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Based on staff interview, medical record review, and policy review the facility failed to ensure that the Condition of Participation - Compliance With Laws was met. The facility failed to ensure that a violation of patient neglect was reported as required by the Mississippi Vulnerable Adult's Act for Patient #1, one (1) of five (5) patients reviewed.

Findings include:

Cross Refer to A145 for the facility's neglect of Patient #1 which resulted in the patient developing severe dehydration, Renal Failure secondary to dehydration, Urinary tract Infection and pressure ulcers. Patient #1's condition declined as a result of neglect while a patient on the geriatric psychiatric unit from 2/1/2010 to 2/15/2010. All findings were discussed during an interview with the Director of Nursing, Nurse Manager for the geriatric-psychiatric and the Administrator on 5/11/2010 from 1:40 p.m. to 1:50 p.m. Staff confirmed that the facility failed to notify the Department of Health of an incident of neglect of Patient #1.


Chapter 47, Mississippi vulnerable Adult Act contains the following requirements. (c) Any employee of a health care facility who has knowledge of a reasonable cause to believe that a patient has been the victim of abuse, neglect or exploitation shall report the abuse, neglect or exploitation orally or telephonically, within (24) hours of discovery, excluding Saturdays, Sundays and legal holidays, to the State Department of Health and the Medicaid Fraud Control Unit of the Attorney General's Office.
(d) Any employee of a health care facility who has knowledge of or reasonable cause to believe that a patient has been the victim of abuse, neglect or exploitation shall report the abuse, neglect or exploitation in writing within seventy-two (72) hours of discovery.

The facility's Suspicion of Abuse, neglect or Exploitation and Patient Injuries of an Unknown Cause Policy 180-02 contained the following requirement. The vulnerable Adults Act requires reporting of abuse, neglect or exploitation orally or telephonically, within twenty (24) hours excluding Saturdays, Sundays and legal holidays of discovery, to the Attorney General's Office and the Mississippi State Department of Health (MSDH) Division of Licensure and Certification.

Review of page six (6) of the facility's Abuse and Neglect, Victim of Alleged or Suspected Policy #100.07 revealed the following requirements. B. If you suspect that one of your patients has been a victim of abuse or exploitation by an employee of the facility, you are required to by law to report: (1) orally or by phone within 24 hours. (2) In writing within two (2) working days of discovery. Reports should contain the name, address, and phone number of the reporter; name and address of victim; details and observations of the incident; date; time; and place of specific incidents(s); and any witnesses. The report must be given to the Division of Licensure and Certification, MS State Department of Health and Medicaid Fraud Control Unit, Office of the Attorney General. D. Some signs of abuse and exploitation include: " Neglect, including failing to give medicine, food or personnel care. "

Based on medical record review, staff interview, and policy and procedure review, the facility failed to ensure that the Condition of Participation - Patient Rights was met.

Findings include:

Cross Refer to A145 for the facility's failure to ensure that Patient #1 was provided the right to be free from neglect which resulted in the patient becoming dehydrated, developing Renal Failure secondary to Dehydration, Urinary Tract Infection and Pressure Ulcers.

Based on medical record review, staff interview, and policy and procedure review, the hospice failed to ensure that the Condition of Participation - Nursing Service was met.

Findings include:

Cross Refer to A392 for the facility's failure to ensure that Patient #1's needs were met by ongoing assessments and provision of care to prevent Dehydration, Renal Failure, Urinary Tract Infection and Pressure Ulcers.

Cross Refer to A396 for the facility's failure to ensure that nursing staff developed a plan for Patient #1 that identified problems of Lethargy, Dehydration, Renal Failure, Urinary Tract Infection, Pressure ulcers, patient's decreased ability to ambulate, turn and reposition, hydrate and feed self.

Based on medical record review, staff interview, and policy and procedure review, the facility failed to ensure that Patient #1, one (1) of five (5) patients reviewed, was provided the right to be free from neglect which resulted in the patient becoming Dehydrated, Renal Failure secondary to Dehydration, developing a Urinary tract infection and Pressure ulcers.

Findings include:

Cross Refer to A396 for the facility's failure to ensure that Patient #1's needs were met by ongoing assessments and provision of care to prevent Dehydration, Renal Failure, Urinary Tract Infection and Pressure Ulcers.


The facility's Documentation Standards/time Frames Policy and Procedure 200.55 dated 01/01/2010 contained the following requirements. " It is the policy of the Geropsychiatric Unit to make a complete systems evaluation of every patient every 24 hours." "Any changes in the patient's condition will be reported to the physician."

Patient #1 was admitted to the geriatric-psychiatric unit on 02/01/2010 at 3:30 p.m. Review of nurse's notes revealed that at the time of admission the patient was: alert, confused, oriented to person only and ambulated independently with an unsteady gait. The admission skin assessment indicated that the patient did not have any skin breaks. The patient's condition declined. There was no documented evidence that the patient was assessed regarding declines in: ability to turn and reposition self; ambulation status; hydration status, nutrition status, skin condition. The patient was transferred to the acute care unit on 2/15/2010. At that time it was discovered that the patient was dehydrated, had a Urinary Tract Infection, Stage I pressure ulcer on bilateral heels and Stage II pressure ulcer on bilateral buttocks. On 02/15/2010 at 8:45 p.m. the patient was transferred to acute care. The acute care admission nursing assessment contained the following information. The patient was confused to person, place and time. A two (2) centimeter (cm) diameter Stage I pressure ulcer was observed on the patient's bilateral heels. "Also noted purplish/red area across buttocks - Sacrum c (with) scattered blistering to R tear in center of sacrum." The Stage II pressure ulcers were not measured until 2/17/2010. At that time the pressure ulcer on the left buttock measured 3 cm. The pressure ulcer on the right buttock measured 2 cm.

Review of the hospital discharge summary revealed the following information. "The patient was initially in GPU (geriatric psychiatric unit) for behavior disorder, and found to be dehydrated. He was subsequently admitted to acute care on the 15th of February 2010. Throughout hospitalization while getting IV (intravenous) fluids, the patient's condition progressively improved. He was also noted to have a urinary tract infection and this was treated with some antibiotics." "The patient had improved significantly with IV boluses and antibiotics. Also found to have Decubitus ulcers and an episode of fever. This was being treated with antibiotics." The patient's condition improved and he was discharged to a nursing home on 2/22/2010. The discharge diagnoses were: 1. Severe Dehydration 2. Acute Renal Failure secondary to severe dehydration 3.Altered mental status which is multi-factorial and 4. Decubitus ulcers.

These findings were discussed during an interview with the Director of Nursing, Nurse Manager for the geriatric-psychiatric and the Administrator on 5/11/2010 from 1:40 p.m. to 1:50 p.m. Staff reported agreement with surveyor findings at that time.

Based on medical record review and staff interview, the facility failed to ensure that Patient #1's, one (1) of five (5) patients reviewed, needs were met by ongoing assessments and provision of care to prevent Dehydration, Renal Failure, Urinary Tract Infection, and Pressure Ulcers.

Findings include:

The facility's Documentation Standards/time Frames Policy and Procedure 200.55, dated 01/01/2010, contained the following requirements. " It is the policy of the Geropsychiatric Unit to make a complete systems evaluation of every patient every 24 hours." "Any changes in the patient's condition will be reported to the physician."

Record review revealed that Patient #1 was admitted to the geriatric-psychiatric unit on 02/01/2010 at 3:30 p.m. Review of nurse's notes revealed the following information. At the time of admission the patient was: alert, confused, oriented to person only and ambulated independently with an unsteady gait. The admission skin assessment indicated that the patient did not have any skin breaks. The patient's abilities to: ambulate, turn and reposition self, transfer self, hydrate self and eat declined. The patient's fluid consumption declined. There was no documented evidence that staff was aware of the decline. The patient developed severe Dehydration and Renal Failure secondary to severe dehydration. The patient became lethargic and his ability to turn and reposition self declined. There was no documented evidence that the patient was routinely turned and repositioned or that the patient's skin was routinely assessed. The patient developed Stage I and Stage II pressure ulcers. There was no documented evidence that the staff was aware of the pressure ulcers. The patient's food consumption declined. A laboratory report dated 2/16/2010 indicated that the patient's Albumin level was 2.7 grams/deciliter (low).

Review of staffing notes revealed:
On 02/02/2010 at 8:00 a.m. the patient was in the dayroom sitting in a wheelchair continuously trying to stand up. Staff was continuously getting him to sit down. Staff fed the patient lunch and supper.
On 02/03/2010 at 2:00 p.m. the patient ambulating in a hall with the assistance of the Physical Therapist and walker.
On 02/04/2010 at 4:00 p.m. the Physical Therapist attempted to assist the patient with ambulation. The patientonly walked a few steps.
On 02/05/2010 at 2:00 p.m. the patient refused to walk with physical therapist assistance.
On 2/6/2010 at 9:45 p.m. the patient was transferred from a wheelchair to bed by assistance of three (3) staff members. At 8:00 p.m., staff changed the patient's wet adult brief. At that time redness was noted to his coccyx. (No intervention was documented.)
On 2/8/2010 at 8:00 a.m., " Remains in bed c (with) eyes closed but moan response when you call his name - Ate a little breakfast c staff feeding him. No behavior problems or distress." At 10:00 p.m. the patient was in bed sleeping. Medications were not given at that time due to the patient's drowsiness.
On 02/09/2010 at 8:00 a.m. " Received in w/c (wheelchair) - Remains lethargic - Skin warm & (and) dry - Will open eyes @ (at) times - No S/S (signs or symptoms) distress - Does not respond verbally but does respond to painful stimuli - Inc (incontinent) B/B (bowel/bladder) " At 12:00 p.m. the patient did not eat lunch. Medications were held because the patient remained lethargic. The patient remained lethargic throughout the day.
On 02/10/2010 at 8:00 a.m. " Pt (patient) is still very sleepy - Unable to get pt to wake up @ present. Staff tried to get pt to eat some breakfast earlier." At 10:00 a.m. "Still has eyes closed most of time - Will respond c moan to his name."
On 02/11/2010 at 8:00 a.m. " Pt is alert & oriented x (times) 1 - Has his eyes open - Mumbling incoherent words." At 6:00 p.m., " Dr. ----- trying to talk c pt. Remains in Geri-chair in dayroom c eyes closed - Opens eyes occasionally."
On 02/13/2010 at 2:00 a.m. "Attempts to get out of bed - Unable to redirect - Given bath/shaved - Will not leave brief on."
On 02/14/2010 at 8:00 a.m., the patient was incontinent of bowel/bladder, unable to make needs known and required maximum assistance to transfer.
On 02/15/2010 at 8:45 p.m. the patient was transferred to acute care. The acute care admission nursing assessment contained the following information: The patient was confused to person, place and time. A two (2) centimeter (cm) diameter Stage I pressure ulcer was observed on the patient's bilateral heels. "Also noted purplish/red area across buttocks - Sacrum c scattered blistering to R (right) tear in center of sacrum." The Stage II pressure ulcers were not measured until 2/17/2010. At that time the pressure ulcer on the left buttock measured 3 cm. The pressure ulcer on the right buttock measured 2 cm.

Review of the physician's orders dated 2/15/2010 revealed that the patient's condition was "Guarded."

Review of the hospital discharge summary revealed: "The patient was initially in GPU (geriatric psychiatric unit) for behavior disorder, and found to be dehydrated. He was subsequently admitted to acute care on the 15th of February 2010. Throughout hospitalization while getting IV (intravenous) fluids, the patient's condition progressively improved. He was also noted to have a urinary tract infection and this was treated with some antibiotics. Hospitalization was otherwise uneventful. The patient had improved significantly with IV (intravenous) boluses and antibiotics. Also found to have decubitus ulcers and an episode of fever. This was being treated with antibiotics." The patient's condition improved and he was discharged to a nursing home on 2/22/2010. The discharge diagnoses were: 1. Severe Dehydration 2. Acute Renal Failure secondary to severe dehydration 3.Altered mental status which is multi-factorial and 4. Decubitus ulcers.

These findings were discussed during an interview with the Director of Nursing, Nurse Manager for the Geriatric-Psychiatric Unit and the Administrator on 5/11/2010 from 1:40 p.m. to 1:50 p.m. Staff reported agreement with all findings at that time.

Based on medical record review, staff interview and policy and procedure review, the facility failed to ensure that a Registered Nurse (RN) supervised and evaluated the nursing care provided for Patient #1, one (1) of five (5) patients reveiwed.

Findings include:

Cross Refer to A392 for the facility's failure to ensure that a RN supervised and evaluated the care provided for Patient #1 to prevent Dehydration, Renal Failure, Urinary Tract Infection, and Pressure Ulcers.

Based on medical record review, staff interview and policy and procedure review, the facility failed to ensure that nursing staff developed a plan that identified problems of Lethargy, Dehydration, Renal Failure, Urinary Tract Infection, Pressure ulcers, and Patient #1's decreased ability to ambulate, turn and reposition, hydrate and feed self. Patient #1 was one (1) of five (5) patients reviewed.

Findings include:

Medical record review for Patient #1 revealed that the patient was admitted to the geriatric-psychiatric unit on 02/01/2010. Review of nurse's notes (NN) for Patient #1 revealed: The admission NN indicated that the patient was: alert, confused, oriented to person only and ambulated independently with an unsteady gait. The admission skin assessment indicated that the patient did not have any skin breaks. There was no documented evidence that nursing staff developed a care plan which identified problems and approaches for Patient #1. The patient's condition declined. The patient was transferred to the acute care unit on 2/15/2010. At that time it was discovered that the patient was Dehydrated, Developed Renal Failure secondary to Dehydration, had a Urinary Tract Infection and developed a Stage I pressure ulcer on bilateral heels and a Stage II pressure ulcer on bilateral buttocks.

These findings were discussed during an interview with the Director of Nursing, the Nurse Manager for the geriatric-psychiatric, and the Administrator on 5/11/2010 from 1:40 p.m. to 1:50 p.m. Staff reported agreement with these findings at that time.

Based on medical record review, staff interview and policy and procedure review, the facility failed to ensure that Patient #1's medical record contained documentation of information necessary to monitor and prevent decline in the patient's condition. Patient #1 was one (1) of five (5) patients reviewed.

Findings include:

Review of page one (1) of the facility's Documentation Guidelines Policy #200.08 revealed the following requirements. Chart information documentation will include: a. Patients emotional and medical status at time of admission and discharge. b. Any changes in the patient's status. C. Date, time and mode of transportation to and from the unit (include who accompanied the patient and patient's status upon return). D. Implementation of interventions and outcome of treatment. E. Any special precautions or follow-up to be taken and patient's response.

Cross Refer to A392 for the facility's failure to ensure Patient #1's needs were met by ongoing assessments and provision of care to prevent dehydration, Renal, Urinary Tract Infection, and Pressure Ulcers.

Cross Refer to A396 for the facility's failure to ensure that nursing staff developed a plan for Patient #1 that identified problems of Lethargy, Dehydration, Renal Failure, Urinary Tract Infection, Pressure ulcers, patient's decreased ability to ambulate, turn and reposition, hydrate and feed self.