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.

MIDDLE TN MENTAL HEALTH INSTITUTE 221 STEWARTS FERRY PIKE NASHVILLE, TN Aug. 11, 2014
VIOLATION: PATIENT RIGHTS: GRIEVANCES Tag No: A0118
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on medical record review, facility policy review, and interview, the facility failed to follow the facility's policy regarding patient complaints/grievances for one (#6) of eleven patients reviewed.

The findings included:

Patient #6 was admitted to the facility on on [DATE], with diagnoses including Bipolar Disorder, Depression, Cannabis Dependence, and Suicidal without Plan.

Medical record review of the History and Physical dated October 14, 2013, revealed the patient had reported depression worsening in past years to the point where the patient felt hopeless and helpless with decreased energy and concentration. Continued medical record review revealed the patient had a history of manic symptoms including irritability, racing thoughts, and distractibility.

Medical record review of the psychosocial assessment dated [DATE], revealed, "...Pt. (patient) reports that she is afraid to be here, doesn't feel like she belongs here. Wants to be in (named hospital) outpatient..."

Medical record review of the admission note dated October 14, 2013, revealed the patient denied suicidal ideation and stated "...I don't want to kill myself. I just had a fight with my (significant other) and to gain attention I said I'm going to kill myself. I'm just bratty. I'm scared in this place. I'm not sick and I just want to go home..."

Medical record review of the physician's note dated October 14, 2013, revealed the patient had problems with self-esteem. Continued review of the physician's note revealed the patient complained of problems with the food and inability to eat it.

Medical record review of the Social Services note dated October 15, 2013, revealed, "...Patient refused after care appointments stating...was dissatisfied with care received here and wanted to make appointments by self when...returned home..."

Medical record review of the Discharge Summary revealed the patient was discharged home on October 15, 2013. Continued review of the Discharge summary revealed the patient was calm and cooperative, denied suicidal or homicidal thoughts, hallucinations, delusions, and was tolerating medications.

Review of the facility policy entitled Procedures, Patients' Complaints/Grievances revised August 31, 2006, revealed "...patients can voice complaints and make suggestions without being subject to coercion, discrimination, reprisal, or unreasonable interruption of care, treatment, and services. The patient, family member, or other concerned individual may initiate a complaint/grievance on the form by checking the Concern box, providing identifying information, the date, and a brief description of the event or concern. Upon receipt of a complaint/grievance, the Patient Rights Advisor or designee will log in the complaint and assign it to the appropriate staff for resolution. The staff member will promptly follow up with the complainant and document the outcome of the investigation, including actions taken or recommendations, and the complainant's response concerning the resolution..."

Interview with the social worker on July 23, 2014, at 2:50 p.m., in the conference room, revealed the patient's father was upset with the hospital but the social worker could not remember specifics and said "...He told me about the dissatisfaction but I don't remember what..." Continued interview with the social worker revealed the patient was given the name of the hospital investigator. Further interview with the social worker revealed the social worker did not keep any notes of the discussion and only wrote notes in the patient record. Interview with the social worker confirmed the social worker failed to offer the patient access to the formal complaint resolution process when the patient complained of dissatisfactions with services upon discharge and failed to document the patient's concerns.

Interview with the hospital investigator on July 23, 2014, at 3:00 p.m., in the conference room, revealed the investigator investigated complaints but some went to the patient rights person if they did not rise to the level of abuse. They would talk to the patient to see if it warranted opening a case. Continued interview with the hospital investigator revealed the investigator was unable to remember if a case was opened concerning the allegations. Further interview with the hospital investigator revealed there was no documentation of a complaint for the patient.
VIOLATION: MAINTENANCE OF PHYSICAL PLANT Tag No: A0701
Based on observation and interview, the facility failed to maintain the environment in patient laundry rooms for six of seven units.

The findings included:

Observation on July 23, 2014, between 2:00 p.m., and 3:45 p.m., of the A hall laundry room, revealed rust on the floor under the washer.

Observation on July 23, 2014, between 2:00 p.m., and 3:45 p.m., of the C hall laundry room, revealed an empty deodorant container in the hole beside the drainage hose from the washer. Continued observation of the laundry room revealed rust under the washer.

Observation on July 23, 2014, between 2:00 p.m., and 3:45 p.m., of the D hall laundry room, revealed tape on the glass where it joined the rubber on the door of the dryer. Continued observation of the laundry room revealed the front of the washer had water streaks down the front of it.

Observation on July 23, 2014, between 2:00 p.m., and 3:45 p.m., of the E hall laundry room, revealed the floor was dirty in front of and beside the dryer. Continued observation revealed water streaks down the front of the washer.

Observation on July 23, 2014, between 2:00 p.m., and 3:45 p.m., of the F hall laundry room, revealed water lying on the floor beside the washer and soap suds on the floor behind the washer and near the drainage hose of the washer.

Observation on July 23, 2014, between 2:00 p.m., and 3:45 p.m., of the I hall laundry room, revealed rust on the floor under the washer.

Interview with the Safety Officer on July 23, 2014, at 3:45 p.m. confirmed the issues in the three patient rooms, and confirmed maintenance issues with the laundry rooms on each hall.

Interview with the Standards Coordinator who was present for the tour, on July 23, 2014, at 3:45 p.m., in the conference room, confirmed the above findings.