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Based on record review, observation and interview the facility failed to provide a safe environment as evidenced by 2 patients of 23 being physically assaulted and having to be seen by Emergency Medical Technicians.

1. Observations on 12/22/2018 of 3 of the four video feeds from the incident on boy's unit on December 15, 2018 at 20:00 revealed that three male adolescent patients (4,5,6) were acting out by turning over tables, chairs, and desks in the day room, throwing phones on the floor in the nursing station, and knocking over a computer monitor. (**A Code Green is coded message announced over a public address system of a hospital to alert staff of on-site emergencies so that additional staff can assist). A code Green was called within 3-4 minutes' people from other units arrived to assist with quieting the unit and making it safe. The charge nurse on the boy's unit was noted to be sitting in the nursing station going over charts while books were being thrown up in air and appeared to be going over his head. At approximately 20:07 the intake nurse arrived on the scene and called 911 due to the fact that no one was intervening.

2. Observations on 12/22/2018 of the video feed from the incident on girl's unit on December 15, 2018 at 20:15 revealed that three female adolescent patients (1,2,3) were acting out by throwing wet paper towels, ripping up papers, throwing phones on the floor, and knocking over a computer monitor. During this time the nursing supervisor was observed standing at the nursing station focusing on the nurses in the nursing station. The charge nurse on the boy's unit was noted to be sitting in the nursing station going over charts while books were being thrown up in air. The girls took off their shirts and were just in their bras and stood on the nursing station while nursing staff stood or sat at the nursing station. A Mental Health Tech. Was noted to be sitting on desk in the nursing station and speaking on her personal cell phone while the three female patients were throwing water or standing on the desk.

3. Interview with Quality Assurance Manager on 12/22/2018 at 12:00 revealed that the nursing Supervisor should have been providing direction when he/she enters a code situation.
4. Record review of the Root Cause Analysis written on 12-17-2018 There were no injuries noted except for two children patient (# 6 & 7) who alleged they were hit by other patients while in their rooms. They were seen by the EMTs and returned to their units with no major injury noted just a couple of scratches on their arms.

Based on record review, observations and interviews the facility supervisor (in the role as an acting director) failed to direct nursing care that was being furnished in an appropriate safe manner as evidenced by 23 OF 23 patients in an unsafe situation.

Observations on 12/22/2018 of the video feed from the incident on boy's unit and girl's unit on December 15, 2018 at 20:00 revealed that three female adolescent patients (1,2,3) and three male adolescent patients (4,5,6) were seen throwing water, books, and turning over a table. Nursing staff was observed in nursing station observing patients acting out with no intervention noted. The nursing supervisor was observed leaning on nursing desk speaking with staff while patients were in the day room throwing and ripping up patient rounding sheets.

Interview with Quality Assurance Manager on 12/22/2018 at 1200 revealed that the nursing Supervisor should have been providing direction when he/she enters a code situation

Interview with (Staff letter H) Mental Health Technician on 12/22/2018 at 14:45 hours revealed, that when asked if could explain what happened that night, he said, there was no direction, no one was making or giving direction which led to an increase in those patients acting out (turning over furniture, knocking phones off desk).

Record Review of the Root Cause Analysis dated 12/17/2018 revealed that; listed under the causes for the incident was a lack of direction and oversight was sighted as a reason for the cause of incident on 12/15/2018.