INITIAL COMMENTS
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This report is a result of an on-site licensure renewal inspection conducted on October 22, 2009 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, DARS, Inc. Supervised Independent Living Program 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 and a plan of correction is due on November 20, 2009.
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Plan of Correction
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709.53(a)(9) LICENSURE Aftercare plans
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:
(9) Aftercare plan, if applicable.
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Observations
Based on a review of client records, the facility failed to document a complete aftercare plan in three of three client records.
The findings include:
Six client records were reviewed on October 22, 2009. Aftercare plans were required in three client records. The aftercare plans in client records #5 and 6 included goals with general time frames, such as "ongoing" and "lifetime." The aftercare plan in client record #5 did not document support services. The aftercare plans in client records #4, 5 and 6 did not document a contact person or criteria for re-entry into the project.
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Plan of Correction
Program Director and Assistant Director will insure that all aftercare plans will include re-entry procedures that are specific in the event of the client's need for SIL services after their discharge from the program. This will include contact information for the Primary Counselor and Program Director. Also, a signature line has been added to the aftercare plan for the Program Director/Asst. Progtram Director to verify all re-entry content is present and complete, including specific timeframes for each goal identified on the aftercare plan. This plan of correction will be effective 11/2/09. |
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 on a review of personnel records and staff interviews, the facility failed to document the required 25 hours of annual training in one of one personnel record.
The findings include:
Four personnel records were reviewed on October 22, 2009. One personnel record was required to have 25 hours of annual training documented for the project's training year running from July 1, 2008 to June 30, 2009. Personnel record #3 only had 18 hours of annual training documented.
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Plan of Correction
Program Director will schedule a minimum of 25 hours of PCB approved trainings for the Assistant Program Director. These hours will be attained during the training year that includes the timeframes of July 1 to June 30 of each calendar year. This plan of correction will be effective 11/2/09. |
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 on a review of personnel records and staff interviews, the facility failed to document the required 30 hours of annual training in one of one personnel record.
The findings include:
Four personnel records were reviewed on October 22, 2009. One personnel record was required to have 30 hours of annual training documented for the project's training year running from July 1, 2008 to June 30, 2009. Personnel record #4 only had 18 hours of annual training documented.
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Plan of Correction
Program Director will schedule a minimum of thirty hours of PCB approved trainings for the Counselor Assistant. These hours will be attained during the training year that includes the timeframes of July 1 to June 30 of each calendar year. This plan of correction will be effective November 2, 2009.
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