Adelphoi Middle Creek II

Citation, renewal inspection : 55 Pa. Code § 3800.184.c Medication Log

The medication log for child A was not completed at the same time each dosage of medication was administered.

Citation, renewal inspection : 55 Pa. Code § 3800.58.e Staff Training

During review of the personnel files, the Department identified Staff member E's previous CPR/First Aid certification was issued on 9/01/2017, which expired prior to renewal of the certification on 9/13/2019.

Citation, renewal inspection : 55 Pa. Code § 3800.58.b Staff Training

During review of the personnel files, the Department identified Staff Member A completed Mandated Reporter Training on 1/11/2015, and the employee's most recent training certificate was dated 2/07/2020. During review of the personnel files, the Department identified Staff Member B completed Mandated Reporter Training on 1/09/2015, and the employee's most recent training certificate was dated 2/06/2020. During review of the personnel files, the Department identified Staff Member C completed Mandated Reporter Training on 1/10/2015, and the employee's most recent training certificate was dated 1/11/2020. During review of the personnel files, the Department was unable to locate verification to confirm Staff Member D had completed Mandated Reporter training. 3 0f4

Citation : 55 Pa. Code § 3800.32.e

All resident incoming and outgoing calls are monitored and logged without weilten permission by the contracting agency of court.

Citation : 55 Pa. Code § 3800.32.g.1

According (o muliiple resident Interviews on 3-7-16, stalf are reading rosidents' Incoming and outgoing mall.

Citation : 55 Pa. Code § 3800.32.g.3

According to multiple resident interviews on 3-7-16, staff are reading residents" Incoming and outgoing mail.

Citation : 55 Pa. Code § 3800.32

According lo resident and staff, ali residents In the unit are being patted-down after ro-entoring the facillly after fire drills.

Citation : 55 Pa. Code § 3800.84.b

Dozens of ants were on the floor In the comer of Child #1's bedroom on 3/5/15. 3. PLAN OF GORRECTION (POC) (Attach pages as necossary, Remember that you must sign and date any attached pages.) include stops to correo! the violation dasaribed above and steps {o prevent a similar violation from occurring again, if sleps cannot be completed Immediately, include datos by which the steps will be completed. Adelphopi will continue with the current monthly pest control treatments and inspections from an outside vendor or contractor. The unit supervisor will review the inspection reports monthly from this vendor, Inspection reports for this time period have been sent and future inspection reports are available upon request. The unit supervisor or assistant supervisor will do a weekly unit walk-through/ inspection looking closely for insects/infestations within the unit. Information regarding the weekly walk-throughs will be documented on the monthly clinical supervision form. The program director will review weekly walk-throughs with the supervisor during monthly clinical supervision meetings starting on July 7, 2015, Any issues with insects will be reported to the director immediately and the outside vendor will also be immediately contacted for removal/treatments. Repeat Violation; No Date(s) of Previous Violation(s): i Signature of Legal Entlty Repragentative { // (Required on EVERY Page) WA A Printed Namo and Title of Legal Entity Representative Di ad) Jenner McClaren, Director ...

Citation : 55 Pa. Code § 3800.202.c

On 3/5/16 at approximately 4:37 PM, Staff Member C and Child #1 were observing dozens of anls on the floor in Child #1's bedroom. As Staff Member A and Staff Member B approached Child #1's bedroom to observe the ants, Child #1 verballzed that he/she did not want Staff Member A to enter his/her badroom. Staff Member A heard Child #1 verbalize that he/she did not want Staff Membar Ato escalated Child #1's behavior and resulted in a manual restraint by Staff Member A and Staff Member B on Child #1,

Citation : 55 Pa. Code § 3800.143.d

Resident #'1's heallh examination record dated 5/27/14 did not Include Ihe address of the examining practitioner. 3, PLAN OF GORREGTION (POC) (Attach pages as necessary, Remember that you must sign and dale any attached pages.) include steps fo correct the viofaifon dascribed above end stops to prevent a similar violation fram eccurring agala. ff steps cannol be compleled immaciately, include dates by which the sleps will be complelod, ‘The Unit supervisors will be the responsible staff at the agency to ensure the treating physician’s address is on all the residents’ medical forms. Starting June 1, 2015, the Director of Nursing will send out a monthly reminder for supervisors to check all medical forms within the residents’ clinical record. Beginning in June, 2015, during monthly clinical supervision of residents, the Unit Supervisor will verify that the addresses are on the physical, dental, and any other medical provider paperwork, If the address is missing from the form, the Unit Supervisor will verify the address and document it on the form, On June 11, 2015, the Program Directors will review the new process with Unit Supervisors during supervisors’ meeting. The sign in sheet will be provided to the Director of Quality Assurance as completion of training of the Unit Supervisors. Please see attached medical form(s) with the address provided on the form(s) Repeat Violation: No Date(s) of Previous Violatton(s): ee ee ee ——> Signature of Legal Entlty Representa {Required on ...

Citation : 55 Pa. Code § 3800.145.e

Resident #'4’s vision screening record dated 5/27/14 did not Include the address of the trealing practitloner,

Citation : 55 Pa. Code § 3800.146.e

Resident #'1's hearing screening record dated 6/27/14 did nol Include the address of the (reattng praciittoner.

Citation, incident inspection : 55 Pa. Code § 3800.141.c

Resident #1, admitted 11/14/13, had a health and sufety assessment dated 11/14/13 that did not include known incidents of aggressive er violent behavior. The child's record contained a document titted Transfer Care Plan that indicated physical aggression as a behavioral difficulty observed, The child's record contained haalth and safety assessments dated 6/7/13 and 9/4/13 that were completed by child residential facilities operated by the same legal entity, which also indicated a history of aggressive or violent behaviors,

Citation, incident inspection : 55 Pa. Code § 3800.58.d

The facility's training year Is the calendar year; Staif Person A had 31.75 hours of annual training from January 2013 through December 2013.