INITIAL COMMENTS
|
This report is a result of an on-site licensure renewal inspection conducted on April 15 through 16, 2013, by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, Pa Care LLC d/b/a State College Medical, 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
|
705.22 (4) LICENSURE Building exterior and grounds.
705.22. Building exterior and grounds.
The nonresidential facility shall:
(4) Store all trash, garbage and rubbish in noncombustible, covered containers that prevent the penetration of insects and rodents, and remove it at least once every week.
|
Observations
Based on the physical plant inspection, the facility failed to store all trash, garbage and rubbish in noncombustible, covered containers. The findings include:Upon arrival of the Licensing Specialist on April 15, 2013, at 10:00 a.m. the dumpster was observed to be uncovered. The finding was reviewed with the facility director who confirmed the lack of a cover.
|
Plan of Correction
The Facility Director will speak with the landlord of the building and inform him of this regulation. A cover for the dumpster will be requested.
This was addressed with landlord on 5/7/13. Dumpster will be covered by 6/1/13 |
705.23 (3) LICENSURE Counseling or activity areas and office space
705.23. Counseling or activity areas and office space.
The nonresidential facility shall:
(3) Ensure privacy so that counseling sessions cannot be seen or heard outside the counseling room. Counseling room walls shall extend from the floor to the ceiling.
|
Observations
Based on an overheard counseling session during the facility licensure inspection, the facility failed to ensure privacy in order that counseling sessions could not be seen or heard outside the counseling room. The findings include:During a physical plant inspection on April 16, 2013, at 11:30 a.m. counseling sessions between counselors and patients were overheard by the licensing specialist. The licensing specialist was reviewing the record storage area across the hall from the counselor offices.The finding was reviewed with the facility director and administrator on April 16, 2013. It was not disputed.
|
Plan of Correction
Sound machines will be purchased and installed in counseling hallway. This will be completed by 5/30/13. Facility Director will be responsible for the purchase of this equipment.
Sound machines were ordered on 5/8/13. Will be installed by 5/30/13. Counselors will be trained on the use of these machines in order to protect confidentiality. Facility Director will monitor the use of these machines to ensure that they are being used daily and during every session. |
709.28(c)(3) LICENSURE Confidentiality
709.28. Confidentiality.
(c) The project shall obtain an informed and voluntary consent from the client for the disclosure of information contained in the client record. The consent shall be in writing and include, but not be limited to:
(3) Purpose of disclosure.
|
Observations
Based on a review of patient records, the facility failed to obtain an informed and voluntary consent from the patient prior to the disclosure of information in two of five patient records.The findings include:Six patient records were reviewed on April 15 through 16, 2013. Five patient records were reviewed for an informed and voluntary consent from the patient that included the purpose of the disclosure.Patient # 4 was admitted on October 12, 2012. Consents to release information were signed by the patient for a legal entity, significant other and another provider which did not include the purpose for the releases. Patient # 6 was admitted on February 12, 2013. A consent to release information was signed by the patient for a significant other which did not include the purpose for the release.The findings were reviewed with the facility director and administrator on April 16, 2013. They were not disputed.
|
Plan of Correction
Facility Director will hold an in-service training for counseling and medical staff on 5/23/13 which will cover the correct way to complete a consent for release of information. Facility Director will monitor charts to ensure that consents are being filled out completely. |
715.9(a)(4) LICENSURE Intake
(a) Prior to administration of an agent, a narcotic treatment program shall screen each individual to determine eligibility for admission. The narcotic treatment program shall:
(4) Have a narcotic treatment physician make a face-to-face determination of whether an individual is currently physiologically dependent upon a narcotic drug and has been physiologically dependent for at least 1 year prior to admission for maintenance treatment. The narcotic treatment physician shall document in the patient 's record the basis for the determination of current dependency and evidence of a 1 year history of addiction.
|
Observations
Based on a review of patient records, the facility failed to document the basis for determining current and one year dependency in one of one record reviewed. The findings include:Six patient records were reviewed on April 15 through 16, 2013. One patient record was reviewed for the physician documentation of the basis for determining current and one year history of dependency. The facility failed to document dependency for one year prior to the admission in patient record # 1.Patient # 1 was admitted on January 10, 2013. The physician admission note identified the patient "relapsed 7/2012." The note also stated the patient had "stopped using 1/2011 when became pregnant." The patient failed to meet the one year dependency requirement and the facility did not submit an exception request to the Department for this admission.The findings were reviewed with the facility director and were not disputed.
|
Plan of Correction
Facility Director will review this regulation with Medical Director on 5/2/13. Facility Director will also review screening protocol, which includes one year dependency, with the receptionist who takes the initial phone calls. This will occur by 5/2/13. The Facility Director will monitor admissions to ensure that this regulation is being followed on an ongoing basis. |
715.17(c)(1)(i-vi)) LICENSURE Medication control
(c) A narcotic treatment program shall develop and implement written policies and procedures regarding the medications used by patients which shall include, at a minimum:
(1) Administration of medication.
(i) A narcotic treatment physician shall determine the patient 's initial and subsequent dose and schedule. The physician shall communicate the initial and subsequent dose and schedule to the person responsible for the administration of medication. Each medication order and dosage change shall be written and signed by the narcotic treatment physician.
(ii) An agent shall be administered or dispensed only by a practitioner licensed under the appropriate Federal and State laws to dispense agents to patients.
(iii) Only authorized staff and patients who are receiving medication shall be permitted in the dispensing area.
(iv) There shall be only one patient permitted at a dispensing station at any given time.
(v) Each patient shall be observed when ingesting the agent.
(vi) Administering and dispensing shall be conducted in a manner that protects the patient from disruption or annoyance from other individuals.
|
Observations
Based on a review of patient records, the facility failed to demonstrate that the narcotic treatment physician made a determination of the patient's initial dose and subsequent orders that was in compliance with all Federal and State regulations and statutes in five of five patient records.The findings include:Six patient records were reviewed on April 15 through 16, 2013. Five patient records were reviewed for written orders by the narcotic treatment physician that determined the patient's initial dose and schedule. The narcotic treatment physician failed to document clear induction orders in patient records # 1, 2, 4, 5 and 6. Patient # 1 was admitted on January 10, 2013. An initial medication order stated the patient was to begin dosing on January 10, 2013, at 30 mg. An order for an increase to 40 mg was dated for January 11, 2013. An order for an increase to 50 mg was dated for January 12, 2013. On January 13, 2013, the nurse wrote a medical note that identified medical "still require assessment sheets for first 3 doses from patient." The increase doses were not based on patient symptoms as the documentation of the patient's response to medication had not been received by medical. Patient # 2 was admitted on November 20, 2012. An initial medication order stated the patient was to begin dosing on November 20, 2012, at 30 mg. An order for an increase to 40 mg was dated for November 21, 2012. An order for an increase to 50 mg was dated for November 22, 2012. Phone contact from the patient's wife on November 27, 2012, was documented. She stated the patient would not be returning due to being sedated.Patient # 4 was admitted on October 12, 2012. An initial medication order stated the patient was to begin dosing on October 12, 2012, at 30 mg. An order for an increase to 40 mg was dated for October 13, 2012. An order for an increase to 50 mg was dated for October 14, 2012.Patient # 5 was admitted on October 24, 2012. An initial medication order stated the patient was to begin dosing on October 24, 2012, at 30 mg. An order for an increase to 40 mg was dated for October 25, 2012. An order for an increase to 50 mg was dated for October 26, 2012Patient # 6 was admitted on February 12, 2013. An initial medication order stated the patient was to begin dosing on February 12, 2013, at 30 mg. An order for an increase to 40 mg was dated for February 13, 2013. An order for an increase to 50 mg was dated for February 14, 2013.On September 4, 2007, all narcotic treatment programs were issued a letter regarding methadone dose orders, especially during the induction phase, by the Department of Health & Human Services, Substance Abuse and Mental Health Services Administration: (SAMHSA) In part, the following is excerpted from the letter:"Because methadone overdose deaths have occurred in early treatment due to the drug's cumulative effects of the first several days, it is also important to be cautious when adjusting the dose. According to the drug labeling, the peak respiratory depressant effects of methadone typically occur later and persist longer than its peak analgesic effects, which can contribute to cases of iatrogenic overdose, particularly during treatment initiation and dose titration. With repeated dosing, "methadone may be retained in the liver and released slowly, prolonging the duration of action despite low plasma concentrations." The drug labeling also states that "steady-state concentrations are not usually attained until 3 to 5 days of dosing," and that doses "will 'hold' for a longer period of time as tissue stores of methadone accumulate." Therefore, patients should be closely monitored during the induction phase, and the increase in dose should be under the close supervision of a physician as stated in 42 CFR 8.12 (h)(4), ' Dosing and administration decisions shall be made by a program physician familiar with the most up-to-date product labeling'. "The pattern of increases was discussed with the facility director and administrator due to not having the physician onsite every day for signing orders. The discussion confirmed the pattern of written increases upon admission.
|
Plan of Correction
Facility Director will review with Medical Director the regulations regarding physician verbal orders and proper assessment of patient dose adjustments. This occured on 5/2/13. Facility Director will monitor medical charts, specifically dose adjusments/orders, to ensure that regulations are being followed. |
709.92(b) LICENSURE Treatment and rehabilitation services
709.92. Treatment and rehabilitation services.
(b) Treatment and rehabilitation plans shall be reviewed and updated at least every 60 days.
|
Observations
Based on a review of patient records, the facility failed to document updates which addressed progress achieved during the reporting period on the stated goals of the treatment plan in two of two patient records.The findings include:Six patient records were reviewed on April 15 through 16, 2013. Two patient records were required to have treatment plan updates, # 4 and 5.Patient # 4 was admitted on October 12, 2012. A comprehensive treatment plan was documented on November 15, 2012. Treatment plan updates were documented on January 12, 2013, and March 12, 2013. Each update identified new patient goals. The treatment plan updates failed to document the progress on the previously stated goals.Patient # 5 was admitted on October 24, 2012. A comprehensive treatment plan was documented on November 23, 2012. Treatment plan updates were documented on January 24, 2013, and March 19, 2013. Each update identified new patient goals. The treatment plan updates failed to document the progress on the previously stated goals.The findings were reviewed with the facility director and administrator on April 16, 2013. They were not disputed.
|
Plan of Correction
Facility Director will hold an in-service training for counseling staff on 5/23/2013 to review how to properly complete a treatment plan, including how to report on progress made on previous treatment goals. The Facility Director will monitor treatment plans to ensure that this regulation is being met. |