Observations
Based on a record review investigation and interview with staff, the House Manager failed to notify the resident in writing of a decision to end residency. A Plan of Correction is needed.
|
Plan of Correction
PLAN OF CORRECTION
Facility: Club Serenity, Inc.
Regulation: §717.23 Notification of Decision to End Residency
Deficiency Date: 05/19/2026
Plan of Correction:
Club Serenity, Inc. has reviewed the findings related to §717.23 regarding notification of a decision to end residency. The facility has developed and implemented a revised Residency Discharge Summary & Notice form to ensure that all future residency terminations are documented in writing and maintained within the resident record.
The revised form includes documentation of the reason for discharge, discharge status, discharge summary, resident notification, resident's opportunity to request reconsideration of the decision to end residency, documentation of notice provided, documentation of attempts to provide notice when the resident is unavailable, and emergency contact notification, when applicable.
All House Managers and staff responsible for resident discharge decisions have received training regarding the requirements of 28 PA Code §717.23, proper completion of the revised discharge documentation, and resident notification procedures. The training was completed on June 8, 2026, at 2:30 p.m.
Moving forward, the Executive Secretary will review all future discharge documentation to ensure written notification requirements are completed and maintained in accordance with state regulations and organizational policy.
The Vice President is responsible for oversight, monitoring, and ongoing compliance with this requirement.
Date Full Compliance Achieved: June 8, 2026. We also have a signed attendance training log available upon request.
New form:
CLUB SERENITY, INC.
RESIDENCY DISCHARGE SUMMARY & NOTICE
Resident Name: _______________________________________
House: ______________________________________
Admission Date: ___________________
Discharge Date: ___________________
Time: ___________________
Staff Completing Form: _______________________________
DISCHARGE STATUS
☐ Successful Discharge
☐ Unsuccessful Discharge
TYPE OF DISCHARGE
☐ Voluntary Departure
☐ Left Without Notice
☐ Rule/Policy Violations
☐ Safety/Behavioral Concerns
☐ Transfer to Another House/Program
☐ Incarceration/Legal Issues
☐ Medical Reasons
☐ Other: ______________________________
DISCHARGE SUMMARY
Briefly summarize the resident's discharge, including any important circumstances, referrals, recommendations, or follow-up provided.
RESIDENT RECONSIDERATION OPPORTUNITY
In accordance with Club Serenity policy, the resident was informed of the opportunity to request reconsideration of the decision to end residency.
☐ Resident requested reconsideration
☐ Resident declined reconsideration
☐ Resident unavailable to request reconsideration
Date: ___________________
Time: ___________________
Staff Initials: ___________________
NOTICE OF DISCHARGE PROVIDED
Was the resident offered/provided a copy of this discharge notice? (Check all that apply)
☐ Yes ? Physical Copy Provided
☐ Resident Refused Copy
☐ Yes ? Copy Sent by Text/Email/EC Phone if client does not have a Phone
☐ Resident Left Before Notice Could Be Given/Still sent by Text/Email/EC
☐ Resident Could Not Be Reached/Blocked/Sent to Text/Email/Phone Regardless
Date of Attempt: ___________________
Time of Attempt: ___________________
Staff Initials: ___________________
JUSTIN'S LAW / EMERGENCY CONTACT NOTIFICATION
For all unsuccessful discharges, the resident's Emergency Contact (EC) must be contacted immediately, and the attempt must be documented in accordance with organizational policy.
Was the Emergency Contact notified?
☐ Yes
☐ No
☐ Unable to Contact
Emergency Contact Name: __________________________________
Relationship to Resident: _________________________________
Phone Number: _________________________________________
Method of Contact to the Emergency Contact:
☐ Phone Call
☐ Text Message
☐ Voicemail
☐ Email
☐ Other: ___________________________
Date of Contact Attempt: ___________________
Time of Contact Attempt: ___________________
Staff Completing Notification: ______________________________
Outcome/Notes:
SIGNATURES
Resident Signature: _________________________________
☐ Resident Refused to Sign
☐ Resident Unavailable to Sign
Staff Signature: ___________________________________
Date/Time: ________________________________________
|