1) Section 12070(b)(4)(A) Recovery or Treatment Planning
The above section states, in part, “Staff shall develop the initial treatment plan with input from the participant within 30 days from the dale of the participant’s admission.”
The provider was deficient in meeting this standard because a treatment plan was not contained in participant file who was admitted on.
2) Section 13000(d) Individual and Group Sessions
The above section states “The counselor/program specialist shall document, by signing their name and putting the date on the following information for participant’s attendance at individual and group sessions. This documentation shall be placed in the participant’s;
1. Date of each session attended;
2. Type of session;
3. Progress toward achieving the participant’s recovery or treatment plan goals.
The provider was deficient in meeting this standard because the aforementioned documentation was not contained in participant file
3) Section 17010 Program Policies
The above section states, in part “All program policies and procedures shall be contained in an operation manual that is located at each certified site and that shall be available to staff and volunteers. The policies and procedures manual shall contain but not be limited to the following:
a. Program mission and philosophy statement(s)
b. Program description;
c. Program objectives; and
e. Policies and procedures for:
5. Alumni involvement;
7. Recreational activities;
8. Detoxification services, if applicable;
9. Program administration;
11. Participant grievances/complaints;
12. Fiscal practices;
14. Participant rights;
17. Community relations;
18. Maintenance of program in a clean, safe and sanitary physical environment;
19.Use of prescribed medications by participants; 20. Maintenance and disposal of participant files;
21. Drug screening; and
22.Code of conduct
The provider was deficient in meeting this standard because the operation manual did not contain the aforementioned statements, policies and procedures.
4) Section 19005(b) Personnel Policies
The above section states, in part, “The program shall maintain personnel fifes for all employees. Each personnel file shall contain: 1. Resume; 2. Employment confirmation statement; 3. Job description; 4. Salary schedule ; 6. Health records including a health screening report or health questionnaire… ”
The provider was deficient in meeting this standard because the following items were missing from the personnel file:
• Resume for employee
• Employment confirmation statement for all employees
• Job description for employee
• Salary schedule for all employees
• Health questionnaire for employee
5) Section 19015(b) Health Screening and Tuberculosis Requirements
The above section states “The tuberculosis test shall be conducted under licensed medical supervision not more than three months prior to or seven days after employment and renewed annually from the date of the fast tuberculosis test.”
The provider was deficient in meeting this standard because current tuberculosis tests were not contained in personnel files for employees.
6) Section 26010(a)(2) Health and Safety
The above section states, in part, “The program shall be clean, safe, san ita, y and in good condition .. .”
The provider was deficient in meeting this standard because the men’s toilet contained a leak between the floor and the porcelain.
7) Section 26020 Hours of Operation
The above section states “Each program shall post the hours of operation to inform the general public and participants. When not open, the program shall provide information concerning the availability of short-term emergency counseling or referral services , including, but not limited to, emergency telephone services.”
The provider was deficient in meeting this standard because hours of operation were not posted near the entrance of the building.