Inspection IDReason for InspectionInspection DateInspection Status 
SIN-00235616 Renewal 01/17/2024 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2380.20(a)Staff #3 has a documented hire date of 3/6/23. The Pennsylvania criminal history check was completed on 3/27/23. An additional Pennsylvania criminal history check was provided with a date of 9/8/20. The criminal history check completed prior to Staff #3's hire date was outside of the one year prior to hire date. The criminal history check completed on 3/27/23 exceeded the allowed five working days after the person's date of hire.An application for a Pennsylvania criminal history record check shall be submitted to the State Police for prospective employees of the facility who will have direct contact with individuals, and for part-time and temporary staff persons who will have direct contact with individuals, within 5 working days after the person's date of hire.The Executive Director will submit applications for Pennsylvania criminal history record checks to the State Police for prospective employees (part-time, full-time and substitutes) of The Pike County Developmental Center who will have direct contact with individuals, as well as volunteers who will have direct contact with individuals, within 5 working days after the employee and/or volunteer's date of hire. On January 18, 2024, the Executive Director revised "The Pike County Developmental Center Staff and Volunteer Orientation Form" to include the following: Date of Hire, Criminal Record Check Date and FBI Clearance Date. The Executive Director is the staff person that fills out "The Pike County Developmental Center Staff and Volunteer Orientation Form," the Executive Director and employee and/or volunteer signs and dates "The Pike County Developmental Center Staff and Volunteer Orientation Form" after reviewing each category on the form. 01/18/2024 Implemented
2380.181(a)The assessments completed for Individual #1 were dated as being completed on 12/13/21 and 3/9/23. The assessments completed for Individual #2 were dated as being completed on 4/25/23 and 3/4/21. The assessments for Individual #3 were dated as being completed on 10/18/23 and 11/20/21. Assessments for Individuals #1, #2 and #3 were not completed on time annually as required.Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the facility and an updated assessment annually thereafter.The Program Specialist will complete an initial assessment with each individual within 1 year prior to or 60 calendar days after admission to The Pike County Developmental Center. The Program Specialist will complete an updated assessment with each individual annually thereafter. As of January 18, 2024 and further, the Executive Director will review all assessments and upon review completion, will sign the assessments. The Program Specialist and individual sign the assessment upon completion; the Executive Director will sign after the Program Specialist and individual have signed the assessment. The Executive Director has educated the Program Specialist on this regulation, as well as the change of the Executive Director monitoring and signing all individual assessments, as of January 18, 2024. 01/18/2024 Implemented
SIN-00217668 Renewal 01/17/2023 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2380.59(b)Hot water in the bathrooms of the facility exceeded 120 degrees. The water temperature in one bathroom measured at 133.5 degrees and the second bathroom measured at 131.8 degrees.Hot water temperatures in areas accessible to individuals may not exceed 120°F.Staff #1 called the Landlord on January 17, 2023, after the on-site inspection to ask the Landlord to turn down the temperature on the hot water heater so the water temperature of 2 bathrooms and the kitchen faucet would not exceed 120 degrees. The Landlord turned down the temperature of the hot water heater on January 27, 2023, at 9:00am and tested the temperatures of 2 bathrooms and the kitchen faucet with an "Ideal Single Laser Targeting 10:1 Infrared Thermometer." All locations of water temperatures do not exceed 120 degrees. Staff #1 bought an "Ideal Single Laser Targeting 10:1 Infrared Thermometer" at Lowes on January 27, 2023, at 5:33pm to have a water temperature testing thermometer on-site for periodic water testings to make sure that the water temperatures in 2 bathrooms and the kitchen faucet will always be below 120 degrees. 01/27/2023 Implemented
2380.62Telephone at the facility did not contain the telephone numbers of the nearest hospital, police department, fire department, ambulance and poison control center.Telephone numbers of the nearest hospital, police department, fire department, ambulance and poison control center shall be posted on or by each telephone in the facility with an outside line.On January 17, 2023, after the on-site inspection, Staff #1 affixed a type written label of the telephone numbers of the nearest hospital, police department, fire department, ambulance and poison control center to the office phone handset (located on Staff #1's desk) and the secondary phone handset (located in the "PCDC Craft Store"). The telephone numbers of the nearest hospital, police department, fire department, ambulance and poison control center are also posted on the wall in the office (near the office phone located on Staff #1's desk). 01/17/2023 Implemented
2380.111(a)Individual #1's annual physical was completed late. Individual #1 had a physical completed on 10/21/21 and did not have another physical completed until 1/9/23.Each individual shall have a physical examination within 12 months prior to admission and annually thereafter.Staff #1 revised the Physical Reminder Letter that is given to Individual #1 and all individuals attending the Center, annually, to remind individuals that their annual physical is due. Staff #1 revised the Physical Reminder Letter so it states, "IF A PHYSICAL EXAMINATION CANNOT BE COMPLETED BY THE DUE DATE ABOVE, THERE IS A 15 DAY ALLOWABLE GRACE PERIOD, THEN IT IS REQUIRED BY THE STATE THAT A DOCTOR'S NOTE IS NEEDED FOR CANCELLED APPOINTMENTS/RE-SCHEDULED APPOINTMENTS. Staff #1 discussed with the Program Specialist the importance of physicals and the regulation that each individual must have a physical examination within 12 months prior to admission and annually thereafter (with a 15 day allowable grace period). The Program Specialist will highlight the statement when giving the Physical Reminder Letter to Individual #1 and all individuals attending the Center, when their physicals are due. The Program Specialist will request a Doctor's note when annual physicals are cancelled due to illnesses, cancellations by Doctor Offices, military leave and situations in life when physicals are cancelled and re-scheduled for a later date that is not within the annual due date (with a 15 day allowable grace period). Staff #1 will monitor physical due dates to make sure that Individual #1 and all individuals attending the Center complete annual physicals within 12 months prior to admission and annually thereafter (with a 15 day allowable grace period). 02/03/2023 Implemented
2380.113(c)(3)Staff #1's physical examination dated 4/6/21 and Staff #2's physical examination dated 6/10/21 did not include a signed statement that the person is free of serious communicable diseases.The physical examination shall include: A signed statement that the person is free of serious communicable diseases as defined in 28 Pa. Code §  27.2 (relating to specific identified reportable diseases, infections and conditions) to the extent that confidentiality laws permit reporting, or that the person has a serious communicable disease as defined in §  27.2 to the extent that confidentiality laws permit reporting, but is able to work in the facility if specific precautions are taken that will prevent spread of disease to individuals.Staff #1 re-typed the "Staff Physical Examination Form" in order for the physical to be legible and there are two statements on the "Staff Physical Examination Form" which clearly states the following: PART II - Is the individual free of communicable tuberculosis as shown by: 1. Negative skin test results within the past two years? (Yes/No) 2. Positive skin test followed by one negative x-ray and an asymptomatic history at this examination? (Yes/No) and PART III - Does the individual have any of the following medical problems: 1. Communicable diseases? (List) (Yes/No). 02/01/2023 Implemented
2380.181(e)(3)(ii)Individual #1's assessment did not include the Indvidual's progress over the last 365 calendar days l in the following area: Communication.The assessment must include the following information: The individual¿s current level of performance and progress in the following areas: Communication.Staff #1 re-trained the Program Specialist on the regulation that the assessment of Individual #1 and assessments of all individuals attending the Center must include the individuals current level of performance and progress in Communication. The Program Specialist revised the assessment form to include the following (located on page 2 of the assessment): Current Level of Progress, Performance and Growth - Summary of individual's current skill level, progress and growth over the past year - Communication Skills. 02/03/2023 Implemented
2380.181(e)(13)(i)Individual #1's assessment did not include the Indvidual's progress over the last 365 calendar days l in the following area: Health.The assessment must include the following information: The individual¿s progress over the last 365 calendar days and current level in the following areas: Health.Staff #1 re-trained the Program Specialist on the regulation that the assessment of Individual #1 and assessments of all individuals attending the Center must include the individuals current level of performance and progress in Health. The Program Specialist revised the assessment form to include the following (located on page 2 of the assessment): Current Level of Progress, Performance and Growth - Summary of individual's current skill level, progress and growth over the past year - Health. 02/03/2023 Implemented
2380.181(e)(13)(iii)Individual #1's assessment did not include the Indvidual's progress over the last 365 calendar days l in the following area: Personal adjustment.The assessment must include the following information: The individual¿s progress over the last 365 calendar days and current level in the following areas: Personal adjustment.Staff #1 re-trained the Program Specialist on the regulation that the assessment of Individual #1 and assessments of all individuals attending the Center must include the individuals current level of performance and progress in Personal Adjustment. The Program Specialist revised the assessment form to include the following (located on page 2 of the assessment): Current Level of Progress, Performance and Growth - Summary of individual's current skill level, progress and growth over the past year - Personal Adjustment. 02/03/2023 Implemented
2380.181(e)(13)(iv)Individual #1's assessment did not include the Indvidual's progress over the last 365 calendar days in the following area: SocializationThe assessment must include the following information: The individual¿s progress over the last 365 calendar days and current level in the following areas: Socialization.Staff #1 re-trained the Program Specialist on the regulation that the assessment of Individual #1 and assessments of all individuals attending the Center must include the individuals current level of performance and progress in Socialization. The Program Specialist revised the assessment form to include the following (located on page 2 of the assessment): Current Level of Progress, Performance and Growth - Summary of individual's current skill level, progress and growth over the past year - Socialization. 02/03/2023 Implemented
2380.181(e)(13)(v)Individual #1's assessment did not include the Indvidual's progress over the last 365 calendar days l in the following area: Recreation.The assessment must include the following information: The individual¿s progress over the last 365 calendar days and current level in the following areas: Recreation.Staff #1 re-trained the Program Specialist on the regulation that the assessment of Individual #1 and assessments of all individuals attending the Center must include the individuals current level of performance and progress in Recreation. The Program Specialist revised the assessment form to include the following (located on page 2 of the assessment): Current Level of Progress, Performance and Growth - Summary of individual's current skill level, progress and growth over the past year - Recreation. 02/03/2023 Implemented
2380.181(e)(13)(vi)Individual #1's assessment did not include the Indvidual's progress over the last 365 calendar days l in the following area: Community Integration.The assessment must include the following information: The individual¿s progress over the last 365 calendar days and current level in the following areas: Community-integration.Staff #1 re-trained the Program Specialist on the regulation that the assessment of Individual #1 and assessments of all individuals attending the Center must include the individuals current level of performance and progress in Community Integration. The Program Specialist revised the assessment form to include the following (located on page 2 of the assessment): Current Level of Progress, Performance and Growth - Summary of individual's current skill level, progress and growth over the past year - Community Integration. 02/03/2023 Implemented
SIN-00197747 Renewal 01/28/2022 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2380.111(c)(5)Individual #1 had a Tuberculin skin testing with negative results on 3/21/19 and then not again until 5/24/21. This exceeds the requirement.The physical examination shall include: Tuberculin skin testing with negative results every 2 years; or, if the tuberculin skin test is positvie, an initial chest X-ray with results noted.Staff #2 will send a reminder document of when the physical and tuberculin test is due with "The Pike County Developmental Center Physical Examination Form" attached. A copy of the reminder will be placed in the individual's file in a locked file drawer. The reminder & physical form will be sent to the individual at least 2 months before the due date to give the individual time to make an appointment for the physical and TB Test. Staff #1 has revised the physical form as of February, 3, 2022 and is no longer using the previous physical form (MA51). The revised form, "The Pike County Developmental Center Physical Examination Form" states the following: Tuberculin Test (TB test must be given every two years with results noted). There is also a section under the TB Test which states the following: Date Given, Date Read, Results: Negative or Positive (if positive describe follow-up action). 02/03/2022 Implemented
2380.111(c)(6)Individual #3's physical exam dated 8/11/21 did not indicate if they were free from communicable diseases or indicate specific precautions that shall be taken if the individual has a serious communicable disease. This section was left blank on the exam form.The physical examination shall include: Specific precautions that shall be taken if the individual has a serious communicable disease as defined in 28 Pa. Code §  27.2 (relating to specific identified reportable diseases, infections and conditions) to the extent that confidentiality laws permit reporting, to prevent the spread of the disease to other individuals.Staff #1 created a new physical form, "The Pike County Developmental Center Physical Examination Form," on February 3, 2022 that will be utilized instead of the previous physical form (MA51). The Pike County Developmental Center Physical Examination Form states the following on the 2nd page: Is the individual free from communicable diseases? Yes or No. If no, include specific precautions that must be taken (to the extent that confidentiality laws apply) to prevent the spread of disease. 02/03/2022 Implemented
2380.111(c)(9)Individual #1's physical exam dated 5/21/21, Individual #2's physical exam dated 2/25/21, and Individual #3's physical exam dated 8/11/21 did not indicate or include their allergies or contraindicated medications.The physical examination shall include: Allergies or contraindicated medication.Staff #1 created a new physical form, "The Pike County Developmental Center Physical Examination Form," to utilize as of February 3, 2022, instead of the previous physical form (MA51). On the new Pike County Developmental Center Physical Examination Form, on page 1, there is a section for Allergies/Sensitivities and Contraindicated Medications. 02/03/2022 Implemented
2380.111(c)(11)Individual #2's physical exam dated 2/25/21 did not include the special instructions for an individual's diet as this section of the form was left blank.The physical examination shall include: Special instructions for an individual's diet.Staff #1 created a new physical form, "The Pike County Developmental Center Physical Examination Form," on February 3, 2022, to be utilized instead of the previous physical form (MA51). The Pike County Developmental Center Physical Examination Form has a section on page 1, Special Instructions for Diet. The Program Specialist was oriented on the new physical form to be utilized and no sections will be left blank. 02/03/2022 Implemented
2380.21(u)Individual #1's date of admission was on 1/12/21 and they were informed of their individual rights on 11/23/21.Individual #3's date of admission was on 8/30/21 and they were informed of their individual rights on 12/1/21. This exceeds the requirement.The facility shall inform and explain individual rights and the process to report a rights violation to the individual, and persons designated by the individual, upon admission to the facility and annually thereafter.Staff #1 will include "The Pike County Developmental Center Individual Rights Policy" with the orientation packet that is given to the individual upon admission, informing and explaining individual rights and the process to report a rights violation to the individual and the persons designated by the individual. The Individual Rights Policy will also be given to each individual annually. The individual and the persons designated by the individual will sign the 2nd page of the policy that they have received the policy, informed of their rights and understand the process of reporting a rights violation. The signed document will be placed in the individual's file upon admission and annually thereafter. 01/31/2022 Implemented
2380.39(c)(1)Staff #1, Staff #2, Staff #3, and Staff #4 did not receive annual training on the application of person-centered practices, community integration, individual choice and supporting individuals to develop and maintain relationships.The annual training hours specified in subsections (a) and (b) must encompass the following areas: The application of person-centered practices, community integration, individual choice and supporting individuals to develop and maintain relationships.Staff #1, Staff #2, Staff #3 and Staff #4 will complete annual training on the following: application of person-centered practices, community integration, individual choice and supporting individuals to develop and maintain relationships by completing the annual training on the topics above on-line on the odp website by February 28, 2022. Staff #1 will keep a record of all trainings and place certificates in The Pike County Developmental Center Training Book for all staff, as well as document the topic of training, date of training and hours of training. 02/28/2022 Implemented
2380.39(c)(5)Staff #1, Staff #2, Staff #3, and Staff #4 did not receive annual training on the safe and appropriate use of behavior supports.The annual training hours specified in subsections (a) and (b) must encompass the following areas: The safe and appropriate use of behavior supports if the person works directly with an individual.Staff #1, Staff #2, Staff #3 and Staff #4 will complete the annual training on the safe and appropriate use of behavior supports by February 28, 2022. The training will be completed by all staff on-line on the ODP website. Once completed, Staff #1 will document the training in "The Pike County Developmental Center Training Book." The topic of the training, date of the training, hours of the training and certificates received will be placed in the training book. 02/28/2022 Implemented
2380.39(c)(6)Staff #3 and Staff #4 did not receive annual training on Implementation of the individual plan.The annual training hours specified in subsections (a) and (b) must encompass the following areas: Implementation of the individual plan if the person works directly with an individual.Staff #3 and Staff #4 will complete the annual training on Implementation of the individual plan by March 18, 2022. Staff #3 and Staff #4 will sign a signature page after reading each individual's plan. The Implementation of the individual plan training will be completed on-line on the ODP website. Staff #1 will record Staff #3 and Staff #4's training in "The Pike County Developmental Center's Training Book." The topic of the training, date of the training, hours of the training and supporting documentation will be placed in the training book after completion. 03/18/2022 Implemented
SIN-00162321 Renewal 09/03/2019 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2380.111(c)(7)Health maintenance needs & the need for bloodwork were not on the physical exam for Individual #1 dated 2/1/2019 and Individual #2 dated 3/26/2019.The physical examination shall include: An assessment of the individual's health maintenance needs, medication regimen and the need for blood work at recommended intervals.The Executive Director will re-type The Pike County Developmental Center's Client Physical Forms today, September 23, 2019, to add the following information to the physical forms: an assessment of the individual's health maintenance needs, medication regimen and the need for blood work at recommended intervals. Client 1 and Client 2 physical forms will be sent home by the Assistant Director with the added information (the corrected version of the physical form) so the missing information will be filled out. On September 23, 2019, and moving forward, all client physical forms will have the added necessary information. All PCDC Staff will be aware of the additional changes in the client physical forms by the Executive Director showing all staff the added information on the physical forms. The original physical form template will be discarded. 09/23/2019 Implemented
SIN-00138772 Renewal 09/05/2018 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2380.53(b)Dish soap was found stored not in its original, labeled container on the counter near the sink in the kitchen area.Poisonous materials shall be stored in their original, labeled containers.The Pike County Developmental Center will not purchase and utilize dish soap that is poisonous and will keep all dish soap purchased in their original, labeled containers on the counter near the sink in the kitchen area. All Pike County Developmental Center Staff will make sure non-poisonous dish soap is purchased and kept in original, labeled containers on a consistent basis, daily. The Executive Director spoke to the Program Specialist and Program Aide about the violation and trained all staff on poisonous vs. non-poisonous dish soap and to keep all dish soaps in their original, labeled containers, at all times. 09/05/2018 Implemented
2380.113(a)Staff #1's current physical examination occurred on 8/19/18, and the previous physical examination was on 6/22/16.A staff person who comes into direct contact with the individuals or who prepares or serves food, for more than 5 days in a 6-month period, including temporary, substitute and volunteer staff persons, shall have a physical examination within 12 months prior to employment and every 2 years thereafter.All staff people who come into direct contact with individuals at The Pike County Developmental Center or who prepare or serve food, for more than 5 days in a 6-month period, including temporary, substitute and volunteer staff people will have a current physical examination within a 2 year period. The Executive Director will follow the "Employee Physical Policy" which states that "All employees must complete a physical every two years from the previous physical's completion date." The Executive Director referred to the "Employee Physical Policy" for training purposes of this violation. 09/05/2018 Implemented
2380.113(c)(2)Staff #1's current Tuberculin skin testing occurred on 8/19/18, and the Tuberculin skin testing was on 6/22/16.The physical examination shall include: Tuberculin skin testing with negative results every 2 years; or, if the tuberculin skin test is positive, an initial chest X-ray with results noted. Tuberculin skin testing may be completed and certified in writing by a registered nurse or a licensed practical nurse instead of a licensed physician, certified nurse practitioner or certified physician's assistant.All employees of The Pike County Developmental Center will have completed physical examinations to include: Tuberculin skin testing with negative results every 2 years; or, if the tuberculin skin test is positive, an initial chest X-ray with results noted. The Executive Director will remind all employees when their tuberculin skin testing is due, every 2 years, and give all employees physical examination forms which includes the tuberculin skin testing section to be completed and certified in writing by a registered nurse, a licensed practical nurse, a licensed physician, certified nurse practitioner or certified physician's assistant. The Executive Director reviewed the "Employee Physical Policy" for re-training of the tuberculin skin test requirements. 09/05/2018 Implemented
2380.181(a)Individual #2's current annual assessment was completed on 2/13/18, and the previous assessment was dated 1/05/17.Each individual shall have an initial assessment within 1 year prior to or 60 calendar days after admission to the facility and an updated assessment annually thereafter.Each individual's updated annual assessments will be completed annually; initial assessments within 1 year prior to or 60 calendar days after admission to The Pike County Developmental Center. The Program Specialist will complete all individual assessments within 1 year prior to or 60 calendar days after admission to The Pike County Developmental Center and update assessments annually thereafter; utilizing Assessment forms. The Executive Director spoke to the Program Specialist and trained the Programs Specialist on what is expected of assessments with due dates and she is aware of the violation. 09/05/2018 Implemented
2380.181(e)(13)(i)The current annual assessments for Individuals #1 and #2 did not include progress over the last 365 calendar days in the following area: health.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Health.All annual assessments will include progress over the last 365 calendar days and the current level in the area of "health." The Program Specialist will complete the area of "health" on the annual assessments annually reporting on progress over the last 365 calendar days and current level of individuals in the area of "health," utilizing the assessment forms. The Executive Director showed the Program Specialist the violation and trained the Program Specialist on reporting in the area of "health." 09/05/2018 Implemented
2380.181(e)(13)(ii)The current annual assessments for Individuals #1 and #2 did not include progress over the last 365 calendar days in the following area: motor and communication skills.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas:  Motor and communication skills.The Program Specialist has added the "Motor and Communication Skills" section on the annual assessment and the Program Specialist will complete all individuals' annual assessments to include progress over the last 365 calendar days in the area of "Motor and Communication Skill" utilizing the Assessment forms. The Executive Director showed the Program Specialist the violation and trained the Program Specialist on reporting requirements on the annual assessments in the area of "Motor and Communication Skills." 09/05/2018 Implemented
2380.181(e)(13)(iii)The current annual assessments for Individuals #1 and #2 did not include progress over the last 365 calendar days in the following area: personal adjustment.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Personal adjustment.All individuals' annual assessments will include progress over the last 365 calendar days and current level in the area of "personal adjustment." The Program Specialist will complete all assessments annually; reporting on the progress over the last 365 calendar days and current level in the area of "personal adjustment;" utilizing the assessment forms. The Executive Director showed the Program Specialist the violation and trained the Program Specialist on the requirements related to the "Personal Adjustment" area on the assessment. 09/05/2018 Implemented
2380.181(e)(13)(iv)The current annual assessments for Individuals #1 and #2 did not include progress over the last 365 calendar days in the following area: socialization.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Socialization.All individuals' annual assessments will include progress over the last 365 days and current level in the area of "socialization." The Program Specialist will include progress over the last 365 days and current levels of all individuals, annually, in the area of "socialization" utilizing the assessment forms. The Executive Director showed the Program Specialist the violation and trained the Program Specialist on requirements related to completing the "socialization" section of the assessments. 09/05/2018 Implemented
2380.181(e)(13)(v)The current annual assessments for Individuals #1 and #2 did not include progress over the last 365 calendar days in the following area: recreation.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: Recreation.All individuals' annual assessments will include progress over the last 365 calendar days and current level in the area of "recreation." The Program Specialist will complete progress over the last 365 days and current level in the area of "recreation" for all individuals, annually, utilizing the assessment forms. The Executive Director showed the Program Specialist the violation and trained the Program Specialist on individuals' assessments in the area of "recreation." 09/05/2018 Implemented
2380.181(e)(13)(vi)The current annual assessments for Individuals #1 and #2 did not include progress over the last 365 calendar days in the following area: community integration.The assessment must include the following information: The individual's progress over the last 365 calendar days and current level in the following areas: community integration.All individuals' annual assessments will include progress over the last 365 calendar days and current level in the area of "community integration. The Program Specialist will complete all individuals' assessments to include progress over the last 365 calendar days and current levels, annually, utilizing the assessment forms. The Executive Director showed the Program Specialist the violation and trained the Program Specialist on reporting requirements in regards to the area of "community integration." 09/05/2018 Implemented
SIN-00122621 Renewal 10/31/2017 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2380.111(c)(8)The section regarding physical limitations was not found on any of the three Individuals' physical forms.The physical examination shall include: Physical limitations of the individual.A physical limitations section has been added to The Pike County Developmental Center physical form. ((The required information is being requested from each individuals' physician - CH 12/7/17)) 11/01/2017 Implemented
2380.111(c)(10)The section regarding info pertinent to diagnosis in case of emergency was not on any of the physicals of the three individuals reviewed.The physical examination shall include: Medical information pertinent to diagnosis and treatment in case of an emergency.A medical information pertinent to diagnosis and treatment in case of an emergency section has been added to The Pike County Developmental Center physical form. ((The required information is being requested from each individuals' physician - CH 12/7/17)) 11/01/2017 Implemented
2380.173(1)(v)Individual #2's photo was dated 07-18-2006 and was clearly outdated.Each individual's record must include the following information: Personal information including: A current, dated photograph.Individual #2's photo has been updated to include a current, dated photograph. All individuals' photos will be updated annually and sooner, if changes occur, as needed. 11/01/2017 Implemented
2380.181(f)There was no documentation in any of the three files reviewed that the assessments were sent out to the SC and team members at least thirty days prior to the ISP meeting.The program specialist shall provide the assessment to the SC or plan lead, as applicable, and plan team members at least 30 calendar days prior to an ISP meeting for the development, annual update and revision of the ISP under § §  2380.182, 2390.152, 6400.182 and 6500.152 (relating to development, annual update and revision of the ISP).The Program Specialist will put documentation (a fax cover letter or signed form if handed out) in each individuals' files that the assessment was given to the SC and plan team members at least 30 calendar days prior to an ISP meeting for the development, annual update and revision of the ISP under 2380.182, 2390.152, 6400.182 and 6500.152 (relating to development, annual update and revision of the ISP). 11/01/2017 Implemented
SIN-00100254 Renewal 12/01/2016 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2380.173(1)(ii)Identifying marks are not listed in the records for Individual #1, Individual #2, and Individual #4.Each individual's record must include the following information: Personal information including: The race, height, weight, color of hair, color of eyes and identifying marks.The Emergency Medical Information Form has been revised by Liz Torkildsen, PCDC Executive Director, as of 1/10/17, to include "Identifying Marks (ie: tattoos/scars)". A cover letter with the new Emergency Medical Information Form has been sent home to each individual attending the Center; to fill out and return to the Center for their individual files. 01/10/2017 Implemented
2380.173(1)(iii)Language or means of communication spoken or understood by the individual isn't listed in Individual #4's record. Each individual¿s record must include the following information: Personal information including: The language or means of communication spoken or understood by the individual and the primary language used in the individual¿s natural home, if other than English.The Emergency Medical Information Form has been revised by Liz Torkildsen, PCDC Executive Director, as of 1/10/17, to include the following: "Language_________". It is located next to the original "Means of Communication" section. A cover letter and the revised Emergency Medical Information Form have been sent home to individuals attending the Center to fill out and return to the Center for their individual files. 01/10/2017 Implemented
2380.186(c)(2)Reviews of ISP areas such as health and safety are not being completed in the ISP Reviews for Individual #1, Individual #2, Individual #3, and Individual #4.The ISP review must include the following: A review of each section of the ISP specific to the facility licensed under this chapter.The ISP Review sheet has been revised by Laura Godfrey, PCDC Assistant Director, as of 1/17/17. As of 1/17/17, the revised ISP Review sheet will be utilized to avoid further violation with this issue. Things added are as follows: "Health/Safety - Are there any changes in needs from Assessment? No Yes_______", "Community Life Activities", "Employment/Volunteer" and "*All areas of ISP have been reviewed for accuracy. Yes No ***Changes in ISP No Yes___________" 01/17/2017 Implemented
SIN-00082691 Renewal 10/28/2015 Compliant - Finalized
RegulationLIS Non-Compliance AreaCorrection RequiredPlans of CorrectionCorrection DatePOC Status
2380.91(a)Individual #1 has a date of admission of 4/29/2015. Individual #1 received fire safety training on 5/1/2015. Individual #2 has a date of admission of 4/29/2015. Individual #2 received fire safety training on 5/6/2015.An individual shall be instructed in the individual's primary language or mode of communication, upon initial admission and reinstructed annually in general firesafety, evacuation procedures, responsibilities during fire drills, the designated meeting place outside the building or within the fire safe area in the event of an actual fire, and smoking safety procedures if individuals smoke at the facility.The Executive Director has created a "Fire Safety Training Policy" which is included in The Pike County Developmental Center's Policy and Procedure Manual. All staff have been given a copy of the policy and trained on the information within the policy. The policy states the following: all employees and PCDC Participants must complete fire safety training on their first day of attendance/enrollment at The Pike County Developmental Center. Fire safety training is completed annually thereafter. 10/29/2015 Implemented
2380.111(c)(6)Individual #1's physical dated 4/17/15 does not address if he is free from communicable diseases. Individual #3's physicals dated 5/14/14 and 11/24/14 do not address if he is free from communicable diseases. Individual #4's physical dated 4/6/2015 does not address if she is free from communicable diseases. The physical examination shall include: Specific precautions that shall be taken if the individual has a serious communicable disease as defined in 28 Pa. Code §  27.2 (relating to specific identified reportable diseases, infections and conditions) to the extent that confidentiality laws permit reporting, to prevent the spread of the disease to other individuals.The Executive Director has revised The Pike County Developmental Center's Medical Evaluation Form (pg. 2) which states the following: Free from Communicable Diseases (if no, list specific precautions necessary to prevent the spread of diseases to others) Yes______ No______. Every year this form will be given to individuals for their annual physicals. 10/29/2015 Implemented
2380.113(a)Staff #1 had a physical exam on 6/7/13 and again on 7/7/15. Staff #2 had a physical on 7/16/13 and again on 8/3/15. A staff person who comes into direct contact with the individuals or who prepares or serves food, for more than 5 days in a 6-month period, including temporary, substitute and volunteer staff persons, shall have a physical examination within 12 months prior to employment and every 2 years thereafter.The Executive Director has created an "Employee Physical Policy" which is now included in The Pike County Developmental Center's Policy and Procedure Manual. All Staff have been given a copy of the "Employee Physical Policy" and trained on the information within the policy. The Executive Director will give written notification, as well as verbal reminders to all staff as to when their physical exams are due. 10/29/2015 Implemented
2380.113(c)(2)Staff #1 had a negative TB skin test on 6/7/13 and again on 7/9/15. Staff #2 had a negative TB skin test on 7/14/13 and again on 8/5/15. The physical examination shall include: Tuberculin skin testing with negative results every 2 years; or, if the tuberculin skin test is positive, an initial chest X-ray with results noted. Tuberculin skin testing may be completed and certified in writing by a registered nurse or a licensed practical nurse instead of a licensed physician, certified nurse practitioner or certified physician's assistant.The Executive Director has created an "Employee Physical Policy" which is included in The Pike County Developmental Center's Policy and Procedure Manual. The policy includes requirements for staff to have a tuberculin skin testing completed every two years. All staff have been given a copy of the "Employee Physical Policy" and trained on the information within the policy. The Executive Director will provide written notification, as well as verbal notification to all staff as to when tuberculin skin testings are due. 10/29/2015 Implemented
SIN-00066954 Renewal 09/15/2014 Compliant - Finalized
SIN-00037660 Renewal 08/01/2012 Compliant - Finalized