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Pennsylvania Department of Drug & Alcohol Programs
Inspection Results

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WOMEN'S INSTITUTE FOR FAMILY HEALTH
255 S.17TH STREET, SUITE 808
PHILADELPHIA, PA 19103

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Survey conducted on 07/16/2013

INITIAL COMMENTS
 
This report is a result of an on-site licensure renewal inspection conducted on July 15-16, 2013 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, Women's Institute for Family Health 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:
 
Plan of Correction

705.28 (c) (4)  LICENSURE Fire safety.

705.28. Fire safety. (c) Fire extinguishers. The nonresidential facility shall: (4) Instruct staff in the use of the fire extinguisher upon staff employment. This instruction shall be documented by the facility.
Observations
Based on the review of personnel records, the facility failed to document that fire extinguisher training was provided upon employment.



The findings include:



Two personnel records were reviewed for documentation of fire extinguisher training on July 16, 2013. The facility did not document that fire extinguisher training was provided upon employment in one out of two personnel records reviewed, specifically personnel record #3.



Employee #3 was hired on March 13, 2013, but the training certificate indicated this training occurred on April 9, 2013.



The findings were discussed with the facility director during the exit interview.
 
Plan of Correction
The Executive Director shall assume responsibility for fire extinguisher training of all newly hired staff. To assure that there is not a reoccurence the Executive Director will provide fire extinguisher training to staff on their first day of work. Staff will be issued a fire extinguisher training certificate at that time that will be signed and dated by both the staff person and the Executive Director

 
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