The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

RIVERVIEW REGIONAL MEDICAL CENTER 600 SOUTH THIRD STREET GADSDEN, AL 35901 May 11, 2017
VIOLATION: PATIENT RIGHTS: PARTICIPATION IN CARE PLANNING Tag No: A0130
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interviews and medical record review, the hospital failed to develop an individualized therapeutic recreational plan for Patient Identifier (PI) # 1. As a result, PI # 1's recreational preferences were not identified. There was no oversight of Activities staff by a Certified Recreational Therapist. This deficient practice affected PI # 1 and had the potential to affect all patients served by the Geriatric Psychiatric Unit.

Findings include:

PI # 1 was admitted on [DATE] to the Geriatric Psychiatric Unit with bizarre behavior and disorganized thought processes. Diagnoses include Dementia in Alzheimer's Disease with early onset with behavioral disturbance, Alcohol Abuse and Major Depressive Disorder, severe, recurrent, without psychotic features.

During an interview with PI # 1 on 4/9/17, PI # 1 stated the only activity offered was coloring and PI # 1 does not like to color.

A review of PI # 1's Care Plan dated 2/15/17 and 2/22/17 revealed:

Problem # 1: Dementia with Behavioral Disturbance;
Problem # 2: Self Care Deficit;
Problem # 3: Risk for Falls and
Problem # 9: Discharge Planning.

A review of the Activities Notes as documented by the CTRS, Certified Therapeutic Recreation Therapist, revealed:

2/16/17 at 10:18 AM: "Patient (PI # 1) is confused with a flat affect. Patient did attend group and participated without prompting...did not attend social time but did come to relaxation group.

There is no documentation to indicate the name/type group PI # 1 attended, nor were any details documented about PI # 1's participation or response to the groups.

There was no documentation for group on 2/18/17 (Saturday) or 2/19/17 (Sunday).

2/20/17 at 10:38 AM: "Patient (PI # 1) has poor eye contact and a blunted affect. Patient did attend morning groups but refuses to participate in group. Patient did come to afternoon groups but did not participate."

There was no documentation about the content of the groups, nor were attempts to engage PI # 1 documented.

2/21/17 at 10:51 AM: "Patient (PI # 1) has poor eye contact and a blunted affect. Patient did attend morning groups but refuses to participate in group. Patient did come into the dayroom but did not participate. Patient would come and go at lib."

There was no documentation regarding the content of the specific groups, nor were attempts to engage PI # 1 documented.

2/22/17 at 10:40 AM: "Patient (PI # 1) did attend group but was uncooperative. Patient refuses to say a goal and decide what to eat for the day."

There was no documentation regarding the content of the specific groups, nor were attempts to engage PI # 1 documented.

During an interview on 5/10/15 at 3:10 PM, the Director of the Geriatric Psychiatric Unit / Employee Identifier (EI ) # 1 stated no recreational assessment was done. The activities are provide by a Mental Health Worker who obtained a recreational certification. No recreational therapist provides oversight.

"Recreational programs promote quality of life by providing an appropriate level of stimulation using meaningful activities. Greater efficacy is realized when activity interventions are individualized along the lines of a person's interests and functional abilities, www.ncbi.nlm.nih.gov/pmc/articles/PMC 21."