HospitalInspections.org

Based on Interview, Record Review the hospital failed 1 of 1 Patient (Patient #1), by failing to ensure that nursing staff develops and keeps current, a nursing care plan for each patient that reflects the patient's goals and the nursing care to be provided to meet the patient's needs. The nursing care plan may be part of an interdiscipinary care plan. The hospital failed to provide a medical assessment, and document the medical assessment for Patient #1 after being physically assaulted by another Patient (Patient #2).

Findings Include:

During Interview with hosptial Staff #3, on 10/01/25 at 11:30 AM, 'There is no medical record in the system showing Patient #1 was medically assessed by nursing following him being Punched and pushed to the floor by Patient #2."

During Record Review, the hospital Incident Log reflected, On 08/11/2025, at 11:11 AM, Physical Assault/Confrontation.

During Record Review the hospital Incident Report reflected, " On 08/11/2025, at 11:11 AM, in the Dayroom. Patient #2 and Patient #1, got into a physical altercation. Patient #2 was observed punching Patient #1 and shoving Patient #1 to the floor.


Policy
The hospital policy Patient's Rights 04/2025, "You have the right, under the rules by, which this Hospital is licensed, to be given a copy of these rights before you are admitted to the Hospital as a patient. If you desire, a copy should also be given to the person of your choice. If a guardian has been appointed for you or you are under 18 years of age, a copy will also be given to your guardian, parent, or conservator."

The hospital Policy on Nursing Services 10/2023, "All patients admitted to the Hospital will receive nursing care delivered in accordance with established standards of care and practice."

The hospital Policy on Physician Services 03/2025, "Each Physician and/or AHP must ensure timely, adequate, professional care for his/her patients by being available, or having available an alternate Physician and/or AHP, who assumes responsibility for management of the patient. This alternate Medical Staff Member should be of a similar discipline and possess equivalent Clinical Privileges at the Hospital."