INITIAL COMMENTS
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This report is a result of an on-site complaint investigation conducted on October 22, 2007 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site complaint investigation, Gaudenzia - New Destiny 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 investigation and a plan of correction is due on November 27, 2007.
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Plan of Correction
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705.8 (1) LICENSURE Heating and cooling.
705.8. Heating and cooling.
The residential facility:
(1) Shall have a heating and cooling ventilation system that is adequate to maintain an indoor temperature of at least 65F in the winter. When indoor temperatures exceed 90F, mechanical ventilation such as fans or air conditioning shall be used.
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Observations
The agency failed to maintain a heating system that was able to maintain a building temperature of at least 65 degrees Fahrenheit. During the inspection of the facility on October 22, 2007, an HVAC (heating ventilation and air conditioning) contractor was is the process of installing a heating system. An interview conducted with facility staff and HVAC owner provided verification that the system has not been maintained or installed in the facility.
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Plan of Correction
High velocity fans are maintaining facility temperatures between 65 and 75 degrees. Clinical Director ensures temperature is maintained. Completion of installation of new heating system will be completed on 11/16/07. |
705.8 (2) LICENSURE Heating and cooling.
705.8. Heating and cooling.
The residential facility:
(2) May not permit in the facility heaters that are not permanently mounted or installed.
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Observations
The organization has permitted the use of heaters that are not permanently mounted or installed. During an inspection of the facility conducted on October 22, 2007 supplemental heaters that were not permanently mounted or installed were found in offices and living quarters throughout the second and third floors.
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Plan of Correction
Supplemental heaters were removed from the facility. Clinical Director inspected areas to ensure removal. |
705.10 (b) (5) LICENSURE Fire safety.
705.10. Fire safety.
(b) Smoke detectors and fire alarms. The residential facility shall:
(5) Maintain automatic smoke detectors and fire alarms of a type approved by the Department of Labor and Industry or by the Underwriters Laboratories.
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Observations
The organization failed to maintain automatic smoke detectors throughout the physical plant. An inspection of the facility conducted on October 22, 2007 verified that "duct tape" had been applied to smoke detectors on the second and third floors which disabled the fire alarm system.
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Plan of Correction
"Duct tape" covering smoke detectors has been removed. Program Director inspected area to ensure removal. |