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.

PARIS REGIONAL MEDICAL CENTER 820 CLARKSVILLE ST PARIS, TX 75460 July 12, 2013
VIOLATION: PATIENT RIGHTS: GRIEVANCES Tag No: A0118
Based on observation, interview and record review the facility failed to ensure patient grievances about the elevated air temperatures were resolved promptly.
This deficient practice had the potential to cause harm to all patients.
Findings include:

Review of the facility policy "Patient Complaint/Grievance" revised 04/2013 revealed the following definitions:
"Patient Complaint: a verbal or written expression of dissatisfaction with some aspect of care and or services that can be resolved immediately by staff present, manager or their designee. Most complaints will have simple and obvious causes that can be promptly addressed to the patient' s satisfaction between the patient, hospital staff and the Patient Relations Coordinator.
Patient Grievance: a formal, written or a verbal complaint by patient or the patient's representative, regarding the patient's care, abuse or neglect. If it cannot be resolved promptly by the staff present, is postponed for later resolution, if referred to other staff for later resolution, requires investigation, and/or requires further actions for resolution then the complaint is classified as a grievance. Patient grievances will be sent through the process defined in this policy and will require a written response. A complaint received by email or fax is considered "written".
If staff present cannot resolve a complaint, they are to report it to the Patient Relations Coordinator.
Employees who receive complaints are to enter them in Occurrence Insight located on ( the hospital's name) intranet. All complaints filed in Occurrence Insight are forwarded to the Patient Relations Coordinator for investigation. Information should include at minimum the patient' s name, details of the complaint/grievance and contact information for follow up.
The Patient Relations Coordinator shall conduct or direct the investigation. An investigation will begin within 24 hours of the receipt of the grievance and a response will be provided within 24 hours of completion of the investigation.
The Patient Relations Coordinator will ensure that a written response is sent to the appropriate party regarding the grievance. This response should be be sent within 30 days .....
The Patient Relations Coordinator will enter complaints and grievances into a database for appropriate tracking, monitoring and trendings .... "

During observations on 07/11/2013 starting at 4:15 p.m. air temperatures were found above 75 degrees on the 4th floor, 5th floor and patients in the emergency room waiting area were complaining about the heat in the area.
During an interview on 07/11/2013 at 4:30 p.m., Staff #13 reported they knew something was wrong with the air conditioner because during January 2013 they did not have to use the heat much. Staff #13 reported when she received complaints they were put into the computer system as work orders. The stream of patient complaints started in May 2013 about the air. Staff #13 reported the air temperature felt a lot better today than on yesterday. Staff #13 reported they have been working to get something done and getting quotes to get the system fixed. Since Staff #3 started working there he had brought in an air conditioner company (1 month ago).
During a confidential interview it was reported the temperature had been that way (warm) in a patient's room since Tuesday (07/09/2013) and it had been reported to staff.
During an interview on 07/11/2013 at 6:35 p.m., Staff #10 reported she had worked in the emergency department for 3 months. Every time the temperature gets hot outside it gets warm in the emergency room waiting room area. The problem had been already been reported to maintenance.
Review of the complaint/grievance log from 04/01/2013-07/03/13 revealed no complaints about the air conditioning.
Review of "Service Call Work Order" from 05/01/2013 -07/09/2013 revealed the following:
*Eighteen (18) complaints about it being too hot in the emergency room , intensive care unit, 4th floor rooms, and 5th floor rooms.
*There were 4 out of the 18 complaints with work orders completed within 24 hours. The other work orders were completed in a timeframe of 48 hours -21 days.
During an interview on 07/12/2013 at 10:21 a.m., Staff #12 reported she had been over complaint and grievances since 04/08/2013. There was a problem with the complaints going to the wrong campus and she was still trying to get them caught up. Staff #12 confirmed there were no complaints logged about the air conditioner in her log. She confirmed the complaints on the work orders and agreed she should have been informed of them. Staff #12 confirmed all the patient identifying information was not listed on the work order forms for her to follow up on the complaints. Staff #12 reported Staff #3 who was over maintenance was not trained yet to access the computerized complaint system. Staff #12 provided the surveyor with an incident form dated 07/10/2013 which she had given to maintenance to resolve. The incident form revealed on 07/09/2013 at 6:00 p.m. there were visitor complaints of the emergency department having an " uncomfortable environment ". There was documentation on the form that for the past 2 days there was extreme heat glaring into the ER (emergency room ) waiting area through the large window. Staff #12 documented on the form for Staff #3 to let her know what to do for this so they could close out the incident report.
VIOLATION: PATIENT RIGHTS: GRIEVANCE REVIEW TIME FRAMES Tag No: A0122
Based on observation, interview and record review the facility failed to ensure patient grievances about the elevated air temperatures were resolved promptly.
This deficient practice had the potential to cause harm to all patients.
Findings include:

Review of the facility policy "Patient Complaint/Grievance" revised 04/2013 revealed the following definitions:
"Patient Complaint: a verbal or written expression of dissatisfaction with some aspect of care and or services that can be resolved immediately by staff present, manager or their designee. Most complaints will have simple and obvious causes that can be promptly addressed to the patient' s satisfaction between the patient, hospital staff and the Patient Relations Coordinator.
Patient Grievance: a formal, written or a verbal complaint by patient or the patient's representative, regarding the patient's care, abuse or neglect. If it cannot be resolved promptly by the staff present, is postponed for later resolution, if referred to other staff for later resolution, requires investigation, and/or requires further actions for resolution then the complaint is classified as a grievance. Patient grievances will be sent through the process defined in this policy and will require a written response. A complaint received by email or fax is considered "written".
If staff present cannot resolve a complaint, they are to report it to the Patient Relations Coordinator.
Employees who receive complaints are to enter them in Occurrence Insight located on ( the hospital's name) intranet. All complaints filed in Occurrence Insight are forwarded to the Patient Relations Coordinator for investigation. Information should include at minimum the patient' s name, details of the complaint/grievance and contact information for follow up.
The Patient Relations Coordinator shall conduct or direct the investigation. An investigation will begin within 24 hours of the receipt of the grievance and a response will be provided within 24 hours of completion of the investigation.
The Patient Relations Coordinator will ensure that a written response is sent to the appropriate party regarding the grievance. This response should be be sent within 30 days .....
The Patient Relations Coordinator will enter complaints and grievances into a database for appropriate tracking, monitoring and trendings .... "

During observations on 07/11/2013 starting at 4:15 p.m. air temperatures were found above 75 degrees on the 4th floor, 5th floor and patients in the emergency room waiting area were complaining about the heat in the area.
During an interview on 07/11/2013 at 4:30 p.m., Staff #13 reported they knew something was wrong with the air conditioner because during January 2013 they did not have to use the heat much. Staff #13 reported when she received complaints they were put into the computer system as work orders. The stream of patient complaints started in May 2013 about the air. Staff #13 reported the air temperature felt a lot better today than on yesterday. Staff #13 reported they have been working to get something done and getting quotes to get the system fixed. Since Staff #3 started working there he had brought in an air conditioner company (1 month ago).
During a confidential interview it was reported the temperature had been that way (warm) in a patient's room since Tuesday (07/09/2013) and it had been reported to staff.
During an interview on 07/11/2013 at 6:35 p.m., Staff #10 reported she had worked in the emergency department for 3 months. Every time the temperature gets hot outside it gets warm in the emergency room waiting room area. The problem had been already been reported to maintenance.
Review of the complaint/grievance log from 04/01/2013-07/03/13 revealed no complaints about the air conditioning.
Review of "Service Call Work Order" from 05/01/2013 -07/09/2013 revealed the following:
*Eighteen (18) complaints about it being too hot in the emergency room , intensive care unit, 4th floor rooms, and 5th floor rooms.
*There were 4 out of the 18 complaints with work orders completed within 24 hours. The other work orders were completed in a timeframe of 48 hours -21 days.
During an interview on 07/12/2013 at 10:21 a.m., Staff #12 reported she had been over complaint and grievances since 04/08/2013. There was a problem with the complaints going to the wrong campus and she was still trying to get them caught up. Staff #12 confirmed there were no complaints logged about the air conditioner in her log. She confirmed the complaints on the work orders and agreed she should have been informed of them. Staff #12 confirmed all the patient identifying information was not listed on the work order forms for her to follow up on the complaints. Staff #12 reported Staff #3 who was over maintenance was not trained yet to access the computerized complaint system. Staff #12 provided the surveyor with an incident form dated 07/10/2013 which she had given to maintenance to resolve. The incident form revealed on 07/09/2013 at 6:00 p.m. there were visitor complaints of the emergency department having an " uncomfortable environment ". There was documentation on the form that for the past 2 days there was extreme heat glaring into the ER (emergency room ) waiting area through the large window. Staff #12 documented on the form for Staff #3 to let her know what to do for this so they could close out the incident report.
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
Based on observation and interview the facility failed to ensure patient care was provided in a safe air temperature on 3 of 5 floors (5t, 4th and Emergency department on the 2nd floor).
This deficient practice had the potential to cause harm to all patients.
Findings include:

Review of the Texas Administrative Code, Title 25, Part 1, Chapter 133, Subchapter I (Physical Plant and Construction Requirements), Rule 133.169 revealed the following:
"(d) Table 3. Filter efficiencies for central ventilation and air conditioning systems."
Patient rooms and emergency suite waiting should be 70-75 degrees Fahrenheit and the Pharmacy 75 degrees Fahrenheit.

During observation and interview on 07/11/2013 the following was found:
* At 4:15 p.m., the 5th floor foyer near the elevator had an air temperature of 77.2 degrees Fahrenheit (F) by the surveyors thermometer and 75.8 degrees F by Staff #3' s thermometer.
*At 4:22 p.m., Room #504 was 76.4 degrees F and Room # 502 was 76.8 degrees F by Staff #3' s thermometer.
*At 4:30 p.m., Staff #13 reported they knew something was wrong with the air conditioner because during January 2013 they did not have to use the heat much. Staff #13 reported when she received complaints they were put into the computer system as work orders. The stream of patient complaints started in May 2013 about the air. Staff #13 reported the air temperature felt a lot better today than on yesterday. Staff #13 reported they have been working to get something done and getting quotes to get the system fixed. Since Staff #3 started working there he had brought in an air conditioner company (about 1 month ago).
* At 4:35 p.m., Staff #3 reported he was taking random temperatures on the units, but he was not keeping up with them. Staff #3 reported he tries to keep the temperature in the building from 72-74 degrees F. Staff #3 could not voice what the required temperature needed to be and reported he had no policy addressing temperatures except for in the surgery area.
*At 4:35 p.m., Room #505 was 75.4 degrees F by Staff #3's thermometer.
*At 4:40 p.m. during a confidential interview a patient reported their room was warm and they wanted it cooler. The temperature in the room was 82 degrees F with the surveyor's thermometer and 78.0 with Staff #3's thermometer. The wall mounted thermostat showed the unit was set at 60 degrees F. Staff #3 said this was a reverse thermometer, meaning it was blowing heat when set at 60 degrees. Staff #3 moved the control on the thermostat the other direction and cool air starting blowing from the vent.
*At 4:52 p.m. the 5th floor nursing supply room was 80.6 degrees F on the surveyor's thermometer and 77.6 F on Staff #3's thermometer.
*At 4:53 p.m. the 5th floor medication room was 81.4 degrees F on the surveyor's thermometer and 79.3 and 75.7 degrees on Staff #3's thermometer. The temperature on the wall mounted thermostat revealed it was set at 62 degrees. The thermostat reading revealed a room temperature between 75-80 degrees F.
There were antibiotics and eyedrops stored in the room which had instructions to store between 68-77 degrees Fahrenheit.
*At 5:10 p.m, Staff #3 immediately moved the control on the wall mounted thermostat to 64 degrees upon entering Room #568. The room temperature reading on the thermostat was between 75-80 degrees. The indicator on the thermostat was jumping as if it was broken. Staff #3 confirmed it was not working.
*At 5:25 p.m., Room #407 had a temperature of 77.6 degrees F by Staff #3's thermometer. During a confidential interview it was reported the temperature had been that way in the room since Tuesday (07/09/2013).
*At 5:35 p.m., Room #409 had a temperature of 75.2 degrees F by Staff #3's thermometer. During a confidential interview it was reported it's been a little warm in the room. Tuesday (07/09/2013) it was warmer than last night ( 07/10/2013)
At 5:45 p.m., the wall mounted thermostat in Room #459 was set between 54-56 degrees F, but the temperature gauge which would indicate the temperature in the room was broken. Staff #3 took a temperature of the room and it was 73.7 degrees.
*At 5:45 p.m., the wall mounted thermostat in Room #460 was set at 79 degrees F, but the temperature gauge which would indicate the temperature in the room was broken. Staff #3 took a temperature of the room and it was 73.1 degrees.
*At 6:32 p.m., 13 people were sitting in the waiting area of the emergency department and some were complaining of the area being hot. The temperature on the surveyor's thermometer was 74.3 degrees F and 73.9 degrees F on Staff #3's thermometer. There was a large window in the area which was not covered and allowed direct sunlight into the room.
*At 6:35 p.m., Staff #10 had a desk sitting in the emergency department. Staff #10 reported she had worked in the emergency department for 3 months. Everytime the temperature gets hot outside it gets warm in the emergency room waiting room area. The problem had been already been reported to maintenance.
*During an interview on 07/12/2013 at 8:40 a.m., Air conditioner workers #s' 15 and 16 reported they had been working on the air conditioner units for about 3 weeks. When they first started the temperature on the 5th floor was 80 degrees F. Right now they were only able to get the system to drop the temperature 30 degrees. Meaning if it was 100 degrees F outside the air conditioner system would drop the temperature to 70 degrees F on the inside. The air conditioner system was old and their recommendation was going to be for an engineer to come in and take a look at it.
VIOLATION: MAINTENANCE OF PHYSICAL PLANT Tag No: A0701
Based on observation and interview the facility failed to ensure safe air temperatures in the physical plant on 3 of 5 floors (5th, 4th and Emergency department on the 2nd floor).
This deficient practice had the potential to cause harm to all patients.
Findings include:

Review of the Texas Administrative Code, Title 25, Part 1, Chapter 133, Subchapter I (Physical Plant and Construction Requirements), Rule 133.169 revealed the following:
"(d) Table 3. Filter efficiencies for central ventilation and air conditioning systems."
Patient rooms and emergency suite waiting should be 70-75 degrees Fahrenheit and the Pharmacy 75 degrees Fahrenheit.

During observation and interview on 07/11/2013 the following was found:
* At 4:15 p.m., the 5th floor foyer near the elevator had an air temperature of 77.2 degrees Fahrenheit (F) by the surveyors thermometer and 75.8 degrees F by Staff #3' s thermometer.
*At 4:22 p.m., Room #504 was 76.4 degrees F and Room # 502 was 76.8 degrees F by Staff #3' s thermometer.
*At 4:30 p.m., Staff #13 reported they knew something was wrong with the air conditioner because during January 2013 they did not have to use the heat much. Staff #13 reported when she received complaints they were put into the computer system as work orders. The stream of patient complaints started in May 2013 about the air. Staff #13 reported the air temperature felt a lot better today than on yesterday. Staff #13 reported they have been working to get something done and getting quotes to get the system fixed. Since Staff #3 started working there he had brought in an air conditioner company (about 1 month ago).
* At 4:35 p.m., Staff #3 reported he was taking random temperatures on the units, but he was not keeping up with them. Staff #3 reported he tries to keep the temperature in the building from 72-74 degrees F. Staff #3 could not voice what the required temperature needed to be and reported he had no policy addressing temperatures except for in the surgery area.
*At 4:35 p.m., Room #505 was 75.4 degrees F by Staff #3's thermometer.
*At 4:40 p.m. during a confidential interview a patient reported their room was warm and they wanted it cooler. The temperature in the room was 82 degrees F with the surveyor's thermometer and 78.0 with Staff #3's thermometer. The wall mounted thermostat showed the unit was set at 60 degrees F. Staff #3 said this was a reverse thermometer, meaning it was blowing heat when set at 60 degrees. Staff #3 moved the control on the thermostat the other direction and cool air starting blowing from the vent.
*At 4:52 p.m. the 5th floor nursing supply room was 80.6 degrees F on the surveyor's thermometer and 77.6 F on Staff #3's thermometer.
*At 4:53 p.m. the 5th floor medication room was 81.4 degrees F on the surveyor's thermometer and 79.3 and 75.7 degrees on Staff #3's thermometer. The temperature on the wall mounted thermostat revealed it was set at 62 degrees. The thermostat reading revealed a room temperature between 75-80 degrees F.
There were antibiotics and eyedrops stored in the room which had instructions to store between 68-77 degrees Fahrenheit.
*At 5:10 p.m, Staff #3 immediately moved the control on the wall mounted thermostat to 64 degrees upon entering Room #568. The room temperature reading on the thermostat was between 75-80 degrees. The indicator on the thermostat was jumping as if it was broken. Staff #3 confirmed it was not working.
*At 5:25 p.m., Room #407 had a temperature of 77.6 degrees F by Staff #3's thermometer. During a confidential interview it was reported the temperature had been that way in the room since Tuesday (07/09/2013).
*At 5:35 p.m., Room #409 had a temperature of 75.2 degrees F by Staff #3's thermometer. During a confidential interview it was reported it's been a little warm in the room. Tuesday (07/09/2013) it was warmer than last night ( 07/10/2013)
At 5:45 p.m., the wall mounted thermostat in Room #459 was set between 54-56 degrees F, but the temperature gauge which would indicate the temperature in the room was broken. Staff #3 took a temperature of the room and it was 73.7 degrees.
*At 5:45 p.m., the wall mounted thermostat in Room #460 was set at 79 degrees F, but the temperature gauge which would indicate the temperature in the room was broken. Staff #3 took a temperature of the room and it was 73.1 degrees.
*At 6:32 p.m., 13 people were sitting in the waiting area of the emergency department and some were complaining of the area being hot. The temperature on the surveyor's thermometer was 74.3 degrees F and 73.9 degrees F on Staff #3's thermometer. There was a large window in the area which was not covered and allowed direct sunlight into the room.
*At 6:35 p.m., Staff #10 had a desk sitting in the emergency department. Staff #10 reported she had worked in the emergency department for 3 months. Everytime the temperature gets hot outside it gets warm in the emergency room waiting room area. The problem had been already been reported to maintenance.
*During an interview on 07/12/2013 at 8:40 a.m., Air conditioner workers #s' 15 and 16 reported they had been working on the air conditioner units for about 3 weeks. When they first started the temperature on the 5th floor was 80 degrees F. Right now they were only able to get the system to drop the temperature 30 degrees. Meaning if it was 100 degrees F outside the air conditioner system would drop the temperature to 70 degrees F on the inside. The air conditioner system was old and their recommendation was going to be for an engineer to come in and take a look at it.