HospitalInspections.org

The hospital failed 4 of 4 Patients (Patients #1, #2, #3, and Patient #4) by failing to ensure that staff accountability to the governing body for the quality of care provided to patients.

Findings Include:

During record review, the hospital failed to reprimand Staff #9 after abondoning his shift.

During record review, the hospital failed to reprimand Staff #9 after engaging in a physical altercation with with Patient #3.

During interview Staff #2 confirmed there was video footage and documentation of Staff #9 engaging in a Physical altercation with Patient #3, and the hospital failed to report this incident to the department.

During record review Staff #11 failed to follow up with closure of the allegations incident involving staff #9, The hospital Staff #1 confirmed through documentation that Staff #9 returned to work and had been retrained.

During interview it was reported at the conclusion of this investigation Staff #9 was terminated as a result of this investigation.

During record review the hospital staff #2, Staff #8 confirmed that the doors on the girls unit automatically opens at midnight and the unit is monitored by staff rounding. The hospital indicated that their is repair work on the unit and the unit has been temporarily closed post investigation due to failure to properly repair doors.

During Record Review Hospital staff failed properly assess Patient #1's diet when the Patient arrived to the unit. The hospital Staff #12 failed to have a Log or Special Diet for Patient #1 after not recieving orders for the special diet. The pateints medical record was noted (Assessment and Referral), but the patient's did not have a special diet logged with the hospital dietician.

During Record Review, Patient #1, Patient #2, and Patient #3 were noted as being able to successfully elope from the hospital grounds.

During Interview with Hospital Staff #8 reported each patient was returned to the facility, but failed to report this incident to the department. The patients were able to get outside of hospital grounds without proper supervision or monitoring. The patients were able to kick open a unit exit door. As a result the patients were eventually returned to the hospital by police.

Policy

The hospital policy on Neglect Abuse dated 07/17/2019 reflected, "Perimeter Healthcare promotes and requires professional, ethical and legal conduct of staff. The advocacy role of health care is maximized when addressing issues of conduct of staff. Perimeter Healthcare assesses the conditions of illegal, unethical and/or unprofessional conduct of staff. All health care services providers will immediately report to the appropriate supervisors, manager, or department head any suspected illegal, unethical and/or unprofessional conduct by another individual. Illegal, unethical and/or unprofessional conduct by any health care services providers are prohibited behaviors and will be grounds for disciplinary action and reporting to local and or state regulatory and/or legal authorities as mandated by statue, hospital policy and/or regulation(s). It is the responsibility of all staff members and health care professionals of Perimeter Healthcare to report concerns regarding illegal, unethical and/or unprofessional conduct to hospital administration."

The hospital Policy on Patient Rights dated 07/17/2019, reflected, "The rights, benefits, responsibilities, and privileges guaranteed by the constitutions and laws of the United States of Texas unless they have been restricted by specific provisions of law. The rights include, but are not limited to, the right to impartial access to and provision of treatment, regardless of race, nationality, religion, sex, ethnicity, sexual orientation, age, or disability; the right to petition for habeas corpus; the right to register and vote at elections, the right to acquire use, and dispose of property including contractual licenses, permits, privileges and benefits under law, the right to religious freedom and rights concerning domestic relations."

The hospital Policy on Nursing Services dated 07/17/2019 reflected, "It is the policy of the Perimeter Healthcare Nursing Services Department to provide the highest attain able quality of nursing care to all patients consistent with the mission, values, vision and goals."

The hospital Policy on Dietary Services 02/2020 reflected, "A registered Dietician is available for consultation regarding special dietary needs and for nutritional assessment as identified as a need from the Nursing Assessment nutrition screening section and/or treatment team planning. Snacks approved by the Registered Dietician are made available in the patient dining area at specific times per the unit schedule. Special diets and special snacks may be provided when required by patient condition."

The hospital Policy on Administration/Personnel Perimeter Healthcare is dedicated to providing patient-centered care and working to understand each individual's needs in order to supply excellent, differentiated treatment plans. We strive to employ passionate mental health professionals to ensure the highest level of care by providing hope and transforming lives.

The hospital Policy on Physical Environment 08/2022 reflected, "Perimeter Healthcare shall maintain building features to protect staff, patients and visitors from fire and smoke. The Elements of Performance for this standard are included in the Electronic Statement of Conditions (e-SOC).
Original construction on the building was completed in 1985. At that time the property was rural and later was annexed by the City of Arlington. With approximately 44,000 square feet the building is compartmentalized with two compartments of approximately equal size that are separated by a fire/smoke partition rated with a one-hour fire resistant construction.
Occupancy classification is 1-2 Institutional Occupancy and construction type is Type II-B. *The building does not comply with 100% of the requirements for Type II-B construction. Due to being annexed by the City of Arlington post construction the building is simply non-conforming.
Originally licensed as a "Psychiatric Hospital" on 12/5/1984 the building met the "minimum requirements for construction & equipment for private Psychiatric Hospitals, Licensed by the Texas Department of Mental Health and Mental Retardation" in compliance with 1998 NFPA Life Safety Codes, Chapter 12 - New Health Care Occupancies.

The hospital Policy on Emergency Behavioral Interventions Use of Restraint/Seclusion 07/2019 reflected, " IT is the policy of Perimeter Healthcare to create an environment that protects the patient health and safety and preserves his or her dignity, rights and well-being. All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member or others. In recognition that the patient has the right to be free of seclusion or restraint in any form that is not medically necessary; seclusion and restraint are to be used only in clinically appropriate and adequately justified situations when other less restrictive intervention have been determined ineffective or inappropriate. The use of Seclusion or Restraints at Perimeter Healthcare will be initiated in response to a behavioral emergency, and when less restrictive interventions have been determined to be ineffective to protect the patient or others from harm. It is the intent of Perimeter Healthcare to reduce the use of restraint and seclusion to the extent possible. Other less restrictive alternatives are to be attempted first, unless they are determined to be ineffective of are judged unlikely to protect the individual or others from harm. Before ordering restraint or seclusion, the physician and staff must consider identified contraindications and other information and factors indicative of negative results to patient care outcome(s).

The hospital Policy on Elopement/AWOL dated 05/2022 reflected, "It is the policy of Perimeter Healthcare to minimize the potential for elopement from secured inpatient clinical units through prompt identification and/or intervention for patients at risk. Although staff shall look for missing patients, it is the philosophy of Perimeter Healthcare that staff will not provide chase to patients who elope from the facility."

The hospital Policy on Incident Reported to the Department 04/2022 reflected, "The Incident Report is a mechanism for informing administration of the occurrence of circumstances surrounding individual problematic events. An 'Incident' is defined as any happening that is not consistent with the normal or usual operations of the hospital and/or department. Injury does not have to occur. The potential for injury and/or property damage is sufficient for an event to be considered an incident. Incidents are reviewed by the Perimeter Healthcare Performance Improvement Committee and referred to other committees as indicated by the hospital or legal, regulatory or accreditation requirements."

The hospital failed 4 of 4 Patients (Patients #1, #2, #3, and Patient #4) by failing the Patients Rights to receive care in a safe setting.


Findings Include

During record review, the hospital failed to reprimand Staff #9 after abondoning his shift.

During record review, the hospital failed to reprimand Staff #9 after engaging in a physical altercation with with Patient #3.

During interview Staff #2 confirmed there was video footage and documentation of Staff #9 engaging in a Physical altercation with Patient #3, and the hospital failed to report this incident to the department.

During record review Staff #11 failed to follow up with closure of the allegations incident involving staff #9, The hospital Staff #1 confirmed through documentation that Staff #9 returned to work and had been retrained.

During interview it was reported at the conclusion of this investigation Staff #9 was terminated as a result of this investigation.

During record review the hospital staff #2, Staff #8 confirmed that the doors on the girls unit automatically opens at midnight and the unit is monitored by staff rounding. The hospital indicated that their is repair work on the unit and the unit has been temporarily closed post investigation due to failure to properly repair doors.

During Record Review Hospital staff failed properly assess Patient #1's diet when the Patient arrived to the unit. The hospital Staff #12 failed to have a Log or Special Diet for Patient #1 after not recieving orders for the special diet. The pateints medical record was noted (Assessment and Referral), but the patient's did not have a special diet logged with the hospital dietician.

During Record Review, Patient #1, Patient #2, and Patient #3 were noted as being able to successfully elope from the hospital grounds.

During Interview with Hospital Staff #8 reported each patient was returned to the facility, but failed to report this incident to the department. The patients were able to get outside of hospital grounds without proper supervision or monitoring. The patients were able to kick open a unit exit door. As a result the patients were eventually returned to the hospital by police.


Policy

The hospital policy on Neglect Abuse dated 07/17/2019 reflected, "Perimeter Healthcare promotes and requires professional, ethical and legal conduct of staff. The advocacy role of health care is maximized when addressing issues of conduct of staff. Perimeter Healthcare assesses the conditions of illegal, unethical and/or unprofessional conduct of staff. All health care services providers will immediately report to the appropriate supervisors, manager, or department head any suspected illegal, unethical and/or unprofessional conduct by another individual. Illegal, unethical and/or unprofessional conduct by any health care services providers are prohibited behaviors and will be grounds for disciplinary action and reporting to local and or state regulatory and/or legal authorities as mandated by statue, hospital policy and/or regulation(s). It is the responsibility of all staff members and health care professionals of Perimeter Healthcare to report concerns regarding illegal, unethical and/or unprofessional conduct to hospital administration."

The hospital Policy on Patient Rights dated 07/17/2019, reflected, "The rights, benefits, responsibilities, and privileges guaranteed by the constitutions and laws of the United States of Texas unless they have been restricted by specific provisions of law. The rights include, but are not limited to, the right to impartial access to and provision of treatment, regardless of race, nationality, religion, sex, ethnicity, sexual orientation, age, or disability; the right to petition for habeas corpus; the right to register and vote at elections, the right to acquire use, and dispose of property including contractual licenses, permits, privileges and benefits under law, the right to religious freedom and rights concerning domestic relations."

The hospital Policy on Nursing Services dated 07/17/2019 reflected, "It is the policy of the Perimeter Healthcare Nursing Services Department to provide the highest attain able quality of nursing care to all patients consistent with the mission, values, vision and goals."

The hospital Policy on Dietary Services 02/2020 reflected, "A registered Dietician is available for consultation regarding special dietary needs and for nutritional assessment as identified as a need from the Nursing Assessment nutrition screening section and/or treatment team planning. Snacks approved by the Registered Dietician are made available in the patient dining area at specific times per the unit schedule. Special diets and special snacks may be provided when required by patient condition."

The hospital Policy on Administration/Personnel Perimeter Healthcare is dedicated to providing patient-centered care and working to understand each individual's needs in order to supply excellent, differentiated treatment plans. We strive to employ passionate mental health professionals to ensure the highest level of care by providing hope and transforming lives.

The hospital Policy on Physical Environment 08/2022 reflected, "Perimeter Healthcare shall maintain building features to protect staff, patients and visitors from fire and smoke. The Elements of Performance for this standard are included in the Electronic Statement of Conditions (e-SOC).
Original construction on the building was completed in 1985. At that time the property was rural and later was annexed by the City of Arlington. With approximately 44,000 square feet the building is compartmentalized with two compartments of approximately equal size that are separated by a fire/smoke partition rated with a one-hour fire resistant construction.
Occupancy classification is 1-2 Institutional Occupancy and construction type is Type II-B. *The building does not comply with 100% of the requirements for Type II-B construction. Due to being annexed by the City of Arlington post construction the building is simply non-conforming.
Originally licensed as a "Psychiatric Hospital" on 12/5/1984 the building met the "minimum requirements for construction & equipment for private Psychiatric Hospitals, Licensed by the Texas Department of Mental Health and Mental Retardation" in compliance with 1998 NFPA Life Safety Codes, Chapter 12 - New Health Care Occupancies.

The hospital Policy on Emergency Behavioral Interventions Use of Restraint/Seclusion 07/2019 reflected, " IT is the policy of Perimeter Healthcare to create an environment that protects the patient health and safety and preserves his or her dignity, rights and well-being. All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member or others. In recognition that the patient has the right to be free of seclusion or restraint in any form that is not medically necessary; seclusion and restraint are to be used only in clinically appropriate and adequately justified situations when other less restrictive intervention have been determined ineffective or inappropriate. The use of Seclusion or Restraints at Perimeter Healthcare will be initiated in response to a behavioral emergency, and when less restrictive interventions have been determined to be ineffective to protect the patient or others from harm. It is the intent of Perimeter Healthcare to reduce the use of restraint and seclusion to the extent possible. Other less restrictive alternatives are to be attempted first, unless they are determined to be ineffective of are judged unlikely to protect the individual or others from harm. Before ordering restraint or seclusion, the physician and staff must consider identified contraindications and other information and factors indicative of negative results to patient care outcome(s).

The hospital Policy on Elopement/AWOL dated 05/2022 reflected, "It is the policy of Perimeter Healthcare to minimize the potential for elopement from secured inpatient clinical units through prompt identification and/or intervention for patients at risk. Although staff shall look for missing patients, it is the philosophy of Perimeter Healthcare that staff will not provide chase to patients who elope from the facility."

The hospital Policy on Incident Reported to the Department 04/2022 reflected, "The Incident Report is a mechanism for informing administration of the occurrence of circumstances surrounding individual problematic events. An 'Incident' is defined as any happening that is not consistent with the normal or usual operations of the hospital and/or department. Injury does not have to occur. The potential for injury and/or property damage is sufficient for an event to be considered an incident. Incidents are reviewed by the Perimeter Healthcare Performance Improvement Committee and referred to other committees as indicated by the hospital or legal, regulatory or accreditation requirements."

The hospital Failed 1 of 1 Patient (Patient #1), by failing to include a therapeutic diet ordered by a practitioner responsible for the care of the patietns, or by a qualified nutrition profession as authroized by the medical staff and and in accordance with teh State Law governing dietitians and ntrition professionals.

Findings Include:

During Record Review Patient #1's (Assessment and Referral) reflected Patient is not to sugar due to medical condition.

During Record Review Physician Orders do not follow up Patient #1's diet, request for a sugar free diet.

During Record Review there is no Orders or Specialized diet found in the Dietician's Patient Specialized Diet food log.

During Interview Hosptial Staff #6 verified with the surveyor that there was no record of Physician Order or Specialized Diet noted by the dietician in the medical record. There is no regular food log to identify what Patient #1 consumed while in the hospital.

During Interview Hospital Staff #6 verified with the Staff #12, that there was no Specialized Diet in the Dieticians Log Book identified for Patient #1.

Policy
The hospital Policy on Abuse, Neglect, Exploitation, Unethical or Unprofessional Conduct dated 06/2022 reflected, "Perimeter Healthcare promotes and requires professional, ethical and legal conduct of staff. The advocacy role of health care is maximized when addressing issues of conduct of staff. Perimeter Healthcare assess the condition of illegal, unethical and/or unprofessional conduct of staff. All health care service providers will immediately report to the appropriate supervisor, manager, or department head any suspected illegal, unethical and/or unprofessional conduct by another individual. Illegal, unethical and/or unprofessional conduct by any health care service providers are prohibited behaviors and will be grounds for disciplinary action and reporting to local and/or state regulatory and/or legal authorities as mandated by statute, hospital policy and/or regulation(s). It is the responsibility of all staff members and healthcare professionals of Perimeter Healthcare to report concerns regarding illegal, unethical and/or unprofessional conduct to hospital administration."

The hospital Policy on Dietary Services 02/2020 reflected, "A registered Dietician is available for consultation regarding special dietary needs and for nutritional assessment as identified as a need from the Nursing Assessment nutrition screening section and/or treatment team planning. Snacks approved by the Registered Dietician are made available in the patient dining area at specific times per the unit schedule. Special diets and special snacks may be provided when required by patient condition."

The hospital Policy on Patient Rights dated 07/17/2019, reflected, "The rights, benefits, responsibilities, and privileges guaranteed by the constitutions and laws of the United States of Texas unless they have been restricted by specific provisions of law. The rights include, but are not limited to, the right to impartial access to and provision of treatment, regardless of race, nationality, religion, sex, ethnicity, sexual orientation, age, or disability; the right to petition for habeas corpus; the right to register and vote at elections, the right to acquire use, and dispose of property including contractual licenses, permits, privileges and benefits under law, the right to religious freedom and rights concerning domestic relations."