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Based on review of documents and staff interview, the hospital failed to provide a complainant with a written response to concerns (complainant #3). This affected one (1) of ten (10) medical records reviewed. This has the potential to limit the patient's right to have their concerns addressed in accordance with the hospital Grievance Policy (page 4), dated 1/30/09. Findings include:

1. Upon receipt of the complaint regarding complainant #3, the hospital provided evidence they had investigated the matter and made the file available to surveyors.

2. During interview with the Psychiatric Unit Nurse Manager on 9/8/10 in the a.m. he stated that after he investigated the complaint he forwarded the complaint to the Risk Manager in Administration. The Risk Manager verified during interview (the same afternoon) that he received the complaint but did not provide the complainant with a written response regarding the hospital's investigation and the results of the hospital's effort made on behalf of the complainant.

3. The hospital's complaint policy dated 1/30/09 (page 2) indicated in part, "Patient grievances also include situations where ...patient's representative phone or write Appalachian Regional Healthcare about concerns related to care or services, or with an allegation of abuse or neglect ....... ."

4. The Complaint Policy (dated 1/30/09) indicated on page 4 that "In its resolution of the grievance, the organization must provide the patient/patient representative with written notice of its decision and must include: The name of the contact person, the steps taken on behalf of the patient, the results of the grievance process and the date of the completion".

5. These findings were reviewed and verified with the Psychiatric Unit Nurse Manager on 9/9/10 in the p.m.

Based on review of documents, medical record and staff interview it was determined the hospital failed to protect the rights of the patient (#1), in one (1) of ten (10) medical records reviewed for the right to be able to request or refuse treatment. This has the potential to negatively affect all hospitalized patient's, by interfering with their right to refuse treatment.
Findings include:

1. Hospital Policy #51/57.32 relative to Discharge Against Medical Advice (AMA), last reviewed/revised 6/26/08, states in part: "If attempts to persuade the patient to remain in treatment fail, the RN Team Leader will: Contact the attending physician with the patient's request for AMA."

2. Patient #1 was admitted to the hospital (Behavioral Science Unit-BSU) on 7/15/10 and discharged on 7/19/10. Nursing documentation indicates the patient requested to leave daily and the physician was not notified.

3. During interview conducted with the Clinical Nurse Manager of the BSU in the morning of 9/7/10 and again in the afternoon of 9/8/10, he revealed there was a miscommunication during the admission of the patient. He feels the staff were led to believe the patient was an involuntary commitment and therefore did not realize the patient could leave the hospital at his will. He also stated the patient had been admitted previously as an involuntary commitment (3/10). He also stated the hospital did not pursue an involuntary commitment for this patient, as he did not display any of the behaviors reported leading up to the admission. The staff was under the impression the family was initiating the mental hygiene request and later realized the family had no intentions of pursuing this avenue at that time.

Based on observation during a complaint investigation conducted on 09/07/10 to 09/09/10, it was determined the hospital failed to provide/maintain the required special design consideration for the environment on the Behavioral Science Center unit to prevent potential patient injury or suicide. Therefore, this Condition is not met. Refer to physical environment deficiency identified as tag A0722.

Based on observation and staff interview it was determined the hospital failed to maintain a sanitary environment for all patients. Findings include:

1. On 09/07/10 between the time frame of 10:00 a.m. and 1:00 p.m., a tour of the hospital's Behavioral Science Center (BSC) was conducted. At this time, the following observations were made on the B unit:

a. The vinyl floor surfaces in the patient rooms on the B unit were observed to be inadequately cleaned and appeared not to have been scrubbed, sealed, and waxed on a routine basis.

b. The wall surfaces were damaged in room 171, seclusion room and the corridor. The condition of these walls does not allow them to be adequately cleaned.

2. On 09/09/10 at approximately 10:00 a.m., an interview with the housekeeping director revealed that the floor surfaces in the patient rooms on the B unit had not been scrubbed, sealed, and waxed since his employment date of approximately ten (10) months.

Based on observation it was determined the hospital failed to maintain the required special design consideration for the environment by failing to remove all potential looping devices in the Behavioral Science Center (BSC) unit. Findings include:

1. On 09/08/09 at approximately 10:00 a.m., a tour of the hospital Behavioral Science Center (BSC) unit was conducted. At this time, the following design requirements of AIA guidelines for Design and Construction of Health Care Facilities in reference to behavior/psychiatric units were observed not to be met:

a. Sixteen (16) of thirty (30) patient rooms had ceiling mounted sprinkler heads (not the required institutional type). Also, other areas in BSC unit that did not have the required institutional type sprinkler heads were the corridors, personal laundry rooms, seclusion room (A and B unit), and group rooms (A and B unit). All sprinkler heads in the BSC unit must be institutional type heads.

b. Thirty (30) of (30) patient toilet rooms had wall mounted toilet water service lines and hand sink plumbing exposed creating tie-off points. The handicap shower on B unit was equipped with a grab bar that did not have the space filled between the wall and bar creating another tie-off point.

c. Room 124 on the adolescent unit did not have the required type water service handle in the shower.

d. Handrails are installed in the B unit corridor and are not designed to prevent them from being a looping device.

e. Door handles and hinges in the common areas of this unit do not meet the required design standards. Also, self closures on smoke barrier doors must be spring type or mounted on the outside of the unit.

These conditions found in the BSC unit are not giving the required special design consideration to prevent patient injury or suicide.