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Based on interview and record review, the facility failed to follow policy and procedure for thoroughly investigating and reporting abuse allegations for 1 (#1) of 2 patients reviewed for abuse from a total of 7 sampled patients resulting in the potential for unidentified abuse and/or reoccurrence with the potential to affect 26 patients currently being serviced by the facility. Findings include:

On 8/17/16 at 1300 a review of the closed medical for patient #1 was conducted.
A review of the admission facesheet documented the patient was a 67 year old female admitted into the facility on 6/1/16 with diagnoses that included sepsis, endocarditis and end stage renal disease.

On 8/17/16 at 1330 patient #1's grievance report and investigation was reviewed with Quality Manager Staff (A). When queried Staff A explained she interviewed the patient of concern regarding the allegations of abuse on 6/13/16. According to Staff A the patient alleged she was punched in the stomach and talked to roughly by Staff I on the midnight shift on 6/10/16. When asked if the patient had complained of pain. Staff A stated, "Yes." Staff A was observed as she touched her own upper abdomen to demonstrate where the patient had expressed where her pain was at that time.

On 8/17/16 at approximately 1350 during an interview and review of the investigation findings Chief Nursing Officer Staff (B) explained he was contacted by Staff J on the morning of 6/11/16. He explained Staff J had contacted him regarding an abuse allegation that Medical Doctor (MD) Staff (K) had reported regarding the patient of concern. Staff B additionally stated "I contacted Staff I and told her she was suspended pending review of an abuse allegation. I took her off the work schedule immediately." At that time a review of a disciplinary action (dated 7/4/16) in Staff I's personnel file documented she was given a verbal warning regarding the allegation. There was no mention of suspension. Staff B stated, "She (Staff I) had called in and had scheduled time off during the time frame for the investigation."

When further queried regarding the investigation of the abuse allegation, Staff B explained when he interviewed Staff H she reported that while she (Staff H) and Staff I were in the patient's room she saw the patient crying and telling Staff I that she did not have to "poke her in the stomach like that, she was not a dog, and she (#1) had refused for Staff I to touch her or do anything else towards".

When asked to explain why Staff H did not report the patient's crying and complaint of being poked in the stomach and being treated like a dog to the charge nurse Staff B stated, "I asked her that same question. She (staff H) should have reported what she saw and heard to the Charge Nurse that night. When I asked her why she didn't she told me she was busy and forgot."

On 8/17/16 at approximately 1615 during a phone interview Staff H was queried regarding patient #1's allegation of abuse. Staff H confirmed the aforementioned concerns. When asked why she did not report what she observed and overheard patient #1 say, Staff H stated, "I should have reported it to the charge nurse. I was busy. I forgot."

On 8/17/16 at approximately 1630 during a phone interview Staff I was queried regarding patient #1's allegation of abuse. Staff I stated "I came in the following week and wrote my statement for Staff B. I worked the following day (6/11/16). I was never suspended. I was told by Staff B to sign the form acknowledging that I was consulted regarding the complaint."

On 8/17/16 a review of Staff I's timesheet revealed she clocked in and out on the following dates and times:
On 6/10/16 in at 1854 out at 0726.
On 6/11/16 in at 1900 out at 0730.
On 6/12/16 in at 1600 out at 1700.

On 8/17/16 at approximately 1645 Staff A was asked to provide an Incident/Accident report Staff A stated, "We don't have one. We did the investigation. When asked to explain if she or anyone else had examined the patient for any injury. Staff A stated, "No." When asked how she determined that the patient had not suffered any injury Staff A stated, "When I interviewed Staff I she denied hitting the patient."

On 8/17/16 at 1655 a review of the facility's "Abuse, Neglect" Policy Number A 02-A, (dated 7/1/12) documented:
Policy: Any hospital employee suspecting a patient or visitor has been abused, neglected or harassed will immediately report the situation to the Chief Executive Officer, Chief Nursing Officer or Administrator on-call immediately....The Hospital shall actively comply with all CMS requirements related to patient abuse and neglect, which include:...5. Protection of Patients: Any allegation of abuse or neglect by an employee must result in removal of the patient from potential or further abuse. Any employee involved in such an accusation, will be suspended with pay and instructed not to come to the hospital, until the investigation is completed and the matter resolved. The CEO or designee will begin the investigation with the advice and counsel of the Corporate Legal and Human Resources Departments. All relevant State and local laws related to reporting will be complied with fully.

Based on document review and interview, the facility failed to obtain a physician order for restraints for 1 (#2) of 2 patients reviewed with restraints out of a total sample of 7 patients resulting in the potential for inappropriate use of restraints for all 26 patients currently receiving care in the facility. Findings include:

On 8/17/2016 at 0921, the medical record for Patient #2 revealed that the patient was in restraints to prevent dislodging of tubes while unable to understand the seriousness of his condition and the need for treatment. Physician orders for restraints were present for the following time periods: 6/25/2016-7/1/2016 and 7/3/2016-7/14/2016. There was no physician order dated for 7/2/2016. On 8/17/2016 at 1010, this was confirmed by Staff A who stated, "No, it's not there. They must've forgotten to fill it out." In the careplan dated 7/2/2016, on page six (6), in the section titled "Restraints", there is a hand written notation stating "R/L wrist restraints" and assessment boxes are initialed by staff members every two (2) hours from 0700-0500.

On 8/17/2016 at 0953, facility policy titled, "Restraints and Seclusion", number R02-N, last revised 6/2012 was reviewed. On page five (5), under "Orders to Initiate Restraint", the policy states, "...Orders for restraints must be renewed on a daily basis..."