HospitalInspections.org

Based on interview and record review, the facility failed to ensure staff followed their policy and procedures for investigating allegations of sexual abuse for 1 (#1) of 5 patients alleging abuse, resulting in the potential for less than optimal outcomes. Findings include:
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A-118
Failure to investigate a grievance of allegations of sexual abuse for 1 (#1) of 1 patients that alleged sexual abuse.

Based on document review and interview, the facility failed to implement their policy for patient concerns and grievances for 1 (#1) of 5 patients reviewed for complaints/grievances, resulting in the potential for less than optimal outcomes. Findings include:

On 2/7/2020 at 1100, review of the Grievance Logs revealed there were no entries for complaints/grievance for patient #1. During an interview on 2/7/2020 at 1115 Staff B confirmed there were no complaints or grievances logged for patient #1.

On 2/11/2020 at 0950 an interview was conducted with Social Worker Staff I. When queried regarding patient #1's course of stay during her hospitalization (1/28/20-2/5/20), Staff I explained that she had received a phone call from the patient's husband after the patient's discharge. Staff I said she did not recall the day or time that the call was received. Staff I explained that the patient's husband had called to report that his wife had been "sexually violated" while at the facility. Staff I said the patient's husband was angry on the phone call. When further queried Staff I said she did not have any notes or documentation pertaining to the phone call or follow-up regarding the phone call.

At that time, Staff I was asked to explain her actions after she received the phone call from patient #1's husband regarding the allegations of sexual abuse. Staff I stated, I reported the allegations to the charge nurse (Staff J).

On 2/11/2020 at 1010, Charge Nurse Staff J was interviewed. Staff J was asked to explain if she was aware of allegations of sexual abuse that were reported to her by Staff I. Staff J responded, "I have no knowledge of that."

On 2/11/2020 at 1150, Chief Nursing Officer Staff F was interviewed regarding the allegations of sexual abuse and lack of documentation and follow-up related to allegations reported to Staff I by the patient's (#1's) spouse. Staff F explained that she would do more investigation.

On 2/11/2020 at 1540, Recipient Rights Advisor Staff B reported that 2 attempts to reach the patient via phone were unsuccessful on 2/8/2020.

There was no further evidence provided by the facility that documented the patient's grievance was under investigation by facility staff according to their policy and procedure.

A review of the facility's "Patient Concerns and Grievances" policy dated December 2019 documented:
B. Receipt of Grievance:
1. "...Grievances about such situations that endanger the patient, such as abuse or neglect, should be handled immediately, given the seriousness of the allegation and the potential for harm to the patient."
C. Patient Grievance Tracking:
1. All patient complaints and grievances are logged and filed by the Recipient Right Office for trending purposes and future reference by the hospital or legal counsel.