1)(i-vi)) LICENSURE Medication control
(c) A narcotic treatment program shall develop and implement written policies and procedures regarding the medications used by patients which shall include, at a minimum:
(1) Administration of medication.
(i) A narcotic treatment physician shall determine the patient 's initial and subsequent dose and schedule. The physician shall communicate the initial and subsequent dose and schedule to the person responsible for the administration of medication. Each medication order and dosage change shall be written and signed by the narcotic treatment physician.
(ii) An agent shall be administered or dispensed only by a practitioner licensed under the appropriate Federal and State laws to dispense agents to patients.
(iii) Only authorized staff and patients who are receiving medication shall be permitted in the dispensing area.
(iv) There shall be only one patient permitted at a dispensing station at any given time.
(v) Each patient shall be observed when ingesting the agent.
(vi) Administering and dispensing shall be conducted in a manner that protects the patient from disruption or annoyance from other individuals.
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Observations
715.17(c)(1)(i)
Based on a review of patient records, the Certified Registered Nurse Practitioner (CRNP) issued verbal orders and written orders for methadone dose and schedule changes in two of seven applicable patient records. The narcotic treatment physician is the only practitioner authorized to determine methadone dose and schedules.
Patient #3 was admitted on April 9, 2022 and transferred out to another facility on August 10, 2022. A medication order was written as a Verbal Order and signed by the CRNP on May 17, 2022, June 21, 2022 and June 27, 2022.
Patient #5 was admitted on December 19, 2019 and transferred out to another facility on October 11, 2022. A medication order was written as a Verbal Order and signed by the CRNP on May 5, 2022, May 18, 2022, June 3, 2022, June 24, 2022, and August 11, 2022. The orders written on May 5, 2022 and August 11, 2022 were orders for take home privileges / schedule change.
The findings were reviewed with facility staff during the licensing process.
This is a repeat citation from the annual licensing and methadone monitoring inspection conducted on March 17, 2022.
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Plan of Correction
The facility has revised the policy that states that that each medication order and dosage shall be written and signed by the narcotic treatment physician. This policy changed on November 16, 2022 and will be in compliance immediately. The CRNP met with the medical and project director to review the regulations of ordering (71517) and was told that she was not allowed to continue to place orders due to she was given false information previously. The medical director was informed that he is the only person allowed to place orders. The medical director will oversee nursing and tend to the ordering of methadone. The project director will continue to monitor the orders daily as she meets with the doctor to discuss the orders that were placed or requested for each business day.
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715.20(1) LICENSURE Patient transfers
A narcotic treatment program shall develop written transfer policies and procedures which shall require that the narcotic treatment program transfer a patient to another narcotic treatment program for continued maintenance, detoxification or another treatment activity within 7 days of the request of the patient.
(1) The transferring narcotic treatment program shall transfer patient files which include admission date, medical and psychosocial summaries, dosage level, urinalysis reports or summary, exception requests, and current status of the patient, and shall contain the written consent of the patient.
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Observations
Based on a review of patient records, the facility failed to document the transfer of the required patient files to the receiving narcotic treatment program in two of three patient records.
Patient #1 was admitted on August 15, 2022 and was transferred out to another facility on October 5, 2022.
Patient #2 was admitted on July 6, 2022 and was transferred out to another facility on October 11, 2022.
The findings were reviewed with facility staff during the licensing process.
This is a repeat citation from the annual licensing and methadone monitoring inspection conducted on March 17, 2022, and March 9-11, 2020.
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Plan of Correction
The facility has written transfer policies and procedures which shall require that the narcotic treatment program transfer a patient to another narcotic treatment program for continued maintenance, detoxification or another treatment activity within 7 days of the request of the patient.
Lead nurse is responsible for any ingoing and outgoing correspondence regarding clients. The lead nurse will fax all required records pertaining to the patient to the receiving clinic and will be responsible for the uploading of documents and fax conformation into the electronic medical record. The clinical supervisor and lead nurse will audit EMR weekly to ensure that documents are uploaded correctly and documented. The Project Director will oversee the staff handling this throughout the process to ensure that it is being handled correctly and effectively.
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715.20(4) LICENSURE Patient transfers
A narcotic treatment program shall develop written transfer policies and procedures which shall require that the narcotic treatment program transfer a patient to another narcotic treatment program for continued maintenance, detoxification or another treatment activity within 7 days of the request of the patient.
(4) The receiving narcotic treatment program shall document in writing that it notified the transferring narcotic treatment program of the admission of the patient and the date of the initial dose given to the patient by the receiving narcotic treatment program.
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Observations
Based on a review of patient records, the facility failed to document in writing that it notified the transferring narcotic treatment program of the admission of the patient and the date of the initial dose given to the patient in one of four records reviewed.
Patient # 4 was admitted on November 11, 2022.
The findings were reviewed with facility staff during the licensing process.
This is a repeat citation from the annual licensing and methadone monitoring inspection conducted on March 17, 2022.
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Plan of Correction
Training was provided on 11/17/22 to all staff by the project Director. The organization is in compliance as of 11/17/22. Lead nurse is responsible for all transfers patients, in and out of the facility.
The Clinical Supervisor will review charts with CRNP to ensure accurate documentation has taken place to allow for coordination of services. The project director will oversee those who are in charge of ensuring that this is done accurately. |
709.17(a)(3) LICENSURE Subchapter B.Licensing Procedures.Refusal/rev
709.17. Refusal or revocation of license.
(a) The Department may revoke or refuse to issue a license for any of the following reasons:
(3) Failure to comply with a plan of correction approved by the Department, unless the Department approves an extension or modification of the plan of correction.
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Observations
Based on a review of patient records, the facility failed to comply with plans of correction that were approved by the Department.
A plan of correction for failing to document the transfer of the required patient files to the receiving narcotic treatment program was submitted and approved by the Department for the annual licensing and methadone monitoring inspections conducted on March 17, 2022, and March 9-11, 2020. Failing to document the transfer of the required patient files to the receiving narcotic treatment program was again found to be a deficiency during the November 15, 2022 inspection.
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Plan of Correction
The previous facility director failed to implement the plan of corrections regarding patient transfers as submitted. Due to an increased rate of turnover at the facility and inconsistent training practices under the previous direction, this plan of action was overlooked. Immediately after the current inspection took place, action was taken to train staff and provide a competent policy of completing transfers that meets regulatory standards. The facility was in compliance with this plan of correction as of 11/17/22. The project director will oversee all staff and continue to discuss the regulations and the importance of following through with the plan of corrections. |