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.

BEHAVIORAL HOSPITAL OF LONGVIEW 22 BERMUDA LANE LONGVIEW, TX June 21, 2016
VIOLATION: PATIENT RIGHTS: NOTICE OF RIGHTS Tag No: A0117
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of records, the hospital failed to appropriately notify patient representative of patient discharge rights in 1 (Patient #3) of 4 patients reviewed (Patients #2, #3, #4, and #5).

Patient #3 was admitted on [DATE] involuntarily. He had an admitting diagnosis of Schizophrenia. He was assessed and found to have dementia. His dementia was such that he was not appropriate for admission and was discharged home with a caretaker on 6-2-16.

Prior to discharge, patient was allowed to sign the Important Message from Medicare about Your Rights. This form explains a patient's rights pertaining to discharge. The form was dated and timed as 6-2-16 at 2:45 pm.

The nursing note written at the same time states, "Discharge paperwork completed. Pt (patient) doesn't verbalize understanding - mumbles and laughs to self." The next note is timed 10 minutes later at 2:55 pm and states, "Pt escorted to admissions by MHT (mental health technician). All personal belongings returned. Pt transported by private vehicle."
VIOLATION: MAINTENANCE OF PHYSICAL PLANT Tag No: A0701
Based on a review of records, observation, and interview, the facility failed to:

A. Identify risks to psychiatric patient's safety in the hospital environment.

B. Take action to correct identified environmental deficiencies in a timely manner to protect patient safety.

C. Ensure routine maintenance and preventive maintenance was completed to protect patient safety.

Findings include:

A.
1. During tour of the Patient Dining Area, seven window treatments in the patient dining room were found to have 14 tie backs 12 to 14 inches long. The tie backs were easily removed and could be used by a patient for harm to self or others.

Staff #1 was shown how easily the ties could be removed and used to by a patient to choke another patient or staff. Staff #1 acknowledged that the ties had been there for at least 3 years and had never been identified as a potential hazard.

2. The women's bathroom between Unit 3 and Unit 4 had not been toured during the original survey. A female patient had been using the restroom while a male Mental Health Technician waited outside of the bathroom for her. The restroom was unoccupied during the follow-up survey and toured. The three stalls in the bathroom did not have doors. They had scored PVC pipes across the door frames of the three stalls. The pipes (three total) were holding cloth shower curtains (three total) with plastic shower curtain rings. The pipe was broken easily by the surveyor exposing a sharp pointed pipe that could be easily used as a weapon by a psychiatric patient. The stall walls had connection points allowing the surveyor the opportunity to tie one end of the shower curtain in a knot and drape the material between the stall walls at the connection point. By placing the knot on one side of the wall and the excess material on the other side of the wall, using the connection point for support, this would allow a psychiatric patient to use the shower curtain for a hanging device.

3. On Unit 4, nine out of twelve electrical outlets inspected in patient access areas did not have the covers locked to prevent psychiatric patients from accessing live outlets.

Staff #12 was interviewed during the tour. Staff #12 stated sometime nursing staff takes the locks off to hook up medical equipment and they forget to put the lock back on. Staff #12 did not know why locks had not be placed back on the outlets.


B.
1. A tour of the gymnasium was conducted on the afternoon of June 20, 2016. Staff #16 was present during the tour. The door of the gymnasium had signs on the door indicating that the gymnasium was closed until further notice. When asked how long the gymnasium had been closed, Staff #16 stated he thought it had been closed a week or two, but could not provide a date. He pointed out that the floors were in the process of being painted. The holes in the wall had been repaired. Staff #16 stated they had a personnel lift in the gymnasium that allowed the vent ducting to be cleaned. When asked why the ceiling tile was still hanging, representing a danger of falling on patients or staff, he stated the lift did not reach that high and that they would have to find another means of accessing it. Staff #16 confirmed that there was not a means identified at that time and was unsure of a timeline when it would be inspected and repaired. Staff #16 did confirm that patients had used the gymnasium up until its closure. This was allowed without an adequate inspection of the ceiling tile that was hanging to identify the severity of risk that patients and staff would be exposed to if the tile came loose and fell on someone. Staff #7 was interviewed on the morning of June 21, 2016. When discussing low safety priorities like painting that were being completed, rather than addressing immediate jeopardy safety items, Staff #7 commented, "We need a team to approve changes. It seems we're just scrambling around."

2. The men's and women's bathroom outside of the dining area were frequently used by patients. The toilets were standard porcelain toilets with removable tops. The tops had been secured to prevent patient removal by use of heavy duty nylon zip ties. The excess end of the zip ties had been cut off but had not been cut off flush to the connection. This left a sharp edge that could be used by patients for self-harm. This problem had been identified to Staff #5 and Staff #12 on June 20, 2016. A second tour of the bathroom was conducted on the morning of June 21, 2016. This condition still existed and the bathrooms were open and available for patient use.

3. During a tour of Unit 3 and Unit 4, it was noted that the can lights did not have secured covers over them. Secure covers were needed to prevent patients from accessing the light bulbs and live light sockets. On Unit 3, one can light in the day room and one can light in the solarium did not have light bulbs in the socket and the light switch was on. This left exposed open light bulbs and light sockets for psychiatric patients to harm themselves.

Interview with Staff #12 was conducted during the tour. Staff #12 stated they put up all of the covers that were available after it was noted on the last survey, but ran out. Staff #12 stated he had just received Plexiglas material to make covers the day before (June 19, 2016) but had not had a chance to work on that project.

4. Beds in patient rooms on Unit 3 and Unit 4 had not been bolted down. Beds can be easily moved and used as blockades by psychiatric patients, preventing staff from accessing the patient during a psychiatric emergency situation. Beds not being bolted down had been identified as a problem during previous survey.

5. The patient TV on the wall in Unit 4 was not secured to prevent damage or breakage of the screen. This had been previously identified. Plexiglas covers had been ordered and received. The covers were available during the May 6, 2016 survey, but had not been installed. Staff #12 explained that he had not had time to work on that project.

C.
1. During tour of the Patient Admissions area, the thermostat box on the wall near patient processing area had exposed wires.

2. The women's restroom in the patient admission area had damaged walls where the soap dispenser had been replaced. The wall had not been repaired, leaving exposed wall board.

3. Ceiling tiles in the women's restroom in the patient admission area had cracked ceiling tiles.

4. The men and women restrooms in the patient admission area were missing signage.

5. The drop-down ceiling in the men's restroom had damaged ceiling tile frames and ceiling tiles with evidence of water leakage.

6. The patient wheelchair scale in the admissions area was soiled with hair, dust, and debris. The scale preventative maintenance sticker was expired. The last date preventive maintenance was documented was in 2012.

7. In the patient admissions area, by the patient scales, cable boxes were missing covers and were broken.

8. In the patient admissions area the ceiling had evidence of a water leak.

9. In the patient admission area there were can lights without safety covers, exposing bulbs and sockets.

10. Vinyl floor strips in the admissions area were lifted and buckled, presenting a trip hazard.

11. A chair in the admissions area had the bottom underside covering torn away in one corner and hanging down.

12. An air vent in the Environmental Services supply storage office was attached to the ceiling with duct tape.

13. In the maintenance hallway a clean laundry holding room was very dim with poor lighting. There was only one fixture and only one bulb burning in the fixture.

14. Down the maintenance hallway, a light switch plate was broken and repaired with tape.

15. Down the maintenance hallway the boiler room had air conditioner window units stored, obstructing a pathway for maintenance. Six dirty soiled rags were found around the housing pumps, behind the pipes, and laying on the floor.

16. Outside by the service entry doors the roof had missing and torn shingles. The vents coming from the kitchen were covered in rust and had visible holes. The entrance walkway had debris, exposed wires and dead bug debris.

17. The door handle to the kitchen door from the maintenance hallway was broken and greasy.

18. The ultraviolet light to prevent flies in the kitchen showed the last maintenance date as 4/21/14.

19. In the dry goods storage room of the kitchen, the walls were found to be dirty and soiled. Sheet rock was ripped and exposed. Water coolers were stored on the top shelves too close to the ceiling.

20. In the kitchen housekeeping closet, the door knob was broken. The walls were soiled with unknown stains and substances. The light switch and plate was broken and heavily soiled with dirt and a greasy substance.

21. The door frames in the kitchen were missing paint, rusted, and had exposed sheet rock.

22. In the kitchen walk-in freezer, cardboard boxes were stacked up to and touching the freezer light.

23. The kitchen walk-in refrigerator was found to have standing water on the floor. The floor tile was broken and mildewed. Mildew was found on the side wall where patient food was being stored. Ice had formed between the ceiling and wall of the unit. The wall had buckled and caused separation of the interior wall.

24. The kitchen walk-in refrigerator had multiple rusted areas in the ceiling of the unit. A condenser fan in the unit was dripping water into bins of unopened milk cartons, fresh fruits and vegetables.

25. Can lights in the patient dining room had exposed bulbs and sockets.

26. The popcorn ceiling in the patient dining room was cracked falling with debris on the floor next to patient tables.

27. The wall in the women's restroom outside of the patient dining area had sheet rock exposed.

28. A closet in the multipurpose room was full of kitchen supplies, cups, vinyl gloves, lids, napkins, and food items. The boxes were shipping boxes tossed in the room. Some were sitting on a soiled floor and touched the ceiling.

29. Ceiling tiles in the closet in the multipurpose room had evidence of water leak and was sagging. The floor had tiles missing.

30. A radio was found in a filing cabinet drawer on Unit 3. Annual preventive maintenance / inspection of electrical equipment had not been performed. The preventative maintenance sticker dated 12-20-12.

31. Two commercial hot water heaters were found in the gym area. The heaters had plastic balls and gym equipment sitting close to them.

32. The bathroom in patient room 403 had a rusted toilet tank. The rust was chipping off onto the toilet seat and base.
VIOLATION: INFECTION CONTROL OFFICER RESPONSIBILITIES Tag No: A0749
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on observation and interview the facility failed to ensure all areas of the hospital were clean and sanitary. The infection control program failed to include appropriate monitoring of housekeeping, maintenance, and other areas to ensure a sanitary environment was maintained.

The condition and deficient practices were identified and determined to pose Immediate Jeopardy to patient health and safety and placed all patients at risk for the likelihood of harm, serious injury, and possibly subsequent death.

A tour of the facility was conducted on 6/20/2016 with staff #'s 1, 2, 4, 5, and 12. The following infection control issues were found in the following areas:

A.) On a shelf in the time keeping room a manual for "family and medical leave act" notebook was covered in a heavy brownish stain and sticky substance.

B.) The following infection control issues were found in the patient admissions area:

1.) The ladies bathroom had water stained ceiling tiles and torn wallpaper on the wall exposing sheet rock. The toilet base was soiled with dried urine and dust. The floor tiles were mildewed and soiled with dust, hair, and dried urine. The faucet handles were soiled with a thick yellow substance. The sink area was soiled with hair and a green substance.

2.) The men's bathroom had a soiled toilet base. The base was soiled with hair, dust and dirt. The floor was soiled with mildew and dried urine. The sink faucet was broken and the handle was covered with a hard sticky substance.

3.) A large "walk on" patient weight scale was soiled with hair, dust, and debris. The ceiling was dripping water over the scale area.

4.) A couch in the patient admissions waiting room was soiled under the first cushion with a bloody dressing and a nickel underneath. The couch had a tear on top and soiled under the second cushion with hair, dirt, dried food particles and paper.

5.) The tile on the floor was gapped and missing in multiple areas. The floor tile gaps had debris, dust and hair in the cracks.

6.) A chair in the patient admissions area was torn and ripped underneath. The fabric was hanging on the floor.

C.) The following infection control issues were found in the maintenance hallway and housekeeping areas:

7.) A room was found with cleaning supplies and 20 boxes of gloves for patient care and cleaning. The room was also used as a break room with food products mixed with patient and cleaning supplies. The air vent on the ceiling was held by duct tape and covered with a mildew substance.

8.) In the main clean laundry room the floor was soiled with dust, hair, and debris. Laundry was found uncovered and exposed to dust and dirt. On three large shelves, the cloth curtains surrounding the laundry did not cover the entire rack exposing laundry to the environment. Six clean rugs were found bundled on the dirty floor of the linen room.

9.) A housekeeping closet used for storage of housekeeping carts, wet floor signs, brooms, and mops was found soiled with copious amounts of dirt, rust, debris, and trash. The floor was heavily soiled with dirt, hair, and dead bugs. Staff #12 confirmed clean brooms, and mopping equipment were stored in this closet. Staff #12 confirmed the closet was heavily soiled and needed to be cleaned.

10.) An eyewash station was found in a bathroom. This was the designated eyewash station for the housekeeping and maintenance staff. The wall had missing sheet rock under the soap dispenser and eyewash sign. The sink and faucet that held the eye wash station was soiled with a black substance and hard water build up. The left side of the eye wash station did not have any flow of water. The sink was sitting on an exposed wooden frame that was soiled with dust and hair. The light above the eyewash station was just an exposed bulb not in a light fixture. The sink and faucet that held the eye wash station was very close to the toilet. The toilet was heavily soiled with dried urine, hair, dust, feces, and rust. The floor was heavily soiled with trash debris.

11.) The carpet and floor stripping equipment used to clean the patient care areas were soiled with dust, dirt, and a heavy sticky substance.

12.) Outside, by the service entry doors, a cart was found. The cart was being used to unload supplies and deliver inside the facility. A blanket was covering the bottom of the cart. The blanket was mildewed and heavily soiled from wet products and exposure to the elements. Underneath the blanket the cart was rusted and the wooden surface was rotted. The wood had splintered off into multiple pieces and was missing in some places.

13.) Outside by the service entry doors, a large rolling trash cart was found with trash items, not bagged, thrown in the bottom of the bin. The bin was exposed to the elements and had no cover.

14.) Outside, by the service entry doors, the roof had missing and torn shingles. The vents coming from the kitchen were covered in rust and had visible holes. The entrance walkway had debris, exposed wires and dead bug debris.

D.) The following infection control items were found in the kitchen:

15.) The floor and threshold entrance to the kitchen, from the hallway, was soiled with dirt, cob webs, chewed up gum, and a nail. The door handle to the door was broken and greasy.

16.) In the dry goods storage room, walls were found to be dirty and soiled. Sheet rock was ripped and exposed. Water coolers were stored on the top shelves next to the ceiling.

17.) The kitchen housekeeping closet floor and mop basin had copious amounts of dirt, dust, dried insects, and debris. The outside of the "clean" mop bucket was heavily soiled with a black substance. The "caution wet floor" signs were sitting on the floor in dirt, dust and debris. These signs had previously been on the floor of the patient dining room. The door knob was broken. The walls were soiled with unknown stains and substances. The light switch and plate was broken and heavily soiled with dirt and a greasy substance.

18.) The kitchen floor was soiled with food debris and a slick greasy substance. All door frames were missing paint, soiled, and rusted.

19.) The kitchen walk in refrigerator was found to have standing water on the floor. The floor tile was broken and mildewed. Mildew was found on the side wall where patient food was being stored. Ice had formed between the ceiling and wall of the unit. The wall had buckled and caused separation of the interior wall.

20.) The kitchen walk in refrigerator had multiple rusted areas in the ceiling of the unit. A condenser fan in the unit was dripping water into bins of unopened milk cartons, fresh fruits and vegetables. The water in the bins was yellow, mildewed, and had a soured smell.

21.) The kitchen walk in refrigerator had shipping boxes on the shelf and the food containers were soiled with food debris.

22.) The stove and oven handles in the kitchen were soiled with food and grease build up.

23.) 14 baking pans were found in the kitchen stacked as clean. The pans were removed and found to be soiled with food particles, food residue, and stored wet.

24.) The popcorn ceiling in the patient dining room was cracked with falling debris on the floor next to patient tables.

E.) The following infection control items were found in the main hallway:

25.) The women's bathroom outside of the dining area was frequently used by patients. The floor was soiled with dust, hair, and mildew. The wall had sheet rock exposed and the trash receptacle was soiled with dust and hair.

26.) The men's bathroom outside of the dining area was frequently used by patients. The floor was soiled with hair, dust, and debris. The base of the toilet was soiled with urine and rusted.

27.) A closet in the employee training room was full of kitchen supplies, cups, vinyl gloves, lids, napkins, boxes and food items. The boxes were shipping boxes tossed in the closet. Some were sitting on a soiled floor and touched the ceiling.

F.) The following infection control items were found on patient unit 3:

28.) The medication room on unit three had the refrigerator sitting on a dirty unfinished wooden pallet. The freezer part of the medication refrigerator had ice buildup. Two bottles of insulin had illegible written dates of when they were opened. The storage bins for the insulin bottles were soiled with dried liquid substances and hair.

29.) The medication room on unit three had a soiled pill cutter. The cutter had medication residue on and in it. The door to the medication room was missing paint, exposing wood.

30.) The quiet/restraint room had a plywood base bed with a mattress. The mattress was raised and found to be torn on the back side. The wooden frame was not sealed and bare wood was exposed. The frame had a dead bug in the corner and was dusty.

31.) The main patient bathroom next to the quiet room had a soiled toilet with dried urine and hair. The floor was found dusty, mildewed, and hair on the floor.

32.) In the locked patient personal belongings storage area, the shelves were soiled with dry liquids, dust, hair, and trash. Patient clothing was lying directly on the soiled areas.

33.) In the designated low stimulus room, a chair was found with trash, food, dust, and hair under the cushion. Mold had grown up the side of the wooden chair from the old food products.

34.) On unit three, the laundry room had linen uncovered exposing it to the dusty floor. A linen commercial transport bin from the contracted linen service was found in the clean linen room. The outside of the bin was dirty with multiple tape residue on the outside.

35.) In the patient nourishment room, a microwave was soiled and covered in scorch marks. The cabinet shelves that held patient nutrition was soiled with dust and food particles.

36.) In the patient nourishment room the refrigerator temperature sheet revealed the temperature was below or above the 35-40 degree range 15 times out of 20 with no documented adjustments. Patient food, liquids, and fruits were stored in the refrigerator.

37.) The bathroom in patient room 301 was found to have a toilet with rust on the tank. The commode was dirty with dried urine and hair. The base of the toilet was soiled with hair and dust. The toilet anchor was rusted and covered in dried urine and unknown substances. A hole in the wooden window frame was found. The hole was an inch in diameter exposing rotting wood.

38.) The patient sunroom was dusty and had dead bugs on the windowsills. The ceiling skylight had multiple dead bug coverage and there was a black residue on the walls.

39.) Patient #1 reported to the surveyor that she had brushed her teeth between 6:00 and 6:30 am. At 11:31 am, in room 305, there was approximately 1 inch of water still standing in the sink with toothpaste residue . Patient #1 complained it took all day for the sink to drain. Patient #1 reported she had complained about the sink since her admission to the facility on [DATE]. Tiles were missing at base of the wall by the shower. Patient #1 reported the tile fell off the first day she was in the room and she tripped on it. She said she didn't fall, she caught herself and was not injured.

G.) The following infection control items were found on patient unit 4:

40.) In the medication room of unit four the medication refrigerator was found on exposed wooden pallets. The freezer of the refrigerator had ice buildup.

41.) The medication room refrigerator had insulin labeled with an opening date with no year. The glucometer was in a tray with exposed 2x2's. The counter was soiled with dust and hair.

42.) In the medication room a cabinet was found with patient lotions and topical medications. Next to the medication were cleaning supplies and a pressurized can of lemon deodorizer that was labeled as highly flammable.

43.) In patient room 406 a used urinal was found on the floor. The patient had two full cups of a brown liquid in the windowsill. Staff #2 reported that patients were not to have any food, liquids, or toiletries in their rooms. These items were considered contraband.

44.) The bathroom in 406 had contraband in the bathroom and toothpaste with brush was found in the windowsill. The base of the toilet was soiled with hair and dust. The anchor to the toilet was rusted and soiled with unknown substance.

45.) The patient bathroom floor in room 406 had a mildewed floor with thick black substance on the tile and a patient medication transdermal patch was found. The patch was stuck on the floor and dated 6/16.

46.) The linen in the clean linen room was found uncovered and exposed to dust and contaminates. The soiled commercial laundry transport container was found in the clean linen room.

47.) In the patient hallway bathroom the toilet had not been flushed and was full of urine. The floors were soiled with dust, hair, and mildew.

48.) In the quiet room on unit four, a restraint bed was found. Sheets and a blanket were on the bed. The linen had dead insects on the sheets. A pillow was found torn and worn exposing the contents. The mattress was lifted and a white package was noted lying on the base of the bed. The package was an unopened Tylenol packet which had expired on ,d+[DATE].

49.) Patient room 403 was found to have two pieces of dried out and hard turkey lying on the floor. The bathroom had a copious amount of rust on the toilet tank. The rust was chipping off onto the toilet seat and base.


An interview was conducted with staff #1 on 6/21/16. Staff #1 was present during the tour of the facility and was shown the issues with infection control. Staff #1 stated, "It shouldn't be like this. I don't know why it's not clean."

An interview was conducted with staff #12 on 6/20/16. Staff #12 reported that there was no increase of housekeeping staff for the last 6 weeks and at any given time there were only three housekeepers on duty. Staff #12 reported there were no additional housekeepers hired or overtime allowed to ensure the cleanliness of the facility.

An interview was conducted with staff #5 on 6/21/16. Staff #5 reported that she has had a limited time to develop an infection control plan. The facility had hired an infection control consultant to assist with the plan. Staff #5 reported that she had been gone for over a week to training and had not been at the facility to monitor closely. Staff #5 reported that she had identified multiple issues in the facility but there had been no correction to the problems.
VIOLATION: PATIENT RIGHTS: CONFIDENTIALITY OF RECORDS Tag No: A0147
Based on observation and interview, the facility failed to store patient records with appropriate safeguards to prevent medical record information from unauthorized disclosure.

A tour of the facility was conducted on the morning of June 20, 2016. In the main hallway that separates Unit 1 and Unit 2 from Unit 3 and Unit 4 was a room identified as the multidisciplinary room. The closet in the multidisciplinary room was locked. Staff # 12 had keys to the door and opened it. When asked who else had key access to the room, he could not provide a specific list of people. He stated Maintenance Staff, Administrative Staff, Human Resources, and Medical Records had keys to the storage closet.

In the storage closet was a large tub filled with architectural plans for the facility and 55 cardboard boxes marked with the name of the previous hospital that occupied the facility. Inside the boxes were approximately 20 patient charts per box from the previous hospital.

Staff #5 was on the tour and stated, "I've never looked in that closet before. I didn't know those were in there."

Staff #1 was interviewed in the afternoon of June 20, 2016 and advised that the patient charts were not adequately safeguarded in the closet. Staff #1 stated, "I don't know why those haven't been sent to off-site storage. We have an off-site storage."



A tour of Unit 3 was conducted on the morning of June 20, 2016. In a storage room, an unlocked cabinet was found. The third and fourth drawer was full of old patient census sheets and report logs to include patient assessment information. This patient sensitive information dated back as far as 2014. This room was accessed with a key that all employees carry. Staff #5 advised that patients were not allowed to access this room. Staff #12 confirmed that employee access to this room was not controlled.