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Based on record review and interview, the facility failed to develop individualized physician and nursing treatment interventions based on the individual needs of the patients for eight (8) of eight (8) sample patients (G6, G20, H5, H7, K7, K8, J15 and J24). This failure resulted in staff being unable to provide direction, consistent approaches and focused treatment for the patients' identified problems.

Findings include:

A. Record Review

1. Patient G6's Master Treatment Plan dated 3/17/16 identified the problem, "Pt. has a history of assaulting his father." There were no physician interventions. There were no nursing safety interventions.

2. Patient G20's Master Treatment Plan dated 3/16/16 identified the problem, "Pt. has thoughts of cutting himself." There were no physician interventions. There were no nursing safety interventions.

3. Patient H5's Master Treatment Plan dated 3/25/16 identified the problem, "Patient attempted to kill herself by over dosing on pills." There were no physician interventions. There were no nursing safety interventions.

4. Patient H7's Master Treatment Plan dated 3/25/16 identified the problem, "Pt. hears voices that tell her to hurt herself." There were no physician interventions. There were no nursing safety interventions.

5. Patient K7's Master Treatment Plan dated 3/10/16 identified the problem, "Pt. interacts with staff and peers with either anger or jokingly hits pt. in the back of the head." There were no physician interventions. There were no nursing safety interventions.

6. Patient K8's Master Treatment Plan dated 3/10/16 identified the problem, "Paranoid." The following was the only physician intervention: "MD/NP will meet [with] pt. at least monthly [and] prn to establish trust [with] pt. [and] encourage to interact [with] staff." This was not individualized for this patient. There were no nursing interventions.

7. Patient J15's Master Treatment Plan dated 3/16/16 identified the problem, "[Patient] is noncompliant with medications." The following was the physician intervention: "Recommend and monitor psychotropic medication and therapy by clinical counselor to educate patient about importance and need of medications." This intervention did not name the specific medications or the focus of the medication. The following was the nursing intervention: "[Nursing] staff will observe pt. taking medications and will sit at cheeking table [with] pt. for 30 minutes after taking medications." This intervention was not individualized for this specific patient.

8. Patient J24's Master Treatment Plan dated 3/15/16 identified the problem, "Belief that they have babies." The following was the only physician intervention: "Meet with pt. at least monthly to discuss symptoms, beliefs, and any side effects." This physician intervention was not specific for this patient. The following was the only nursing intervention: "Staff will talk [with] pt. to direct toward happening of now." This nursing intervention was not specific to individual patient's needs.

B. Interviews:

1. On 3/29/16 at 10:00 a.m. RN4 stated, "Yes, the nursing interventions do not include safety issues."

2. On 3/29/16 at 11:00 a.m. the Director of Nursing stated, "Interventions should include what to do [referring to aggressive behaviors]. You must ensure that you include monitoring to keep the patient safe."

3. On 3/29/16 at 2:00 a.m. the Medical Director stated, "The physicians are having trouble wording their interventions. There is also confusion about the role of the scribe."