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 PLANO 4301 MAPLESHADE LANE PLANO, TX March 15, 2016
VIOLATION: PATIENT RIGHTS: EXERCISE OF RIGHTS Tag No: A0129
Based on record review, observation and interview, the hospital failed to ensure the exercise of rights' requirements for dignity and personal hygiene were met for two of two patients.

1) Patient #11 was in soiled clothes, smelled of urine, and did not have a bath for six days, and
2) Patient #10 had not received a bath in three days and felt she smelled bad.


Findings included:

1) An observational tour was conducted with Employee #3 on the hospital's inpatient unit on 03/15/16 between 13:40 and 14:25. Patient #11 was observed in a wheelchair. Patient #11's white T-shirt was soiled in multiple spots. The patient's dark sweat pants were soiled. His wheelchair was observed with white crumbs and white spots. The patient was unshaven and smelled of urine. The patient asked for a shave.

During an interview on 03/15/16 at approximately 13:50, Employee #3 agreed that the patient smelled of urine and stated she had noticed the patient's pants were wet.

Record review of Patient #11's close observation records reflected the patient had a bath on 03/09/16 at 10:45.

2) Patient #10 was surveyor observed on 03/15/16 at 14:25. The patient stated to the surveyor, "I have not had a bath for three days...I [smell bad]..."

Record review of Patient #10's chart reflected a shower was provided on 03/12/16 at 11:30.

Employee #3 agreed on 03/15/16 at approximately 14:30 that Patient #10 received her last bath on 03/12/16, three days prior to surveyor interaction with Patient #10.

During a telephone interview on 03/16/16 at 13:15, Employee #3 stated the hospital's nursing policy did not address specific bath times for patients.

Record review of the hospital's Patients' Rights policy (RTS-02) dated 01/11/16
reflected hospital patients had the right to a treatment environment that ensured protection "...with regard to personal needs, and promotes respect and dignity for each patient."
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review, observation, and interview, the hospital failed to provide a safe care setting for one of ten patients (Patients #5). Patient #5 was documented in nursing and physician assessments to be without bruises on his 09/04/15 admission. Two weeks later, Patient #5 was noted to have multiple bruises on his body. There was no incident report of a fall.


Findings included:

1) Patient #5's Physician's Preadmission Examination orders dated 09/04/15 at 19:05 reflected the patient was voluntarily admitted with diagnoses that included Mood Disorder, Psychosis, Stroke, Diabetes, and Dementia.

Comprehensive Integrated Nursing assessment dated [DATE] reflected a nursing skin assessment. The patient did not have any bruises.

Patient #5's Physician History and Physical Examination dated 09/05/15 at 14:00 reflected the patient did not have any bruising.

The Braden Reassessment documentation dated 09/13/15 reflected the patient had bruises on both hands. The Braden Reassessment documentation dated 09/20/15 noted Patient #5 had a bruise on his head, a bruise covering an area from above his left knee to below his left knee, and a bruise on his upper left arm and on top of his left hand.

Patient #5's multidisciplinary note dated 09/16/15 at 08:30 reflected "head swelling...skin tear...fell from getting to wheelchair...ice pack applied..."

Patient #5's daily nursing note dated 09/16/15 at 08:30 reflected the patient had "ice to [his] head."

Hospital Employees #3 and #4 acknowledged the findings during an interview on 03/15/16 at 13:20.

During an interview on 03/15/16, Employee #3 denied she received an incident report about Patient #5's fall.
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review, observation, and interview, the hospital nursing staff failed to supervise and evaluate the nursing care for each patient according to patients' needs for two of ten patients (Patients #5, #11).

1) Patient #5 was physician and nursing assessed with intact skin at the time of his admission on 09/04/15. Patient #5's head was swollen and had a skin tear twelve days into his hospitalization . The patient informed staff he had fallen. There was no evidence of assessment and/or reassessment data of Patient #5's head injury.

2) Patient #11 was surveyor observed with bruises on both arms. There was no evidence of assessment and/or reassessment of Patient #11's bruises.


Findings included:

1) Patient #5's Physician's Preadmission Examination orders dated 09/04/15 at 19:05 reflected the a patient was voluntarily admitted with diagnoses that included Mood Disorder, Psychosis, Stroke, Diabetes, and Dementia.

Patient #5's Comprehensive Integrated Nursing assessment dated [DATE] reflected a nursing skin assessment. The patient did not have any bruises.

Patient #5's Physician History and Physical Examination dated 09/05/15 at 14:00 reflected the patient did not have any bruising.

Patient #5's multidisciplinary note dated 09/16/15 at 08:30 reflected "head swelling...skin tear...fell from getting to wheelchair...ice pack applied..." There were no further patient assessment data.

Daily Nurses Notes dated 09/16/15 and 09/17/15 did not reflect assessment data of Patient #5's head injury.

Patient #5's Braden Skin Reassessment documentation dated 09/20/15 noted the patient had a bruise on his head, a bruise covering an area from above his left knee to below his left knee, and a bruise on his upper left arm and on top of his left hand.

Hospital Employees #3 and #4 were asked to review Patient #5's chart on 03/15/16 at 13:20 and acknowledged the findings.

2) Patient #11 was surveyor observed on 03/15/16 between 13:40 and 14:25. Patient #11 had a dark red bruise the size of about two quarters on his left forearm next to a scar. His right arm had multiple small bruises. Employee #3 acknowledged the findings at that time.

Patient #11's Comprehensive Integrated Nursing assessment dated [DATE] at 17:55 did not reflect bruises on the patient's arms.

Daily Nurse Notes dated 03/14/16 (day and night shifts) and 03/15/16 (day shift) did not reflect that Patient #11 had bruises.

Employees #2 and #3 acknowledged the findings on 03/15/16 at approximately 14:00.