HospitalInspections.org

Based on document review and interview the facility failed to ensure that it followed established policy/procedures for suspected abuse/neglect of patients for 1 inpatient geri-psychatric unit.

Findings include:

1. Review of policy/procedure SPP NO: A-114, Suspected Abuse/Neglect Patients, indicated the following:
"Statement of Purpose: Facility #1 supports and complies with the State of Indiana Code in reporting cases of suspected abuse/neglect of patients.
A. Elder Abuse:
1. Elder abuse is any form of mistreatment that results in harm or loss to an older person.
3. Adult Protective Services can be reached at (800) 992-6978."
This policy/procedure was last reviewed/revised on 10-2011.

2. Review of patient #1's medical record (MR) indicated the patient, a 96 year old was admitted to the facility Geriatric Psychiatric inpatient unit on 10-09-12 who had a diagnosis of dementia and was being admitted due to hitting other residents, yelling, screaming and refusing medications.

3. In interview on 11-05-12 at 1040 hours, staff #44 indicated that staff #42 approached him/her on 10-10-12 in the am and indicated that he/she had witnessed possible abuse on the Geri-Psych unit on 10-09-12 between the hours of 1500 to 1900. Staff #42 saw staff #45 was admitting a new patient, patient #1, and said "now that you alls protection is gone, sit the fuck down." Staff #45 took off patient #1's shoes and then continued to assess patient #1 and lifted the patient's leg high and the patient complained of pain. The patient then picked up a shoe and hit staff #45 in the head. Staff #42 was doing something and saw patient #1's head move to the side and asked staff #45 if he/she hit patient #1 with the shoe to the head and staff #45 indicated Yes, I did, she hit me, so I hit her back. The patient then tried biting staff #45 and staff #45 shoved the patient's arm into the patient's mouth and staff #45 stated to the patient if you want to bite someone, bite yourself. Staff #42 indicated he/she saw 2 teeth bite marks on the patient's arm from the patient's mouth. Staff #44 indicated that staff #42 saw staff #43 with patient #2 in the shower room. Staff #43 was trying to make patient #2 stand up by putting the patient's head between his/her legs from the shower chair.

4. On 11-05-12 at 1105 hours, staff #41 confirmed that no one called Adult Protective Services and that staff #43 and 45 are no longer employed at the facility.

5. On 11-05-12 at 1415 hours, staff #49 confirmed that no one called Adult Protective Services.