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RIVERSIDE GENERAL HOSPITAL 3204 ENNIS ST HOUSTON, TX March 23, 2012
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on observation, record review, and interview the facility failed to evaluate the safety needs of patients with history of sexual acting out and sexual abuse. Citing two patients #s 1 and 2, named a complaint investigation.

Findings:

Observation on 3/22/12 at 11:34 am on the Adolescent Unit revealed in the boys patient care area there was a room with six(6) beds, one room with two(2) beds and another room with one (1) bed.
The rooms with one and two beds shared a common bath room that opened on either side into each room. When the bathroom doors are not locked then patients from either room had access to the other room. Patient (# 1) and Patient (# 2) were assigned to these rooms. Both boys had history of inappropriate sexual behavior. Both boys were on standard monitoring by unit staff.



Review of admission assessment record for Patient (# 1) revealed he was a [AGE] years old admitted to the facility on [DATE] with history of behavior disorder, aggressive especially towards males. He had history of sexual abuse and there were allegations that he himself sexually abused others.
He was assessed as not being able to take responsibility for his actions. The patient was placed on routine fifteen minutes monitoring.

Further review of the nurses ' notes dated 1/14/12 and 1/18/12 there were several documentation that the Patient (#1) kept going to the other boys ' rooms at nights although he was instructed not to.

Review of nurses ' notes dated 1/24/12 documented that the patient stated he had two sexual assault charges pending against him.

Review of Behavior Health Technician observation sheet dated 2/3/12 made the following documentation at 2:45pm:
" Patient in rest room with a peer, had him pinned down, staff stopped him " .

There was no nursing documentation of the incident on the patient ' s clinical record.

Patient # 2

Review of admission assessment record for Patient (# 2) revealed he was an eight (8) year old, admitted to the facility on [DATE] with history of Mood Disorder, Suicidal Ideation and aggressive ineffective coping skills. He had frequent conflict with others, afraid to be in a room alone. Had recent increase in aggression and agitation. The patient had history of physical abuse by his father who broke his femur at [AGE] months old and he was locked in dark closet.

Patient (# 2) was placed in a room with adjoining bathroom to Patient (# 1) ' s room.

Review of Social worker notes dated 1/25/12 documented that Patient (# 2) was having hallucinations regarding hearing voices at nights telling him to come with him and they scare him.
Nurses notes dated 1/26/12 documented the patient complains of hearing voices and seeing shadows in his room.

There was nursing documentation dated 1/27/12 at 8:45 am that the patient was telling the Physician that he is afraid of the dark, afraid of shadows and thinks that people are out to get him. The patient was frequently coming to staff to say that peers are trying to hurt him. The patient always tattle-telling on other peers. Encouraged patient to focus on himself and learn to use his coping skills and relaxation technique.

There was no nursing documentation that Patient # 2 was questioned regarding these incidents.

Review of Behavior Health Technician observation sheet dated 2/3/12 made the following notation at 2:45pm:
" Patient in rest room pinned down by a peer " .
There was no nursing documentation of the incident on the patient ' s clinical record.

Review of Social Worker notes dated 2/10/12 revealed information that prior to this incident the treatment team for Patient (# 2) had observed sexually acting out behavior exhibited by the patient and that there was a concern that he might have been sexually assaulted in the past '
This behavior was never documented in the patient ' s clinical record. There was no documentation in the patient ' s record that the inappropriate behavior was communicated to other team members.

During an interview on 3/22/12 on the Adolescent at 11:50 am with Staff #50 Registered Nurse, she stated the Technicians make rounds every fifteen minutes on the unit. The facility had electronic monitoring that did not monitor inside the patient rooms. According to the Nurse she was not on duty at the time of the incident.

During an interview on 3/22/12 on the Adolescent at 2:15 pm with Staff #51, Chief Nursing Officer, she stated the Nurses did not evaluate that the patients had a shared bath room and should have been separated or more closely monitored.
VIOLATION: MAINTENANCE OF PHYSICAL PLANT Tag No: A0701
Based on observation and interview the facility failed to ensure patients were cared for in a clean and sanitary environment.

Findings:

Observation on 3/22/12 between 11:25 am and 12:15 pm on the Adult patient unit and the Adolescent patient unit at the facility the following observations were made:

The floors in the patients ' rooms were dirty. There was built up dirt and dust in the corners of the floor.

There were missing floor tiles in rooms and loose floor tiles in bath rooms. Chipped paint from walls and doors.

Ceiling and wall vents had heavy built up of dust with dust webs.

The window ledges in all patient rooms were heavy with dust and dust webs including the bars on the windows.

Observation on 3/22/12 at 11:34 am on the Adolescent unit revealed several items of clothing on the floor in the boy ' s rooms.

During an interview on 3/22/12 with the Nurse in charge of the unit she stated she was not able to tell if the clothing on the floor were clean or dirty. According to the Nurse the children put their clothes on the floor because there was no receptacle to store their clean or soiled clothing.

During an interview on 3/22/12 at 12:35 pm with Housekeeping Supervisor she stated it was difficult to clean the bars on the windows. According to the Assistant Administrator who was on rounds with the Surveyor, some cleaning need to be done, she further stated the facility was aware of the needed repairs and had some plans that were pending.