HospitalInspections.org

Based on Review of Policy and Procedures, the facility failed to have an adequate Policy and Procedure in place that addresses procedures for appraisals or emergencies, initial treatments and referrals when appropriate for patients arriving at unscheduled times.

The findings include:

On 9/19/11, a review of the Policy titled "After Hours Admissions" was reviewed. The Policy number is A-006 with an effective date of 10/1/94 and revised on 10/3/07. The review revealed under POLICY: It is the policy of the Willough at Naples to admit patients 24 hours a day, seven (7) day a week. During the hours of 8:00 a.m. and 6:30 p.m., there will be an assessment and referral counselor in the admissions office Monday through Friday. After hours and on the week-ends the nursing staff will handle all admissions."

During an interview with sampled Patient #16 on 9/18/11 at approximately 8:40 p.m., the patient said that he had been living at a local halfway house since his discharge from the hospital. He said that a male staff member at the halfway house was abusive towards him and he needed to get out. He had been admitted to their Crisis Unit and was discharged on 9/14/11. A friend drove him to the hospital at about 11:30 p.m., on Thursday 9/15/11. He rang the bell and a nurse answered and let him into the hospital lobby. The Nursing Supervisor told him he had to leave and would not let him stay there. He said he showed the staff his papers about being admitted on 9/16/11. The police were called and they came at about 12:15 a.m. The nurse asked the police how to get him off the property and asked if there was any way they could Baker Act him (involuntary commitment for evaluation at a psychiatric crisis unit). The police said the only way to make him leave was to swear out a warrant for trespassing
The patient said a male staff member then took him to the carwash next door because he didn't want the patient to be arrested for trespassing. The patient spent the night at the carwash. He said the police sat in their car and watched over him and he finally fell asleep at about 1:30 in the morning. He walked back to the hospital around 8:00 a.m., he was then admitted.

The patient's clinical record contains a computer generated form, which is dated 9/14/11. The form shows that Patient #16 has 60 Medicare days left and also says "Unconditional acceptance."
An interview was conducted with the Admissions Coordinator on 9/19/11 at 4:45 p.m. He stated that the patient was supposed to call the hospital and make an appointment for an assessment and the patient didn't call. The other Admission Coordinator had spoken to the Community Mental Health Center about admitting the patient. On 9/16/11, he said that he knew about the patient's potential admission and the patient had been told to call on Friday, there was a waiting list. He said that the hospital does admissions, if the assessment is done, 24 hours a day. He admitted Patient #16 right away, on 9/16/11, because someone (a patient) was leaving that day. He said that he cancelled two other patient admissions to admit Patient #16. He was asked if he told anyone about the patient sleeping at the carwash. He said as soon as he found out, he told the Administrator.
Interview with administrative staff on 9/19/11, showed they were aware of this incident. The hospital C.O.O (Chief Operating Officer) stated that they were going to discuss it in the morning meeting on Monday but due to the survey, the meeting was delayed.
When asked what policy and procedure is followed when a person presents to the hospital for admission after hours, no procedure was available. Administrative staff stated that the nurse on duty had followed the chain of command and called her supervisor. On 9/19/11, the Nursing Supervisor confirmed that the nurse called her and asked what to do. She stated that she told the nurse her gut feeling was to let him stay but "Do what you usually do."
The hospital administrative team was asked about the incident and the hospital's response. At that time, Administrative staff said that Patient #16 was not a patient of the hospital when he presented on 9/15/11. Therefore it was not a case of violating patient rights, he was trespassing.

Based on interviews and record reviews, the facility failed to have in place a grievance process that addressed a written notice, a notice of decision after investigation, a contact person and date of completion for a grievance filed by 1 (Patient #15) of 23 sampled patients.

The findings include:

Patient #15 was admitted to the hospital on 9/8/11. The patient has a diagnosis of Bipolar Disorder and Poly Substance Abuse. The patient is oriented x 4. During an interview with the patient on 9/18/11 at approximately 8:25 p.m., the patient stated that she had made out a complaint about a week ago against a female Mental Health Technician (MT). She said that she was trying to help another patient who didn't feel well and the MT said loudly and in a mean ton, "Miss F-----, you need to take care of yourself!" The patient said it was embarrassing; she was very upset because the MT used her last name. She was asked if the hospital had gotten back to her about the complaint she said no one has talked to her about it. She said the patient's don't use last names here and she doesn't want every one knowing her last name.

Review of the hospital complaint log on 9/19/11 shows that a complaint from this patient was not listed. The patient was interviewed again on 9/20/11 at 9:50 a.m. She was asked what she did with the complaint she had turned in and she said she thought she gave it to the nurse and asked if she should fill out another one. She said that the MT ignored her last night but was giving her dirty looks. The MT had come in her room. She said "Can I help you?" to the MT and the MT started yelling at her so she asked her to leave. She said the MT said "No, I'm not leaving your room." The patient said she told the MT don't talk to me and I won't talk to you.