HospitalInspections.org

Based on record review and interview it was determined that the facility failed to provide an adequate number of licensed practical (vocational) nurses, and unlicensed patient care staff for two shifts; on 10/23/11 (Sunday) the facility failed to meet the staff-to-patient ratio identified in their staffing plan for the 7am-3pm and 3pm-11pm shifts.

Findings were:

The following documents were reviewed on 11/17/11:

A facility document entitled "Allegiance Specialty Hospital of the Permian Basin Staffing Matrix," indicated the following:
- For the 7am-3pm and 3pm-11pm shifts with a census of 15 patients on one unit and a census of 12 patients on the second unit, there must be a total of 3 registered nurses (RN), 3 licensed vocational nurses (LVN), and 4 mental health technicians (MHT) working.

On 10/23/11 the facility's daily census included 15 patients on one unit, and 12 patients on the second unit.

The facility ' s staffing schedule on 10/23/11 identified that during the 7am-3pm shift there were 3 RNs, 2 LVNs, and 2 MHTs working. According to the facility's staffing plan, during this shift the facility was short 1 LVN and 2 MHTs.

The facility ' s staffing schedule on 10/23/11 identified that during the 3pm-11pm shift there were 3 RNs, 3 LVNs, and 2 MHTs working. According to the facility's staffing plan, during this shift the facility was short 2 MHTs.

During an interview with the Chief Nursing Officer (Personnel #7), on 11/17/11, she confirmed that the facility was short staffed on 10/23/11 for the 7am-3pm and 3pm-11pm shifts.

Based on record review and interview it was determined that the facility failed to provide laboratory services ordered by a physician in 2 of 7 patient records reviewed.

Findings were:

The following patient records were reviewed on 11/17/11:

- Patient #1 had a laboratory test ordered by a physician for a "stool occult blood x3" on 10/14/11: however there was no indication of a completed stool occult blood lab found in her medical record.

- Patient #7 had a laboratory test ordered by a physician for a CBC (complete blood count) on 10/12/11; however there was no indication of a completed CBC lab found in her medical record.

During and interview with the Facility's Chief Nursing Officer (Personnel #7) on 11/17/11 she confirmed the above findings, and stated that when labs are ordered by a physician they should completed as ordered within a timely manner.

Based on record review and interview it was determined that the facility failed to make appropriate arrangements to avoid unnecessary delays in discharge for 1 of 7 patient records reviewed.

Findings were:

Patient #4's medical record was reviewed on 11/17/11. The patient had an order written on 10/17/11 stating that he was to be discharged home on 10/18/11; a document entitled "Billing Form" indicated that he was not discharged until 10/19/11. The record indicated that the patient was discharged to an area outside of the town in which the facility was located.

During an interview with the facility's CEO on 11/17/11 she stated that the patient's discharge was delayed due to transportation issues, however an order to delay the discharge was never documented in the patient's medical record.