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Based on observation, interview, and record record review, the facility failed to develop care or treatment plan for thirty-one of thirty-one sampled patients (Patients 1 - 31). The facility failed to develop care plans for patient's behavior putting them at risk of contracting COVID - 19 (coronavirus disease, a new infectious disease caused by a virus that can spread person to person via respiratory droplets, symptoms include fever, cough, and shortness of breath).

This deficient practice resulted in patients not having a plan of care for the potential risk of contracting COVID - 19 due to their risky behavior.

Findings:

On 8/4/2020, beginning at 8:50 AM, the following was observed during the initial tour of the facility.

Four patients and one staff member were observed in the day room of the DDMI unit. None of the four patients wore face mask. One patient was observed wandering in the hallway, without a face mask.

Six patients and two staff members were observed in the day room of 2 North unit. None of the patients wore face mask.

Five patients and one staff member were observed in the day room of 1 North unit. Two of the patients wore face mask below the chin, not covering their nose or mouth.

On 8/5/2020 at 10:37 AM, during a concurrent interview, and review of Patient 26's medical record, the Chief Nursing Officer (CNO) stated that Patient 26 tested positive for COVID - 19 and was discharged to an acute care hospital on 3/25/2020. The CNO stated that treatment plans relating to the potential exposure for COVID - 19 were only developed for roommates and not for all patients.

A review of Patient 26 medical record indicated Patient 26 was originally admitted to the facility on 2/22/2019 to the EICU unit. Patient 26's diagnosis included psychosis (loss of contact with reality). Patient 26 tested positive for COVID - 18 on 3/25/2020. Patient 26 was discharged short term care on 3/25/2020 and readmitted on 4/9/2020.

A review of Patient 21's medical record indicated Patient 21 was admitted to the facility on 2/20/2020 to the EICU unit. Patient 21's diagnosis included schizophrenia (a mental illness characterized by psychosis, hallucinations, delusions, and disorganized thinking).

A review of medical records for Patient 1 - 31, indicated that none of patients had a care plan developed for the potential exposure to COVID - 19.

A review of the line list, indicated that six patients (Patients 26, 27, 28, 29, 30, and 31) tested positive for COVID - 19, between 3/25/2020 and 7/7/2020.

On 8/5/2020 at 10:47 AM, the CNO stated that since the COVID - 19 pandemic began, six patients and 10 healthcare workers tested positive for COVID - 19. The CNO stated that patients who tested positive for COVID - 19 were transferred out of the facility to be medically cleared in order to return to the facility.

On 8/5/2020 at 10:54 AM, during an interview, the Infection Control Practitioner (ICP) stated that everyone, everywhere was at risk of contracting COVID-19, including all patients. ICP verified that none of the patients (Patient 1 - 31) had care plans developed for the potential exposure of COVID - 19. The ICP stated all patients should have a care plan relating to the potential exposure to COVID - 19.

On 8/5/2020 at 11:30 AM, during an interview, the Nurse Manager (NM 1) stated Patient 21 was in the same unit (EICU) as Patient 26 when Patient 26 tested positive for COVID - 19. NM 1 stated Patient 21 was exposed to COVID - 19, and verified their was no care plan developed for potential exposure to COVID - 19. NM 1 stated that all patients on the EICU unit should have had care plans developed for the potential exposure to COVID - 19.

The facility's policy and procedure titled, "Interdisciplinary Treatment Planning," dated 8/2018, indicated each patient admitted to the hospital shall have a written treatment plan that is appropriate to the patient's specific assessed needs. The treatment plan will be revised and maintained based on the patient's response to identified interventions. The treatment plan shall be individualized to meet the patient's unique needs and circumstances as identified through assessment data and patient/family in-put to the extent possible, and shall be appropriate to the patient's needs, strengths, limitations, and goals.