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Based on interview and record review, it was determined the facility failed to have a process in place for notifying Patient #8's legal guardian of his/her health status following the patient to patient altercation; therefore, Patient #8's legal guardian was not provided the opportunity to make an informed decision regarding his/her medical care following the altercation.

Patient #8 was involved in an altercation with Patient #9 on 06/21/15. Patient #8's legal guardian was not notified of the altercation until he visited on 06/23/15. Patient #8 sustained right orbital (around the eye) bruising and scratches to the left forearm.

The findings include:

Interview with the Director of Patient Safety/Accreditation, on 07/08/15 at 9:00 AM, revealed the facility did not have a specific policy that addressed notifying the patients' family/legal guardian of a change in condition. She continued by stating it was her expectation for family, legal guardian notification to be made and documented at the time of the injury or change in condition.

Review of Resident #8's clinical record revealed the facility admitted him/her with diagnoses which included Dementia with Behavioral Disturbances, Hypersexuality, Chronic Respiratory Failure (documented refusals to consistently wear Oxygen) and Atrial Fibrillation. Review of the Mini Mental Status Exam (MMSE) dated 04/14/15 revealed Patient #8 had a score of 10/30 which indicated he/she was severely cognitively impaired.

Record review of Patient #9's clinical record revealed the facility had admitted him/her with diagnosis of Dementia with Aggressive Behaviors. Review of Patient #9's MMSE revealed a score 0/0 indicating severe cognition impairment.

Review of the facility's Risk Management Worksheet, dated 05/26/15 revealed Patient #8 sustained right orbital bruising and left forearm scratches from an altercation with another resident.

Review of Nursing Notes, dated 05/21/15 at 4:41 PM, 05/21/15 at 10:54 PM and 05/23/15 at 1:13 PM, documented the altercation; however, there was no documentation the legal guardian had been notified of the altercation.

Interview with the Assistant Nurse Manager/Behavioral Health I, on 07/08/15 at 11:05 AM, revealed it would have been the responsibility for the primary nurse for that shift, on duty at the time of the incident, to inform the legal guardian of the patient that was injured. Further, she stated notification should be made so that the guardian can make informed care decisions and this notification should be documented in the Nursing Notes.

Review of Nursing Notes, dated 05/21/15 through 05/24/15, revealed that via review of a videotape of 05/21/15 (tape unavailable for review, had been recorded over), Patient #8 had been sexually inappropriate with Patient #9 in the hallway and Patient #9 struck Patient #8, resulting in a black eye and scratches to his/her arm.

Review of a Nursing Notes, dated 05/23/15 at 5:59 PM, revealed family arrived on the Unit earlier in the day (no time given) to visit Patient #8 and questioned staff as to why they had not been informed of the altercation and bruising/scratches to Patient #8. The nurse (unable to interview related to being on vacation) documented she notified security, nursing supervisor and nurse manager of the family's arrival and questions.

Review of the Physician documentation, dated 05/24/15 at 11:40 AM, by the Unit Psychiatrist revealed Patient #8 had a black eye but denied orbital pain. Review of documentation by the Hospitalist dated 05/27/15 at 8:50 AM revealed Patient #8 had not sustained any adverse effects to his/her eye. Continued review revealed Patient #8 denied pain, discomfort or visual disturbance. The Hospitalist ordered an Ophthalmology consult per the legal guardian's request; however; the patient was discharged before the consult was done.

Interview with the Director of Risk Management, on 07/07/15 at 8:45 AM, revealed the incident was reviewed via videotape (tape was not available, on a loop and was recorded over) which showed Patient #8 being sexually inappropriate with Patient #9 which resulted in Patient #9 striking Patient #8. Further, the Director of Risk Management stated the legal guardian should have been notified of the altercation and the injury.