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Based on record review and interview the facility failed to thoroughly investigate and respond to 2 of 3 allegations of staff abuse (for patients #3 and #4) in a through and timely manner, increasing the risk of abuse for all patients. Findings include:

Record Review: Patient #3:
1. On 12/17/13 and 12/18/13 patient complaints of staff abuse were reviewed.
2. An Incident Report dated 11/21/13 at 0900 states: "Pt (patient) stated that staff hit her in the face."
3. A letter, dated 11/26/13, from staff H to patient #3 stated that the complaint was received for investigation on 11/25/13, four days after the incident.
4. No interview with patient #3 was found in the staff H's investigation file.

Interview:
1. On 12/18/13 at 1420 staff H stated that he is responsible for investigating patient allegations of staff abuse.
2. On 12/18/13 at 1420 staff H stated that there was no documentation that patient #3 was interviewed as part of this investigation.

Record Review: patient #4:
On 12/17/13 and 12/18/13 patient complaints of staff abuse were reviewed. An Incident Report dated 11/4/13 at 0630 states that patient #4 reported that staff K "hit her and touched her inappropriately." The areas (body parts) where the patient was allegedly hit and touched were not documented on the "Incident Report." A note by staff L states: "Discussed in team. (Patient #4) stated staff did not do it." The patient interview with the staff member responsible for investigating abuse allegations, staff H, is 4 phrases long and illegible in parts. There was no documentation that patient #4 was asked to provide a complete statement of the abuse allegation as part of this investigation. There was no documentation that patient #4 was asked if there were any witnesses to the alleged abuse.

Interview:
1. On 12/18/13 at 1420 staff H stated that he was responsible for investigating patient allegations of staff abuse.
2. On 12/18/13 at 1425 staff H stated that there was no documentation that patient #4 was asked to state the abuse allegation and state whether there were an witnesses to the alleged abuse. Staff H confirmed that the partially illegible note, referenced above, was the only documentation of patient #4 being interviewed in the investigation file.

Based on record review, observation and interview, 1 of 2 female patients that were physically restrained (#4) was not restrained in the least restrictive manner due to ill-fitting wrist restraint devices increasing the risk of excessive use of physical restraint and harm from restricting circulation or ingesting foreign material for all patients who are physically restrained. Findings include:

Record Review:
On 12/18/13 from 2:20-3 pm Incident Reports (IRs) and Safety Department Reports (SDRs) for patient #4 for 11/11/13 revealed:
-an IR at 12:30 pm states- "while in restraints pt (patient) ripped and swallowed the cloth from the restraints on her wrists." An x-ray was ordered due to ingestion of foreign material.
-an IR at 12:45 pm states- "pt (patient) got wrists out of restraints"
-a SDR at 12:46 states- "The patient's restraints were readjusted and towels were put underneath restraints" and "staff placed mitts on the patient."

Observation:
On 12/18/13 from 2:20-3 pm the wrist restraints used on patient #4's unit (R-6) were examined. The wrist restraints are hard plastic bands with slit openings placed approximately 2-3 cm apart, for insertion of a metal clamp. The wrist restraint device was applied to both the surveyor and staff J, both females. On both subjects the restraint was either so tight that it cut off circulation to the hand or, on the next looser slit, allowed the subjects to slip out of the device. The Supervisor's review section of the Incident Report form, for "action taken...to remedy and /or prevent recurrence" did not address the restraint device's failure in any of the IRs.

Interview:
On 12/18/13 from 2:20-3 pm patient #4's Unit Manager (UM), staff B, was interviewed. The UM stated that a towel and mitts were added to patient #4's wrist restraints on 11/11/13 because the wrist restraints could not be applied so that they stayed on and did not cut off circulation to the patient's hands. The UM confirmed that the failure of the restraint devices on 11/11/13 was not identified as a problem to be addressed on patient #4's Incident Reports. The UM stated that he was unaware of any follow-up communication regarding the failure of the wrist restraint devices.