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Based on record review and interview, the hospital failed to ensure the complainant was provided written notice of the hospital's decision in response to a filed grievance for 1 (#2) of 2 (#2, #R1) sampled patients reviewed for grievances.

Findings:

Review of the hospital's complaints and grievances for the last 12 months revealed the hospital had received notification on 8/19/17 of a grievance filed by the family of Patient #2 alleging the patient had been physically and sexually abused during her stay at the hospital from 8/3/17-8/10/17.

In an interview on 12/12/17 at 9:30 a.m. with S1Adm and S3HR (Human Resources), they indicated the hospital had received complaint documentation from the local DA's (District Attorney) office informing them that the family of Patient #2 was filing a complaint with LDH-HSS alleging abuse/neglect of the patient during her hospital stay in August of 2017. S1Adm and S3HR confirmed, during the interview, that an investigation had been conducted into the allegations of physical abuse.

In an interview on 12/12/17 at 9:40 a.m. with S1Adm, she confirmed the hospital had not provided a written response to the complainant (Patient #2's family), as of 12/12/17, detailing the hospital's decision regarding the grievance referenced above.

Based on record review and interview, the hospital 1) failed to report allegations of abuse/neglect to LDH-HSS (Louisiana Department of Health-Health Standards Section) within 24 hours of receipt of the allegation for 1 (#2) of 2 (#2, #R1 ) sampled patients reviewed for grievances; and 2) failed to ensure an allegation of sexual abuse was thoroughly investigated for 1(#2) of 2 (#2, #R1) sampled patients reviewed for grievances alleging sexual abuse.

Findings:

1) Failure to report allegations of abuse/neglect to Louisiana Department of Health within 24 hours of receipt of the allegation.

Review of the hospital's complaints and grievances for the last 12 months revealed the family of Patient #2 had filed a grievance on 8/19/17 alleging the patient had been physically and sexually abused during her stay at the hospital from 8/3/17-8/10/17.

Review of the LDH Hospital Abuse/Neglect Initial Report form, utilized by the hospital to self-report allegations of abuse/neglect to LDH-HSS, revealed the following, in part: Fax completed form to 225-342-0157 within 24 hours of awareness of allegation.

Review of the hospital's self-reports of allegations of abuse/neglect to LDH-HSS for the last 12 months revealed no documented evidence that the allegations of abuse/neglect regarding Patient #2 had been reported to LDH-HSS within 24 hours of discovery/becoming aware of the allegations.

In an interview on 12/12/17 at 9:30 a.m. with S1Adm and S3HR, they indicated the hospital had received complaint documentation from the local DA's (District Attorney) office informing them that the family of Patient #2 was filing a complaint with LDH-HSS alleging abuse/neglect of the patient during her hospital stay in August of 2017.

In an interview on 12/12/17 at 9:40 a.m. with S1Adm, she confirmed the hospital had not self-reported the allegations of abuse (physical and sexual) of Patient #2 (during her hospital stay in August 2017) to LDH-HSS within 24 hours of receiving notification of the allegations. S1Adm also confirmed the hospital had not, as of 12/12/17, self-reported the allegations abuse/neglect of Patient #2 to LDH-HSS.

2) Failure to ensure an allegation of sexual abuse was thoroughly investigated.

Review of the hospital's complaints and grievances for the last 12 months revealed the family of Patient #2 had filed a grievance on 8/19/17 alleging the patient had been physically and sexually abused during her stay at the hospital from 8/3/17-8/10/17.

Review of the grievance filed by Patient #2's family revealed the patient had made statements to the family saying she wanted to kill someone because they had put their finger in her rectum and vagina. Further review revealed the patient, as quoted by the family, had made the following statement when being cleaned and changed," I know all you want to do to me is play with me. "

Review of the hospital's investigation of allegations of abuse of Patient #2 during her hospital stay in August 2017 revealed no documented evidence of an investigation into the allegations of sexual abuse. Further review revealed no documented evidence that law enforcement had been notified of the allegations of sexual abuse of Patient #2.

In an interview on 12/12/17 at 9:00 a.m. with S3HR, she indicated she remembered Patient #2. She said she had assisted in the investigation regarding allegations of physical abuse. S3HR was shown the above referenced statements, made by the patient, that were included in the grievance information and she indicated she had not seen the allegations of sexual abuse. S3HR said she remembered the patient's daughter had said something about her mother being touched. S3HR said they had told the patient's daughter they could watch the hospital's video recordings during Patient #2's stay, but there were no cameras in the shower room or in the patient bedrooms. S3HR reported they had reviewed video recordings of the patient's stay and the patient had not had any bruising in her private area.

Based on interview and record review, the registered nurse failed to supervise and evaluate the nursing care provided to each patient as evidenced by failing to ensure the condition of patients' skin was accurately assessed, both on admit and daily, as per policy, for 3 (#2, #3, #5) of 5 sampled patients reviewed for skin assessments.

Findings:

Review of the hospital policy titled, "Wound Care" revealed in part: The purpose of this policy is to identify any alterations in skin integrity, to give the nurse insight into the patient's risk for skin compromise and ultimately early interventions to help protect skin/wound from infection or further compromise. Procedure: The RN will be responsible for the following procedure for wound care. 1. Will assess the patient skin for alteration in skin integrity upon admission. 6. Will provide a skin and wound assessment daily or as ordered by wound care instructions for dressing changes by the physician.

Patient #2
Review of Patient #2's medical record revealed an admission date of 8/3/17 with an admission diagnosis of worsening Dementia. Further review revealed the patient had abnormal clotting studies and her Coumadin (anticoagulant medication) had been held from 8/7/17 to 8/10/17 due to the abnormal results. Additional review revealed a discharge date of 8/10/17.

Review of Patient #2's medical record revealed an admit skin assessment had been performed on 8/3/17 at 9:00 p.m. The admit skin assessment revealed the following findings: Redness to sacrum, Stage I to left buttock- reddened, blistered, bruise to left upper thigh, bruise to left lower leg, bruises to left antecubital and arm. The documentation of the bruises failed to include a description of the bruising such as color, size, and whether the bruise was flat or raised.

Further review revealed a weekly skin assessment, dated 8/17/17, which revealed the following: Stage I to buttock- reddened, blistered to buttocks Stage II to left groin-excoriation see nursing notes.

Review of Patient #2's daily nurses' note entries for 8/4/17- 8/9/17 revealed the only documentation of Patient #2's bruising was a check marked in a box labeled "bruising". Further review revealed no documented evidence of a description of the patient's bruising such as the number, location, size, color, and whether the bruise was flat or raised.

Additional review revealed a nurses note late entry, dated 8/10/17 at 2:15 p.m. The nurses' note revealed the following: Called into shower room by MHT to assess extensive bruising on left chest wall, and breast. S1OMD still present on unit, meeting with family and notified of additional bruising.

Patient #3
Review of Patient #3's medical record revealed an admission date of 12/6/17. Further review revealed the patient had a co-morbid diagnosis of Diabetes Mellitus Type II and was receiving Sliding Scale insulin for treatment of his blood sugar.

Further review of the patient's medical record revealed the patient's skin had been assessed on admit and multiple actinic keratosis growths had been noted on both of his arms, both hands, and legs. The patient was also noted to have crumbling, thickened toenails (all 10 nails were affected), and hardened skin growths on the left side of his right great toe and the right side of his left great toe.

Review of Patient #3's daily nurses' notes dated 12/7/17, 12/8/17, 12/10/17, and 12/11/17 revealed no documented evidence of assessment of the patient's skin and no entries describing the identified skin issues referenced above. The spaces referencing assessment of skin issues (choices provided were excoriated, rash, skin tears/wounds and bruises) were left blank.

On 12/13/17 at 1:30 p.m. an observation was made of Patient #3. The observation revealed the patient had multiple actinic keratosis growths on both of his arms, both hands, and legs. The patient was also noted to have crumbling, thickened toenails (all 10 nails were affected), and hardened skin growths on the left side of his right great toe and the right side of his left great toe. S2DON was interviewed during the observation and confirmed the observed findings. She agreed the patient's skin should have been assessed daily and the findings should have been reflected in the daily nurses' notes. S2DON agreed accurate skin assessments were especially important since this patient was Diabetic.

Patient #5
Review of Patient #5's medical record revealed an admission date of 9/18/17 with an admission diagnosis of Schizophrenia, Parkinson's Disease, and Dementia. Further review revealed a discharge date of 9/22/17.

Review of Patient #5's medical record revealed an admit skin assessment had been performed on 9/18/17 and the patient was noted to have a bruise on his right shoulder (documented as wound #4). Further review revealed no documented evidence of a description of the size, the color, and whether the bruise was flat or raised. Additional review of patient #5's daily nurses' note skin assessments revealed the following: 9/19/17 7:00 a.m. and 7:00 p.m.: no assessment or mention of bruise to right shoulder; 9/20/17: 7:00 a.m.: Bruise to right shoulder with no further description, 7:00 p.m.: Bruise: checked box but no description or location was documented; 9/21/17: 7:00 a.m. and 7:00 p.m.: Bruise documentation box left blank and no other documentation noted.

In an interview on 12/12/17 at 10:16 a.m. with S2DON, she indicated patient skin assessments were to be performed upon patient admission and daily. S2DON acknowledged the documentation of patient skin assessments was poor. She confirmed the hospital's current skin assessment policies had not addressed documentation of bruising such as the number of bruises, the location, the color, and whether the bruise was flat or raised on the daily skin assessments. S2DON indicated the daily nursing skin assessments only had a check box indicating bruising was present with no further details. S2DON agreed accurate assessment and documentation of bruising was especially important with a patient like Patient #2 who had been receiving Coumadin and had abnormal clotting studies which increased her risk for all types of bleeding.

Based on record reviews and interview, the hospital failed to ensure the RN assigned the nursing care of each patient to other nursing personnel in accordance with the specialized qualifications and competence of the nursing staff available . This deficient practice was evidenced by the hospital's failure to maintain documented evidence of staff training and competence in safe methods of manual patient transfers for 3MHTs (S5MHT, S6MHT, S7MHT) of 3 MHT personnel records reviewed from a total of 5 personnel records reviewed.

Findings:

Patient #2
Review of Patient #2's medical record revealed an admission date of 8/3/17 with an admission diagnosis of worsening Dementia. Further review revealed the patient had abnormal clotting studies and her Coumadin (anticoagulant medication) had been held from 8/7/17 to 8/10/17 due to the abnormal results. Additional review revealed a discharge date of 8/10/17.

Review of Patient #2's medical record revealed an admit skin assessment had been performed on 8/3/17 at 9:00 p.m. The admit skin assessment revealed the following findings: Redness to sacrum, Stage I to left buttock- reddened, blistered, bruise to left upper thigh, bruise to left lower leg, bruises to left antecubital and arm. Additional review revealed a nurses note late entry, dated 8/10/17 at 2:15 p.m. The nurses' note revealed the following: Called into shower room by mental health tech to assess extensive bruising on left chest wall, and breast. S1OMD still present on unit, meeting with family and notified of additional bruising.

In an interview on 12/12/17 at 9:30 a.m. with S2DON, she indicated the bruising on Patient #2's chest had been made by hands of the staff when grasping the patient under the arms to lift and transfer her from the geri chair to the bed. She agreed there was a better method for transferring the patient such as using a drawsheet.

Review of the personnel records of S5MHT, S6MHT, and S7MHT revealed no documented evidence of training and competence in safe methods of manual patient transfers.

In an interview on 12/12/17 at 10:16 a.m. with the S2DON, she confirmed the staff had only been trained in use of the Hoyer (mechanical) lift for patient transfers. S2DON indicated the Hoyer lift was no longer used to transfer patients because it did not work with the hospital's box type patient beds. S2DON confirmed the staff and had no training on safe manual patient transfer techniques. She agreed the method currently being used by staff to transfer patients was not the safest method of manual transfer. She acknowledged the staff needed training on safe patient transfer techniques.

In an interview on 12/12/17 at 10:24 a.m. with S4RN, she confirmed the hospital no longer used a Hoyer lift for patient transfers because it did not work with the hospital's box type patient beds. She reported she had witnessed MHT staff manually transferring patients by grasping them under the arms, encircling the patient's chest with their arms/hands, and grasping their feet while moving them from one location to another (such as from geri-chair to bed).

In an interview on 12/13/17 at 1:05 p.m. with S5MHT, she confirmed she had taken care of patients that required assistance with transfers. She indicated the hospital no longer had a Hoyer lift for patient transfers because of the box type patient beds in the hospital. She reported patients were transferred manually with two staff members. She said one staff member grasped the patient under the arms, encircling the patient's chest with their arms, and the other person held the patient's legs/feet. S5MHT explained the patient was then lifted and placed on the bed after being grasped under the arms and legs.