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Based on review of medical records, personnel records, hospital policies and procedures, and staff interview, the hospital failed to protect and promote each patient ' s rights related to the right to be free from all forms of abuse and harassment.
Findings were:
Staff #1 verbally harassed and abused Patient #1 by yelling and not allowing Patient #1 to request discharge when under a voluntary status.
Cross refer: CFR 482.24(c)(1)

Based on review of medical records, hospital policies and procedures, and staff interview, the facility failed to ensure the right for patients to be free from all forms of abuse and harassment.

Findings were:

A review of the facility based internal investigation regarding the complaint filed by Patient # 1 revealed, 3 witnesses (Staff # 2, 3, and 4) that confirmed observing Staff # 1 yell at Patient # 1. Staff member # 1 confirmed that he was frustrated and lost his composure during this encounter with Patient #1.

Facility policy & procedure titled Abuse, Neglect, and Exploitation states, in part, " Mental abuse-Includes cursing a patient, telling a patient to " shut up " , threatening a patient with physical or emotional harm, yelling at a patient, verbally tormenting a patient. "

A review of the facility based internal investigation related to a complaint by Patient # 1, also revealed that on the evening of 11/23/2011 Staff # 2 observed Patient # 1 tell Staff # 1 that she wanted to leave the facility due to her voluntary status. Staff # 2 observed Staff # 1 telling Patient # 1 who was voluntary, that she could not leave until she was assessed by the police. The same evening staff # 3 observed Staff #1 stating on the phone that Patient #1 " was going to elope " . There was no documentation present in the clinical record for Patient # 1 to indicate any request for discharge.

Facility policy & procedure titled Voluntary Patient Requesting Discharge states, in part,
" A. Persons voluntarily admitted to inpatient services for treatment of a psychiatric disorder have the right to request release from the hospital at any time.
B. A person requesting release shall be given by nursing staff on the person ' s unit an explanation of the process for requesting release and shall be afforded the opportunity to request release in writing. "

Facility policy & procedure titled Patient ' s Bill of Rights states, in part,
" Voluntary Patients -Special Rights
1. You have the right to request discharge from the hospital. If you want to leave, you need to say so in writing or tell a staff person you want to leave, the staff person must write it down for you ...
3. You have the right not to have an application for court ordered services filed while you are receiving voluntary services at the hospital unless you physician determines that you meet the criteria for court-ordered services as outlined in ?573.022 of the Texas Health and Safety Code ... "

In an interview on 1/4/12, the Director of Nursing acknowledged that the facility failed to ensure the right for patients to be free from all forms of abuse and harassment as evidence by Patient # 1 being yelled at by Staff member #1 and policy was not followed regarding Patient # 1, a voluntary patient making a request for discharge.

Based on review of 1 of 1 patient records and staff interview, the director of nursing service failed to ensure that nursing staff documented or communicated a change in patient dietary information.

Findings were:

Review of the medical record for Patient #2 revealed that a registered nurse (RN) documented on 11/17/11 at 1805 that " Pt refused breakfast. Stated it has meat on tray and that he was vegetarian. Pt was offered cereal or breakfast bar. Pt refused. " There was no documentation in the record to indicate that the RN addressed the information that the patient stated he was a vegetarian. There was no documentation in the medical record that the RN notified the physician that the patient stated he was vegetarian, and no documentation of a referral by the nurse for a nutrition assessment. Review of facility policy, " Diet Order Communication " Policy number DT-105 stated " 6. The RD will be notified of any special diets (i.e., gluten-free or renal) to assure the diet is ordered by the MD. "
Review of facility policy, " Nutrition Risk Assessment " Policy number DT-123 stated, " i. Nursing assesses weight changes, intake prior to admission, special diet needs, altered nutrition-related labs ...food allergies/intolerances, and cultural/religious diet needs ...ii. The nurse makes a referral for RD services ... "

The above was confirmed in interview on 1/4/12 with the Director of Nursing and Risk Manager.

Based on review of 1 of 1 patient records and staff interview, the director of nursing service failed to ensure the medical record for Patient #2 was promptly completed..

Findings were:

Review of the medical record for Patient #2 revealed that 13 out of 19 entries by the Mental Health Techs on the " Vital Signs Flow Sheet " were incomplete in the columns for percent of meals/diet intake. The " Vital Signs Flow Sheet " checklist graphic to document percent of meals/diet intake was incomplete for 11/5/11, 11/7/11, 11/8/11, 11/9/11, 11/10/11, 11/11/11, 11/12/11, 11/13/11, 11/14/11, 11/15/11, 11/17/11, 11/18/11, and 11/19/11. The entire column and patient information/results for 11/15/11 was missing from the medical record.

Review of the medical record for Patient #2 revealed that the nursing " 24-Hour Nursing Assessment and Patient Education " note was incomplete as 9 out of 19 entries for " % of Meal Eaten " were incomplete, including 11/4/11, two undated notes filed between 11/5/11 and 11/7/11, 11/8/11, 11/13/11, 11/18/11, 11/19/11, 11/20/11, and 11/22/11.

Review of facility policy, " Recording Meal Intake in Medical Records " Policy number DT-125 stated " Staff will document the percentage of meal consumed for each resident on a meal by meal basis ...1. MHT ' s or nursing staff covering the dining room will record the percentage eaten for each meal by each patient on the graphics page for that meal. "

The above was confirmed in interview on 1/4/12 with the Director of Nursing and Risk Manager.