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Based on record review and interview, the hospital failed to ensure a patient grievance was identified and investigated for 1 Patient (#2) of 2 Patients (#2, #3) reviewed for complaints/grievances from a total patient sample of 5 Patients (#1 - #5).

Findings:

Review of the hospital policy titled "Grievance Procedure Patient and Family Louisiana" presented as current policy by S1Adm revealed in part a grievance is an allegation, however made, of a violation of a patient's rights, quality of care, premature discharge, and/or a complaint that is not resolved at the time the complaint is made and requires further action for resolution. Timeframes for Administrator Review/Investigation: Logs the grievance allegation onto the "Complaint/Grievance Log" and contacts the patient and /or family and opens an investigation to determine validity of the grievance allegation within 48 hours of notification or receipt of the grievance allegation. Completes the investigation "Grievance Report" within 10 days of the date of notification or receipt of the grievance allegation. Issues a written determination ....sent to the grievant on the 10th day following notification or receipt of the grievance allegation.

A Complaint/Grievance Log presented as the log dating between 09/01/2019 and 02/03/2020 failed to include Patient #2.

Review of Patient #2's medical record revealed the patient had been admitted on 09/19/2019 under a PEC with admission diagnoses of Chronic Paranoid Schizophrenia. Further review revealed Grievance Report dated 10/20/2019 at 3:30 p.m. stated in part Patient #2 was missing cigarettes; was requesting a second opinion; and was "Also, given forced meds. I am still bruised on my left side where my ribcage is located."

In an interview on 02/05/2020 at 11:20 a.m. with S1Adm, she verified Patient #2's medical record contained a grievance form and Patient #2 was not listed on the grievance log and S1Adm verified this patient should have been followed up as a grievance.

Based on record review and interview, the hospital failed to ensure a RN supervised and evaluated the care of each patient as evidenced by failing to ensure an assessment was performed when pain was identified for 1 Patient (#2) of 2 Patients (#2, #3) reviewed for PRN pain medications.

Findings:

Review of the hospital policy titled "Assessment and Management of Pain" presented as current policy by S1Admin revealed in part:
Policy: The patient's report of pain will be accepted and respected as the best indicator of the amount of pain he or she is experiencing ....
Procedure:
1. The RN conducts a pain assessment for every patient at admission, on every shift and more frequently as indicated thereafter if pain is identified as active pain, by ongoing assessments and patient report. The nurse will include the following in the initial and ongoing pain assessments: Description; Intensity; Location; Frequency; Precipitating/Exacerbating factors; Effects of functioning; and Pain relief measures (pharmalogic and non-pharmalogic).
2. The intensity level of pain will be rated using an established pain scale utilizing a numeric value to indicate the pain level ....
5. ...The patient's nurse will use the 0 to 10 scale to rate the patient's pain ...
6. Report findings to practitioner for determination of treatment and process orders.

Review of an incident report dated 9/28/2019 at 3:29 p.m. by S2DON states, "Pt physically aggressive with staff throwing items at staff. Pt started kicking staff. Unable to deescalate. Pt placed in therapeutic hold and bite staff."

Review of Patient #2's medical record revealed the patient had been admitted on 09/19/2019 under a PEC with admission diagnoses of Chronic Paranoid Schizophrenia. Further review revealed a physician's order by S3Psych dated 09/28/2019 at 10:01 p.m. for Tramadol 50 mg PO Q6 hours PRN pain. Further review revealed a nursing note dated 09/28/2020 at 10:45 p.m. stating, "Patient c/o left side pain at this time 8/10 and refused Tramadol ...Patient refused medication ..." Nursing note dated 09/28/2019 at 11:45 p.m. stated, "Patient lying in bed appears to be asleep, eyes closed ..." Further review revealed the Psychosocial Assessment dated 10/18/2019 stated, " ...Patient current soreness to chest from forced meds. It's hard to sleep on my left side". Further review of the medical record revealed a Grievance Report dated 10/20/2019 at 3:30 p.m. stated in part Patient #2 was "Also, given forced meds. I am still bruised on my left side where my ribcage is located." Further review revealed no documentation of an assessment of Patient #2's left side after complaints of pain. 10/22/2019 Patient #2 was discharged from the hospital.

In an interview on 02/05/2020 at 11:10 a.m. with S1Adm, she stated Patient #2 complained of pain to the nurse on 09/28/2019 and there is no documentation of a description of the pain nor observation of the site (chest). S1Adm further stated the nurse did not update the patient's pain using the scale assessment as per policy. S1Adm further stated there is no documented nurses' note with an assessment of Patient #2's pain on 10/18/2019. S1Adm further stated there is no documentation in any of the progress notes regarding the patient's pain.

In an interview on 02/03/2020 at 3:10 p.m. with S3Psych, he stated he remembered a nurse calling him one evening because Patient #2 was in pain. He further stated he never heard a complaint about pain again.