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Based on record reviews and interviews, the facility failed to develop Master Treatment Plans (MTP) for 8 of 8 sample patients (C1, C4, C6, C7, F2, F3, F8 and F10) that clearly delineated physician interventions to address specific psychiatric problems. Instead, the physician interventions on the plans were general assessment and monitoring functions, as well as routine milieu and discipline-related practices. This deficiency results in failure to provide specific guidance for staff to provide care for patients based on individual psychiatric needs.

Findings include:

A. Record Review

1. Patient C1 (MTP review 8/23/12). For the identified problem of "Aggression," the only psychiatrist intervention was "Evaluate behavioral response to medication and review for side effects."

2. Patient C4 (MTP review 8/23/12). For the identified problem of "Aggression," the only psychiatrist intervention was "Provide safe structured supportive environment, collaborative problem solving cooping [sic] skills, evaluate for possible psychopharmacological interventions."

3. Patient C6 (MTP review 8/22/12). For the identified problem of "Aggression," the only psychiatrist intervention was "Provide education about medication regarding purpose and side effects."

4. Patient C7 (MTP review 8/23/12). For the identified problem of "Aggression," the only psychiatrist intervention was "Provide education about medication regarding purpose and side effects."

5. Patient F2 (MTP review 8/24/12). For the identified problem of "Aggressive toward others," the only psychiatrist intervention was, "Help pt. to understand connection between underlying emotion and acting out."

6. Patient F3 (MTP review 8/23/12). For the identified problem of "Aggression," the only psychiatrist intervention was, "Assess pt. for need/use of medication to target aggression."

7. Patient F8 (MTP review 8/24/12). For the identified problem of "Life Skills," no intervention by the psychiatrist was identified. For the identified problem of "Psychosis," the only psychiatrist intervention was, "Educate pt. on the benefits of medication and side effects."

8. Patient F10 (MTP review 8/22/12). For the identified problem of "Aggression," the only psychiatrist intervention was, "Help pt. to understand connection between underlying emotion and acting out."

B. Staff Interview

During an interview on 8/28/12 at 1 p.m., the Medical Director acknowledged the lack of specific psychiatrist interventions to address the identified problems on the MTP's of the sample patients.

Based on record reviews and interviews, it was determined that the Medical Director failed to ensure that the Master Treatment Plans for 8 of 8 sample patients (C1, C4, C6, C7, F2 F3, F8 and F10) clearly delineated physician interventions to address specific psychiatric problems. The physician interventions on the plans were general assessment and monitoring functions, as well as routine milieu and discipline-related practices. This deficiency results in failure to provide specific guidance for staff to provide care for patients based on individual psychiatric needs.

Findings include:

A. Record Review

1. Patient C1 (MTP review 8/23/12). For the identified problem of "Aggression," the only psychiatrist intervention was "Evaluate behavioral response to medication and review for side effects."

2. Patient C4 (MTP review 8/23/12). For the identified problem of "Aggression," the only psychiatrist intervention was "Provide safe structured supportive environment, collaborative problem solving cooping [sic] skills, evaluate for possible psychopharmacological interventions."

3. Patient C6 (MTP review 8/22/12). For the identified problem of "Aggression," the only psychiatrist intervention was "Provide education about medication regarding purpose and side effects."

4. Patient C7 (MTP review 8/23/12). For the identified problem of "Aggression," the only psychiatrist intervention was "Provide education about medication regarding purpose and side effects."

5. Patient F2 (MTP review 8/24/12). For the identified problem of "Aggressive toward others," the only psychiatrist intervention was, "Help pt. to understand connection between underlying emotion and acting out."

6. Patient F3 (MTP review 8/23/12). For the identified problem of "Aggression," the only psychiatrist intervention was, "Assess pt. for need/use of medication to target aggression."

7. Patient F8 (MTP review 8/24/12). For the identified problem of "Life Skills," no intervention by the psychiatrist was identified. For the identified problem of "Psychosis," the only psychiatrist intervention was, "Educate pt. on the benefits of medication and side effects."

8. Patient F10 (MTP review 8/22/12). For the identified problem of "Aggression," the only psychiatrist intervention was, "Help pt. to understand connection between underlying emotion and acting out."

B. Staff Interview

During an interview on 8/28/12 at 1 p.m., the Medical Director acknowledged the lack of specific psychiatrist interventions to address the identified problems on the MTP's of the sample patients.