INITIAL COMMENTS
|
This report is a result of an on-site complaint investigation conducted on May 2, 2014 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site complaint investigation, The Consortium was found not to be in compliance with the applicable chapters of 28 PA Code which pertain to the facility.
|
Plan of Correction
|
705.27 (1) LICENSURE General safety and emergency procedures.
705.27. General safety and emergency procedures.
The nonresidential facility shall:
(1) Be free of rodent and insect infestation.
|
Observations
Based on the results of a complaint investigation, the facility failed to develop written policy and procedures addressing bed bug infestations, which has been an ongoing and recurring problem at the facility.
The findings include:
The complaint investigation was conducted on-site on May 2, 2014. There were two incidents where bed bugs were found in two group rooms and the security office on the first floor of the building. The facility hired a pest control company and submitted two incident reports to the Department, but failed to develop policy and procedures to address the problem.
An interview with the facility director on May 2, 2014 confirmed that the facility did not develop policy and procedures to address the specific problem of bed bug infestation.
|
Plan of Correction
Responsibility
The Facilities Department and the Policy Development Department is responsible for developing policies that affect the entire organization. The Project Director is responsible for approval of all policies.
Plan of Correction: Corporate Policy 156, Rodent and Insect Infestation was developed and approved by the Project Director.
Monitoring: Policy CPP will be reviewed with all staff by 8/15/14 and adhered to by program staff |
715.28(a)(1-10) LICENSURE Unusual incidents
(a) A narcotic treatment program shall develop and implement policies and procedures to respond to the following unusual incidents:
(1) Physical assault by a patient.
(2) Inappropriate behavior by a patient causing disruption to the narcotic treatment program.
(3) Selling of drugs on the premises.
(4) Complaints of patient abuse (physical, verbal, sexual and emotional).
(5) Death or serious injury due to trauma, suicide, medication error or unusual circumstances.
(6) Significant disruption of services due to disaster such as fire, storm, flood or other occurrence.
(7) Incident with potential for negative community reaction or which the facility director believes may lead to community concern.
(8) Theft, burglary, break-in or similar incident at the facility.
(9) Drug related hospitalization of a patient.
(10) Other unusual incidents the narcotic treatment program believes should be documented.
|
Observations
Based upon staff interviews, the facility failed to ensure that patients were not subjected to any form of abuse.
The findings include:
Two complaints relating to patient abuse were investigated on May 2, 2014. Facility staff were interviewed on May 2, 2014 concerning allegations that on April 29, 2014 clients were not permitted to enter the facility to wait in the multipurpose room, but, were made to wait outside the building while it was raining and cold outside.
Facility staff who were interviewed on May 2, 2014 all confirmed that security had been directed not to allow clients in the multipurpose room; clients were made to wait outside while it was raining.
|
Plan of Correction
Responsibility: It is the responsibility of all staff to ensure that members are not subject to any form of abuse by the program.
Plan of correction: Although this was a miscommunication between management and security staff, all staff have been made aware that members are able to wait for scheduled services inside the building in all conditions. Despite if any one room is unavailable for waiting for a given amount of time, other indoor arrangements will be made and security will be on post to ensure safety for all persons |