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Based on observation, interview, and record review, the hospital failed to provide a safe setting for one of ten patients (Patient #9) on the hospital's geriatric unit in that two long cords connecting patients' CPAP (continuous positive airway pressure) machines to their power outlet were observed accessible for patients on two consecutive survey dates.

Findings Included:

1) Observations on the hospital's geriatric unit on 08/13/14 at 12:56 reflected Patient #9 wandered the hallway and entered another patient's room through an open door which exposed her to potential injury.

Observations on 08/13/14 reflected the door to Room 61 was left open between 12:05 and 12:45. The CPAP machine in Room 61 was connected by an approximately 3 feet long cord to the power outlet.

Hospital Personnel #2 stated on 08/13/14 at 12:05 that she had not seen that cord before.

Hospital Personnel #14 stated on 08/13/14 at 12:45 that the door should have been closed.

Observations on the hospital's geriatric unit on 08/14/14 at approximately 16:00 reflected the door to Room 56 was left open. A CPAP machine was cased in a small, polyurethane type cabinet on the floor between Bed A and Bed B. The door to the cabinet was left open, and the power cord was partially on the floor, making it accessible to patients wandering into the room.

Record review of of Patient # 9's History and Physical document noted a patient admission date of 08/13/14. The patient had dementia.

Review of Hospital Patients' Rights Policy # 1200.412 revised 07/2012 noted patients had the right to an environment where they were "...protected from harm..."

Based on interview and record review, the hospital failed to ensure the rights of four of six patients (Patient #1, #17, #21, and #28) who were restrained on the hospital adolescent units in that

1) Patient # 1 was restrained four times during her inpatient hospitalization without a signed physician order

2) Patient #17 was restrained on 06/01/14 without a signed physician order.

3) Patient #21 was restrained on 06/20/14 without a signed physician order

4) Patient #28 was restrained on 06/03/14 without a signed physician order.

Findings Included:

1) Patient #1's Physician's Discharge Summary dated 07/19/14 noted a patient admission date of 05/10/14 and discharge date of 06/27/14.

RN Progress, undated, untimed, provided by the hospital as "page 5 of 7 [pages]" of restraint event documentation dated 05/10/14 noted the patient was "...uncooperative...refused contraband search..." Patient #1 "...was restrained by male staff and escorted to room..."

Physician Orders for Seclusion/Restraint attached to the 05/10/14 restraint incident documentation did not have a nurse or a physician signature.

Physician Orders for Seclusion/Restraint dated 05/29/14 reflected an order to restrain Patient #1 "...for up to 2 hours..." because Patient #1 was in a fight. The order did not have a physician signature.

Physician Orders for Seclusion/Restraint dated 06/13/14 reflected an order to restrain and/or seclude Patient #1 for "...up to 2 hours...[the patient] ...escaped off [the] unit." The order was not signed by a physician.

Physician Orders for Seclusion/Restraint dated 06/22/14 reflected an order for Patient #1 to be restrained/secluded "...for up to 2 hours." The order was not signed by a physician.

2) Patient #17's Physician Discharge Summary dated 06/21/14 noted an admission date of 05/22/14 and a discharge date of 06/14/14. Patient #17's Physician Orders for Seclusion/Restraint dated 06/01/14 noted a physical hold. The physician did not sign the order.

3) Patient #21's Physician Discharge Summary dated 07/14/14 noted the patient was admitted on 06/13/14 with diagnoses including Mood Disorder Not Otherwise Specified (NOS).

Patient #21's Physician Orders for Seclusion/Restraint dated 06/20/14 ordered the patient to be secluded. the order did not have a physician signature.

4) Patient #28's Physician Orders for Seclusion/Restraint dated 06/03/14 ordered Patient #28 to be placed in a physical hold to prevent the patient to leave the unit. The order did not have a physician signature.

On 08/14/14 at 12:30 Hospital Personnel #2 reviewed the above charts and agreed to the findings.

The hospital's Seclusions and Restraints Policy # 1200.315 revised 07/2012 noted that "...the physician shall authenticate the telephone/verbal order within 24 hours."

Based on record review, interview, and observation, the hospital failed to supervise and evaluate the nursing care for one of one patient (Patient #10) in that the patient's high blood pressure was not reevaluated within the physician ordered time parameter.

Findings Included:

Patient #10's Integrated Psychosocial Assessment was initiated on 08/13/14 at 09:19 "PM" and completed on 08/13/14 at 11:10 "AM." The assessment reflected a heart rate of 133 beats per minute. Patient #10 had a blood pressure of "184/145 [mm/Hg]" taken in her right arm. The blood pressure taken in the patient's left arm was documented as "191/125 [mm/Hg]" with a pulse of 127 beats per minute. There was no evidence of a blood pressure recheck.

Patient #10's Physician Preadmission Orders and Preliminary Plan of Care dated 08/12/14 at 21:20 noted orders for "...detoxification vital signs every four hours for 24 hours..." The orders noted to notify the physician if the patient's systolic blood pressure was above 190 mm/Hg and heart rate above 100 beats per minute.

Nursing assessment documentation dated 08/13/14 noted Patient #10's vital signs were taken at 16:35.

On 08/13/14 at 16:30 Hospital Personnel #2 was asked to review Patient #10's blood pressure and stated she "would have brought that to someone's attention."

Hospital Personnel #6 reviewed Patient #10's blood pressure readings of 184/145 mmHg and 191/125 mmHg on 08/13/14 at 17:30 and stated the patient's blood pressure "should have been rechecked."