HospitalInspections.org

Based on record review and interview, the hospital failed to ensure that a patient or patient advocate was called to discuss a grievance for one (Pt #3) of five patients.

Review of policy titled "Complaint and Grievance Process" reviewed 10/01/20 read in part, "The Director of Quality Management and/or Chief Nursing Officer will investigate the circumstances surrounding the concern or complaint" "If a face to face meeting is not possible the DQM, CNO and/or CEO will contact the patient or the patient representative, to discuss the investigation and actions taken...."

Findings:
A review of "Complaint and Grievance Log" showed a complaint received 05/14/25 for Pt #3 that was received from another facility and related to the hospitalization at Select Specialty Hospital from April 11 - 23, 2025. A "Patient/Family Report" showed .... "Pt. called 911 because she couldn't breathe and when a staff member came into the room, she began to pinch and poke her arms, saying if you can feel this and you can answer me and you can call 911, then you can breathe."

The investigation handwritten notes did not show that the patient or patient's daughter were met with face to face or called to obtain information regarding the allegations.

The Complaint/Grievance records did not show that the incident was fully investigated due to the patient or the patient's daughter were not met with face to face (per policy) or called to obtain further information (date of incident, names of those involved, extent of possible abuse).

On 06/12/25 at 11:25 am, Staff B stated the patient and the daughter had not been contacted in person or by telephone.

Based on observation and interview, the hospital failed to ensure rooms (Rooms #2 and 3) of three patient rooms were free of possible patient exposure to environmental bacteria/toxins.

Findings:
The surveyor was given a tour of units in the hospital. The surveyor requested to see an empty clean room on each floor.

Room #2
On 06/11/25 at 9:40 am the surveyor observed:
1) To the left of the sink in the room the cove base (trim on wall at floor) had an area missing with exposed drywall that was brown and had the appearance of having been exposed to moisture;
2) The paint above the cove base was peeling and appeared loose;
3) An area near the bed had blue fuzz/fabric in the floor;
4) Areas to the right and left of the toilet that appeared to have a buildup of dark grime.

Room #3
On 06/11/25 at 9:50 am the surveyor observed:
1) An area to the left of the toilet that appeared as a buildup of dark grime.
2) An area of the cove base that had five brown spots.

06/12/25 at 10:19 am, Staff I stated:
1) The room was not as clean as I would like it to be;
2) Issues with water damage to drywall could produce mold;
3) If cove base can't be cleaned it should be replaced.