HospitalInspections.org

Based on record reviews, interviews, review of staff training records related to abuse and neglect, review of the hospital's policies and procedures related to abuse and neglect, it was determined the hospital failed to ensure a thorough complete investigation of a patient's allegation of abuse, failed to ensure that all hospital staff responsible for the provision of patient care received training for the prevention and screening of abuse and neglect, and failed to ensure that all of the hospital's policies and procedures are followed that include but not limited to a social service assessment and interventions for potential psychosocial injury.

The findings are:

Cross Reference to A 0144: The hospital failed to ensure its staff was trained and knowledgeable in its policies and procedures for abuse and neglect and conducting a thorough investigation for a complaint of abuse and/or neglect.

Cross Reference to A 0145: The hospital failed to ensure a thorough investigation of the patient's allegation of physical abuse was implemented in a responsive manner. Failure to conduct a thorough investigation with potential witnesses for 1 of 1 inpatient, failed to follow the hospital's own policies for abuse, and failed to ensure all direct care staff receive training for recognition and prevention of abuse may place patients at increased risk for abuse.

Based on record reviews, interviews, and review of the hospital's policies and procedures, the hospital failed to ensure its staff was trained and knowledgeable in its policies and procedures for abuse and neglect and conducting a thorough investigation for a complaint of alleged abuse and/or neglect for 1 of 1 patient. (Patient 4)

The findings are:

Cross Reference to A 0145: The hospital failed to ensure a thorough investigation of the patient's allegation of physical abuse was implemented in an organized manner. Failure to conduct a thorough investigation with potential witnesses for 1 of 1 inpatient, failed to follow the hospital's own policies for abuse, and failed to ensure all direct care staff receive training for recognition and prevention of abuse may place patients at increased risk for abuse.

On 4/29/2020 at 5:45 PM, the State Agency received a self report from Hospital A via a fax that revealed an allegation of patient abuse that occurred on 4/27/2020 at 4:00 AM on the 7:00 PM to 7:00 AM shift. The self report revealed the patient alleged that a Certified Nursing Assistant (CNA) "was yelling, snatching covers, grabbing her, and then began to beat on her" after the patient called her a bitch in anger on the night shift on 4/27/2020. On 4/30/2020 at 2:30 PM, two qualified surveyors made an unannounced visit to Hospital A to investigate the patient's allegation of abuse.

Record Review
Review of Patient 4's chart revealed there was no documentation of a physical or psychosocial assessment related to the patient's reported allegation of physical abuse on the 7:00 PM - 7:00 AM shift on 4/27/2020 - 4/28/2020. When Hospital A's Director of Quality and Chief Executive Officer(CEO) was queried as to the hospital's investigative response to the patient's allegation, they stated the incident was reported to the state, a physical assessment of the patient was completed, the allegation of abuse was reported to the police department, and the CNA was removed from the schedule immediately. The CEO reported that staff had not been interviewed or statements obtained. The hospital submitted a typed unauthenticated statement dated 4/30/2020 from the CNA identified as the perpetrator in the alleged abuse for review. The hospital had no other witness statements related to the incident.

Review of Patient 4's chart revealed a registered nurse documented at 8:00 PM on 4/28/2020, "Patient is alert and oriented, slow to respond, asked her birthday, she said January but doesn't remember the year. Patient brings up "She hit me" & (and) I asked her what she's talking about and I asked her "Did I hurt you ?" She said, " No, she's black". I asked what's her name. Who, from last night? " My tech(technician) hurt you? " I tried to ask her if she thought maybe her giving her a bath made her feel like she may have accidentally hurt you. She said "no". Show me what she did. She showed me punching me in my shoulder. I asked her why didn't you scream out? You know I always hear you call my name. She said she doesn't know. I asked were you scared? She didn't respond. I sympathized with her and tried to make her feel as safe as possible and made sure she understood to scream as loud as she can, and when I come in the room to immediately tell me what happened if that ever happened again so I can get that handled. She said "OK. " On 4/29/2020 from 6:30 PM to 6:50 PM, Registered Nurse (RN) 1 reviewed the documentation entry and verified the he/she had written the entry. RN 1 reported, "The patient told me this on the night after it supposedly happened. By the time she was telling me, the police was interviewing the CNA(Certified Nursing Assistant). " There was no other documentation related to the incident in the patient's chart.

Review on 5/1/20 at 4:00 PM of the hospital's employee staff listing and abuse training records provided by the hospital revealed not all the hospital staff had received abuse training. During an interview with the Interim Director of Nursing and Director of Quality on 5/1/20 at 4:20 PM, the finding was verified. Review on 5/4/20 at 3:00 PM, of an e-mail sent by the Director of Quality on 5/4/2020 at 1:57 PM revealed 5 of 29 Registered Nurses (RN 7, 8, 9, 10, and 11), 4 of 21 Certified Nursing Assistants (CNA 3, 6, 7, and 8), 1 of 5 Medical Technicians (Med Tech 1), and 5 of 17 Respiratory Therapists (RT 1- 5) did not have documented training for abuse and neglect.

Review of the hospital's policies, provided by the hospital, entitled, "General Orientation" and "Annual Skills/Mandatory Education", revealed, " All new employees will attend a General Orientation on hire, and all employees will be educated annually on topics to include Patient Rights and organizational ethics including abuse, neglect and exploitation, and patient Complaints and Grievance procedure."

Review of Patient 4's chart revealed a registered nurse documented at 8:00 PM on 4/28/2020, "Patient is alert and oriented, slow to respond, asked her birthday, she said January but doesn't remember the year. Patient brings up "She hit me" & (and) I asked her what she's talking about and I asked her "Did I hurt you ?" She said, " No, she's black". I asked what's her name. Who, from last night? " My tech(technician) hurt you? " I tried to ask her if she thought maybe her giving her a bath made her feel like she may have accidentally hurt you. She said "no". Show me what she did. She showed me punching me in my shoulder. I asked her why didn't you scream out? You know I always hear you call my name. She said she doesn't know. I asked were you scared? She didn't respond. I sympathized with her and tried to make her feel as safe as possible and made sure she understood to scream as loud as she can, and when I come in the room to immediately tell me what happened if that ever happened again so I can get that handled. She said "OK. " On 4/30/2020 from 6:30 PM to 6:50 PM, Registered Nurse (RN) 1 reviewed the documentation entry and verified the he/she had written the entry. RN 1 reported, "The patient told me this on the night after it supposedly happened. By the time she was telling me, the police was interviewing the CNA(Certified Nursing Assistant). " There was no other documentation related to the incident in the patient's chart.

Patient 4 (alleged abuse)
On 4/30/2020 at 5:15 PM and on 5/1/2020 at 12:15 PM, attempts were made to conduct an interview with Patient 4 about the allegations, but Patient 4 stated that she did not want to talk about the incident.

Director of Quality/Risk Manager
A face to face interview was conducted on 4/30/2020 at 4:02 PM with the Director of Quality who stated, "I was not notified of the patient's allegation of abuse until 4/29/20. Then, I sent an incident report to the state on 4/29/2020. We met with the Chief Executive Officer (CEO). The CEO notified the corporate Vice President. I don't know why I wasn't notified of the incident until 4/29/2020.

Director of Quality/ Chief Executive Officer (CEO)
A face to face interview was conducted on 5/1/2020 at 3:00 PM with the Director of Quality and the hospital's CEO. The Director of Quality stated, "If we get a (patient)complaint, it goes to the Charge Nurse and Chief Nursing Officer (CNO). I'm made aware of it. I keep up with the log. The CNO or I will resolve the issue. " The CEO stated, "The Interim Director of Nursing (DON) was notified of the alleged incident by the patient's nephew. I was standing there when the call came in. The Interim DON started the investigation. She (Interim DON) talked with the patient and performed a physical assessment. No statements from staff were gotten. The police were notified, and the (Host) hospital security was notified. "

Registered Nurse (1)
A face to face interview was conducted on 4/30/2020 at 6:30 PM with Registered Nurse (RN 1) who verified that he/she worked the 7:00 PM shift on 4/27/2020 to 7:00 AM on 4/28/2020. RN 1 reported that he/she had no knowledge of the alleged incident of abuse reported by Patient 4's family on 4/28/2020. RN 1 stated, "CNA 2(who was named in the allegation) and I worked together because I needed help with another patient in Room 27 across the hall. I got everything ready, knocked on Room 24's (Patient 4) door and went in. There was nothing out of the ordinary. I told her (CNA 2) that I was ready in the patient's room(Patient Room 27). She (CNA 2) said to give her 5 more minutes, and she'd be there. CNA 2 was his/her usual self during the shift. We were talking and laughing with the patient in Room 727 because we like to distract her (during care). There was nothing out of the ordinary. CNA 2 is real sweet to patients. The police took my statement. "

CNA 2 (Alleged Perpetrator)
A telephone interview was conducted on 5/1/2020 at 10:06 AM with CNA 2 who stated, "I worked the night shift(7:00 PM) on 4/27/20. I had nine (9) patients. I usually have 9 or 10 patients. I received report and made rounds. It was a normal night. I had a patient(Patient 4) that was a 2 person assist. I was in her room at 3:45 AM. We had a conversation. She had a stool(bowel movement). I asked her if it was okay for me to change her sheets. I was changing her bed as I was giving her a bath. I was getting her situated when RN 1 came in and asked if I could help her with the patient across the hall. I told her(RN 1) to give me 5 more minutes, and I would be there. When I change or turn her (Patient 4), she always yells out. Her right leg is always bent, and her left leg has staples in it. When CNA 2 was asked if he/she hit or roughly handled the patient, CNA 2 replied, " No ma'am. I'm very professional. "

Hospital policy and procedure, titled, " Abuse, Neglect and Exploitation", reads ....
"Procedure:
1. Any employee who witnesses, suspects or is informed of incidents of patient abuse, neglect or exploitation shall immediately report the allegation to the supervising nurse. The supervising nurse will immediately ensure the patient is free of eminent danger by: removing the perpetrator of the abuse from the patient care area, ensuring that all staff are aware that the perpetrator will not be allowed patient contact by making a notation on patient care kardex which will be updated at each shift report and placing a note in the patient chart. The supervising nurse will then notify the chief nursing officer or designee who will report the incident to the South Carolina lieutenant governors department of aging at 803-545-4370, report the allegation to the patient social worker, and begin an investigation of the incident.

2. The chief nursing officer or his/her designee is responsible to assess the patient who is believed to have been victimized. Assessment shall include documentation; treatment where appropriate; injuries a present and other evidentiary information. The chief nursing officer or his/her designation will notify of the suspected abuse, neglect, or exploitation to ensure that appropriate documentation, medical intervention, and reporting occurs.

3. When the patient is in imminent danger and in need of immediate protection the local police department or the South Carolina state police shall be contacted.

4. In the absence of the chief nursing officer/their designee/or the supervising nurse, it is responsibility of the employee who witnessed, suspected or was informed of an incident of patient neglect, abuse, or exploitation to ensure the patient is free of eminent danger, immediately report the allegation to the protection hotline and follow steps 1 - 4 of this procedure.

5. All employees involved in reports of patient abuse, neglect or exploitation shall exercise caution in safeguarding patient rights and confidentiality. Mandatory reporting laws apply if the victim is either married to the offender or is a vulnerable adult. Healthcare providers are permitted to disclose information about someone to believe to be a victim only if: the disclosure is required by law and compliance with the law, the individual authorizes the release.

6. The social worker or designee will ensure that all events related to reporting are clearly documented in the patient's medical record. The documentation shall include:
The identification of the suspected/alleged abuse/neglect
The assessment of the extent of the reported abuse/neglect
Who reported to the authorities
Who receive the report (agency name)
Entry should be dated and timed

7. The social worker will provide supportive counseling and/or referral for spiritual counseling or community agencies that can provide resources to patient that had been victimized

8. When the allegation involves an employee, the accused will be removed from having any patient care contact, until investigation is complete....".

Based on record reviews, interviews, and review of the hospital's policies and procedures, the hospital failed to ensure a thorough investigation of the patient's allegation of physical abuse was implemented in an organized manner. Failure to conduct a thorough investigation with potential witnesses for 1 of 1 inpatient, failed to follow the hospital's own policies for abuse, and failed to ensure all direct care staff receive training for recognition and prevention of abuse may place patients at increased risk for abuse.

The findings are:

On 4/29/2020 at 5:45 PM, the State Agency received a self report from Hospital A via a fax revealing an allegation of patient abuse that occurred on 4/27/2020 at 4:00 AM on the 7:00 PM to 7:00 AM shift. The report showed the patient alleged that a Certified Nursing Assistant (CNA) "was yelling, snatching covers, grabbing her, and then began to beat on her" after the patient called her a bitch in anger. On 4/30/2020 at 2:30 PM, two qualified surveyors made an unannounced visit to Hospital A to investigate the patient's allegation of abuse.

Review of Patient 4's chart revealed a registered nurse documented at 8:00 PM on 4/28/2020, "Patient is alert and oriented, slow to respond, asked her birthday, she said January but doesn't remember the year. Patient brings up "She hit me" & (and) I asked her what she's talking about and I asked her "Did I hurt you ?" She said, " No, she's black". I asked what's her name. Who, from last night? " My tech(technician) hurt you? " I tried to ask her if she thought maybe her giving her a bath made her feel like she may have accidentally hurt you. She said "no". Show me what she did. She showed me punching me in my shoulder. I asked her why didn't you scream out? You know I always hear you call my name. She said she doesn't know. I asked were you scared? She didn't respond. I sympathized with her and tried to make her feel as safe as possible and made sure she understood to scream as loud as she can, and when I come in the room to immediately tell me what happened if that ever happened again so I can get that handled. She said "OK. " On 4/29/2020 from 6:30 PM to 6:50 PM, Registered Nurse (RN) 1 reviewed the documentation entry and verified the he/she had written the entry. RN 1 reported, "The patient told me this on the night after it supposedly happened. By the time she was telling me, the police was interviewing the CNA(Certified Nursing Assistant). " There was no other documentation related to the incident in the patient's chart.

Review of Patient 4's chart revealed there was no documentation in the patient's chart on either 4/27/2020 or 4/28/2020 of a physical or psychosocial assessment related to the patient's reported physical abuse that allegedly occurred on the 7:00 PM to 7:00 AM 4/27/2020 - 4/28/2020. When the hospital's Interim DON and Chief Executive Officer was queried as to their investigative response to the patient's allegation, they stated that they reported the incident, did a physical assessment of the patient, reported the allegation of abuse to the police department, and the CNA was removed from the schedule immediately. Hospital A produced a typed unauthenticated statement dated 4/30/2020 from the CNA (who was identified as the perpetrator in the alleged abuse). The hospital had no other witness statements related to the incident.

Review on 5/1/20 at 4:00 PM of the hospital's employee staff listing and abuse training records provided by the hospital revealed not all the hospital staff had received abuse training. During an interview with the Interim Director of Nursing and Director of Quality on 5/1/20 at 4:20 PM, the finding was verified. Review on 5/4/20 at 3:00 PM, of an e-mail sent by the Director of Quality on 5/4/2020 at 1:57 PM revealed 5 of 29 Registered Nurses (RN 7, 8, 9, 10, and 11), 4 of 21 Certified Nursing Assistants (CNA 3, 6, 7, and 8), 1 of 5 Medical Technicians (Med Tech 1), and 5 of 17 Respiratory Therapists (RT 1- 5) did not have documented training for abuse and neglect.

Review of the hospital's policies, provided by the hospital, entitled, "General Orientation" and "Annual Skills/Mandatory Education", revealed, " All new employees will attend a General Orientation on hire, and all employees will be educated annually on topics to include Patient Rights and organizational ethics including abuse, neglect and exploitation, and patient Complaints and Grievance procedure."

The State Agency received a report of the alleged abuse via fax dated 4/29/2020 at 5:53 PM. The incident report revealed the date of 4/28/20202, with no time recorded, and was initiated by the Interim CNO (Chief Nursing Officer) based on a telephonic complaint from the patient's family. The report reads, "On 4/27 on PM shift CNA Black Girl with dreads beat me up. She came in my room snatching covers off pulling and grabbing on me yelling "you don't look like you had a bath. They said you had a bath" Then out of anger, patient stated that she called the CNA a bitch, and when she said that, immediately the CNA started beating on her. When asked did she report it to anyone, she stated that she was too scared. She told her sister and nephew. Called sister &(and) nephew, CPD (C Police Department), and security notified." Documentation showed the "CEO notified on 4/28/2020 at 1645." In section E. of the form labeled "Investigative Findings" was recorded, "No scratches, no bruises, no witnesses. Called Police department @(at) 1730 spoke c(with) Officer. Report was taken. Officer dispatches. Security notified. Security @ bedside 1750. interviewed patient with her consent. CPD interviewed patient with her consent @ 1915." In Section F. labeled "Conclusions of Review/Actions Taken:", the CNO recorded, "Security and CPD conducted interviews with patient. CPD conducted interviews with assigned nurse and assigned and alleged CNA. .....investigation remains in progress." Review of the hospital's "Patient Complaint/Grievance Log" provided by the hospital on 4/30/20 revealed an alleged physical abuse of Patient 4 on 4/27/20, and the investigation had not been documented as completed.

The incident report revealed Patient 4, when asked did she report it(the incident) to anyone, stated that she was "too scared". There was no social services interview or psychosocial assessment and/or interventions documented in the patient's chart related to fear.

Review of the hospital's policy and procedure, revealed, "6. The social worker or designee will ensure that all events related to reporting are clearly documented in the patient's medical record. The documentation shall include:
The identification of the suspected/alleged abuse/neglect
The assessment of the extent of the reported abuse/neglect
Who reported to the authorities
Who receive the report (agency name)
Entry should be dated and timed
7. The social worker will provide supportive counseling and/or referral for spiritual counseling or community agencies that can provide resources to patient that had been victimized.

Review on 5/1/20 at 4:00 PM of the employee staff list and abuse training records provided by the hospital revealed not all the hospital staff had received abuse training. During an interview with the Interim Director of Nursing and Director of Quality on 5/1/20 at 4:20 PM, the finding was verified. Review on 5/4/20 at 3:00 PM of the e-mail sent by the Director of Quality revealed 5 of 29 Registered Nurses (RN 7, 8, 9, 10, and 11), 4 of 21 Certified Nursing Assistants (CNA 3, 6, 7, and 8), 1 of 5 Medical Technicians (Med Tech 1), and 5 of 17 Respiratory Therapists (RT 1- 5, did not have documented training for abuse and neglect. This information had been provided through the e-mail message sent by the Director of Quality on 5/4/20 at 1:57 PM.

Review of the hospital's policies, provided by the hospital, entitled, "General Orientation" and "Annual Skills/Mandatory Education", revealed, "All new employees will attend a General Orientation on hire, and all employees will be educated annually on topics to include Patient Rights and organizational ethics including abuse, neglect and exploitation, and patient Complaints and Grievance procedure."

Interim Director of Nursing
During an interview on 4/30/20 at 3:35 PM, the Interim Director of Nursing (IDON) stated she/he had received a telephone call from Patient 4's nephew (on 4/28/20). He(nephew) had received a call from his mother, which is a sister to Patient 4, who told him, "A CNA (Certified Nursing Assistant) beat her up". He(Nephew) attempted to call his aunt, but she wouldn't talk to him. The IDON stated she/he had been on the telephone with him for about 15-20 minutes. The IDON stated she/he went directly to the patient's room and spoke with Patient 4. After telling the patient that she/he had just spoken with her/his nephew and sister, the IDON asked the patient if anyone had been treating her/him poorly. The patient said "yes, the pretty black girl with dreads came in and beat her up." When asked when this happened, the patient said it was the previous night. The IDON asked Patient #4 what (the alleged perpetrator) was wearing, and the patient said dark blue. The IDON stated that CNAs (Certified Nursing Assistants) wore this color scrubs. The patient reported that the CNA was upset and started yelling and saying, they told me you had a bath. You don't look like you had a bath. The patient told the CNA she had a bath, and called the CNA a bitch. The IDON asked the patient why she had called the CNA a bitch. The patient said because (the CNA) was acting like that, pulling on her and hurting her. When asked, the patient demonstrated by throwing her fists to show how the CNA had hurt her. The patient gestured all over her body when asked where the CNA had hit her. The IDON stated she/he had checked the patient's body for any marks or bruises at that time, after asking the patient's permission. The IDON checked the patient from the neck down and there was no broken skin, no scratches. No pictures were taken. The patient told the IDON that she thought the CNA was her friend and had previously brought her a blanket. The IDON stated that when the alleged perpetrator came in to work the night of 4/28/20 (the night after the alleged abuse occurred), they took the CNA to the police who completed an interview. According to the IDON, she/he did not speak with the alleged perpetrator (CNA 2) about the alleged abuse. There was no documentation of any hospital staff interviews with CNA 2 related to to the incident. After the police interview, the CNA was suspended and did not work that night.

Review of personnel files on 4/30/20 at 4:50 PM for the alleged perpetrator, CNA 2 revealed no disciplinary action notes. During a telephone interview on 5/1/20 at 10:20 AM, CNA 4 verified that she/he had not had any disciplinary action except for the current suspension related to the alleged abuse for Patient 4. Review of the time card for CNA 2 revealed she/he had worked on 4/27/20 from 7:07 PM through 4/28/20 at 7:21 AM.

Interviews
Director of Quality/Risk Manager
A face to face interview conducted on 4/30/2020 at 4:02 PM, the Director of Quality stated, "I was not notified of the patient's allegation of abuse until 4/29/20. Then, I sent an incident report to the state on 4/29/2020. We met with the Chief Executive Officer (CEO). The CEO notified the corporate Vice President. I don't know why I wasn't notified of the incident until 4/29/2020.

Patient 4 (alleged abuse)
On 4/30/2020 at 5:15 PM and on 5/1/2020 at 12:15 PM, attempts were made to conduct an interview with Patient 4 about the allegations, but Patient 4 stated that she did not want to talk about the incident.

Registered Nurse (1)
A face to face interview conducted on 4/30/2020 at 6:30 PM with Registered Nurse (RN 1) who verified that he/she worked the 7:00 PM shift on 4/27/2020 to 7:00 AM on 4/28/2020. RN 1 reported that he/she had no knowledge of the alleged incident of abuse reported by Patient 4's family on 4/28/2020. RN 1 stated, "CNA 2(who was named in the allegation) and I worked together because I needed help with another patient in Room 27 across the hall. I got everything ready, knocked on Room 24's (Patient 4) door and went in. There was nothing out of the ordinary. I told her (CNA 2) that I was ready in the patient 's room(Patient Room 27). She (CNA 2) said to give her 5 more minutes, and she'd be there. CNA 2 was his/her usual self during the shift. We were talking and laughing with the patient in Room 727 because we like to distract her (during care). There was nothing out of the ordinary. CNA 2 is real sweet to patients. The police took my statement. "

CNA 1
A face to face interview was conducted on 4/30/2020 at 6:55 PM with CNA 1 who verified that he/she was assigned and worked on 4/27/2020 on the 7 PM shift. CNA 1 reported that he/she had no knowledge of the alleged incident of abuse of Patient 4.

RN 2
A face to face interview was conducted on 4/30/2020 at 7:03 PM with RN 2 who verified that he/she worked on the 7:00 PM shift on 4/27/2020. RN 2 reported that he/she had no knowledge of the alleged incident of abuse by Patient 4.

Licensed Practical Nurse (LPN) 1
A face to face interview was conducted on 4/30/2020 at 7:12 PM with LPN 1 who verified that he/she worked on the 7:00 PM shift on 4/27/2020. LPN 1 reported that he/she had no knowledge of the alleged incident of abuse reported by the patient (Patient 4).

RN 3
A telephone interview conducted on 4/30/2020 at 7:20 PM with RN 3 who verified that he/she worked on the 7:00 PM shift on 4/27/2020. RN 3 reported that he/she had no knowledge of the alleged incident of abuse for Patient 4. RN 3 reported nothing out of the ordinary occurred during the shift.

RN 4
A face to face interview was conducted on 4/30/2020 at 7:25 PM with RN 4 who verified that he/she worked the 7:00 PM shift on 4/27/2020. RN 4 reported that he/she had no knowledge of the alleged incident of abuse reported by the patient. (Patient 4).

Monitor Technician (1)
A telephone interview was conducted on 5/1/2020 at 9:30 AM with Monitor Technician 1 who verified that he/she worked on the 7:00 PM shift on 4/27/2020. Monitor Technician 1 reported that he/she had no knowledge of the alleged incident of abuse reported by the patient (Patient 4).

CNA 5
A telephone interview was conducted on 5/1/2020 at 9:38 AM with CNA 5 who verified that he/she worked on the 7:00 PM shift on 4/27/2020. CAN 5 reported that he/she had no knowledge of the alleged incident of abuse reported by the patient (Patient 4).

CNA 4
A telephone interview was conducted on 5/1/2020 at 9:51 AM with CNA 4 who verified that he/she worked on the 7:00 PM shift on 4/27/2020. CNA 4 reported that he/she had no knowledge of the alleged incident of abuse reported by the patient (Patient 4).

CNA 2 (Alleged Perpetrator)
A telephone interview was conducted on 5/1/2020 at 10:06 AM with CNA 2, who stated, "I worked the night shift(7 PM) on 4/27/20. I had nine (9) patients. I usually have 9 or 10 patients. I received report and made rounds. It was a normal night. I had a patient(Patient 4) that was a 2 person assist. I was in her room at 3:45 AM. We had a conversation. She had a stool(bowel movement). I asked her if it was okay for me to change her sheets. I was changing her bed as I was giving her a bath. I was getting her situated when RN 1 came in and asked if I could help her with the patient across the hall. I told her(RN 1) to give me 5 more minutes, and I would be there. When I change or turn her (Patient 4), she always yells out. Her right leg is always bent, and her left leg has staples in it. When CNA 2 was asked if he/she hit or roughly handled the patient, CNA 2 replied, " No ma'am. I'm very professional. "

RN 6
A telephone interview was conducted on 5/1/2020 at 10:26 AM with RN 6 who verified that he/she worked on the 7:00 PM shift on 4/27/2020. RN 6 reported that he/she had no knowledge of the alleged incident of abuse reported by the patient (Patient 4).

Charge (Registered) Nurse 1
A telephone interview was conducted on 5/1/2020 at 10:40 AM with Charge Nurse 1 who verified that he/she worked on the 7:00 PM shift on 4/27/2020 and was the Charge Nurse that shift. Charge Nurse 1 stated, "I made off going walking rounds from 7:00 AM - 7:30 AM. No patients reported anything out of the ordinary. There was no yelling or screaming that I heard during the (7:00 PM)shift. We did check on the patient and the patient was fine. If they're asleep, I don't wake them up. " Charge Nurse 1 reported that he/she had no knowledge of the abuse that was reported by the patient (Patient 4).

Inpatient Patient 6
On 5/1/20 between 12:15 PM- 12:30 PM, in a face to face interview with Patient 6, the patient revealed no concerns related to care.

Inpatient Patient 11
On 5/1/20 between 12:15 PM- 12:30 PM, in a face to face interview with Patient 11, the patient revealed no concerns related to care.

Inpatient Patient 12
On 5/1/20 between 12:15 PM- 12:30 PM, a face to face interview with Patient 12 showed the patient revealed no concerns related to care.

Inpatient Patient 13
On 5/1/20 between 12:15 PM- 12:30 PM, a face to face interview with Patient 13 showed the patient revealed no concerns related to care.

CNA 3
A telephone interview was conducted on 5/1/2020 at 1:15 PM with CNA 3 who verified that he/she was worked on 4/28/2020 on 7:00 AM shift which was the morning after the alleged incident occurred. CNA 3 reported that he/she had no knowledge of the alleged incident of abuse concerning Patient 4 . CNA 3 reported, "I came in about 7:00 AM on 4/28/20. I took report from CNA 2. We rounded in the patient rooms. CNA 2 (alleged perpetrator) was her normal self. I turned and positioned my patients. When I turned Patient 4, I didn't see any bruises or anything on the patient. " CNA 3 reported that the patient said nothing to him/her about abuse.

Director of Quality/ Chief Executive Officer (CEO)
A face to face interview was conducted on 5/1/2020 at 3:00 PM with the Director of Quality and the hospital's CEO. The Director of Quality stated, "If we get a (patient)complaint, it goes to the Charge Nurse and Chief Nursing Officer (CNO). I'm made aware of it. I keep up with the log. The CNO or I will resolve the issue. " The CEO stated, "The Interim Director of Nursing (DON) was notified of the alleged incident by the patient's nephew. I was standing there when the call came in. The Interim DON started the investigation. She (Interim DON) talked with the patient and performed a physical assessment. No statements from staff were gotten. The police were notified, and the hospital security was notified. "

RN 5
A telephone interview was conducted on 5/1/2020 at 3:12 PM with RN 5 who verified that he/she worked the 7:00 AM shift on 4/28/2020. RN 5 reported that he/she had no knowledge of the alleged incident of abuse by Patient 4 during the 7 PM shift on 4/27/2020.

Hospital policy and procedure, titled, " Abuse, Neglect and Exploitation", reads ....
"Procedure:
1. Any employee who witnesses, suspects or is informed of incidents of patient abuse, neglect or exploitation shall immediately report the allegation to the supervising nurse. The supervising nurse will immediately ensure the patient is free of eminent danger by: removing the perpetrator of the abuse from the patient care area, ensuring that all staff are aware that the perpetrator will not be allowed patient contact by making a notation on patient care kardex which will be updated at each shift report and placing a note in the patient chart. The supervising nurse will then notify the chief nursing officer or designee who will report the incident to the South Carolina lieutenant governors department of aging at 803-545-4370, report the allegation to the patient social worker, and begin an investigation of the incident.

2. The chief nursing officer or his/her designee is responsible to assess the patient who is believed to have been victimized. Assessment shall include documentation; treatment where appropriate; injuries a present and other evidentiary airy information. The chief nursing officer or his/her designation will notify the position of suspected abuse, neglect, or exploitation to ensure that appropriate documentation, medical intervention, and reporting occurs.

3. When the patient is in imminent danger and in need of immediate protection the local police department or the South Carolina state police shall be contacted.

4. In the absence of the chief nursing officer/their designee/or the supervising nurse, it is responsibility of the employee who witnessed, suspected or was informed of an incident of patient neglect, abuse, or exploitation to ensure the patient is free of eminent danger, immediately report the allegation to the protection hotline and follow steps 1 - 4 of this procedure.

5. All employees involved in reports of patient abuse, neglect or exploitation shall exercise caution in safeguarding patient rights and confidentiality. Mandatory reporting laws apply if the victim is either married to the offender or is a vulnerable adult. Healthcare providers are permitted to disclose information about someone to believe to be a victim only if: the disclosure is required by law and compliance with the law, the individual authorizes the release.

6. The social worker or designee will ensure that all events related to reporting are clearly documented in the patient's medical record. The documentation shall include:
The identification of the suspected/alleged abuse/neglect
The assessment of the extent of the reported abuse/neglect
Who reported to the authorities
Who receive the report (agency name)
Entry should be dated and timed

7. The social worker will provide supportive counseling and/or referral for spiritual counseling or community agencies that can provide resources to patient that had been victimized

8. When the allegation involves an employee, the accused will be removed from having any patient care contact, until investigation is complete....".