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.

ROSELAND COMMUNITY HOSPITAL 45 W 111TH STREET CHICAGO, IL 60628 June 25, 2019
VIOLATION: COMPLIANCE WITH LAWS Tag No: A0021
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on document review and interview, it was determined that for 1 of 1 (Pt. #4) clinical record reviewed for potential patient abuse, the Hospital failed to ensure that abuse was reported as required.

1. On 6/26/19 at approximately 11:00 AM, the Hospital's policy titled "Allegations of Abuse and Neglect" (effective 11/18) was reviewed and included, " ... To provide procedure for reporting ... The IDPH (Illinois Department of Public Health) ... will receive notice and reports of findings as required by licensure ... A written report will be completed for all allegations of abuse and will include: a. name, address, and age of the abused; b. person responsible for the patient ' s care; c. name and address of the person who is alleged to have abused ..." The IDPH notification time-frame was not specified in the policy.

2. On 6/26/19 at approximately 9:00 AM, the clinical record of Pt. #4 was reviewed. Pt. #4 was a [AGE] year old male who came to the ED (Emergency Department) on 1/9/19 due to chest pain. The clinical record indicated that Pt. #4 was discharged on [DATE].

3. A letter from Pt. #4 ' s health insurance to the Hospital dated 3/12/19 included, " ... Dear (E #8/Risk Manager) ... As part of our program, we conduct quality reviews, review quality of care concerns ... We have identified a potential quality of care concern for the member ... The member or someone in behalf of the member reported that the member was "beat up" by the security guards at (the Hospital) when he was to be discharged . We support providers ... and therefore we want to bring this issues to your attention ..."

4. On 6/26/19 at approximately 10:56 AM, an interview was conducted with E #8 (Risk Manager). E #8 stated, "I received an email about the patient around March 12, 2019 ... There was an allegation of physical abuse by Hospital security guards ... Right away, I conducted an investigation ... After my investigation, I reported my findings to (E #1/Chief Nursing Officer). She (E #1) contacts the appropriate agencies for reporting purposes..."

5. On 6/26/19 at approximately 11:28 AM, an interview was conducted with E #1 (Chief Nursing Officer). E #1 stated, "If the abuse did not happen in the Hospital, we do not report ... Otherwise, we will report within 48 to 72 hours ..." E #1 could not provide documentation that Pt. #4's allegation of abuse was reported to IDPH.