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.

PERIMETER BEHAVIORAL HOSPITAL OF DALLAS 2696 W WALNUT STREET GARLAND, TX Nov. 7, 2020
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
The hospital failed 1 of 1 patient by not providing the right to receive care in a safe setting.

Findings include

Through interview, record review, the hospital failed Patient #1 by not documenting in the medical record that Patient #1 was physical restrained, and secluded.

Through interview and physical observation the hospital failed Patient # 1 by causing physical injury to patient #1.

Through interview with hospital Staff # 6 it was confirmed that the injury was caused by stating, "Yes, I have a long fingernail, and did grab Patient #1.

Through record review with hospital Staff #2, Staff #3 and Staff #4 it was verified through oberservation of Patient #1's medical record that there was no documentation of the incident.

Through record review with hospital Staff #3 verified that the hospital Seclusion and Restraint log did not reveal documentation of the incident.

The hospital failed to contact the patients legal authroized representative regarding this incident.


The hospital failed to follow its own Policies.

Policy
The hospital Nursing Services Policy dated 10/22/2019 reflected, "It is the policy of Perimeter Healthcare to provide a safe treatment environment for all patients and to utilize interventions that are the least restrictive when confronted with potentially dangerous patient behaviors. A physical hold is a therapeutic emergency behavioral intervention used when a patient is in imminent danger or harming him/herself or others and less restrictive interventions have been ineffective. The use of physical holds will be monitored as part of the performance/quality improvement activities of Perimeter.

The hospital Policy of Perimeter Healthcare to create an environment that protects the patient's health and safety and preserves his or her dignity, rights and well-being. All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety or the patient, a staff member or others."

The hospital Nursing Services Policy dated 07/17/2019 reflected, "The Seclusion/Restraint event is documented in each case of patient seclusion and/or restraint ...A Registered Nurse (RN) who has been trained and tested to be competent in restraint/seclusion is responsible for initiating and reviewing the Seclusion/Restraint documentation records. The RN shall be responsible for nursing assessments at a minimum of every 2 hours, for ensuring that the physician has been contacted in the appropriate time frame to obtain a renewal order if the criteria for seclusion and/or restraint continue to be met, and for supervising the observation and care provided by other assigned staff. The documentation is used to ensure the patient's rights are respected, that the patient's privacy and care needs are met, and to provide means for monitoring the use of seclusion and/or restraint at Perimeter Healthcare."The
VIOLATION: USE OF RESTRAINT OR SECLUSION Tag No: A0154
The hospital failed 1 of 1 patient by placing the patient by not allowing the patient the right to be free from physical or mental abuse, and corporal punishment. All patinets have the right to be free from restraint or seclusion of any form. imposed as a means of coercion, discipline, convenience or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member,or others and mst be discontinued at the earliest possible time.

Findings include

Through interview, record review, the hospital failed Patient #1 by not documenting in the medical record that Patient #1 was physical restrained, and secluded.

Through interview and physical observation the hospital failed Patient # 1 by causing physical injury to patient #1.

Through interview with hospital Staff # 6 it was confirmed that the injury was caused by stating, "Yes, I have a long fingernail, and did grab Patient #1.

Through record review with hospital Staff #2, Staff #3 and Staff #4 it was verified through oberservation of Patient #1's medical record that there was no documentation of the incident.

Through record review with hospital Staff #3 verified that the hospital Seclusion and Restraint log did not reveal documentation of the incident.

The hospital failed to contact the patients legal authroized representative regarding this incident.


The hospital failed to follow its own Policies.

Policy
The hospital Nursing Services Policy dated 10/22/2019 reflected, "It is the policy of Perimeter Healthcare to provide a safe treatment environment for all patients and to utilize interventions that are the least restrictive when confronted with potentially dangerous patient behaviors. A physical hold is a therapeutic emergency behavioral intervention used when a patient is in imminent danger or harming him/herself or others and less restrictive interventions have been ineffective. The use of physical holds will be monitored as part of the performance/quality improvement activities of Perimeter.

The hospital Policy of Perimeter Healthcare to create an environment that protects the patient's health and safety and preserves his or her dignity, rights and well-being. All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety or the patient, a staff member or others."

The hospital Nursing Services Policy dated 07/17/2019 reflected, "The Seclusion/Restraint event is documented in each case of patient seclusion and/or restraint ...A Registered Nurse (RN) who has been trained and tested to be competent in restraint/seclusion is responsible for initiating and reviewing the Seclusion/Restraint documentation records. The RN shall be responsible for nursing assessments at a minimum of every 2 hours, for ensuring that the physician has been contacted in the appropriate time frame to obtain a renewal order if the criteria for seclusion and/or restraint continue to be met, and for supervising the observation and care provided by other assigned staff. The documentation is used to ensure the patient's rights are respected, that the patient's privacy and care needs are met, and to provide means for monitoring the use of seclusion and/or restraint at Perimeter Healthcare."The
VIOLATION: CONTENT OF RECORD - OTHER INFORMATION Tag No: A0467
The hospital failed 1 of 1 patient by not documenting all Practitioner's oerders, nursing notes, reports of treatment, medication reords...and other information necessary to monitor the patient's condition.

Findings include

Through interview, record review, the hospital failed Patient #1 by not documenting in the medical record that Patient #1 was physical restrained, and secluded.

Through interview and physical observation the hospital failed Patient # 1 by causing physical injury to patient #1.

Through interview with hospital Staff # 6 it was confirmed that the injury was caused by stating, "Yes, I have a long fingernail, and did grab Patient #1.

Through record review with hospital Staff #2, Staff #3 and Staff #4 it was verified through oberservation of Patient #1's medical record that there was no documentation of the incident.

Through record review with hospital Staff #3 verified that the hospital Seclusion and Restraint log did not reveal documentation of the incident.

The hospital failed to contact the patients legal authroized representative regarding this incident.


The hospital failed to follow its own Policies.

Policy
The hospital Nursing Services Policy dated 10/22/2019 reflected, "It is the policy of Perimeter Healthcare to provide a safe treatment environment for all patients and to utilize interventions that are the least restrictive when confronted with potentially dangerous patient behaviors. A physical hold is a therapeutic emergency behavioral intervention used when a patient is in imminent danger or harming him/herself or others and less restrictive interventions have been ineffective. The use of physical holds will be monitored as part of the performance/quality improvement activities of Perimeter.

The hospital Policy of Perimeter Healthcare to create an environment that protects the patient's health and safety and preserves his or her dignity, rights and well-being. All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety or the patient, a staff member or others."

The hospital Nursing Services Policy dated 07/17/2019 reflected, "The Seclusion/Restraint event is documented in each case of patient seclusion and/or restraint ...A Registered Nurse (RN) who has been trained and tested to be competent in restraint/seclusion is responsible for initiating and reviewing the Seclusion/Restraint documentation records. The RN shall be responsible for nursing assessments at a minimum of every 2 hours, for ensuring that the physician has been contacted in the appropriate time frame to obtain a renewal order if the criteria for seclusion and/or restraint continue to be met, and for supervising the observation and care provided by other assigned staff. The documentation is used to ensure the patient's rights are respected, that the patient's privacy and care needs are met, and to provide means for monitoring the use of seclusion and/or restraint at Perimeter Healthcare."The
VIOLATION: Document Therapeutic Efforts Tag No: A1650
The hospital failed 1 of 1 patient by the treatment received by the patient was not documented in such a way to assure that all active therapeutic efforts are included.
Findings include

Through interview, record review, the hospital failed Patient #1 by not documenting in the medical record that Patient #1 was physical restrained, and secluded.

Through interview and physical observation the hospital failed Patient # 1 by causing physical injury to patient #1.

Through interview with hospital Staff # 6 it was confirmed that the injury was caused by stating, "Yes, I have a long fingernail, and did grab Patient #1.

Through record review with hospital Staff #2, Staff #3 and Staff #4 it was verified through oberservation of Patient #1's medical record that there was no documentation of the incident.

Through record review with hospital Staff #3 verified that the hospital Seclusion and Restraint log did not reveal documentation of the incident.

The hospital failed to contact the patients legal authroized representative regarding this incident.


The hospital failed to follow its own Policies.

Policy
The hospital Nursing Services Policy dated 10/22/2019 reflected, "It is the policy of Perimeter Healthcare to provide a safe treatment environment for all patients and to utilize interventions that are the least restrictive when confronted with potentially dangerous patient behaviors. A physical hold is a therapeutic emergency behavioral intervention used when a patient is in imminent danger or harming him/herself or others and less restrictive interventions have been ineffective. The use of physical holds will be monitored as part of the performance/quality improvement activities of Perimeter.

The hospital Policy of Perimeter Healthcare to create an environment that protects the patient's health and safety and preserves his or her dignity, rights and well-being. All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety or the patient, a staff member or others."

The hospital Nursing Services Policy dated 07/17/2019 reflected, "The Seclusion/Restraint event is documented in each case of patient seclusion and/or restraint ...A Registered Nurse (RN) who has been trained and tested to be competent in restraint/seclusion is responsible for initiating and reviewing the Seclusion/Restraint documentation records. The RN shall be responsible for nursing assessments at a minimum of every 2 hours, for ensuring that the physician has been contacted in the appropriate time frame to obtain a renewal order if the criteria for seclusion and/or restraint continue to be met, and for supervising the observation and care provided by other assigned staff. The documentation is used to ensure the patient's rights are respected, that the patient's privacy and care needs are met, and to provide means for monitoring the use of seclusion and/or restraint at Perimeter Healthcare."The