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Based on record review and interviews, the Hospital failed to ensure that complaints regarding nursing care and unhappiness with the overall hospital experience were addressed through the grievance process for 1 of 3 patients (Patient #1).

Findings include:

The Hospital's Policy/Procedure titled Patient Complaint/Grievance Process indicated that a grievance was a written or verbal, formal or informal complaint made by the patient/family/authorized representative regarding a concern that could not be resolved at the time the complaint was made. A complaint regarding patient care provided, abuse or neglect was to be processed as a grievance. The Department Director/Manager was responsible for entering grievance into the Hospital's electronic reporting system and notifying the Risk Manager of the grievance.

The Resident Transfer Form from the Facility, dated 1/25/12, indicated that Patient #1 developed altered mental status.

The History & Physical (H&P), dated 1/25/12, indicated that Patient #1 was admitted to Medical/Surgical (Med/Surg) Unit #1 with acute change in behavior, hepatic encephalopathy (caused by disorders that affect liver function), metastatic breast cancer and Bipolar Disorder.

The Clinical Notes Report, dated 1/27/12 at 10:30 A.M., indicated that the HCA came in and was concerned because Patient #1 had not been bathed. The Clinical Notes Report indicated that Nurse #2 informed the HCA the nursing staff could not force Patient #1 to bathe, but would continue to encourage Patient #1 to accept care. The Clinical Notes Report indicated that the HCA requested to speak with a member of management to file a complaint and Nurse #2 notified the Unit Manager.

The Clinical Notes Report, dated 1/27/12 at 1:50 P.M., indicated that the HCA was frustrated and wanted to invoke the HCP so that care could be forced onto Patient #1. The Clinical Notes Report indicated that the Nurse Manager and a Social Worker explained to the HCA that even with the HCP invoked they could not physically force care on Patient #1.

The Clinical Notes Report, dated 1/27/12, indicated that Patient #1's HCA was upset due to Patient #1's refusal of care and treatment including laboratory testing, personal care and medications. The Clinical Notes Report indicated that the HCA was informed that the staff could not force Patient #1 to take medications. The Clinical Notes Report indicated that Hospitalist #1 spoke with the HCA and explained that with medication adjustments and improved behaviors, Patient #1 may comply with care. The Clinical Notes Report indicated that nursing would continue to encourage Patient #1 to allow care and treatments and take medications as ordered.

Review of the Patient Complaint Log, dated 10/1/11 to 4/9/12, indicated that there were no complaints logged regarding the HCA's complaint regarding nursing care.

The Surveyor interviewed the Risk Manager on 4/9/12 at 11:30 A.M. The Risk Manager said that on 1/27/12, she was informed by the Medi/Surg Unit's Charge Nurse that Patient #1's HCA was upset with the nursing care. The Risk Manager said she contacted the Nurse Manager and informed her of the HCA's complaint and told the Nurse Manager to come up with a plan to ensure that Patient #1 received care.

The Hospital did not activate or follow through with the Patient Complaint process to ensure that the HCA's concerns were acted upon and a response was provided to the HCA..

The Clinical Notes Report, dated 1/31/12, indicated that Patient #1 was discharged against medical advice with the HCA.

Nurse #5 said that on 1/31/12, the HCA signed Patient #1 out against medical advise because the HCA was unhappy with the care.

Based on record review and interviews, the Hospital failed to address Patient #1's allegation of rape.

Findings include:

The Hospital's Policy/Procedure titled Patient Complaint/Grievance Process indicated that a grievance was a written or verbal, formal or informal complaint made by the patient/family/authorized representative regarding a concern that could not be resolved at the time the complaint was made. A complaint regarding patient care provided, abuse or neglect was to be processed as a grievance.

The Clinical Notes Report, dated 1/26/12 at 1:52 A.M., indicated that Patient #1 was being assisted to the bathroom with 2 staff members, including Nurse #1. The Clinical Notes Report indicated that while Patient #1 was being assisted to the bathroom, Patient #1 yelled at the staff to stop raping her.

The Surveyor interviewed Nurse #1 on 4/9/12 at 4:05 P.M. Nurse #1 said that when Patient #1 made the allegation, he/she was confused and agitated. Nurse #1 said Patient #1 was being ambulated to the bathroom and there had been no physical contact such as with pericare, enemas or injections. Nurse #1 said she reported the allegation to the shift Supervisor and could not recall if she had told the physician about the allegation as well.

The Shift Assessment, dated 1/26/12 at 3:00 A.M., indicated that Patient #1 was confused, agitated and restless.

The History and Physical, dictated 1/26/12 at 3:31 A.M., indicated that Patient #1 was confused, restless and agitated.

The Psychiatric Consult, dated 1/26/12 and dictated at 6:50 P.M., indicated that the nurse told the Psychiatrist that Patient #1 reported the previous night that he/she was concerned that he/she was being raped.

Review of the Patient Complaint Log and Incident Report Log, dated 10/1/11 to 4/9/12, indicated that there were no complaints or incidents logged indicating that Patient #1's allegation of rape was reported to management or that the allegation was investigated.

The Surveyor interviewed the Risk Manager on 4/9/12 at 11:30 A.M. The Risk Manager said she was not aware of Patient #1's allegation of rape.

No action was taken by the Hospital regarding Patient #1's allegation of rape.

Based on review of the Medication Administration Record (MAR), record review and interviews, the Hospital failed to ensure that Patient #1's Lactulose (synthetic, non-digestible sugar used in the treatment of hepatic encephalopathy), Metoprolol Tartrate a beta-blocker that reduces chest pain, lowers high blood pressure and stabilizes heart rhythm), Senna (laxative to treat constipation) and Olanzapine (antipsychotic medication for behavior management) were administered in accordance with the Physician orders.

Findings include:

The Physician Orders, dated 1/25/12, included Lactulose 20 grams orally every 3 hours, Metoprolol Tartrate 50 milligrams every 12 hours and Senna 17.2 milligrams at bedtime.

The Physician Orders, dated 1/26/12, included the addition of Olanzapine 5 milligrams orally at bedtime.

The Physician Orders regarding medications, dated 1/28/12, included to change Lactulose 20 grams four times daily.

Review of Physician Orders, dated 1/25/12 to 1/28/12, indicated that the medication orders did not specify that the medications could be held if Patient #1 was sleeping.

Review of the MAR, dated 1/26/12, indicated that Olanzapine 5 milligrams, due at 10:00 P.M., was not administered because Patient #1 was sleeping.

Review of the MAR, dated 1/26/12, indicated that Lactulose 20 grams, due at 11:30 P.M., was not administered because Patient #1 was sleeping.

Review of the MAR, dated 1/27/12, indicated that Metoprolol Tartrate 50 milligrams, due at 9:00 P.M., was not administered because Patient #1 was sleeping.

Review of the MAR, dated 1/27/12, indicated that Senna Concentrate 17.2 milligrams, due at 10:00 P.M., was not administered because Patient #1 was sleeping.

Review of the MAR, dated 1/27/12, indicated that Lactulose 20 grams, due at 8:30 P.M., was not administered because Patient #1 was sleeping.

Review of the MAR, dated 1/28/12, indicated that Lactulose 20 grams, due at 2:30 A.M., was not administered because Patient #1 was sleeping.

The Surveyor interviewed Hospitalist #1 by telephone on 4/18/12 at at 2:50 P.M. Hospitalist #1 said he was not made aware that medications were held while Patient #1 was sleeping.