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Based on medical record review, facility policy review, and interview, the facility failed to ensure a greivance was addressed in a timely manner for one patient (#15) of fifteen patients reviewed.

The findings included:

Medical record review revealed patient #15 was admitted to the facility on February 16, 2012, with diagnoses to include Psychotic Disorder Not Otherwise Specified and Depressive Disorder Not Otherwise Specified.

Medical record review of the Admit Physician Medication Reconciliation Order (home medications on admit), dated February 16, 2012, at 12:53 a.m., revealed the patient was admitted to the facility on the following medications: Prozac (used to treat depression) 20 milligrams at bedtime and Naltrexone (used to treat alcohol abuse) 25 milligrams at bedtime, and these medications were continued by the admitting physician. Continued review of the patient's Physician's Order, dated February 17, 2012, at 9:18 a.m., revealed Lithium 300 milligrams twice daily was added for mood disorder and the Naltrexone was increased to 50 milligrams at bedtime.

Medical record review of the Social Services Contact Note, dated February 18, 2012, at 9:00 a.m., revealed the social worker (named) met individually with the patient to discuss treatment goals and plans to deal with anger. No other notation by the social worker.

Medical record review of the Physician's Progress Note, dated, February 21, 2012, at 9:45 a.m., revealed the patient was very irritable, more easily angered than upon admission, tearful, more agitated, and experiencing anxiety. Continued review revealed the patient "...is responding opposite to all meds..."

Medical record review of the Physician's Order, dated February 21, 2012, at 10:45 a.m., revealed the Lithium, Prozac, and Naltrexone were discontinued.

Medical record review of the Physician's Progress Note, dated February 22, 2012, at 10:50 a.m., revealed "...had a family session yesterday which had to be ended early because (patient) made threats to the social worker...angry and disrespectful to mother...family session had to be stopped for safety concerns...talked to reviewer (insurance) who didn't feel (patient) needed inpatient ...it was explained that with medications she is like a ticking time bomb with no warning of emotional stability. Discussed stopping medications with her recent behavior...after all meds stopped (patient) reports less intense today...more somber...discussed not starting meds and trial of partial hospital program (day treatment) without meds...more of a home environment..."

Medical record review revealed patient was discharged on no medications on February 22, 2012. Continued review revealed the patient was admitted to the partial hospital program on February 23, 2012.

Interview in the conference room with the Utilization Review (UR) Manager on October 10, 2012, at 10:35 a.m., revealed the UR Manager had contacted the patient's insurance company on February 16, 2012, for pre-certification for inpatient hospitalization and was approved for one day. Continued interview revealed the continued stay review was conducted on February 17, 2012, and further inpatient stay was denied. Continued interview revealed there was no documentation of the review of February 17, 2012. Continued interview revealed the case was sent for a doctor (facility) to doctor (insurance) review. Continued interview revealed the closed chart had been sent to the insurance company after the insurance company denied payment for continued stay through February 22, 2012. Continued interview revealed the insurance company had not yet responded. Continued interview revealed the UR manager would have notified the patient's social worker the patient had not been approved for further days.

Interview in the conference room with the Director of Social Services on October 10, 2012, at 10:40 a.m., confirmed the social worker was to notify the patient (or family of a minor child) the insurance company had denied further inpatient coverage; the case was sent for physician to physician review; the patient would be responsible for the hospital bill if the insurance company did not cover the stay; and the physician recommended further treatment. Continued interview confirmed there was no documentation the social worker had informed the patient (or family of a minor child) of the denial of insurance benefits for the inpatient stay beyond February 17, 2012.

Interview in the conference room with the Director of Social Services on October 10, 2012, at 10:40 a.m., confirmed the facility was notified in writing on April 9, 2012 the family had complained to the insurance company regarding being very upset by the treatment the patient received. The mother complained not seeing the social worker for five days, the patient being dirty, and being billed for the deductable for the entire stay. The mother reported being told by a social worker the facility had not filled out paperwork for authorization and the social worker lied and said the authorization had been gotten when insurance said it had not. Mother said the state had been notified and mother felt the patient's rights had been violated. Continued interview revealed the facility investigated the complaint and the patient was only charged for one day and any days not covered were not billed. Continued interview revealed the patient bill was adjusted after it became apparent the denial was not proceeding and only the deductable for the one day was charged. Continued interview confirmed the facility responded in writing to the patient's mother's complaint on May 7, 2012, (29 days after receipt of the complaint).

Review of the facility's document Patient Rights and Responsibility, revealed "...13. The patient has the right to be informed of the cost of his/her care including an itemized accounting of the bill, if requested, and to appeal any funding decisions regarding treatment, care, or services...14. The patient has the right to initiate the hospital's mechanism for the review and resolution of patient complaint/grievance, conflicts, and ethical issues..."

Interview in the conference room on October 10, 2012, at 12:10 p.m., with the Director of Clinical Services and the Director of Regulatory Compliance confirmed the patient's right had been violated related to notification of denial of payment by the insurance company.

C/O #29875

Based on medical record review, facility policy review, and interview, the facility failed to ensure a greivance was addressed in a timely manner for one patient (#15) of fifteen patients reviewed.

The findings included:

Medical record review revealed patient #15 was admitted to the facility on February 16, 2012, with diagnoses to include Psychotic Disorder Not Otherwise Specified and Depressive Disorder Not Otherwise Specified.

Medical record review of the Admit Physician Medication Reconciliation Order (home medications on admit), dated February 16, 2012, at 12:53 a.m., revealed the patient was admitted to the facility on the following medications: Prozac (used to treat depression) 20 milligrams at bedtime and Naltrexone (used to treat alcohol abuse) 25 milligrams at bedtime, and these medications were continued by the admitting physician. Continued review of the patient a Physician's Order, dated February 17, 2012, at 9:18 a.m., revealed Lithium 300 milligrams twice daily was added for mood disorder and the Naltrexone was increased to 50 milligrams at bedtime.

Medical record review of the Social Services Contact Note, dated February 18, 2012, at 9:00 a.m., revealed the social worker (named) met individually with the patient to discuss treatment goals and plans to deal with anger. No other notation by the social worker.

Medical record review of the Physician's Progress Note, dated, February 21, 2012, at 9:45 a.m., revealed the patient was very irritable, more easily angered than upon admission, tearful, more agitated, and experiencing anxiety. Continued review revealed the patient "...is responding opposite to all meds..."

Medical record review of the Physician's Order, dated February 21, 2012, at 10:45 a.m., revealed the Lithium, Prozac, and Naltrexone were discontinued.

Medical record review of the Physician's Progress Note, dated February 22, 2012, at 10:50 a.m., revealed "...had a family session yesterday which had to be ended early because (patient) made threats to the social worker...angry and disrespectful to mother...family session had to be stopped for safety concerns...talked to reviewer (insurance) who didn't feel (patient) needed inpatient ...it was explained that with medications she is like a ticking time bomb with no warning of emotional stability. Discussed stopping medications with her recent behavior...after all meds stopped (patient) reports less intense today...more somber...discussed not starting meds and trial of partial hospital program (day treatment) without meds...more of a home environment..."

Medical record review revealed patient was discharged on no medications on February 22, 2012. Continued review revealed the patient was admitted to the partial hospital program on February 23, 2012.

Interview in the conference room with the Utilization Review (UR) Manager on October 10, 2012, at 10:35 a.m., revealed the UR Manager had contacted the patient's insurance company on February 16, 2012, for pre-certification for inpatient hospitalization and was approved for one day. Continued interview revealed the continued stay review was conducted on February 17, 2012, and further inpatient stay was denied. Continued interview revealed there was no documentation of the review of February 17, 2012. Continued interview revealed the case was sent for a doctor (facility) to doctor (insurance) review. Continued interview revealed the closed chart had been sent to the insurance company after the insurance company denied payment for continued stay through February 22, 2012. Continued interview revealed the insurance company had not yet responded. Continued interview revealed the UR manager would have notified the patient's social worker the patient had not been approved for further days.

Interview in the conference room with the Director of Social Services on October 10, 2012, at 10:40 a.m., confirmed the social worker was to notify the patient (or family of a minor child) the insurance company had denied further inpatient coverage; the case was sent for physician to physician review; the patient would be responsible for the hospital bill if the insurance company did not cover the stay; and the physician recommended further treatment. Continued interview confirmed there was no documentation the social worker had informed the patient (or family of a minor child) of the denial of insurance benefits for the inpatient stay beyond February 17, 2012.

Interview in the conference room with the Director of Social Services on October 10, 2012, at 10:40 a.m., confirmed the facility was notified in writing on April 9, 2012 the family had complained to the insurance company regarding being very upset by the treatment the patient received. The mother complained not seeing the social worker for five days, the patient being dirty, and being billed for the deductable for the entire stay. The mother reported being told by a social worker the facility had not filled out paperwork for authorization and the social worker lied and said the authorization had been gotten when insurance said it had not. Mother said the state had been notified and mother felt the patient's rights had been violated. Continued interview revealed the facility investigated the complaint and the patient was only charged for one day and any days not covered were not billed. Continued interview revealed the patient bill was adjusted after it became apparent the denial was not proceeding and only the deductable for the one day was charged. Continued interview confirmed the facility responded in writing to the patient's mother's complaint on May 7, 2012, (29 days after receipt of the complaint).

Review of the facility policy Patient Grievance and Customer Complaint Management, policy: RI-POL/PRO-2.016.002, dated as revised May 2010, revealed "...to establish a process for timely referral, prompt review, investigation and resolution of patient grievances or complaints...upon receipt of a grievance, the Risk Manager with the assistance from the department manager should review, investigate and resolve with the patient and/or representative within seven days...if the grievance is not resolved or if the investigation is not or will not be completed within seven days, the complainant should be informed the facility is working to resolve the grievance and that the facility will follow-up with a written response within 30 days..."

Interview in the conference room on October 10, 2012, at 12:10 p.m., with the Director of Clinical Services and the Director of Regulatory Compliance confirmed the patient's right had been violated related to the facility policy to respond to a grievance and the facility policy had not been followed.

C/O #29875

Based on observation and interview, the facility failed to ensure the contract services staff for disposal of hazardous waste utilized proper hand hygiene in one (Intensive Care Unit) of two patient care areas observed.

The findings included:

Observation with the Clinical Manager and Chief Nursing Officer in the Intensive Care Unit on October 8, 2012, at 12:10 p.m., revealed an employee of the contract service for disposal of hazardous waste in the Intensive Care Unit walking about with a full sharps container (device for disposal of used syringes); entered room #9, occupied by a patient, with gloved hands and the full sharps container; removed the sharps container in the room; replaced a new sharps container in the bracket; without removing the gloves and washing the hands, exited the room; entered room #8, occupied by a patient, without removing the gloves or washing the hands and carrying two full sharps containers; removed the sharps container in the room; replaced a new sharps container in the bracket; without removing the gloves and washing the hands, exited the room carrying three full sharps containers.

Interview with the employee of the contract service for disposal of hazardous waste in the Intensive Care Unit on October 8, 2012, at 12:10 p.m., confirmed the hands were never washed or sanitized and the gloves were never removed between entering the different rooms.

Interview with the Clinical Manager and Chief Nursing Officer in the Intensive Care Unit on October 8, 2012, at 12:10 p.m., confirmed the full sharps containers were soiled; the soiled sharps containers were not to go from room to room; the hands were to washed or sanitized before entering a patient room; gloves are only to be utilized in the patient room then discarded in the patient room; and the hands were to be washed or sanitized prior to exiting the room.

C/O #29333