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Based on observation and interview, the hospital failed to ensure patients at risk for harm to self or others were provided care in a safe setting as evidenced by:
1) failing to ensure patient clothing were free of drawstrings for 2 (#R1, #5 ) of 14 current patients; and
2) failing to secure an electrical cord and electrical outlet in 1 of 8 patient rooms.

Findings:

A review of the hospital policy titled Body and Belongings Search, Policy number NSG-22, revised 07/01/2019 revealed in part:
A belongings search includes an examination of belongings to ensure and remove contraband.
Procedure:
Admission Personnel:
7. Contraband items include the following:
- Drawstrings
Inpatient
10. No clothing with drawstrings will be allowed in the patient use areas. Any articles found to have drawstrings are to be placed with the patient's valuables in a locked area. If the patient gives verbal permission, staff may remove drawstrings from clothing for patient use during hospitalization.

1) Failing to ensure patients' clothing were free of drawstrings.

An observation was conducted on 02/13/2020 at 09:30 a.m. during the tour with S10 RN and revealed a pair of grey sweat pants with the drawstring noted in a patient's cubby in room "a" and room "c".

S10RN confirmed the string in the sweat pants and verified patients should not have any clothing with drawstrings per policy.


2) Failing to secure an electrical cord and electrical outlet.

Patient room b was noted to have a cord coming from the air conditioner unit on the floor plugged into an electrical outlet with a clear box cover which was not secured. This surveyor was able to open the box exposing the outlet and end of the electrical cord.

In an interview on 02/13/202 at 09:40 a.m. S10RN verified the unsecured cord and outlet. He also confirmed the cord and outlet were a safety risk.

Based on interviews the hospital failed to maintain a medical record for each patient evaluated or treated in any part or location of the hospital for 1 (#2 of 20 (#1-#20) sampled patients.

Findings:

On 02/ 14/ 2020 at 9:40 a.m. in an interview S9MHT, Transport Driver employed approximately 9 months stated she picked Patient #2 in Metairie, Louisiana, approximately 150 miles away from Oceans Behavioral Hospital of Opelousas. While in rout Patient #2 asked to use the bathroom several times and smoked crack cocaine. S9MHT stated she called S3ADON, who instructed her to bring Patient #2 patient to Hospital A for medical clearance. S9MHT stated she dropped Patient #2 off and returned to Oceans Behavioral Hospital of Opelousas and reported the event again to S3ADON. She then left the hospital but returned to go pick up Patient #2 from Hospital A because she was medically cleared. Patient #2 told S9MHT that she needed time and was not ready to be admitted and she refused to be admitted.

On 02/14/2020 at 10:00 a.m. in an interview S11LPN stated she was at home and she received a call about a patient admit coming from Metairie. She was told the patient arrived to the hospital, was in the building and did not want to relinquish her belongings. S11LPN stated that Patient #2 refused to say and S11LPN explained that she was concerned for her safety after doing the drugs and the hospital is located on a rural dark road. S11LPN realized the patient didn't want to stay so she tried to build a report but the patient didn't buy in. Patient#2 ate a sandwich and milk. The patient was focused on getting high. S11LPN explained the process for admission and the detox protocol. She explained the staff is trained in detox. Patient #2 then got up and was standing at the secured door and began screaming and beating on the door. S6MD was called again and instructed S11LPN that they could not force her to stay. S11LPN then gave the phone to Patient #2 and she again refused care. They opened the secure door for Patient #2 to leave. S11LPN followed Patient #2 outside and Patient #2 lit and began to smoke something. S6MD was called and told that the patient had left her belongings near the building and was smoking something. S6MD told S11LPN to call the police due to her smoking something illegal. Patient #2 told the police she was smoking crack. The police were not able to locate the pipe or any drugs and could not charge her. The police called an ambulance because they were concerned about her medical stability. S11LPN also stated, Patient #2 asked to be brought to the ED. S11LPN said Patient #2 asked if she could return after going to the ED. S11LPN said she told Patient #2 she need to be medically cleared first and the hospital Dr. would have to accept her. S11LPN admits Patient #2 met admission criteria before going to the ED the second time. S11LPN verified there was no staff documentation of any of the events involving Patient #2.

On 02/14/2020 at 1:00 p.m. in an interview S7MD, stated he first received the patient after being picked up in Metairie by Oceans Behavioral Hospital of Opelousas for admission but the patient did crack cocaine while in route. He stated he medically cleared Patient #2 and was picked up by and brought back to Oceans Behavioral Hospital of Opelousas by their transportation van. He stated Patient #2 then did crack cocaine on the property of Oceans Behavioral Hospital of Opelousas. He stated the patient returned via ambulance and told him "They want me cleared so I can go back and be admitted." He said the patient admitted to needing help. He said he cleared Patient #2 again. S7MD said he spoke with S6MD, who told him Patient #2 had been doing crack and he could not take her back. S7MD said he told S6MD Patient #2 was cleared and wanted to return to his hospital. S7MD said S6MD told him that he had been doing this for 40 years and nobody was going to stop him. "I'm not going to take her."

In an interview on 02/13/2020 at 12:30 p.m. S5LPN, stated she started employment on 02/01/2020. She further stated, she keeps a notebook with all inquiries to be admitted to the hospital. She also admitted there are no pre-admission forms or logs for all potential admits.

In an interview on 2/13/2020 at 2:20 p.m. the ADON and DON stated they do not create or initiate any medical records unless the patient has signed a FVA or has been PECd. No record is created even when vital signs are completed and a patient is sent to the ED for clearance or if the patient leaves the facility. Both confirmed they do not maintain any Central Log of patients presenting to the hospital seeking assistance unless the patient signs a FVA or they are under a PEC.

In an interview on 2/13/20 at 12:54 p.m. S3ADON stated the process for admission is the marketer obtains information from the patient and this information is relayed to S6MD. If S6MD accepts the patient and transportation is needed the hospital will go and pick the patient up. She stated after accepting the patient paperwork is started but if the patient does not come or refuses to sign a FVA the paperwork is shredded.

Based on record review and interview, the hospital failed to ensure compliance with the requirements of CFR 489.24 as evidenced by the hospital:

1) failing to ensure a patient was accepted for admission when the hospital had the capacity and capability to provide psychiatric services. This deficient practice is evidenced by the hospital refusing to accept 1 (#2) of 1 medically cleared patient from an emergency room when the hospital had the capacity and capability to provide psychiatric services (See findings A-2411).

2) failing to maintain a central log on each individual who comes to the hospital seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for 1 (#2) of 20 (#1-#20) patients sampled (see findings A-2405).

Based on record review and interviews the hospital failed to maintain a central log on each individual who comes to the hospital seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for 1 (#2) of 20 (#1-#20) patients sampled.

Findings:

On 02/13/2020 at 12:35 a review of S5LPN's notebook failed to reveal if all patients seeking assistance refused treatment, were refused treatment, were transferred, admitted and treated, stabilized and transferred, or discharged.

On 02/13/2020 at 12:30 p.m. in an interview S5LPN, stated she started employment on 02/01/2020. She further stated, she keeps a notebook with all inquiries to be admitted to the hospital. She also admitted there are no pre-admission forms or logs for all potential admits. She was not aware of any logs prior to her initiating the notebook. She stated all admissions for this hospital goes through her. She then contacts S6MD. She said if the patient does not get admitted, she puts a reason as to why they are refused in her notebook..

In an interview on 2/13/2020 S2DON and S3ADON confirmed they do not maintain any central log of patients presenting to the hospital seeking assistance unless the patient signs a FVA or they are under a PEC. They both confirmed S5LPN has a notebook since her hire but the hospital does not have anything prior to that date. They also confirmed the notebook is S5LPN's personal notebook and not a formal document of the hospital.

Based on record reviews and interviews, the hospital failed to ensure a patient was accepted for admission when the hospital had the capacity and capability to provide psychiatric services. This deficient practice is evidenced by the hospital refusing to accept 1 (#2) of 1 medically cleared patient from an emergency room when the hospital had the capacity and capability to provide psychiatric services.


Findings:


On 02/14/2020, a review of the hospital policy: Transferring of Patients: Transfer of Emergency Cases from Other Hospitals, Policy # PC-04 revised 10/01/2019 revealed in part:

Policy:

The facility will accept any appropriate transfer from a hospital of an individual with an unstabilized emergency medical condition who requires specialized capabilities or facilities may exist at the facility, provided that the Facility has the capacity to treat such individual.

Capacity means the ability of the Facility to accommodate the treatment of the transferred individual. Capacity encompasses such things as numbers and availability of qualified staff, beds and equipment, and the number and acuity level of existing patients.

Unless waived by the Medical Director, only psychiatric or co-occurring substance abuse emergencies can qualify as an emergency medical condition under this policy because this Facility does not provide specialized capabilities or facilities of a medical- surgical nature.


On 02/14/ 2020 at 9:40 a.m., in an interview S9MHT, Transport Driver employed approximately 9 months, stated, she picked Patient #2 in Metairie, Louisiana, approximately 150 miles away from Oceans Behavioral Hospital of Opelousas. While in route Patient #2 asked to use the bathroom several times and smoked crack cocaine. S9MHT stated, she called S3ADON, who instructed her to bring Patient #2 patient to Hospital A for medical clearance. S9MHT stated, she dropped Patient #2 off and returned to Oceans Behavioral Hospital of Opelousas and reported the event again to S3ADON. She then left the hospital and returned to go pick up Patient #2 from Hospital A because she was medically cleared. Patient #2 told S9MHT that she needed time and was not ready to be admitted and she refused to be admitted.


A review of Patient #2's Hospital A's emergency department medical record revealed on 02/07/2020 at 12:05 a.m., Patient #2 presented to the ED for medical clearance from Oceans Behavioral Hospital of Opelousas after using crack 30 minutes prior to arrival to the ED. Patient #2 was picked up from New Orleans by Oceans Behavioral Hospital to go to Oceans Behavioral Hospital. Further review revealed, Patient #2 was medically cleared to return to Oceans Behavioral Hospital.


Review of the Reexamination/ Reevaluation notes on 02/07/2020 at 00:31 a.m. revealed, Hospital A's ED called Oceans Behavioral Hospital of Opelousas to transfer Patient #2 back but they refused to take the patient back to their facility saying the patient did not want to sign in, although the patient is telling the ED staff she wants to sign in. Time: 02/07/2020 at 12:36 a.m. Notes: S6MD called back from Oceans saying that he refuses to take the patient back and he says the patient has refused to get admitted to the facility but the patient is telling me, S7MD, that she wants to be admitted in their facility and she wants to go there. She wants to go to Ocean's Hospital to get help with her drug problem. She has not voiced any suicidal or homicidal ideations. S6MD recommends she is not our patient. She refused to sign in to the hospital, so she is not our responsibility. S6MD said it's S7MD's responsibility to find a disposition for the patient.


In an interview on 02/14/2020 at 08:45 a.m. S8RN stated she was working the 7p-7a shift on 02/06/2020 when she received report from S3ADON that Patient #2 was medically cleared from the ED. She then ensured S9MHT went to get Patient #2 in the hospital's van. S8RN stated, S3ADON had informed her that the patient was brought from Metairie and en route the patient had diarrhea approximately 4 times and had used drugs in the restroom on the 4th stop. Said, patient had been brought to Hospital A' ED for medical clearance. Patient #2 was then brought to Oceans Behavioral Hospital for admission but refused to sign the FVA. S8RN called S6MD who informed her they could not force the patient to stay. Patient #2 smoked crack in the parking lot and the staff called S6MD who advised to contact the police. S8RN stated that she had been informed by S3ADON that Patient #2 would have to find her own transportation if she decided not to stay. S8RN also stated, Patient #2 asked to be brought to the ED. S8RN said, Patient #2 asked if she could return after going to the ED for medical clearance. S8RN said, she told Patient #2 she need to be medically cleared first and S6MD would have to accept her. S8RN admitted Patient #2 met admission criteria before going to the ED the second time if she was medically cleared.


S8RN stated she received a call from Hospital A's ED RN told her the patient was medically cleared for them to take them back. S8RN explained earlier the patient did not want to be admitted to their facility. S8RN called S6MD and explained Patient #2 was medically cleared. S6MD explained they could not force the patient to be admitted. S6MD said he would call the ED. Lastly, S8RN stated if the ED staff would have told her the patient wanted to return they would have completed the normal admit process.


In a telephone interview on 02/14/2020 at 10:35 a.m., S6MD stated he spoke with the staff several times about Patient #2 being admitted and the patient was refusing after the first visit to the ED. At about 12:30 a.m. on 02/07/2020, he received a call that ED was calling and demanding they take Patient #2 back. Hospital A's ED MD, S7MD was very angry insisting they take the patient back and they were dumping on the ED. S6MD explained to S7MD that Patient #2 had refused earlier and the police were called after declining to be admitted and smoking crack. S6MD stated S7MD explained Patient #2 wanted to comeback voluntarily to Oceans Behavioral Hospital of Opelousas. S6MD decided not to accept Patient #2 back. S6MD stated, "I did not want this to go on all night and wanted to get some sleep." This surveyor reviewed the speaker phone interview notes with S6MD which was conducted in front of the S1Admin and S3ADON. S6MD confirmed the notes to be accurate with S1Admin and S3ADON present.


On 02/14/2020 at 2:25 p.m., in a face to face follow up interview S6MD admitted if the ED would have called and advised the patient was PECd, he would have had to admit the patient. S6MD was presented the hospital admission log for the last 6 months and reviewed the admission types: Emergency, Urgent and Elective. He stated all inpatient admits are considered unstable. That is why admission is required. He further stated some of the Elective patients are also unstable.


In an interview on 02/14/ 2020 at 12:30 p.m., S3ADON confirmed the hospital had the capacity and capability to care for Patient #2 the entire time of these events. She also confirmed if the ED would have called and told them Patient #2 was PECd they would have taken her.