HospitalInspections.org

Based on a review of documentation and interview it was determined the facility failed to Properly executed informed consent forms for procedures and treatments specified by the medical staff, or by Federal or State law if applicable, to require written patient consent. The facility failed to failed to comply with the rules of the Texas Administrative Code Chapter 414, Subchapter I of this title (relating to Consent to Treatment with Psychoactive Medication--Mental Health Services), as evidence by failing to ensure that psychoactive medication consent was obtained for each individual psychoactive medication administered.

Findings included:
The Texas Administrative Code Chapter 414, Subchapter I of this title (relating to Consent to Treatment with Psychoactive Medication--Mental Health Services) states in part,

"§414.405. Documentation of Informed Consent.
(a) Informed medication consent must be obtained for each individual medication, not by medication class.
(b) Informed consent for the administration of each psychoactive medication will be evidenced by a completed copy of the department's form, Consent to Treatment with Psychoactive Medication (MHRS 9-7 form (or other format including the same information)) executed by the patient or his or her LAR. A copy of which may be obtained by contacting TDMHMR, Office of Policy Development, P.O. Box 12668, Austin, TX 78711-2668."
Facility based policy entitled, "Patient Rights and Responsibilities Informed Consent for Psychotropic Medication" stated in part,
"Patients, or legal representatives, have the right to make an informed decision to agree to take, or refuse, antipsychotic/psychotropic medications. The treating physician, RN, LVN, or PA will explain the need, benefits, potential drawbacks to psychoactive medication proposed for use to patient and his or her legal representative. Such explanations will be clear, in non jargon language and in the patient's primary language when possible. The Contents [sic] for psychoactive medications will be signed by the pateint or legal representative with staff witness signature."
Review of medical records reveal 1 of 4 patients did not have psychoactive medication consents appropriately completed for the administration of psychoactive medication.
Pateint # 17 received Celexa, Klonopin, Depakote, and Trazadone without any consents for the administration of psychoactive medication completed.
The above findings were confirmed in an interview on 04/ 22/15 with staff member # 24

Based on a tour of the facility and interview, it was determined the facility failed to ensure the physical plant was maintained in such a manner that the safety and well-being of patients are assured.

Findings included:

During a tour of the facility on 04/21/15 the following observations were made:
* In Operating room # 2 a stool used by anesthesia was noted to have 4 X 8 inch piece of tape in the center of the seat. Tape prevents effective cleaning of the surface of this stool.
* In the Operating Room supply closet, bins were noted to have visible dust and debris present.
* In the hallway outside the CT area, cracked tile was observed on the floor, 2 chipped areas, approximately 2 inches and 3 inches in size. This prevents effective cleaning of the floor surface.
* In the Skills Assessment room 2 large pieces of duct tape were observed on the floor approximately 4 feet wide, preventing effective cleaning if the floor in this area.
* In 1 out of 3 outpatient rooms toured, dust was observed on the high horizontal area in this room, indicating ineffective cleaning of the area.

During a tour of the facility on 04/22/15 the following observations were made:
* In the Geriatric Psychiatric unit, the shower room was noted to have rust present on the disability assistive handle bar. Rust cannot be effectively cleaned, increasing the risk for contamination.
* In the kitchen this surveyor asked staff member #35 what solution was used to wipe down kitchen surfaces to decontaminate. The staff member indicated a white unlabeled bucket containing a clear liquid and washcloths. They stated the bucket contained diluted bleach. The staff member was unable to state what the concentration of bleach to water used for sanitizing was. The staff member stated, "there used to a sign that said how much bleach to add, I don't know where it went." The staff member was unable to confirmed the bleach concentration or when it was filled. Without noting the concentration and when mixed, it is unknown how effective this mixture was at sanitizing and decontaminating surfaces in the kitchen.

The above findings were confirmed in an interview on 04/22/15.