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Based on interviews and observation it is not evident that the facility followed their well established and approved resolution of patient grievance policy and process. The effective operation of the grievance process was not resolved.

Findings :

a. Interviewed the complainants #1 Daughter of the patient an 85y/o female who received care at facility September 19-September 28, 2015. Family members of the patient made a grievance known to the facility two days after the patient discharge (due to death) on September 30, 2015. This interview was conducted at 12:53pm January 11, 2017 via telephone. The interviewee stated she re-submitted a second complaint to the facility in November 2016 in addition she sent this letter to the Texas Department State Health Services (DSHS) and the Texas Board of Nursing (BON) of the same concerns expressed by her sister and brother of care received by their mother in September 2015 after her mother passed away. The reason she resubmitted the grievance was because she and her siblings were still grieving their mother demise a year after she past away. They were angry that since September 2015 when they first made their concerns known to the facility they did not get a reply back from Laredo Medical Center. Their original grievance was never closed. They felt the hospital was not listening to them and did not care and showed no empathy. Interviewee#1 said she was not only resubmitting the letter for she and her siblings but also her mother. She said as of the day of this interview (January 11, 2017) she still had not heard from Laredo Medical Center.

b. Interview interviewee #8, 2nd daughter of the patient of concern 85 y/o female who received care at facility September 19-September 28, 2015. Interviewed at 8:15pm on January 12, 2017 via telephone. Interviewee #8 explained she and her brother set up an appointment at Laredo Medical Center to speak with the facility's risk manager in regards to concerns they had about their mother who past away on September 28, 2015. They had spoke to the risk manager the end of the month in September 2015 she thought it was around the September 30th, 2015. In this meeting between the family and the risk manager they spoke of several complaints and grievances of things they witnessed and heard and their perspective of care. She said the risk manager said she would look into the matter and get back in touch with them to let them know what she found out. Interviewee #8 said until this date January 12, 2017 she and her brother had not heard anything from the risk manager or facility about the concerns they complained to her about in September 2015.

c. Interviewed hospital staff #3, risk manager who confirmed of the meeting between she of the family members of the 85 y/o female patient who received care at the facility who received care at facility September 19-September 28, 2015. Staff #3 was interviewed at 3:15pm on January 11, 2017 in the risk manager's office. Staff #3, risk manager said she did investigate the case but could not substantiated the family's concerns but never sent a letter of a facility internal investigation or a follow up letter to the family. She agreed she never close the case and gave the family a resolution as per the hospital's policy.

d. Reviewed the facility's policy " Patient/Resident Complaint/Grievance effective 11/1999 " under definitions 1. It states

" 1. A " patient grievance " is defined as " a written or verbal complaint (when the verbal complaint is not resolved at the time of the complaint by staff present) by a patient or the patient ' s representative regarding the patient ' s care, abuse or neglect ..... "

After the patient death when the patient ' s daughter and son presented themselves to the Risk Manager they voiced a verbal complaint that could not be resolved at the time it was presented. This fit the definition of " Patient grievance "

" 2. A verbal complaint is a patient grievance if:
2.1. It cannot be resolved at the time of the complaint by staff present;
2.2. Is postponed for later resolution;
2.3. Is referred to other staff for later resolution; or
2.4. Requires investigation and/or requires further action for resolution. "

This verbal complaint met all the categories of the definition of a " Patient Grievance " .

" 4. A written complaint is always considered a patient grievance (including email and or fax) whether from an inpatient, outpatient, released or discharged patient or their representatives as long as the concern expressed in the grievance concerns one of the three areas constituting a grievance (i.e., the care provided to the patient, abuse or neglect or the hospital ' s compliance with the COP ' s) "

This grievance expressed concerns in all the areas constituting a grievance.

" 10. A patient complaint or grievance is deemed " resolved " when the patient or his or her representatives is satisfied with the action taken by the hospital or their behalf. There may be times when the patient or his or her representatives continue to be dissatisfied with the hospital ' s actions even when the hospital has taken reasonable actions to address the applicable concerns. In these circumstances, the hospital deems the complaint or grievance resolved even though the patient or his or her representatives is not satisfied with the outcome. "

The grievance was never deemed " resolved " in September 2015 when the grievances was verbally expressed by the family of the patient or in November 2016 when one of the siblings sent a letter to the facility ' s corporation informing them of the concerns and no one ever getting back to the family about the original grievance back in September 2015. In speaking to the family member on January 11 and January 12, 2017 the family express no one from the facility had sent any response to the concerns presented.

On page 2 of 6 of this policy under purpose 3 Note it states: " The patient should have a reasonable expectation of care and services and the facility should address those expectations in a timely, reasonable manner "

Under Policy on page 2 of 6 it states:

" 1. Patients have the right to express concerns and expect resolution in a timely manner ... ...
5. The Hospital Quality Improvement Council ensures the patient is provided written notice of its receipt, investigation and outcomes regarding a complaint/grievance within 7 days of the Hospital ' s receipt of grievance, even though the hospital ' s resolution need not be complete within the seven-day limit ... ... ....
6. If the grievance is not resolved within the initial, written response of 7 days the written response will indicate that the hospital is working towards a resolution of the grievance and that a follow-up written response will be provided within a specified time period not to exceed 30 days until the grievance is resolved. If the grievance remains unresolved after 30 days, additional written follow-up would be indicated within a specified time period but not to exceed an additional 30 days. "

d. As of January 12, 2017 there was no evidence found that any letters were sent out to the patient representatives in 2015 or in 2016. There was no evidence that the facility's Complaint and Grievance policy was followed. There was no evidence that this regulation was met in this case.

Based on interviews and observation it is not evident that the facility followed their well established and approved resolution of patient grievance policy and process. The effective operation of the grievance process was not resolved.

Findings :

a. Interviewed the complainants #1 Daughter of the patient an 85y/o female who received care at facility September 19-September 28, 2015. Family members of the patient made a grievance known to the facility two days after the patient discharge (due to death) on September 30, 2015. This interview was conducted at 12:53pm January 11, 2017 via telephone. The interviewee stated she re-submitted a second complaint to the facility in November 2016 in addition she sent this letter to the Texas Department State Health Services (DSHS) and the Texas Board of Nursing (BON) of the same concerns expressed by her sister and brother of care received by their mother in September 2015 after her mother passed away. The reason she resubmitted the grievance was because she and her siblings were still grieving their mother demise a year after she past away. They were angry that since September 2015 when they first made their concerns known to the facility they did not get a reply back from Laredo Medical Center. Their original grievance was never closed. They felt the hospital was not listening to them and did not care and showed no empathy. Interviewee#1 said she was not only resubmitting the letter for she and her siblings but also her mother. She said as of the day of this interview (January 11, 2017) she still had not heard from Laredo Medical Center.

b. Interview interviewee #8, 2nd daughter of the patient of concern 85 y/o female who received care at facility September 19-September 28, 2015. Interviewed at 8:15pm on January 12, 2017 via telephone. Interviewee #8 explained she and her brother set up an appointment at Laredo Medical Center to speak with the facility's risk manager in regards to concerns they had about their mother who past away on September 28, 2015. They had spoke to the risk manager the end of the month in September 2015 she thought it was around the September 30th, 2015. In this meeting between the family and the risk manager they spoke of several complaints and grievances of things they witnessed and heard and their perspective of care. She said the risk manager said she would look into the matter and get back in touch with them to let them know what she found out. Interviewee #8 said until this date January 12, 2017 she and her brother had not heard anything from the risk manager or facility about the concerns they complained to her about in September 2015.

c. Interviewed hospital staff #3, risk manager who confirmed of the meeting between she of the family members of the 85 y/o female patient who received care at the facility who received care at facility September 19-September 28, 2015. Staff #3 was interviewed at 3:15pm on January 11, 2017 in the risk manager's office. Staff #3, risk manager said she did investigate the case but could not substantiated the family's concerns but never sent a letter of a facility internal investigation or a follow up letter to the family. She agreed she never close the case and gave the family a resolution as per the hospital's policy.

d. Reviewed the facility's policy " Patient/Resident Complaint/Grievance effective 11/1999 " under definitions 1. It states

" 1. A " patient grievance " is defined as " a written or verbal complaint (when the verbal complaint is not resolved at the time of the complaint by staff present) by a patient or the patient ' s representative regarding the patient ' s care, abuse or neglect ..... "

After the patient death when the patient ' s daughter and son presented themselves to the Risk Manager they voiced a verbal complaint that could not be resolved at the time it was presented. This fit the definition of " Patient grievance "


On page 2 of 6 of this policy under purpose 3 Note it states: " The patient should have a reasonable expectation of care and services and the facility should address those expectations in a timely, reasonable manner "

Under Policy on page 2 of 6 it states:

" 1. Patients have the right to express concerns and expect resolution in a timely manner ... ...
5. The Hospital Quality Improvement Council ensures the patient is provided written notice of its receipt, investigation and outcomes regarding a complaint/grievance within 7 days of the Hospital ' s receipt of grievance, even though the hospital ' s resolution need not be complete within the seven-day limit ... ... ....
6. If the grievance is not resolved within the initial, written response of 7 days the written response will indicate that the hospital is working towards a resolution of the grievance and that a follow-up written response will be provided within a specified time period not to exceed 30 days until the grievance is resolved. If the grievance remains unresolved after 30 days, additional written follow-up would be indicated within a specified time period but not to exceed an additional 30 days. "

d. As of January 12, 2017 there was no evidence found that any letters were sent out to the patient representatives in 2015 or in 2016. There was no evidence that the facility's Complaint and Grievance policy was followed. There was no evidence that this regulation was met in this case.

Based on review of medical record and interview with staff it was observed that not all nursing care provided on September 27, 2015 was being provided as ordered.

Findings:

a. In review of physician orders it was observed that Cefepime (Maxipime) every 8 hours IV
was ordered on 9/27/2015 at 9:33am. The first dose scheduled for 12:00 was not administered because the patient was scheduled for dialysis. Hemodialysis was ongoing from 12:42pm to 2:50pm on September 27, 2015. The next dose of Maxipime was scheduled for 8:00pm but not administered until 12:26am on September 28, 2015.
Levofloxacin (Levaquin) was order on Sept. 27, 2015 every 24 hours IV the patient was suppose to received her first dose at 12:00pm on September 27, 2015 but the dose was never given because the patient was on dialysis. The patient was never given a later dose after her dialysis.

b. In an email conversation with the Director of Quality on January 2, 2017 it was explained that the reason the patient was not given the dose of the two medications was because the assigned day nurse was overwhelm with her assignments. She had 8 patients and fell behind in her assignments including administering medications. Then during the night shift a nurse called in sick and that day nurse had to stay behind and wait for a replacement still trying to catch up with her assignments. It was not until 9:30pm to 10:00pm on September 27, 2015 that a nurse was floated to the unit after completing his assignments on his home unit and accepting his new assignments on the telemetry unit. He did not get around to administering medications until after midnight.

The patient did not receive any of her medications on the 7pm shift on September 27, 2015 until after she had the code at 12:05 am on September 28, 2015.