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.

CROSS CREEK HOSPITAL 8402 CROSS PARK DRIVE AUSTIN, TX Dec. 4, 2017
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
Based on review of facility documents, review of medical records and interview, the facility failed to ensure patients received care in a safe setting by restraining patients inappropriately according to facility policies.

Findings included:

Review of the medical record for patient #10 revealed patient #10 was improperly restrained per facility policy. (Refer to A0167)
VIOLATION: USE OF RESTRAINT OR SECLUSION Tag No: A0154
Based on review of facility documents, review of medical records and interview, the facility failed to ensure patient had the right to be free from restraint.

Findings included:

Facility patient rights document stated in part, "You have the right to a human and safe environment that affords reasonable protection from harm. You have the right to be free from mental and/or physical abuse and free from chemical and physical restraints, except when necessary to protect you from injury to yourself or other."

Facility policy titled "Restraint" stated in part, "Policy: Definition - A restraint is any manual method that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely, regardless of the length of time. Holding a patient who is not cooperative with receiving a medication through injection and/or approved CPI holds is considered a personal restraint ...
*Restraint may only be used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member or others after less restrictive interventions are ineffective or ruled-out ...
*Restraint is never used as a means of coercion, discipline, convenience or staff retaliation ..."

Review of patient #10's medical record revealed a nursing note dated 11/14/17 at 9:08 pm that stated in part, "Patient became uncooperative when it was time to leave admissions and go to the unit. Patient refused to go to unit, was given at least three chances to do so independently. Patient was then taken by arms to be guided to unit and became combative, hitting and kicking at staff. Patient continued to hit, kick and stomp at staff's feet, at which point patient was carried part of the way. When patient calmed, he was put down and allowed to walk the rest of the way to the unit. Patient in restraint from 8:00-8:08 pm."

In an interview with staff #2 on 12/4/17 at 2:00 pm, staff #2 stated, "Oh no. They cannot pick anyone up ... No, staff cannot pick anyone up. We go over that in orientation."

The above was verified in an interview with the CEO on the afternoon of 12/4/17.
VIOLATION: PATIENT RIGHTS: INFORMED CONSENT Tag No: A0131
Based on review of facility documents, review of medical records and interview, the facility failed to ensure patient's representatives had the right to make informed decisions regarding their care.

Findings included:

Facility policy titled "Services for persons with limited English proficiency" stated in part, "Policy: Communication is essential in the provision of services and the delivery of quality patient care. The identification of individuals including patient's and/or a patient's family member/caregiver needing assistance with language interpretation will occur immediately upon presentation/admission and throughout the hospital stay. The need will be assessed and a plan of action will be implemented in order to facility effective communication ...
1) Language interpretation: For individuals needing language interpretation, twenty-four hour access to an interpreter is provided through the language interpretation services ... Family member and friends will not be used as interpreters unless specifically requested by the patient and only after the agency's offer of a free interpreter. The facility will document its offer and the patient's response in the patient's medical record ...
...5) The following written materials and forms can be provided in Spanish. The list includes but is not limited to:
a) Consent for treatment
b) Grievance and/or complaint form
c) Written notice of eligibility criteria
d) Non-discrimination notices
Cross Creek Hospital will provide translation of other written materials, if needed, as well as written notice of the availability of translation, free of charge, for LEP [limited English proficiency] individuals."

Facility policy titled "patient rights" stated in part, "Cross Creek Hospital policy is to provide the best possible treatment to all patients at all times, under all circumstances ... No person shall be denied access to available and medically indicated treatment or accommodations on the basis of race ... language ...
You have the right, under the rules by which this hospital is licensed, to be given a copy of these rights before you are admitted to the hospital as a patient ... if ... you are under 18 years of age, a copy will also be given to your guardian, parent, or conservator.
You also have the right to have these rights explained to you aloud in simple terms in a way you can understand within 24 hours of being admitted to the hospital to receive services (e.g., in your language if you are not English-speaking ...).
Basic Rights for all patient
...28. You have the right not to be given medication you don't need or too much medication, including the right to refuse medication (this right extends to your parent or conservator if you are a minor, or your legal guardian when applicable) ..."

Review of patient #2's medical record revealed all paperwork completed by the patient's mother, on 9/18/17 at 7:20 pm were written in English including advanced directives, consent for treatment, receipt of patient rights and responsibilities and privacy practices.
Form titled "Notice to persons needing interpreter services" stated in part, "Do you need a qualified interpreter? Yes
What is your preferred language: Espanol ...
Should you request an interpreter, one can be provided to assist you in situations such as:
*obtaining initial history and physical, psychiatric assessment
*explanation of diagnoses
*obtaining informed consent/permission for treatment
*explanation of treatment program/schedules, individual/family/group therapy, or changes in treatment
*patient education/discharge teaching
*explanation of medications, in absence of written materials ..."
This form, written in English, was signed by patient #2's mother on 9/18/17 at 7:20 pm.

Form titled "Consent to the use of electronic media communication" stated in part, "I, [patient #2's mother], have read the consent to the use of electronic media communication and have chosen the following method of communication ... Video conferencing ..." which was signed by patient #2's mother on 9/18/17 at 7:25 pm. Further down the form stated in part, "Revocation of consent to the use of electronic media communications" which was signed by patient #2's mother on 9/18/17 at 7:25 pm. This indicated the form was not explained to patient #2's mother in a language she could understand.

Three psychoactive medication consents stated in part, "I have received a complete explanation of the psychoactive mediation(s) by means of oral explanation" and was signed by patient #2's mother on 9/18/17 at 10:50 pm with no clarification of language used.

The above was confirmed in an interview with staff #2 on the afternoon of 12/4/17.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0167
Based on review of facility documents, review of medical records and interview, the facility failed to ensure the use of restraints were implemented in accordance with safe and appropriate techniques as determined by hospital policy.

Findings included:

Facility patient rights document stated in part, "You have the right to a human and safe environment that affords reasonable protection from harm. You have the right to be free from mental and/or physical abuse and free from chemical and physical restraints, except when necessary to protect you from injury to yourself or other."

Facility policy titled "Restraint" stated in part, "Policy: Definition - A restraint is any manual method that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely, regardless of the length of time. Holding a patient who is not cooperative with receiving a medication through injection and/or approved CPI holds is considered a personal restraint ...
*Restraint may only be used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member or others after less restrictive interventions are ineffective or ruled-out ...
*Restraint is never used as a means of coercion, discipline, convenience or staff retaliation ..."

Review of patient #10's medical record revealed a nursing note dated 11/14/17 at 9:08 pm that stated in part, "Patient became uncooperative when it was time to leave admissions and go to the unit. Patient refused to go to unit, was given at least three chances to do so independently. Patient was then taken by arms to be guided to unit and became combative, hitting and kicking at staff. Patient continued to hit, kick and stomp at staff's feet, at which point patient was carried part of the way. When patient calmed, he was put down and allowed to walk the rest of the way to the unit. Patient in restraint from 8:00-8:08 pm."

In an interview with staff #2 on 12/4/17 at 2:00 pm, staff #2 stated, "Oh no. They cannot pick anyone up ... No, staff cannot pick anyone up. We go over that in orientation." (Refer to A0144)

The above was verified in an interview with the CEO on the afternoon of 12/4/17.