Facility Evaluation Report

Licensing Program Analyst Jill Nakagawa arrived unannounced on 03/11/22 and met with La Shell Mitchell, Program Manager and Katrina Brass, QIC, to discuss the operational plan for the admission of clients who will be receiving methadone treatments on a daily basis.

LPA Nakagawa went over the daily operational plan, including transportation to and from the clinic for treatment, supports from the on-site clinician, pharmacy back-ups, transportation back-ups, staffing concerns and training, the support plan and the agreement with the client. There will be close communication with the Case Manager as well as the three Psych. physicians. There is also an On-Call in place. Transportation has been secured for 6 days a week. The clinic is not open on Sundays so the client will bring a lock-box with them to the Saturday appointment and the clinician will lock the Sunday dosage in the lock-box where it will be returned for the Medication Technician to administer on Sunday morning. There is a separate MAR specifically for the Methadone administration. Client will be aware of the protocols and will sign Client Agreement. Also, ideally, client will be receiving treatment from the same clinic they have already been going to before.

LPA requested a copy of the MAR, Client Agreement, Operational Plan and Client's Medical Clearance Form and Medical Background/Intake Information; and copy of proof of staff training.

No deficiencies were found during today's inspection.