INITIAL COMMENTS
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This report is a result of an on-site licensure renewal inspection and complaint investigation conducted on July 25-26, 2023, by staff from the Department of Drug and Alcohol Programs, Bureau of Program Licensure. Based on the findings of the on-site inspection, Pyramid Healthcare, Inc. 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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704.6(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
Based on one of seven applicable employee personnel records reviewed, the facility failed to provide documentation of at least two years ' experience or the completion of a core curriculum in clinical supervision for employee # 8.Employee # 8 was hired as a lead counselor on March 20, 2022 and was still in this position at the time of the inspection. Based on employee # 8's resume and personnel, there was no documentation of at least two years ' experience or the completion of a core curriculum in clinical supervision.These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
A re-training occurred on 8/15/2023 during the weekly Clinical Supervisor meeting by the Clinical Director. During this time we reviewed the expectation that all Lead Counselors are enrolled in the DDAP Clinical Supervisor training which is available on Relias. The Clinical Supervisors acknowledged understanding that this training is to occur within 6 months of a counselor transitioning to a Lead Counselor and acknowledged that this is one of their job duties. |
704.9(b) LICENSURE Performance evaluation
704.9. Supervision of counselor assistant.
(b) Performance evaluation. The counselor assistant shall be given a written semiannual performance evaluation based upon measurable performance standards. If the individual does not meet the standards at the time of evaluation, the counselor assistant shall remain in this status until the supervised period set forth in subsection (c) is completed and a satisfactory rating is received from the counselor assistant's supervisor.
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Observations
Based on one of ten counselor assistant personnel records, the facility failed to provide a written semi-annual performance evaluation based upon measurable performance standards within the first year of employment in this position for employee # 28. Employee # 28 was hired as a counselor assistant on August 21, 2022 and was still in this position at the time of the inspection. The only performance evaluation provided by the facility was dated July 5, 2023.These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
A re-training occurred on 8/15/2023 during the weekly Clinical Supervisor meeting. During this time Clinical Director reviewed requirements of Counselor Assistant supervision including the need for a semi-annual and annual performance evaluation. Although, these evaluations are managed through UKG the Clinical Supervisors acknowledged understanding that this tracking is one of their duties and will be tracked along with other components of clinical supervision. |
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
Based on two applicable employee personnel records reviewed, the facility failed to provide documentation of weekly supervision and to also include one hour of direct observation for a counselor assistant in employee records # 28 and # 29. Employee # 28 was hired as a counselor assistant on August 21, 2022 and was still in this position at the time of the inspection. Weekly supervision was not documented to have occurred the weeks of October 9-15, and October 16-22, 2022.Employee # 29 was hired as a counselor assistant on September 1, 2022 and was still in this position at the time of the inspection. Weekly supervision was not documented to have occurred the weeks of January 1-7, March 19-25, and March 26-April 1, 2023.These findings were reviewed with facility staff during the licensing process.This is a repeat citation from the August 25, 2022 annual licensing inspection.
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Plan of Correction
A re-training occurred on 8/15/2023 during the weekly Clinical Supervisor meeting. During this time Clinical Director reviewed Counselor Assistant supervision requirements. The Clinical Supervisors acknowledged their understanding that completing supervision notes in a timely fashion is one of their job duties including submission to the supervision tracking smartsheet for review by Clinical Director and Regional Quality Management team. Additionally, Clinical Supervisors acknowledged their understanding that if a Counselor Assistant is not available for weekly supervision due to illness, vacation, etc. that a note will still be completed indicating that supervision was not able to occur and the appropriate amount of additional time will be added to their required time as a Counselor Assistant. |
704.11(b)(1) LICENSURE Individual training plan.
704.11. Staff development program.
(b) Individual training plan.
(1) A written individual training plan for each employee, appropriate to that employee's skill level, shall be developed annually with input from both the employee and the supervisor.
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Observations
Based on a review of fifty-three personnel records, the facility failed to provide a written individual training plan to include documentation of input from both the employee and the supervisor for employees # 35, 36, 37, 38, 39, 40, 43, 44, 45, 46, 47, and 48.Employee # 35 was hired as a support staff on March 6, 2023 and was still employed at the time of the inspection.Employee # 36 was hired as a support staff on August 8, 2022 and was still employed at the time of the inspection.Employee # 37 was hired as a support staff on May 8, 2023 and was still employed at the time of the inspection.Employee # 38 was hired as a support staff on August 12, 2019 and was still employed at the time of the inspection.Employee # 39 was hired as a support staff on February 27, 2023 and was still employed at the time of the inspection.Employee # 40 was hired as a support staff on April 3, 2023 and was still employed at the time of the inspection.Employee # 43 was hired as a support staff on August 12, 2022 and was still employed at the time of the inspection.Employee # 44 was hired as a support staff on October 22, 2022 and was still employed at the time of the inspection.Employee # 45 was hired as a support staff on September 5, 2016 and was still employed at the time of the inspection.Employee # 46 was hired as a support staff on December 14, 2022 and was still employed at the time of the inspection.Employee # 47 was hired as a support staff on August 22, 2022 and was still employed at the time of the inspection.Employee # 48 was hired as a support staff on June 19, 2022 and was still employed at the time of the inspection.These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Leadership met on 8/17/2023 to discuss the importance of completing training plans. Moving forward all new hires will complete training plans along with new hire paperwork. This will be completed by the staff's hiring manager. Additionally, managers will complete monthly checks to ensure that all staff training plans have been completed and are current. |
704.11(c)(1) LICENSURE Mandatory Communicable Disease Training
704.11. Staff development program.
(c) General training requirements.
(1) Staff persons and volunteers shall receive a minimum of 6 hours of HIV/AIDS and at least 4 hours of tuberculosis, sexually transmitted diseases and other health related topics training using a Department approved curriculum. Counselors and counselor assistants shall complete the training within the first year of employment. All other staff shall complete the training within the first 2 years of employment.
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Observations
Based on a review of personnel records and the facility's Staffing Requirement Facility Summary Report (SRFSR) form, the facility failed to ensure that employee's #41, 42, 49, 50, 51, 52, and 53 received the minimum of 6 hours of HIV/AIDS training and at least 4 hours of TB/STD and other health related topics within the regulatory timeframe.Employee # 41 was hired as a support staff on March 11, 2019 and was still in this position at the time of the inspection. Employee # 41 was due to have the communicable disease trainings no later than March 11, 2021. There was no documentation in the personnel file of the completion of the 4 hours of TB/STD training as of the date of the inspection.Employee # 42 was hired as a support staff on October 18, 2016 and was still in this position at the time of the inspection. Employee # 42 was due to have the communicable disease trainings no later than October 18, 2018. There was no documentation in the personnel file of the completion of the 4 hours of TB/STD training as of the date of the inspection.Employee # 49 was hired as a support staff on December 16, 2019 and was still in this position at the time of the inspection. Employee # 49 was due to have the communicable disease trainings no later than December 16, 2021. There was no documentation in the personnel file of the completion of the 6 hours of HIV/AIDS training and at least 4 hours of TB/STD training as of the date of the inspection.Employee # 50 was hired as a support staff on October 21, 2019 and was still in this position at the time of the inspection. Employee # 50 was due to have the communicable disease trainings no later than October 21, 2021. There was no documentation in the personnel file of the completion of the 6 hours of HIV/AIDS training and at least 4 hours of TB/STD training as of the date of the inspection.Employee # 51 was hired as a support staff on July 17, 2017 and was still in this position at the time of the inspection. Employee # 51 was due to have the communicable disease trainings no later than July 17, 2019. There was no documentation in the personnel file of the completion of the 6 hours of HIV/AIDS training as of the date of the inspection.Employee # 52 was hired as a support staff on December 29, 2020 and was still in this position at the time of the inspection. Employee # 52 was due to have the communicable disease trainings no later than December 29, 2022. There was no documentation in the personnel file of the completion of the 6 hours of HIV/AIDS training and at least 4 hours of TB/STD training as of the date of the inspection.Employee # 53 was hired as a support staff on February 1, 2021 and was still in this position at the time of the inspection. Employee # 53 was due to have the communicable disease trainings no later than February 1, 2023. There was no documentation in the personnel file of the completion of the 6 hours of HIV/AIDS training and at least 4 hours of TB/STD training as of the date of the inspection.The findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Leadership was met with on 8/24/2023 during which time the importance of enrolling new staff in required trainings was reviewed. Moving forward all new employees will be registered on the DDAP training site within the first two weeks of employment for both the 6 hour HIV/AIDS training and the 4 hour TB/STD training. Trainings will be assigned based on their availability. Anyone currently not in compliance will be assigned the next available training. Hiring Managers acknowledged that enrolling their supervisees in training is one of their job duties. Hiring Managers include Clinical Director, Executive Director, Nurse Manager, Assistant Program Director, Facility Manager, Office Manager, and Kitchen Manager. |
704.11(f)(2) LICENSURE Trng Hours Req-Coun
704.11. Staff development program.
(f) Training requirements for counselors.
(2) Each counselor shall complete at least 25 clock hours of training annually in areas such as:
(i) Client recordkeeping.
(ii) Confidentiality.
(iii) Pharmacology.
(iv) Treatment planning.
(v) Counseling techniques.
(vi) Drug and alcohol assessment.
(vii) Codependency.
(viii) Adult Children of Alcoholics (ACOA) issues.
(ix) Disease of addiction.
(x) Aftercare planning.
(xi) Principles of Alcoholics Anonymous and Narcotics Anonymous.
(xii) Ethics.
(xiii) Substance abuse trends.
(xiv) Interaction of addiction and mental illness.
(xv) Cultural awareness.
(xvi) Sexual harassment.
(xvii) Developmental psychology.
(xviii) Relapse prevention.
(3) If a counselor has been designated as lead counselor supervising other counselors, the training shall include courses appropriate to the functions of this position and a Department approved core curriculum or comparable training in supervision.
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Observations
Based three of nineteen applicable employee personnel records reviewed, the facility failed to provide documentation of at least 25 clock hours of annual training required for a counselor for the training year January-December 2022 in employee records # 18, # 19, and # 20.Employee # 18 was hired as a counselor on March 10, 2018 and was still in this position at the time of the inspection. After a review of employee # 18 ' s personnel record, there were only 12.25 training hours documented.Employee # 19 was hired as a counselor on December 23, 2019 and was still in this position at the time of the inspection. After a review of employee # 19 ' s personnel record, there were only 24.25 training hours documented.Employee # 20 was hired as a counselor on December 6, 2021 and was still in this position at the time of the inspection. After a review of employee # 20 ' s personnel record, there were only 17.25 training hours documented.These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
A re-training occurred on 8/15/2023 during the weekly Clinical Supervisor meeting. During this time Clinical Director reviewed the training requirements of 25 hours annually for a counselor. To track training hours it was agreed that Clinical Supervisors will make scheduled and completed training hours part of monthly supervision with their counselors as well as run a report quarterly to track clinical training hours. |
704.11(g)(1) LICENSURE Trng Req-Couns Asst
(g) Training requirements for counselor assistants.
(1) Each counselor assistant shall complete at least 40 clock hours of training the first year and 30 clock hours annually thereafter in areas such as:
(i) Pharmacology.
(ii) Confidentiality.
(iii) Client recordkeeping.
(iv) Drug and alcohol assessment.
(v) Basic counseling.
(vi) Treatment planning.
(vii) The disease of addiction.
(viii) Principles of Alcoholics Anonymous and Narcotics Anonymous.
(ix) Ethics.
(x) Substance abuse trends.
(xi) Interaction of addiction and mental illness.
(xii) Cultural awareness.
(xiii) Sexual harassment.
(xiv) Developmental psychology.
(xv) Relapse prevention.
(h) Training hours. Training hours are not cumulative from one personnel classification to another.
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Observations
Based one of ten applicable employee personnel records reviewed, the facility failed to provide documentation of at least 40 clock hours of annual training required for a counselor assistant in the first year for the training year January-December 2022 in employee record # 25.Employee # 25 was hired as a counselor assistant on December 22, 2021 and was still in this position at the time of the inspection. After a review of employee # 25 ' s personnel record, there were only 26.65 training hours documented.These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
A re-training occurred on 8/15/2023 during the weekly Clinical Supervisor meeting. During this time Clinical Director reviewed the training requirements of 40 hours annually for a counselor assistant. To track training hours it was agreed that Clinical Supervisors will make scheduled and completed training hours part of supervision with their counselor assistants at least once a month as well as run a report quarterly to track clinical training hours. |
705.2 (2) LICENSURE Building exterior and grounds.
705.2. Building exterior and grounds.
The residential facility shall:
(2) Keep the grounds of the facility clean, safe, sanitary and in good repair at all times for the safety and well-being of residents, employees and visitors. The exterior of the building and the building grounds or yard shall be free of hazards.
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Observations
Based on a physical plant inspection, the facility failed to keep the grounds of the facility clean, safe, sanitary, and in good repair at all times for the safety and well-being of the residents, employees, and visitors. Client bedrooms are having repairs done while clients and or client possessions are still residing in the bedroom.These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
On 8/22/2023 the maintenance staff will be educated on the importance of moving client belongings out of a client bedroom in need of repair. Their belongings along with the client will be moved to an unoccupied room until the repairs are completed. |
705.4 (2) LICENSURE Counseling areas.
705.4. Counseling areas.
The residential facility shall:
(2) Maintain counseling areas with furnishings which are in good repair.
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Observations
Based on a physical plant inspection, the facility failed to maintain counseling areas with furnishings which are in good repair. A counselor office in the west building had chairs that were torn and in disrepair. These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
The furniture has been replaced. Inspection of furniture will be included into the monthly physical plant walk-throughs which are completed by the Facility Manager to ensure all furnishings are in a state of good repair. Any furnishings present that are not in a state of good repair will be replaced. This monthly inspection will now include not only client living areas but also staff offices. |
705.6 (3) LICENSURE Bathrooms.
705.6. Bathrooms.
The residential facility shall:
(3) Have hot and cold water under pressure. Hot water temperature may not exceed 120F.
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Observations
Based on a physical plant inspection, the facility failed to have hot water temperature that does not exceed 120F. A bathroom in the East 2 building had a water temperature read at 128F.These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Facility Manager will complete monthly water temperature checks in all residential and withdrawal management units to ensure that the water temperatures do not exceed 120F. |
705.9 (3) LICENSURE General safety and emergency procedures.
705.9. General safety and emergency procedures.
The residential facility shall:
(3) Limit smoking to designated smoking areas.
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Observations
Based on a physical plant inspection, the facility failed to limit smoking to designated smoking areas. There were cigarette butts in several outside areas that were not designated for smoking and staff were smoking in the front of the building that is not designated for smoking.These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
All staff were educated on the designated smoking areas that are to be utilized throughout the day and management has expressed the expectation that these areas be utilized. Cigarette butt receptacles will also be moved to the designated smoking areas limiting the amount of cigarettes butts. Maintenance and BHT staff will monitor daily the placement of cigarette butt receptacles to ensure that both residents and staff are not smoking in designated non-smoking areas. Monthly campus clean-ups will occur during which time members off all departments will be encouraged to participate in maintaining good external cleanliness of the facility. |
705.10 (a) (1) (i) LICENSURE Fire safety.
705.10. Fire safety.
(a) Exits.
(1) The residential facility shall:
(i) Ensure that stairways, hallways and exits from rooms and from the residential facility are unobstructed.
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Observations
Based on a physical plant inspection, the facility failed to ensure that stairways, hallways and exits from rooms and from the residential facility are unobstructed. Two laundry carts were stored in front of the exit doors in the women's detox building.These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
Housekeeping staff has been re-educated on the importance of maintaining clear fire exits throughout the facility. The laundry carts have been removed. Soiled linens are now taken to the outdoor designated storage bins on a daily basis to await pick-up from Pyramid's contracted laundry service. Housekeeping Supervisor and Facility Manager will ensure that the carts are clear from exits at all times by facilitating daily walk throughs of the facility. |
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
Based on a review of the facility policy and procedure manual and client records, the facility failed to follow the policy and procedure manual that indicates a level of care assessment will be completed at intake/initial assessment for client records # 1, 2, 5, 6, and 7. Also, the facility did not follow the policy and procedure for clients leaving the facility against medical advice in client record # 7 and # 12. The policy and procedure manual indicates a client leaving against medical advice needs to contact the emergency contact within 12 hours after the client leaves. Client # 1 was admitted on July 20, 2023 and was still active at the time of the inspection. A level of care assessment was not completed at intake. Client # 2 was admitted on July 21, 2023 and was still active at the time of the inspection. A level of care assessment was not completed at intake. Client # 5 was admitted on June 13, 2023 and was discharged on June 17, 2023. A level of care assessment was not completed at intake. Client # 6 was admitted on May 16, 2023 and was discharged on May 23, 2023. A level of care assessment was not completed at intake.Client # 7 was admitted on June 23, 2023 and was discharged on June 25, 2023. A level of care assessment was not completed at intake. Client # 7 left the facility against medical advice and the facility failed to document contacting the emergency contact with 12 hours of the client leaving.Client # 12 was admitted on June 21, 2023 and was discharged on June 26, 2023. Client # 12 left the facility against medical advice and the facility failed to document contacting the emergency contact with 12 hours of the client leaving.These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
A policy revision request was submitted to the policy review committee on 8/22/2023. The policy review committee will review PHC 1.20 Content of Client Record to clarify that a Level of Care Assessment is not required for 3.7WM level of care as a nursing assessment is completed in its place. This policy will be reviewed and updated accordingly with 45 days. The policy request was submitted by Regional Quality Manager who will communicate with Clinical Director once the policy is changed.
The Clinical Director will education clinical staff regarding this change. Additionally, in response to emergency contact notification for non-routine discharges the clinical department will be trained during the monthly departmental meeting regarding the importance of notifying emergency contacts. The department will be held to the expectation that the emergency contact will be notified and placed as a memo in the chart prior to completing the bed management request for which discharges the electronic medical record. For non-routine discharges that occur Monday through Friday 4:00 PM to 8:00 AM and weekends the emergency contact will be notified by the nurse completing the medical discharge summary and will be noted in their nursing discharge note. These expectations will be monitored by Clinical Director, Clinical Supervisors, and Nurse Manager. |
709.62(c)(v) LICENSURE Physical Examination
709.62. Intake and admission.
(c) Intake procedures shall include documentation of the following:
(5) Physical examination.
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Observations
Based on seven of seven detox client records reviewed, the facility failed to provide documentation of a complete physical in accordance with the facility policy and procedure manual. The policy and procedure manual indicates a complete history and physical be completed by the facility physician on all individuals admitted to the detoxification program within 24 hours of admission.Client # 1 was admitted on July 20, 2023 and was still active at the time of the inspection. A complete history and physical exam was due no later than July 21, 2023. The physical exam had not been completed at the time of the inspection.Client # 2 was admitted on July 21, 2023 and was still active at the time of the inspection. A complete history and physical exam was due no later than July 22, 2023. The physical exam had not been completed at the time of the inspection.Client # 3 was admitted on July 19, 2023 and was still active at the time of the inspection. A complete history and physical exam was due no later than July 20, 2023. The physical exam had not been completed at the time of the inspection.Client # 4 was admitted on July 21, 2023 and was still active at the time of the inspection. A complete history and physical exam was due no later than July 22, 2023. The physical exam had not been completed at the time of the inspection.Client # 5 was admitted on June 13, 2023 and was discharged on June 17, 2023. A complete history and physical exam was due no later than June 14, 2023. The physical exam had not been completed at the time of the inspection.Client # 6 was admitted on May 16, 2023 and was discharged on May 23, 2023. A complete history and physical exam was due no later than May 17, 2023. The physical exam had not been completed until May 18, 2023.Client # 7 was admitted on June 23, 2023 and was discharged on June 25, 2023. A complete history and physical exam was due no later than June 24, 2023. The physical exam had not been completed at the time of the inspection.These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
On 8/2/2023 the Director of Nursing met with the facility physician. The doctor was informed that he will no longer be seeing clients via telehealth. Since 8/2/2023 the facility physician has not facilitated H&P's via telehealth services and has been physically on site to complete history and physicals including the physical examination portion of the assessment. This will be monitored by Nurse Manager and Regional Director of Nursing. |
709.63(a)(8) LICENSURE Follow-up Information
709.63. 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:
(8) Follow-up information.
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Observations
Based on two of three applicable detox client records reviewed, the facility failed to provide follow-up information in accordance with the facility policy and procedure manual. The facility policy and procedure manual indicate a follow-up to occur within seven days after discharge by phone.Client # 6 was admitted on May 16, 2023 and was discharged on May 23, 2023. There was no follow-up information available in the client record. Client # 7 was admitted on June 23, 2023 and was discharged on June 25, 2023. There was no follow-up information available in the client record. These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
The Case Management Department will have a departmental meeting on 08/24/2023 @ 9am to discuss follow up call procedures. All case managers will sign in for this meeting. We will go over discharges from the previous week each day to ensure that each case manager is aware of which client will need a follow up call. We will discuss proper outreach, and how to document. Case Management Supervisor and Lead Case Manager will facilitate chart checks to ensure that follow up calls are occurring appropriately. The sign in sheet will be provided to the clinical director. |
709.53(a)(11) LICENSURE Follow-up information
709.53. 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 one of three applicable residential client records reviewed, the facility failed to provide follow-up information in accordance with the facility policy and procedure manual. The facility policy and procedure manual indicate a follow-up to occur within seven days after discharge by phone.Client # 13 was admitted on April 23, 2023 and was discharged on July 18, 2023. There was no follow-up information available in the client record. These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
The Case Management Department will have a departmental meeting on 08/24/2023 @ 9am to discuss follow up call procedures. All case managers will sign in for this meeting. We will go over discharges from the previous week each day to ensure that each case manager is aware of which client will need a follow up call. We will discuss proper outreach, and how to document. Case Management Supervisor and Lead Case Manager will facilitate chart checks to ensure that follow up calls are occurring appropriately. The sign in sheet will be provided to the clinical director. |