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MCDOWELL ARH HOSPITAL 9879 KENTUCKY ROUTE 122 MC DOWELL, KY 41647 Dec. 13, 2017
VIOLATION: STAFF TREATMENT OF RESIDENTS (483.13(C)) Tag No: C0384
Based on interview, record review, and review of facility policies, it was determined the facility failed to report an allegation of patient abuse to state agencies and failed to ensure one (1) of ten (10) sampled patients was protected from further potential abuse (Patient #1). Review of a facility investigation revealed on 12/06/17 Patient #1 reported that Registered Nurse (RN) #1 touched the patient's breast inappropriately. RN #1 reported the allegation to the facility House Nurse Coordinator; however, the RN was not removed from direct patient care as required by the facility's policy and continued to provide care for Patient #1. In addition, there was no evidence the allegation was reported to the appropriate state agencies immediately and to hospital administration as directed by facility policy.

The findings include:

Review of the "House Nurse Coordinator" position description, dated 10/01/04, revealed the House Nurse Coordinator was accountable for the management of nursing services on a given shift under the guidance of the Director of Nursing Services in order to provide safe, effective, and efficient nursing care. Further review revealed the House Nurse Coordinator reported to the Community Chief Nursing Officer.

Review of the facility policy titled "Abuse, Neglect, Exploitation of Patients and Reporting," dated May 2017, revealed any person having reasonable cause to suspect that a patient had suffered abuse, neglect, harassment or exploitation shall immediately report the incident to their supervisor or House Supervisor. The policy stated the Community Chief Nursing Officer, Administrator On Call, and the CCRAO (compliance officer) should also be notified. Further review revealed patients must be immediately protected from further abuse during investigation of any allegation. The policy stated if an employee was accused of an act of abuse, neglect, harassment, or exploitation, that person should be reassigned to a non-patient care area or placed on leave until cleared of the allegation.

Review of Patient #1's medical record revealed the facility admitted the patient on 12/06/17, with a diagnosis of drug overdose. Review of the nurse's notes dated 12/06/17 at 5:40 PM revealed RN #1 assisted Patient #1 to the bathroom and back to bed. Afterwards, the patient stated to the RN, "You grabbed my titty." The RN called the nurses' station and requested that State Registered Nurse Aide (SRNA) #1 and SRNA #2 immediately come to the patient's room and reattach the patient's heart monitor. According to the nurse's note, the RN then called the facility House Nursing Coordinator and informed her of the incident. The House Nursing Coordinator instructed the nurse to have a female staff member go with the nurse when the nurse needed to enter Patient #1's room. There was no documented evidence the allegation was reported to hospital administrative staff in accordance with the facility's policy and no evidence that the appropriate state agencies were notified of the allegation immediately.

Review of a facility investigation dated 12/07/17 revealed Patient #1 reported to another staff member that a male nurse had touched the patient inappropriately the day before. Further review revealed the Community Chief Nursing Officer, Administrator, and CCRAO, and the state agency were notified of the allegation at that time (one day after the incident occurred).

Interview with the House Nurse Coordinator on 12/13/17 at 2:15 PM revealed RN #1 reported the patient's allegation on the evening of 12/06/17, and she instructed the RN not to enter the patient's room alone. The House Nurse Coordinator stated she did not go to the patient's room to discuss the incident with the patient, did not remove RN #1 from direct patient care, and did not ensure Patient #1's safety. Further interview revealed the House Nurse Coordinator was aware of the facility's policy regarding protection of patients and abuse reporting but did not follow facility policy in this case.

Interview with the Community Chief Nursing Officer on 12/13/17 at 4:16 PM revealed facility staff were expected to immediately report any allegations of abuse or neglect to the House Nurse Coordinator, who should in turn report the allegation to her. The Community Chief Nursing Officer stated if the allegation had been properly reported, RN #1 would have been immediately removed from direct patient care pending the outcome of the investigation.