INITIAL COMMENTS
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This report is a result of an on-site licensure renewal inspection conducted on February 26, 2021 by staff from the Department of Drug and Alcohol Programs, Bureau of Program Licensure. Based on the findings of the on-site inspection, Renew Family Services, LLC 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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704.11(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, the facility failed to ensure that all staff completed the mandatory 6 hours of HIV/AIDS within the regulatory time frame, per the job position, in one of seven applicable personnel records reviewed.
Employee # 4 was hired as a counselor on July 15, 2019. The HIV/AIDS training was due no later than July 15, 2020. The HIV/AIDS training was not completed and documented at the time of inspection.
The findings were discussed with facility staff during the licensing process.
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Plan of Correction
All staff that need the required HIV/AIDS training were directed to sign up for the first available training. In addition the director of the facility has updated new staff training plans to include HIV/AIDS to be completed within the first year of employment.
The facility director is charge of compliance. |
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, the facility failed to document the completion of 25 clock hours of annual trainings required for a counselor during the facility's January 2020 through January 2021 training year in three of five applicable personnel records reviewed.
Employee # 2's personnel training record documented 5 hours of annual training for the prior training year.
Employee # 4's personnel training record documented 21 hours of annual training for the prior training year.
Employee # 5's personnel training record documented 5 hours of annual training for the prior training year.
These findings were reviewed with facility staff during the licensing process.
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Plan of Correction
A meeting was held with all staff the week of March 8th to discuss expectations in regard to staffs' annual required training hours. Staff were asked to take trainings periodically throughout the year to ensure that they are meeting the standard. The director of the facility will be sending periodic reminders to all staff to take trainings and she will provide suggested offerings. In addition during supervisions staffs will be asked to update the director on what trainings they intend to take.
The director of the facility is in charge of implementation and compliance. |