INITIAL COMMENTS
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This report is a result of an initial on-site licensure inspection conducted on April 09, 2010 by staff from the Division of Drug and Alcohol Program Licensure. Based on the findings of the on-site inspection, Project Transition, 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 and a plan of correction is due on June 7, 2010.
Since this was the initial inspection conducted, not all regulations were reviewed. During future inspections, all regulations will be reviewed for compliance.
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Plan of Correction
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709.22(b) LICENSURE Governing Body
709.22. Governing body.
(b) If a project is publicly funded, not more than one staff member of the project may sit on the governing body at a designated time.
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Observations
Based on information included with the original application, and a previous interview with the Quality Improvement Manager, two staff member were serving on the governing body.
The findings include: The facility's Director and the facility's Psychiatrist in Chief were both serving on the Governing Body.
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Plan of Correction
This facility does not file electronically, a Plan of Correction is on file with the Department of Health. |