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.

RED RIVER BEHAVIORAL CENTER, LLC 2800 MELROSE AVENUE BOSSIER CITY, LA July 20, 2012
VIOLATION: PATIENT RIGHTS: PRIVACY AND SAFETY Tag No: A0142
Based upon observations, reviews of reports of abuse/neglect, policies/procedures, and staff interviews the hospital failed to ensure all patients were kept safe from all forms of alleged abuse as evidenced by allegations of verbal and physical abuse directed toward patient #1 by a Mental Health Technician (MHT) (#S10). Findings:

Review of complaints of abuse and neglect reports, dated September 2011 to present, revealed there lacked documented evidence that an incident report relative to these specific allegations had been completed and reported to the Director of Nursing and/or Administrator; nor had the Louisiana Department of Health and Hospitals--Health Standards Section been notified of the alleged abuse.

Interview, on 07/17/12 at 3:40pm, with the complainant revealed S10 MHT allegedly called patient #1 a "bitch" after the patient scratched S10 MHT and "he pushed her down into the wheelchair" when the patient attempted to get up.

Subsequent interview, on 07/19/12 at 9:20am, with the complainant revealed when questioned what had she actually observed, what was the date of the occurrence, and what was done; the complainant stated she could not remember the date. At first the complainant stated it was the 07/07/12 (Saturday), then she stated "No" it must have been 06/30/12; then "no, it was the week before". The complainant could not remember when the incident happened.

Interview, 07/19/2012 at 9:30am, with S9 Registered Nurse (RN) revealed she stated that S12 MHT had told her that another MHT (identified as S10 MHT) had "cursed at a patient and pushed the patient". When S9 RN was questioned as to what her actions were in view of the allegations, she replied, "I tried to call (name S13 RN), who was coming in for the 7p-7a shift, and unable to reach her, I then called (name S2 DON). I was instructed to complete an incident report and put the report under the DON's door to his office." When questioned as to the time of the incident, S9 RN stated she could not remember but "thought it was right after visiting hours, around 4:30pm". S9 RN stated she completed the incident report and placed it under the DON's door as directed. S9 RN stated she was not sure what to do with the situation, that was why she tried to call S13 RN.

Subsequent interview, on 07/19/12 at 3:40pm, with S9 RN revealed she stated that she did not immediately complete the incident report, rather she completed it on a Wednesday following her days off; the surveyors asked how many days had pasted between the incident and the actual completion of the incident report and S9 replied about 4 days. She further stated S2 DON instructed her to write a statement and complete the report and place under his door.

Interview, on 07/20/12 at 8:25am, with S2 DON revealed he could not find the statement and the incident report. Surveyors questioned S2 DON if he remembered S9 RN calling him; he replied, "yes". Further questioning of S2 DON revealed when asked if he recalled S9 RN telling him about the alleged physical abuse (S10 MHT allegedly pushed patient #1 back into her wheelchair according to S12 MHT), he stated he could not remember and honestly thought it was just a case of employees being disgruntled with each other.

Interview, on 07/20/12 at 9:55am, with S1 Administrator and S2 DON revealed both confirmed that an incident report could not be found relative to these allegations. S1 and S2 also confirmed that an investigation had not been conducted and the alleged perpetrator of the abuse continued to work with patients on the day of the alleged abuse and was still working with patients.
VIOLATION: PATIENT RIGHTS: FREE FROM ABUSE/HARASSMENT Tag No: A0145
Based upon observations, reviews of reports of abuse/neglect, policies/procedures, and staff interviews the hospital failed to ensure 1) all allegations of abuse were investigated and reported as evidenced by allegations of verbal and physical abuse directed toward patient #1 by a Mental Health Technician (MHT) (#S10); and 2) nursing staff failed to follow the policy/procedure and remove the MHT from patient care when the allegation of abuse was made by another MHT who stated they had witnessed the incident. Findings:

Observations conducted, 07/18/12 through 07/20/12, at various times revealed patients were treated courteously and respectful; when a patient required redirection for a negative behavior it was performed in a professional manner. The surveyors did not observe any abusive behaviors (during this time), directed toward any patient by staff members.

1) Review of complaints of abuse and neglect reports, dated September 2011 to present, revealed there lacked documented evidence that an incident report, relative to the specific allegations of physical and verbal abuse of patient #1, had been completed and reported to the Director of Nursing and/or Administrator; nor had the Louisiana Department of Health and Hospitals--Health Standards Section been notified of the alleged abuse.

Interview, on 07/17/12 at 3:40pm, with the complainant revealed S10 MHT allegedly called patient #1 a "bitch" after the patient scratched S10 MHT and "he pushed her down into the wheelchair" when the patient attempted to get up.

Subsequent interview, on 07/19/12 at 9:20am, with the complainant revealed when questioned what had she actually observed, what was the date of the occurrence, and what was done; the complainant stated she could not remember the date. At first the complainant stated it was the 07/07/12 (Saturday), then she stated "No" it must have been 06/30/12; then "no, it was the week before". The complainant could not remember when the incident happened.

Interview, 07/19/2012 at 9:30am, with S9 Registered Nurse (RN) revealed she stated that S12 MHT had told her that another MHT (identified as S10 MHT) had "cursed at a patient and pushed the patient". When S9 RN was questioned as to what her actions were in view of the allegations, she replied, "I tried to call (name of S13 RN), who was coming in for the 7p-7a shift, and unable to reach her, I then called (name of S2 DON). I was instructed to complete an incident report and put the report under the DON's door to his office." When questioned as to the time of the incident, S9 RN stated she could not remember but "thought it was right after visiting hours, around 4:30pm". S9 RN stated she completed the incident report and placed it under the DON's door as directed. S9 RN stated she was not sure what to do with the situation, that was why she tried to call S13 RN.

Subsequent interview, on 07/19/12 at 3:40pm, with S9 RN revealed she stated that she did not immediately complete the incident report, rather she completed it on a Wednesday following her days off; the surveyors asked how many days had pasted between the incident and the actual completion of the incident report and S9 replied about 4 days. She further stated S2 DON instructed her to write a statement and complete the report and place under his door.

Interview, on 07/20/12 at 8:25am, with S2 DON revealed he could not find the statement and the incident report. Surveyors questioned S2 DON if he remembered S9 RN calling him; he replied, "yes". Further questioning of S2 DON revealed when asked if he recalled S9 RN telling him about the alleged physical abuse (S10 MHT allegedly pushed patient #1 back into her wheelchair according to S12 MHT), he stated he could not remember and honestly thought it was just a case of employees being disgruntled with each other.

Interview, on 07/20/12 at 9:55am, with S1 Administrator and S2 DON confirmed that an incident report could not be found relative to these allegations. S1 and S2 also confirmed that an investigation had not been conducted and the alleged perpetrator of the abuse continued to work with patients on the day of the alleged abuse and was still working with patients.

2) Review of an "addendum to training program" titled "Abuse/Neglect Procedure, Revised: January 2012" revealed: "ABUSE/NEGLECT PROCEDURE Definition of Abuse: Intentional infliction of physical or mental injury or the causing of the deterioration of a person by means of including but not limited to physical, verbal, mental, sexual abuse; ...STAFF OBLIGATION Any staff member has the obligation to report knowledge or suspicion of abuse to their supervisor immediately. This includes information received from observation, another staff member, a patient as well as a family member or responsible party of a patient. Any health care employee may be held legally liable for non report of abuse and will be held accountable for further disciplinary actions...SUPERVISOR OBLIGATION A Supervisor of Red River must initiate immediate precautions to prevent further potential harm following an allegation of abuse reporting...The first obligation is to protect the patient(s)...gather as much information as possible to identify the appropriate actions...in the initial interviews a specific staff member(s) can be identified, remove the alleged perpetrator(s) from all patient contact areas...Notify Director of Nursing and/or Administrator, as soon as possible for further instruction."

Interview, 07/19/12 at 9:30am, with S9 RN revealed she stated she was not sure of what to do with the situation of alleged abuse (physical and verbal).

Review of a form titled "In-Service and Hospital Sponsored Workshop Record", dated 04/19/12, revealed S2 Director of Nursing (DON) presented this in-service on 04/19/12 and the target audience was all staff. The name of the in-service was "Directed Inservice-Proper incident reporting, Abuse & Neglect, Grievance/Complaints, Accident Prevention". The learning objectives were listed as: "1) Staff will understand the importance of properly reporting incidents. 2) Staff will understand the consequences of not following policy on incident reporting...5) Abuse & neglect P&P review".

Continued review of the In-Service Record revealed there was a "Section B." that indicated all persons attending/participating in the inservice were required to document their name and position on the In-Service Record. Further review revealed S9 Registered Nurse (RN) had signed her name and her position.

Interview, on 07/20/12 at 10:00am, with S1 Administrator and S2 DON confirmed neither of them knew about the alleged abuse and the date of the actual occurrence. It was further revealed that there was a lack of an investigation, reporting, and lack of disciplinary action taken by S1 and S2 relative to the incident.
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based upon medical record review (Patient #1) and staff interviews the hospital failed to ensure all patients received an on-going nursing evaluation relative to possible injuries received as evidenced by a lack of a documented evaluation of a patient (#1) following a report of alleged physical and verbal abuse by a Mental Health Technician (MHT) (S10) that was made to the Charge Nurse (S9 Registered Nurse) by another MHT (S12). Findings:

Review of Patient #1's medical record revealed there failed to be a documented evaluation immediately following an accusation of physical and verbal abuse. The alleged abuse occurred approximately between 3-4:30pm on 06/23/12. Unfortunately the hospital staff and complainant could not remember the exact date nor the time.

Continued review of patient #1's medical record revealed she was admitted [DATE] for agitation, hallucinations and violent behaviors. Upon admission she had bruising to her left and right lateral truck per documented nursing assessment dated [DATE].

Interview, on 07/19/12 at 9:30am, with S9 Registered Nurse (RN) revealed S12 MHT told her that she witnessed another MHT (identified as S10 MHT) verbally and physically abuse patient #1.

Further review of patient #1's medical record revealed S9 RN did not document an immediate assessment following the allegations of abuse.

There lacked documented evidence patient #1 received an immediate RN evaluation following alleged physical and verbal abuse.