INITIAL COMMENTS
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This report is a result of an on-site complaint investigation conducted on July 17-19, 2019 by staff from the Department of Drug and Alcohol Programs, Bureau of Quality Assurance for Prevention & Treatment. Based on the findings of the on-site inspection, Teen Challenge Training Center, Inc was found not to be in compliance with the applicable chapters of 28 PA Code which pertain to the facility.
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Plan of Correction
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709.34 (c) (4) LICENSURE Reporting of unusual incidents
§ 709.34. Reporting of unusual incidents.
(c) To the extent permitted by State and Federal confidentiality laws, the project shall file a written unusual incident report with the Department within 3 business days following an unusual incident involving:
(4) Event at the facility requiring the presence of police, fire or ambulance personnel.
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Observations
Based on staff interviews and a review of client records on 7/17/19-7/19/19, the facility failed to report an incident that occurred on 06/25/19, which required the presence of ambulance personnel.
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Plan of Correction
On 7/31/2019 the counseling director will facilitate a training on properly following incident reporting procedures. Currently the clinical supervisors and clinical team leads are responsible for unusual incident reporting. These team members were present for the training, along with the counselors. Moving forward The counseling director will audit unusual incidents on a monthly basis to ensure proper reporting procedures are being followed. |