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.

CENTRAL TEXAS MEDICAL CENTER 1301 WONDER WORLD DRIVE SAN MARCOS, TX 78666 Jan. 2, 2019
VIOLATION: PATIENT RIGHTS Tag No: A0115
Based on review of medical records and interview, it was determined that Central Texas Medical Center failed to meet the Condition of Participation: Patient Rights as evidenced by:

(1) Failing to ensure that weekly weights and daily skin assessments were completed per physician order/hospital protocol on Patient # 1

(2) Failing to ensure safety for Patient # 1 (as evidenced by widespread bruising and abrasions to knees and feet)

(3) Failing to ensure that Patient # 1's personal belongings were returned to the patient upon discharge.

(4) Failure to ensure Patient # 1 had documented informed consent concerning administered psychoactive medications.

The cumulative effects of these deficient practices resulted in noncompliance with the Condition of Participation for Patient's Rights.
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
Based on review of documentation and interview, it was determined that the facility failed to always provide nursing assessment and appropriate response to injury.

Findings:

Facility Policy entitled "Patient Rights and Responsibilities" stated in part "You have the right to ...Considerate and respectful care, with recognition of your personal dignity including freedom from abuse and harassment. This would include the right to have your cultural, psychosocial, spiritual, and personal values, beliefs, and preferences respected."

Patient # 1 was found to be covered in bruises that were of unknown origin. Patient had multiple bruises to his torso and his arms that were discovered by his wife while visiting in mid-August 2018.

Patient # 1 had "cuts" to his knees and toes after having been allowed to "crawl" on the floor.

Patient # 1 lost 39lbs during his two-month hospital stay. ADL logs did not consistently track his nutritional intake.

The hospital lost/threw away all of Patient # 1's clothing. He was discharged from the hospital in a gown.

Patient # 1 had no psychoactive medication consents in his medical record. He was not on court ordered medications but was given multiple oral and intramuscular psychoactive medications his stay at the hospital.

Review of the medical record on 1/2/19 revealed inconsistent skin assessments by nursing staff although documentation did reveal cuts and abrasions to his knees and toe. Patient # 1 was not weighed weekly per MD order as he was uncooperative. Discharge documentation verified a near 40lb weight loss. These findings were confirmed by the facility self-investigation that was conducted after the family complained to the hospital.