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.

FAITH REGIONAL HEALTH SERVICES 2700 WEST NORFOLK AVE NORFOLK, NE 68701 July 19, 2016
VIOLATION: PATIENT RIGHTS: NOTICE OF RIGHTS Tag No: A0117
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on record and staff interviews and review of policy and procedures the Acute Care Hospital failed to provide patient rights information to 6 of 16 (Patients 11, 12, 13, 14, 15 and 16) sampled patients on admission. This had the potential to affect all patients being admitted to the facility. The facility census was 62 on entrance.

Findings are:

A. A record review revealed the following medical records lacked the signed acknowledgement of receipt of the Patient Rights and Responsibilities information on admission:
-Patient 11 admitted [DATE] for pneumonia (infection in lungs) and congestive heart failure (build up of fluid in the body due to heart failure).
-Patient 12 admitted [DATE] for a knee replacement surgery.
-Patient 13 admitted [DATE] congestive heart failure.
-Patient 14 admitted [DATE] for [DIAGNOSES REDACTED] (inflammed gall bladder) and sepsis (bloodstream infection).
-Patient 15 admitted [DATE] for pneumonia and sepsis.
-Patient 16 admitted [DATE] for peripheral artery disease of lower leg. (blood flow issue requiring a surgical graft to re-establish the blood flow).

B. A review of the "Patient Rights and Responsibilities" policy and procedure (PolicyStat ID 70) dated 8/2015 revealed:
-"In order to assure that all patients are informed of the Rights and Responsibilities as patients within the FRHS (Faith Regional Health Services) Organization, a copy of (FRHS) Patient Rights and Responsibilities will be given to all patients and/or patient representative upon admission to any (FRHS) service."
-"At time of registration, the patient will sign that they have received the Patient Rights and Responsibilities. If verbally consent for treatment is obtained, the Patient Rights and Responsibilities will be mailed to the individual that granted the consent to treat."

C. A staff interview with the Chief Operations Officer (COO) on 7/18/16 at 10:50 AM, verified that Patients 11, 12, 13, 14, 15 and 16's signed acknowledgement of receiving the Patient Rights and Responsibilities was not on the patient's records. Upon investigation of the missing forms it was found that in April 2015 an error was made in Registration regarding the need of providing and obtaining acknowledgement of receipt of the patient Rights and Responsibilities for the patients with each admission. The Registration area was under the impression that the need to provide the patient with the Patient Rights and Responsibilities and obtaining the acknowledgement was only needed yearly so if the patient had been previously admitted in that year cycle it was not obtained.