HospitalInspections.org

This CONDITION is not met as evidenced by:

Based on observation, interview and record review, the facility failed to protect patient's rights, placing all patients at risk for loss of their rights. Findings include:

--The facility failed to obtain consent for treatment and inform 2 current patients (#1 and #12) of their rights, resulting in increase risk of all patients not being informed of rights and granted consent rights. (A-0117)
--The facility failed to provide patients on 3 units (1 South, 4 South and the Generations Unit) with the State Agency's contact information, resulting in the potential of denying all patients the the right to file a complaint/grievance in writing with the State Agency. (A-0118)
--The facility failed to monitor hazardous cleaning products on the Inspirations Unit on 8/26/14, resulting in increased risk of poisoning for all patients. (A-0144)
--The facility failed to ensure that a physician's order was obtained for restraints for 1 of 1 current patients (#1) resulting in increased risk of all patients being restrained without physician's orders. (A-0168)

Based on interview and record review, the facility failed to obtain consent for treatment and inform 2 current patients (#1 and #12) of their rights, resulting in increase risk of all patients not being informed of rights and granted consent rights. Findings include:

On 8/26/14 at approximately 1510, patient #12's treatment consent and rights notification documents were reviewed with staff A. Patient #12 was admitted on a Voluntary basis on 8/16/14. The Facility Admission Note, Adult Inpatient Program Regulations and Procedures, Confidentiality, Acknowledgement of Receipt of Notice of Privacy Practices and Medicare Information Sheet and An Important Message from Medicare, were all unsigned in the patient's chart. No documentation explaining this finding was found. These findings were verified during record review by staff A. The only note on these documents stated that the patient "wants to talk with the doctor." Staff A stated that these documents should have been signed or an explanation of why they weren't signed should have been noted.

On 8/26/14 at approximately 1505, patient #1's legal status, guardianship papers, treatment consent and rights notification consent forms were reviewed with staff A. Patient #1 was admitted to the facility on 8/20/14. Staff A confirmed that partial guardianship papers in patient #1's medical record were current and gave patient #1's guardian the right to "consent to any necessary medical treatment...make all legal, contractual and financial decisions on behalf of the ward...make program and placement decisions." Patient #1's clinical record contained no documentation of any patient consent or rights notification forms being sent to the patient's guardian. Staff A confirmed these findings.

Based on observation and interview the facility failed to provide the patients with the State Agency's contact information, resulting in the potential of denying all patients the the right to file a complaint/grievance in writing with the State Agency. Findings include:

On 8/26/14 from approximately 1000 to 1145 during observations while touring the hospital it was revealed that 1 South, 4 South and the Generations Unit did not have the State Agency phone number and address to allow the patient's to file a grievance.

On 8/26/14 at approximately 1045, during an interview with staff D, it was stated "We do not have the contact information for the state posted on 1 South, 4 South and the Generations Unit yet. The signs are ordered."

Based on observation and interview, the facility failed to monitor hazardous cleaning products on the Inspirations unit, resulting in increased risk of poisoning for all current patients. Findings include:

On 8/26/14 at 1035 a strong odor of bleach was noted in the hallway on the Inspirations Unit. A bleach-soaked wash cloth, one spray bottle of Clorox with Bleach and one spray bottle of Tilex were observed, unattended by staff, in patient room #328 on the Inspirations Unit. Both products were labeled "keep out of the reach of children." Patients were visible in the hallway outside of this room. There was no staff member in the room or within the line of sight of these hazardous products. Staff G stated that she had left the cleaning products unattended after being called to assist in another room.

Based on interview and document review, the facility failed to document obtaining a physician's orders for restraints or seclusion for 1 of 1 current patients (#1), resulting in increased risk of all patients being restrained or secluded without physician's orders. Findings include:

Record Review and Interview:
On 8/26/14 at 1530 documentation of patient #1 being restrained or secluded was reviewed with staff F. Staff F verified the following during record review:
--On 8/21/14 at 1550 Dr. I documented: "Pt (patient #1)...found in 4 point restraints." An unsigned "Restraint/Seclusion and Flow Record" noted that patient #1 was placed in seclusion and 4-point restraints from 1525-1925. No physician orders for restraints or seclusion were found.
--On 8/24/14 at 0845 and 1125 nurse J wrote two separate verbal orders for patient #1 for Haldol 10 mg., Ativan 4 mg. and Benadryl 50 mg. by IM (intramuscular injection). Neither of these telephone orders named an ordering physician or was signed by a physician. A progress note by nurse J stated that patient #1: "Received Haldol 10 mg, Ativan 4 mg, Benadryl IM x 1 now at 1135. At 1235 pt (patient) rec'd (received) Haldol 10 mg and Benadryl 50 mg IM x 1 now per order."
--On 8/24/14 at 1135 nurse J wrote a telephone order for 4-point restraints for up to 4 hours. This order did not name an ordering physician and was not signed. "The Restraint/Seclusion Usage Log" indicates that patient #1 was placed in 4-point restraints from 1135-1235 on 8/24/14.

Policy Review:
On 8/26/14 at 1545 the facility's undated policy titled Noting Medication Orders was reviewed. The policy stated: "The RN/LPN or Pharmacist must document the receipt of the order in the following manner: Verbal Order (Telephone Order), Joe Smith, MD/Jane Doe, RN" indicating the name and title of the ordering Physician followed by the name and title of the person receiving the order. This notation must be followed by the date and time and the signature and credentials of the person receiving the order."

On 8/26/14 at 1550 the facility's policy titled: Restraint and Seclusion, dated 8/22/14 was reviewed. The policy defined chemical restraint as: "the use of a drug or medication, not routinely prescribed/dosed for the patient's condition, for patient behavior management or restrictive movement."