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.

OCEANS BEHAVIORAL HOSPITAL OF PERMIAN BASIN 3300 S FM 1788 MIDLAND, TX 79706 Sept. 14, 2012
VIOLATION: GOVERNING BODY Tag No: A0043
Based on a review of documentation, the hospital failed to provide an effective governing body that was legally responsible for the conduct of the hospital.

Findings were:

During a review of the personnel record for staff #1, it was revealed that, although the staff member ' s employment with BCA Permian Basin began 7-9-12, no employee paperwork, including infection control training, was completed until 9-13-12.

In an interview with staff #19, she stated that she had a concern related to infection control. She stated that, on the evening of 9-9-12, she had observed staff #1 unclog a toilet on unit 1 and, still wearing the same white overcoat, serve dinner to the patients in the cafeteria.

Per page #16 in the new employee packet furnished to the survey team by staff #4, " All newly hired employees must complete the designated new employee orientation within the first 30 days of their employment. "

During a review of the 10 clinical records that contained treatment plans, none of the 10 plans were individualized to the specific patient.

Facility policy titled " Treatment Planning " states, in part, " An individualized interdisciplinary Treatment Plan will be developed for each patient admitted to the Hospital. "

In an interview with staff #19 on 9-12-12, she stated that, because she and the adolescent RN are not allowed to leave their respective units and are the only RNs in the building on the weekends, they are not allowed to have their meal breaks.

Facility policy titled " Hours of Work " states, in part, " In the event a 12-hour shift is worked, the employee should be allowed two meal or rest breaks of at least one-half hour each. "

In an interview on 9-13-12 with staff #2, she stated that she had been instructed by the corporate office (in an e-mail) to staff the units at a ratio of 1 staff member for every 6 patients when making the staffing schedule but that her final approval and instructions for staffing come from the facility administrative staff and the facility controller. She stated that nurses and direct-care staff were counted as staff members for the 1:6 ratio and that the Director of Nursing looks over the schedule when she has completed it.

During a tour of the adult/geriatric unit on 9-11-12 at approximately 3:00 pm, it was noted by the surveyor that the total census was 26 patients. A review of the census revealed that, as of 3:45 pm, two patients had been discharged and two more admitted , keeping the census constant at 26 patients. One of the 26 patients was being observed on a 1:1 for hyponatremia and excessive voluntary water consumption.

A review of the staffing for the unit revealed that the staff assignment consisted of one registered nurse, one licensed vocational nurse and two mental health associates.

An e-mail from the facility controller to staff #2 sent 8-24-12 contains the following statement, " On the units we need to maintain the 1:6 staffing ratio. "

Per a facility document titled " BCA Permian Basin ...2012 Operating Budget " , the minimum staffing for the adult unit with 25 to 28 patients on the day shift is as follows:
? 4.2 Registered Nurses (from 7a to 7p)
? 4.2 Mental Health Associates (from 7a to 7p)
? 1.4 Licensed Vocational Nurses (from 7a to 3p)
? 2.8 Mental Health Associates (from 7a to 3p)

The above was confirmed in an interview with the facility Vice-President of Regulatory Compliance, the CEO, the Director of Nursing and the Clinical Director on the afternoon of 9-14-12 in the facility conference room.
VIOLATION: MEDICAL RECORD SERVICES Tag No: A0431
Based on observation, the hospital did not maintain a completed medical record for every individual evaluated or treated in the hospital.

Findings were:

During a review of 19 clinical records, 5 of the 19 (patients #2, #4, #5, #6, #12) records contained a history and physical not performed within 24 hours of admission.

During a review of 19 clinical records, 16 of the 19 (patients #1, #4 - #18) records contained no discharge summary.

During a review of 19 clinical records, 9 of the 19 (patients #6, #7, #10 - #12, #15 - #18) records contained no treatment plan.

During a review of the 10 clinical records that contained treatment plans, none of the 10 plans were individualized to the specific patient.

During a review of 19 clinical records, 2 of the 19 (patients #6, #12) contained no psychiatric evaluation.

During a review of 19 clinical records, 1 of the 19 (patient #15) contained a psychiatric evaluation not performed within 60 hours of admission.

During a review of 1 clinical record pulled randomly from the facility restraint & seclusion log (patient #3), 1 of 1 patient did not receive a face-to-face evaluation within 1 hour of the initiation of the restraint and/or seclusion.

The above was confirmed in an interview with the facility Vice-President of Regulatory Compliance, the CEO, the Director of Nursing and the Clinical Director on the afternoon of 9-14-12 in the facility conference room.
VIOLATION: INFECTION CONTROL Tag No: A0747
Based on interviews, a review of facility documentation and a personnel file, the facility failed to maintain a sanitary environment to avoid sources and transmission of infections and communicable diseases. There was no documentation of an active program for the prevention, control, and investigation of infections and communicable diseases.

Findings were:

In an interview with staff #19, she stated that, on the evening of 9-9-12, she observed staff #1 unclog a toilet on unit 1 and, still wearing the same white overcoat, serve dinner to the patients in the cafeteria.

During a review of the personnel record for staff #1, it was revealed that, although the staff member ' s employment with BCA Permian Basin began 7-9-12, no employee paperwork, including infection control training, was completed until 9-13-12.

During a review of infection control data for 2012, there was no documentation for the months of January, February, May, June, July and August that infection rates were reviewed and/or monitored.

The above was confirmed in an interview with the facility Vice-President of Regulatory Compliance, the CEO, the Director of Nursing and the Clinical Director on the afternoon of 9-14-12 in the facility conference room.