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.

ALLEGIANCE SPECIALTY HOSPITAL OF KILGORE 1612 SOUTH HENDERSON BLVD KILGORE, TX 75662 Dec. 29, 2011
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
Based on record review and interview the client failed to receive care in a safe setting from the facility.

Review of patient's record revealed patient had a weight gain from 130 pounds on 12/6/2011 to 146.5 pounds on 12/15/2011. Last weight recorded before discharge was 131 pounds on 12/20/2011. The nurse ' s note of the patient's record did not reflect any type of notation about the weight grain of 16.5 pounds or the weight loss of 15.5 pounds on time of discharge.

An interview with staff #10 on 12/29/2011 at 1:30 PM reported after reviewing the patient's record, staff #10 had not picked up on the patient's weight gain or loss during the hospital stay between 12/6/2011 thru 12/23/2011.

Review of patient's record at the hospital facility revealed the patient had fallen on 12/14/2011 at 10:20 PM, It was documented in the client record " no signs of redness or edema Moves all extremities without difficulty No evidence of injury Denies any pain or discomfort."

Review of patient's record from the nursing home where patient was admitted after leaving the hospital setting revealed patient had abrasion below the right knee with a knot the size of a golf ball. X-ray obtained on 12/30/2011 and the results are " Bones: There appears to be old avulsion fracture fragment off the anterior/superior tibial tuberosity. The fracture may not be completely healed. Conclusions: There is either fractured spur or simple fragment off the anterior /superior tibial tuberosity at the proximal right tibia. This appears to be nonunited fracture."
VIOLATION: STAFFING AND DELIVERY OF CARE Tag No: A0392
Based on document review and interview the facility failed to orientate 1 of 1 agency staff employed.

On 12/28/2011 at 3:00 PM nursing department staff folders were reviewed and 1 agency Mental Health Technician (MHT) was found to have no competencies and no general orientation to the Geri psychiatric, unit where the agency staff worked.

On 12/29/2011 at 10:00 AM an interview with the Chief Nursing Officer (CNO) revealed that agency staff was not used often. The CNO revealed that only on occasion was a nurse scheduled through an agency, usually agency staff was MHT and because they were agency they did not attend general orientation. The Agency supplied the background check, drug screening, identifying information, CPR verification, health information and verification of Texas registry or license. Then the agency staff was assigned 1:1 with another experienced staff for the shift.

A reviewed of 5 of 5 hospital MHT employees revealed all employees had signed confidentiality forms, communication forms, how to diffuse an agitated patient, acknowledgement of video surveillance, patient rights forms and Occupational Safety Health Administration (OSHA) forms.