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.

STRATEGIC BEHAVORIAL CENTER-GARNER 3200 WATERFIELD DRIVE GARNER, NC Oct. 26, 2017
VIOLATION: PATIENT RIGHTS: FREE FROM ABUSE/HARASSMENT Tag No: A0145
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of hospital policy, an incident log, an investigative report, a medical record and staff interviews, the hospital staff failed to report an allegation of staff to patient abuse for 1 of 1 sampled patients that alleged staff to patient abuse (Patient #5).

The findings include:

Review on 10/24/2017 of policy and procedure titled "Resident Rights" (revised: 07/10/2017) revealed, "Policy: To protect residents from any abuse, neglect or exploitation... Procedures: I. a. Employees shall not subject a resident to any sort of abuse, neglect, or exploitation (as defined 10 NCAC 14P.0102 of the Resident Right Rule). ... Allegations against [facility name]: d. the director of Risk Management will complete a full investigation of all allegations and file a report with the following agencies outlining the suspected allegations, the investigative summary, outcome and prevention steps taken to resolve the investigation. Reporting to agencies: State of North Carolina ..."

Review of State agency reporting revealed no facility report of an alleged sexual assault on Patient #5. Review revealed the hospital did not self-report the alleged sexual assault on Patient #5.

Review on 10/24/2017 of the closed medical record revealed Patient #5 was a [AGE]-year-old female admitted on [DATE] from an outside facility ER (emergency room ) due to severe anxiety, mania, and agitation. Review revealed Patient #5 was bipolar and manic. Continued review revealed Patient #5 was "very grandiose with multiple grandiose delusion". Further review of the closed medical record review revealed Patient #5 had a history of psychological trauma specified as verbal and physical abuse.

Review of an Incident log dated 09/26/2017 at 2044 revealed "patient states that man from yesterday night grabbed my leg. I'll show you. Come take a picture. States while listening to music on his phone at back table he grabbed her leg, then later while outside on patio, he was talking dirty, ... He sexually assaulted me." Additional review revealed Patient #5 had an inner right thigh bruise. Further review revealed Patient #5 did not want her daughter to be notified.

Internal Report Investigation revealed the alleged incident was investigated from 09/25/2017 at 1740 to 09/26/2017 at 1700. Review of the Internal Investigation report revealed several female patients were sitting in the Geriatric 900 Hall courtyard supervised by two staff (a male and a female). Review revealed the female staff stepped inside briefly for water. Continued review revealed several of the female residents began speaking about their past sexual experiences. Review revealed a male staff redirected the conversation. Review revealed the residents continued to talk about their sexual experiences. Review revealed the male staff then requested the residents to go back inside. Further review revealed Patient #5 reported that the male nurse put his hands on her shoulders and leaned in to whisper in her ear saying " ...that's enough of that type of talk for the night". Review revealed Patient #5 reported to the Nurse that she was inappropriately touched by the male nurse.

Interview on 10/24/2017 at 1405 with Physician MD #13 revealed that he was aware of the allegation of sexual assault by Patient #5. Interview revealed there was "not evidence to support the allegation" because Patient #5 was very psychotic (mental disorder characterized by impaired reality). Continued interview revealed MD #13 was not notified or made aware of any thigh bruising.

Interview on 10/25/2017 at 0956 with RN #4 revealed Patient #5 reported the incident to the RN #4. Interview revealed Patient #5 also wrote a letter and placed it the "box" (box for reporting incidents concerns and suggestions) on the unit. Continued interview revealed RN #4 reported the allegation to the supervisor and did not think "anything came of it." Further interview revealed RN #4 had no indication that the accused staff member had been inappropriate with Patient #5.

Interview on 10/25/2017 at 1120 with RN #12 revealed the RN was aware of Patient #5's allegation. Interview revealed Patient #5 expressed concerns regarding an inappropriate "sexual conversation" that was overheard amongst other patients on the geriatric unit. Continued interview revealed Patient #5 then stated that a staff member touched her inappropriately and accused the staff member sexual assault. Interview revealed the incident was reported to AS #14. Further interview revealed after the incident was reported, AS #14 assumed the responsibility of investigating the allegation.

Interview on 10/26/2017 at 0905 with AS #14 revealed a call was received from RN #12 reporting the alleged assault. Interview revealed Patient #5 told a "ton of people" about the alleged sexual assault. Continued interview revealed AS #14 attempted to meet with Patient #5, but, the patient refused to discuss the incident until "2-3 days later." Further interview revealed when Patient #5 was interview by AS #14, the patient denied the incident occurred. Because of Patient #5's denial, the incident was not reported.
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on policy review, medical record review, daily nursing assignment sheet review and staff interviews the facility failed to complete an initial nursing and falls assessment for 1 of 9 medical records reviewed (Patient #2).

Review on 10/24/2017 of a policy titled "Nursing Assessment" last reviewed/revised 07/10/2017 revealed " ...The nursing assessment must be completed by a registered nurse within 8 hours of the resident's admission ..."

Review on 10/25/2017 of a policy titled "Care of Patient for Falls" last reviewed/revised 06/06/2017 revealed " ...A Registered Nurse (RN) will assess the mobility and gait of all clients, at the time of admission ..."

Review on 10/24/2017 of the medical record for Patient #2 revealed a [AGE] year old female admitted on [DATE] at 1847. Review revealed Patient #2 was involuntarily committed for suicidal ideations. Review of the "Initial Medical Screening Form" revealed it was completed by Patient Assessor #1 on 10/12/2017 at 2000 and stated "Patient reports she fell at home in the kitchen ...Pt (patient) admits to having thoughts of harming herself ..." Review of the "High Risk/High Alert HANDOFF" revealed Patient #2 was handed off to RN #3 at 2000 on 10/12/2017. Continued review of the medical record failed to reveal an initial nursing and falls assessment had been completed.

Review of 8 other medical records revealed each patient had an initial nursing and falls assessment completed within 8 hours of their arrival.

Review of the daily nursing assignment sheet for 10/12/2017 7pm-7am revealed RN #2 and RN #3 were the nurses on duty the night Patient #2 was admitted .

Interview on 10/26/2017 at 1300 with RN #2 revealed he was working the night Patient #2 was admitted . Interview revealed he did not recall if an initial nursing assessment was done. Interview revealed an initial nursing assessment should have been done by himself or RN #3 that night. Interview revealed if there were two nurses assigned to the unit the patients were split up by their name. Interview revealed one nurse would get patients "A-H" and the other nurses would get patient "I-Z." Interview revealed the nurses did nightly chart audits on the patients they were assigned, and if an initial nursing assessment was not completed it should have been picked up on during nightly chart audits.

Interview on 10/25/2017 at 1135 with Nurse Manager #1 revealed she expected the initial nursing and falls assessment to be completed as soon as possible when a new patient arrived to the geriatric unit. Review of Patient #2's medical record with Nurse Manager #1 failed to reveal an initial nursing and falls assessment in the medical record.

Interview on 10/25/2017 at 0955 with RN #1 revealed the initial nursing and falls assessment should be done "immediately when a new patient arrives to the geriatric unit, if not done immediately it should be done within an hour or at least done on the same shift as the patient's arrival." Review of Patient #2's medical record with RN #1 failed to reveal an initial nursing and falls assessment was completed at the time of admission.

Interview on 10/26/2017 at 1000 with the Quality Director revealed an initial nursing and falls assessment for Patient #2 could not be found.
VIOLATION: SUPERVISION OF CONTRACT STAFF Tag No: A0398
Based on review of policy and procedure, review of personnel files and staff interview, the facility failed to evaluate skill/performance of the contract staff that provided care on the nursing units in 3 of 3 contract staff personnel files reviewed (RN #1, RN #5 and LPN #6).

The findings include:

Review on 10/25/2017 of policy and procedure "Staffing Plan for Provision of Care" (revised 7/10/17) revealed, "... 8. A nursing staff member shall be considered to be competent when he/she completes the job-related unit specific critical competencies ..."

1. Review on 10/26/2017 of the personnel file for Registered Nurse (RN) #1 revealed she was a travel RN (date of hire not available). Review of her personnel file showed a self-evaluation checklist provided by the contract agency indicating RN # 1's comfort level with specific nursing skills/activities. Continued review revealed documentation of general hospital orientation attendance. Review revealed no unit specific skill checklist that validated unit based competency for the adolescent or the geriatric units. Review revealed the surveyor could not find evidence that the facility validated the nurse's competency to provide care in the clinical setting.

Telephone interview on 10/25/2017 at 1415 with AS (Administrative staff)) #2 revealed agency nurses got a three day orientation. Interview revealed the three days of orientation consisted of two days in the classroom and one day of "Handle with Care" (conflict intervention). Interview revealed the nurse was then provided three shifts on the unit with an RN before being assigned a patient independently. Continued interview revealed the contract/agency RNs were providing the unit orientation to both contract and core staff. Interview revealed no supplemental training/development was provided to the contract staff whom provided unit based orientation. Continued interview revealed there was no documented unit specific competency to validate nursing clinical skill.

Interview on 10/26/2017 at 1330 with RN #12 revealed the agency provided the hospital with the travel nurse's preference regarding the unit they would be assigned to work on. Further interview revealed there were "no unit specific competencies" available for review and there was no evidence available in the personnel files to validate unit specific nursing skill/competency.

2. Review on 10/26/2017 of the personnel file for RN #5 revealed she was a travel RN whose contract started on 09/01/2017. Review of her personnel file showed a self-evaluation checklist provided by the contract agency indicating RN # 5's comfort level with specific nursing skills/activities. Continued review revealed documentation of general hospital orientation attendance. Review revealed no unit specific skill checklist that validated unit based competency for the adolescent or the geriatric units. Review revealed the surveyor could not find evidence that the facility validated the nurse's competency to provide care in the clinical setting.

Telephone interview on 10/25/2017 at 1415 With AS #2 revealed agency nurses got a three day orientation. Interview revealed the three days of orientation consisted of two days in the classroom and one day of "Handle with Care" (conflict intervention). Interview revealed the nurse was then provided three shifts on the unit with an RN before being assigned a patient independently. Continued interview revealed the contract/agency RNs were providing the unit orientation to both contract and core staff. Interview revealed no supplemental training/development was provided to the contract staff whom provided unit based orientation. Continued interview revealed there was no documented unit specific competency to validate nursing clinical skill.

Interview on 10/26/2017 at 1330 with RN #12 revealed the agency provided the hospital with the travel nurse's preference regarding the unit they would be assigned to work on. Further interview revealed there were "no unit specific competencies" available for review and there was no evidence available in the personnel files to validate unit specific nursing skill/competency.

3. Review on 10/26/2017 of the personnel file for LPN #6 revealed she was a travel LPN whose contract started on 09/08/2017. Review of her personnel file showed a self-evaluation checklist provided by the contract agency indicating LPN #6's comfort level with specific nursing skills/activities. Continued review revealed documentation of general hospital orientation attendance. Review revealed no unit specific skill checklist that validated unit based competency for the adolescent or the geriatric units. Review revealed the surveyor could not find evidence that the facility validated the nurse's competency to provide care in the clinical setting.

Telephone interview on 10/25/2017 at 1415 revealed agency nurses got a three day orientation. Interview revealed the three days of orientation consisted of two days in the classroom and one day of Handle with Care (conflict intervention). Interview revealed the nurse was then provided three shift on the unit with an RN before being assigned a patient independently. Continue interview revealed the contract/agency RNs were providing the unit orientation to both contract and core staff. Interview revealed no supplemental training/development was provided to the contract staff whom providing unit based orientation. Continued interview revealed there was no documented unit specific competency to validate nursing clinical skill.

Interview on 10/26/2017 at 1120 with LPN #6 revealed, one day of orientation was provided. Continued interview revealed LPN #6's day of orientation included both the adolescent and the PRTF unit. Interview revealed LPN #6 had "no orientation to the geriatric unit" prior to being assigned patient care to the unit.

Interview on 10/26/2017 at 1330 with RN #12 revealed the agency provided the hospital with the nurse's preference regarding the unit they would be assigned to work on. Further interview revealed there were "no unit specific competencies" available for review and there was no evidence available in the personnel files to validate unit specific nursing skill/competency.

NC 053
NC 527