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ASSURANCE HEALTH PSYCHIATRIC HOSPITAL
PATIENT RIGHTS: CARE IN SAFE SETTING
Tag No.: A0144
Based on document review and interview, the facility failed to ensure patients received care in a safe setting by failing to ensure line of site (LOS) order was followed for 1 (P2) out of 10 patients medical record reviewed.
Findings Include:
1. Review of policy titled: "Patient Rights and Responsibilities", Policy No.: RE 09. Reviewed 10/2020. Purpose: 4. Patient has a right to be treated in a safe environment, with respect for personal dignity, autonomy and privacy.
2. Review of P2 medical record indicated the patient was admitted to the facility on 04/09/2022 with a diagnosis of dementia with aggressive behaviors. He/She was placed on a line of site order for safety. MR indicated on 04/18/2022 P2 was found with a peer in his/her bed with no bottom clothing on... The facility failed to maintain a Line of Site observation on P2.
3. Interview on 04/27/2022 with A1 at 1500 hours, confirmed that the facility failed to follow the Line of Site order for P2.