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HARLAN ARH HOSPITAL 81 BALL PARK ROAD HARLAN, KY 40831 Feb. 11, 2015
VIOLATION: PATIENT RIGHTS: FREE FROM ABUSE/HARASSMENT Tag No: A0145
Based on observation, interview, and review of the facility policy, the facility failed to ensure patients were free from abuse and harassment. Interviews conducted on 02/09/15 and 02/11/15 with the facility patients revealed the patients observed inappropriate interactions between female patients on the unit and a security officer and reported the observations to the facility staff. Interviews conducted on 02/09/15 and 02/11/15 with facility staff revealed staff suspected a security officer was having inappropriate interactions (talking, kissing, and possibly sexual acts in exchange for lighters, cigarettes, and tobacco) with female patients on the unit. Facility staff failed to report the suspected abuse to administrative staff according to facility policy. Furthermore, the facility failed to ensure staff with access to patients and patient care areas was trained regarding the abuse and neglect policy of the facility. A review of Security Officer #1's (a contracted employee) employee file revealed the Security Officer was not trained regarding the facility's abuse and neglect policy and procedures.

The findings include:

A review of the facility policy, "Reporting of Abuse, Neglect, Harassment and Exploitation," not dated, revealed any person having reasonable cause to suspect a patient has suffered abuse, harassment, or exploitation shall immediately report the incident to their immediate supervisor. Further review of the facility policy revealed the facility staff received training related to the abuse policy and procedures upon hire and annually.

Interview on 02/09/15 at 4:05 PM with Patient #1 revealed the patient stated "no comment" when asked if a security officer brought the patient a lighter into the facility in exchange for a sexual act. Patient #1 further stated, "Only God knows the answer to that question."

Interview on 02/09/15 at 4:15 PM with Patient # 5 revealed the patient observed Security Officer #1 walk down the hall and around the corner out of the sight of the cameras multiple times throughout the weekend of 02/06/15 - 02/08/15 with Patient #1 and Patient #4. Patient #5 denied observing anything inappropriate taking place between the patients and the security officer; however, Patient #5 stated the other patients on the unit were stating the security officer brought tobacco and lighters to the patients in exchange for sexual favors. Patient #5 revealed he/she had informed staff of the incidents earlier in the day on 02/09/15.

Interview on 02/11/15 at 1:15 PM with unsampled Patient A revealed he/she observed Security Officer #1 and Patient #1 kissing in the hallway on Saturday or Sunday (02/07/15 or 02/08/15) and at a later time observed Security Officer #1 pass something to Patient #1 in the day area. The interview further revealed Patient A made the staff aware of his/her suspicions on 02/07/15 or 02/08/15, but could not remember which staff he/she informed.

Interview on 02/11/15 at 11:33 AM with Security Officer #1 revealed the security officer denied having inappropriate interactions with the patients and denied bringing items to the patients. Security Officer #1 revealed he did spend a lot of time on the unit because he had applied for a job as a sitter on the unit and was trying to get familiar with the job.

Interview on 02/09/15 at 3:35 PM with Patient Care Attendant (PCA) #1 revealed the PCA observed instances on Friday, Saturday, and Sunday (02/06/15, 02/07/15, and 02/08/15) of Security Officer #1 walking down the hallway and Patient #1 and Patient #4 following him out of sight of the staff and cameras. PCA #1 stated she was suspicious that something sexually inappropriate could be going on between the patients and the security officer. The PCA revealed she did not report the incidents because she had no proof, but was further suspicious due to items (cigarettes, tobacco, and lighters) appearing on the unit when the patients had no visitors.

Interview on 02/11/15 at 1:36 PM with Certified Nurse Aide (CNA) #2 revealed on Sunday, 02/08/15, Security Officer #1 walked through the unit multiple times. CNA #2 stated Security Officer #1 was observed to go out of sight. Patient #4 followed him and they were gone for a couple of minutes. CNA #2 revealed she walked down the hallway but they were both walking back so the CNA did not witness anything inappropriate. The interview further revealed a lot of contraband such as lighters, tobacco, and cigarettes had been on the unit and the CNA was suspicious that the security officer was bringing the items in to the patients in exchange for sexual favors. The CNA denied reporting the incident to her supervisor because it was just a suspicion and the CNA had no proof anything occurred.

Interview on 02/10/15 at 5:38 PM with Registered Nurse (RN) #1 revealed she was told in report on Saturday 02/07/15 to watch Patient #1, Patient #4, and Security Officer #1 for inappropriate behaviors. RN #1 stated she was told in report that the patients and the security officer were seen in the hall together at different times and items such as lighters, tobacco, and cigarettes had appeared on the unit even though there had been no visitors. RN #1 stated staff was suspicious that the security officer was bringing the items to patients in exchange for "favors," possibly sexual in nature. RN #1 revealed Security Officer #1 was on the unit often and was "chit-chatty" with the patients. RN #1 stated she had not observed anything inappropriate and did not report the incidents because she did not witness anything.

Interview on 02/11/15 at 11:19 AM with RN #2 revealed the RN was instructed in report to watch Patient #1, Patient #4, and Security Officer #1 because staff was suspicious that the security officer was bringing items to the patients that they were not allowed to have in exchange for sexual or inappropriate favors. RN #2 revealed Security Officer #1 was on the unit often and talked a lot with the patients, but denied witnessing anything inappropriate. RN #2 stated she did not report anything because she did not witness anything inappropriate.

A review of the employee file and training for Security Officer #1 revealed no documented evidence the Security Officer was trained by the facility on the abuse/neglect policy and procedures.

Interview on 02/11/15 at 10:55 AM with Security Officer #1 revealed he was not trained regarding the facility's abuse policy.

Interview on 02/11/15 at 11:12 AM with the Security Supervisor revealed the Security Officers were not employed by the facility but were contracted by the facility to provide security. The Supervisor denied the Security Officers received training related to the facility's abuse policy.

Interview on 02/11/15 at 1:45 PM with the Nurse Manager revealed he was made aware of the possible inappropriate behaviors of the security officer and patients by a patient on the unit on 02/09/15. The interview revealed the Nurse Manager immediately informed Administration and an investigation was initiated and the allegation was reported to the state agencies. Further interview revealed Security Officer #1 was suspended while the investigation was ongoing.

Interview on 02/11/15 at 2:00 PM with the Risk Manager revealed the facility began an investigation of the incident as soon as they were aware of the incident. The interview further revealed Security Officer #1 was suspended immediately on 02/09/15 when the administrative staff was made aware of the allegations. The Risk Manager revealed the investigation was currently ongoing with patients and staff being interviewed. Further interview with the Risk Manager revealed the facility did not train the contract staff regarding the abuse policy of the facility.