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LAUREL RIDGE TREATMENT CENTER 17720 CORPORATE WOODS DRIVE SAN ANTONIO, TX 78259 June 13, 2013
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0179
Based on record reviews and interviews, the facility failed to ensure that for one of one patients (Patient #1) who was admitted to an acute care unit and was placed in restraint (containment) and seclusion on 04/08/13, a one hour face-to-face physician evaluation of the patient was conducted in accordance with facility policies and procedures. This had the potential to affect all patients who were placed in restraint or seclusion after 11:00PM.

Findings included:

Record review of Patient #1's Specialized Treatment Procedure Forms for 04/08/13 revealed that she was placed in restraint for less than a minute at 2145 and then placed in locked seclusion from 2310 to 2330. According to the Checklist for Interventions located on these forms, registered nurse (RN) #1 documented that a physician was not available to complete a face to face physician evaluation due to already leaving the facility.

Record review of the facility's Special Treatment Procedures on Seclusion/Restraints, last reviewed by the facility in January 2012, revealed the following: "Within one hour of the initiation of containment or seclusion, a physician or other licensed professional trained in the use of emergency safety interventions and permitted by the Texas Administrative Code and the organization to assess the physical and psychological well-being of residents must conduct a face-to-face assessment of physical and psychological well being of the patient. In the Acute and Residential Units, the Physician credentialed for this function performs the face-to-face evaluations within one hour of the initiation of seclusion or containment. The purpose of this evaluation is to determine if the use of these measures is justified to prevent the patient from causing harm to self or others. It is also completed to ensure that he use of seclusion/restraint poses no undue risk to the patient's medical or psychological well-being. The face-to-face evaluation is performed even in those situations where the person is released prior to the one hour point."

Interview on 06/12/13 at 10:15 AM with RN #1 revealed that she attempted to contact a physician to complete a face-to-face evaluation of Patient #1 in accordance with facility policies and procedures but was told the physician had already left the facility since there were no pending admissions.

Interview on 06/13/13 at 10:30 AM with the Chief Nursing Officer (CNO) confirmed that after 11:00 PM, there was not a physician physically present in the facility. She stated it was up to the attending physician whether they wanted to come in to do a face-to-face assessment at that time. She stated the facility utilizes telemedicine for facility admissions after 11:00 PM.
VIOLATION: PATIENT RIGHTS: INFORMED CONSENT Tag No: A0131
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record reviews and interviews, the facility failed to ensure that for one of one patients with a guardian (Patient #1), the guardian was informed of a restraint and seclusion that occurred on 04/08/13. This had the potential to effect any patient with a guardian.

Findings included:

Record review on 06/11/13 of Patient #1's Admission Psychiatric Evaluation , dated 04/08/13, revealed that Patient #1's was [AGE] years old and her mother was her legal guardian.

Record review on 06/11/13 of Specialized Treatment Procedure Observation Forms, completed by registered nurse (RN) #1 on 04/08/13, revealed that Patient #1 was restrained for less than one minute and placed in locked seclusion for 20 minutes. Continued review of these forms revealed that under "was patient's family/parent/guardian/other notified", it was checked "no" without an explanation as to why the guardian was not notified.

Interview on 06/12/13 at 10:15 AM with RN #1` confirmed that she was aware that Patient #1 had a guardian. She stated that the restraint and seclusion events occurred during a shift change so she assumed the guardian would be notified by the incoming shift.

Interview on 06/12/13 at 11:00 AM with Patient #1's mother/legal guardian revealed she was not aware that Patient #1 was restrained or placed in locked seclusion until after her daughter (Patient #1) was discharged and informed her of those events. She stated that she did not want her daughter being placed in locked seclusion due to traumatic events in her childhood.

Interview on 06/13/13 at 10:30 AM with facility Chief Nursing Officer (CNO) confirmed the nursing staff
should have notified Patient #1's mother/legal guardian about the restraint and seclusion.