INITIAL COMMENTS
|
This report is a result of an on-site licensure renewal inspection conducted on March 5th and April 1st, 2019 of Carbon Monroe Pike Drug and Alcohol Commission, Inc. by staff from the Department of Drug and Alcohol Programs, Bureau of Quality Assurance for Prevention and Treatment, Program Licensure Division. Based on the findings of the on-site inspection, Carbon Monroe Pike Drug and Alcohol Commission, Inc. 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
|
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.
|
Observations
Based on a review of personnel records and the facility's Staffing Requirement Facility Summary Report (SRFSR) form, the facility failed to ensure that employee #5 received the minimum of 6 hours of HIV/AIDS training and at least 4 hours of TB/STD and other health related topics within the regulatory timeframe.
Employee #5 was hired as a Recovery Specialist on December 19, 2016 and was due to have the communicable disease trainings no later than December 19, 2018. Employee completed HIV/AIDS training on February 26, 2019 and TB/STD training on March 5, 2019.
The findings were discussed with facility staff during the licensing process.
|
Plan of Correction
At time of a new hire the unit supervisor will work with new hire to schedule DDAP required trainings that must be completed within the first 12 months of hire date. Unit supervisor will review obtained trainings on a quarterly basis with the new hire to assure they have at least been scheduled if not obtained the trainings. |