Other·October 24, 2022

Regulation Violation: 483.10(a) Resident Rights. The resident has a right to a dignified existence, self-determination, and communication with and access to persons and services inside and outside the facility, including those specified in this section. 483.10(a)(1) A facility must treat each resident with respect and dignity and care for each resident in a manner and in an environment that promotes maintenance or enhancement of his or her quality of life, recognizing each resident's individuality. The facility must protect and promote the rights of the resident. 483.10(a)(2) The facility must provide equal access to quality care regardless of diagnosis, severity of condition, or payment source. A facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the State plan for all residents regardless of payment source. 483.10(b) Exercise of Rights. The resident has the right to exercise his or her rights as a resident of the facility and as a citizen or resident of the United States. 483.10(b)(1) The facility must ensure that the resident can exercise his or her rights without interference, coercion, discrimination, or reprisal from the facility. 483.10(b)(2) The resident has the right to be free of interference, coercion, discrimination, and reprisal from the facility in exercising his or her rights and to be supported by the facility in the exercise of his or her rights as required under this subpart. 72311. Nursing Service - General. (a) Nursing service shall include, but not be limited to, the following: (1) Planning of patient care, which shall include at least the following: (A) Identification of care needs based upon an initial written and continuing assessment of the patient's needs with input, as necessary, from health professionals involved in the care of the patient. Initial assessments shall commence at the time of admission of the patient and be completed within seven days after admission. (C) Reviewing, evaluating, and updating of the patient care plan as necessary by the nursing staff and other professional personnel involved in the care of the patient at least quarterly, and more often if there is a change in the patient's condition. (2) Implementing of each patient's care plan according to the methods indicated. Each patient's care shall be based on this plan. 72315. Nursing Service - Patient Care. (c) Each patient, upon admission, shall be given orientation to the skilled nursing facility and the facility's services and staff. (e) Each patient shall be encouraged and/or assisted to achieve and maintain the highest level of self-care and independence. Every effort shall be made to keep patients active, and out of bed for reasonable periods of time, except when contraindicated by orders of a licensed health care practitioner acting within the scope of his or her professional licensure. 72317. Nursing Service -Standing Orders. Standing orders shall not be used in skilled nursing facilities. 72319. Nursing Service - Restraints and Postural Supports. (a) Written policies and procedures concerning the use of restraints and postural supports shall be followed. (b) Restraints shall only be used with a written order of a licensed healthcare practitioner acting within the scope of his or her professional licensure. The order must specify the duration and circumstances under which the restraints are to be used. Orders must be specific to individual patients. In accordance with Section 72317, there shall be no standing orders and in accordance with Section 72319(i)(2)(A), there shall be no P.R.N. orders for physical restraints. (c) The only acceptable forms of physical restraints shall be cloth vests, soft ties, soft cloth mittens, seat belts and trays with spring release devices. Soft ties mean soft cloth which does not cause abrasion, and which does not restrict blood circulation. (d) Restraints of any type shall not be used as punishment, as a substitute for more effective medical and nursing care, or for the convenience of staff. (e) No restraints with locking devices shall be used or available for use in a skilled nursing facility. (i) (1) Treatment restraints may be used for the protection of the patient during treatment and diagnostic procedures such as, but not limited to, intravenous therapy or catheterization procedures. Treatment restraints shall be applied for no longer than the time required to complete the treatment. (i) (2) Physical restraints for behavior control shall only be used on the signed order of a physician, or unless the provisions of section 1180.4(e) of the Health and Safety Code apply to the patient, a psychologist, or other person lawfully authorized to prescribe care, except in an emergency which threatens to bring immediate injury to the patient or others. In such an emergency an order may be received by telephone and shall be signed within 5 days. Full documentation of the episode leading to the use of the physical restraint, the type of the physical restraint used, the length of effectiveness of the restraint time and the name of the individual applying such measures shall be entered in the patient's health record. (i) (2) (B) Each patient care plan which includes the use of physical restraint for behavior control shall specify the behavior to be eliminated, the method to be used and the time limit for the use of the method. 72515. Admission of Patients. The licensee shall: (b) Accept and retain only those patients for whom it can provide adequate care. On September 22, 2022, at 12:00 PM, an unannounced visit was conducted at the facility to investigate a complaint regarding shackles/restraints being used on Justice Involved Patients (individuals currently in custody and held involuntarily through operation of law enforcement authorities). Patient 1 was observed in bed, a shackle (locking metal device with a chain allowing patient to stand next to bed) to the right ankle and one end attached to bedrail on September 22, 2022, at 12:10 PM. Patient 2 was observed in bed with a shackle to left ankle attached to bedrail on September 22, 2022, at 12:10 PM. Patient 3 was observed in bed with a shackle to left ankle attached to bedrail on September 22, 2022, at 12:28 PM. Patient 4 was observed in bed without a shackle on September 22, 2022, at 12:34 PM. Patient 5 was observed in bed, with a shackle to the right ankle attached to the bedrail on September 22, 2022, at 12:44 PM. Patient 6 was observed in bed with a shackle to left ankle attached to bedrail on September 22, 2022, at 12:44 PM. These patients were observed to not be able to move freely around their room, or the facility or to participate freely in social interactions with other patients or participate in activities outside their room. The facility failed to: 1.Include on restraint orders the rationale for the use of the restraint and the duration of the restraint. 2.Follow the facility's policies and procedures titled "Use of Restraints" and "Residents Rights." 3.Allow these six patients (Patients 1, 2, 3, 4, 5 and 6) to move freely around their room and the facility. 1.Patient 1 was a 50-year-old male, admitted to the facility on September 21, 2022, with diagnoses which included: urinary tract infection (infection of the bladder), diabetes (high blood sugar), hypothyroidism (thyroid does not produce enough hormones), hyperlipidemia (high levels of fat in the blood), schizophrenia (a thought disorder characterized by hallucinations and delusions), Gastro-esophageal reflux disease (gastric fluid backflow into the esophagus) and high blood pressure. A review of patient 1's Physician's order dated September 22, 2022, indicated, "Patient under the custody of California Department of Corrections and Rehabilitation (CDCR, [name of State Hospital] Patients) is under jurisdiction of CDCR. "CDCR officers may use physical restraints or seclusion strictly for security and protection of patients and staff, and to prevent escape." (Exhibit A section S 2016 DSH- [name of State Hospital] contract)." A review of the Patient 1's, Restraint Physical Assessment dated September 22, 2022, at 1:24 PM, indicated "Reasons for use of Physical Restraint... C. Decision to restrain: 1b. State who made the decision to apply the restraint and why: under the custody of California Department of Corrections and (name of State Hospital) patient." A concurrent observation and interview of patient 1 on September 22, 2022, at 12:10 PM, Patient 1 was observed lying in bed with one end of the shackle attached to the bed and the other end of the shackle connected to the right ankle. Patient 1 stated, "The nurses don't do anything to me. The correctional officer checks my shackles every hour to two hours." During an observation on September 23, 2022, at 5:18 PM, Patient 1 was observed lying in bed with one end of the shackle attached to the bed and the other end of the shackle attached to the right ankle. During review of the care plans for patient 1 on September 22, 2022, at 3:02 PM, with the Medical Records Director, the Medical Records Director stated the facility did not have a care plan related to patient 1's shackle/restraint. A review of patient 1's Wandering/Elopement Risk Assessment dated September 21, 2022, at 7:05 PM, indicated Patient 1 was a low risk for elopement/wandering. 2. Patient 2 was a 71-year-old male, initially admitted on September 14, 2022, with diagnoses which included: encephalopathy (damaged area of the brain), pneumonia (infection of the lungs), chronic obstructive pulmonary disease (constriction of the airway and difficulty breathing), obesity (overweight), hyperlipidemia (high levels of fat in the blood), schizophrenia (mood disorder characterized by hallucinations and delusions), Gastro-esophageal reflux disease (gastric fluid backflow into the esophagus), high blood pressure, pressure induced tissue damage of the left ankle, and osteoporosis (thin and weakened bones). A review of patient 2's Physician's order dated September 14, 2022, indicated, "Patient is under the custody of California Department of Corrections and Rehabilitation (CDCR, [name of State Hospital] Patients) is under jurisdiction of CDCR. "CDCR officers may use physical restraints or seclusion strictly for security and protection of patients and staff, and to prevent escape." (Exhibit A section S 2016 [name of State Hospital] contract)." A review of patient 2's, the Restraint Physical Assessment (Initial Evaluation) dated September 15, 2022, at 1:59 PM, indicated "Reasons for use of Physical Restraint. C. Decision to restrain: 1b. State who made the decision to apply the restraint and why: under the custody of California Department of Corrections and (name of State Hospital) patient." During a concurrent observation and interview of patient 2 on September 22, 2022, at 12:10 PM, Patient 2 was observed lying in bed with one end of the shackle attached to the bed and the other end of the shackle connected to the left ankle. Patient 2 stated he does not know how often the nurses come in to check his shackles. During an interview with a Correctional Officer (CO 1) on September 22, 2022, at 12:10 PM, CO 1 stated "We switch the shackles every two hours. We switch the shackles between the two legs. The only time we take the shackles off is when staff are showering the Justice involved patients (JIP)." When the CO was asked why the JIP's are shackled, CO 1 stated, "They are (name of state hospital) patients. They have committed crimes and not mentally capable of going to court. "CO 1 stated further, "The Activity department will come in since they (JIP's) are not allowed to go play bingo." CO 1 then stated, "Typically, with the shackles on they can walk a steps length away from the bed. The chain is about 3 feet. I put the restraint/shackle on to keep them from running. It's (shackle) just long enough for them to step or stand by the bed." CO 1 stated, the three activities that the JIP does when outside of their room are: walk with physical therapy, therapy (occupational), and showers. A review of patient 2's Care plans indicated, 1. Focus: Patient 2 is unable to participate in group or out of room recreational or leisure activities related to (name of state hospital) and Correction Officer guidelines. Undated. 2. Focus: Patient 2 is at risk for decline in psychosocial wellbeing related to need for restraint and bedside corrections officer to be in place. Patient 2 is a (name of state hospital) patient and restraint/officer must be in place in this setting per (name of state hospital) and Corrections guidelines for safety of self and others. Undated. 3. Focus: Patient 2 requires shackles to extremity d/t under custody of California department of Corrections and Patton State Hospital Patient. Undated. A review of patient 2's Wandering/Elopement Risk Assessment dated September 14, 2022, at 7:45 PM, indicated Patient 2 was a low risk for elopement/wandering. 3.Patient 3 was a 73-year-old male, admitted to the facility on June 29, 2022, with diagnoses which included: stroke affecting the right side, seizures (uncontrolled electrical disturbance in the brain), lack of coordination, abnormalities of gait and mobility, high blood pressure, hyperlipidemia (high levels of fat in the blood), hypothyroidism (low activity of thyroid gland), benign prostatic hyperplasia (prostate enlargement), dysphagia (difficulty swallowing), abdominal aortic aneurysm (bulge or swelling in the main blood vessel that runs from the heart) and aphasia (brain disorder that leaves one with trouble speaking or understanding people speaking). A review of patient 3's Physician's order dated September 5, 2022, indicated, "Patient is under the custody of California Department of Corrections and Rehabilitation (CDCR, [name of State Hospital] Patients) is under jurisdiction of CDCR. "CDCR officers may use physical restraints or seclusion strictly for security and protection of patients and staff, and to prevent escape." (Exhibit A section S 2016 DSH- [name of State Hospital] contract." A review of patient 3's Restraint Physical Assessment (Initial Evaluation) dated August 18, 2022, at 8:11 AM indicated "Reasons for use of Physical Restraint... C. Decision to restrain: 1b. State who made the decision to apply the restraint and why: under the custody of California Department of Corrections and (name of State Hospital) patient." During a observation of patient 3 on September 22, 2022, at 12:28 PM, Patient 3 was observed lying in bed with one end of the shackle attached to the bed and the other end of the shackle connected to the left ankle. Patient 3 did not respond to questioning. During an interview with Correctional Officer (CO 2) on September 22, 2022, at 12:28 PM, CO 2 stated, "Patient 3 is wearing the shackle because its's (name of state hospital) policy. It can be removed every two hours. The shackle is removed when JIP goes to physical therapy or for a shower. If Patient 3 is lying there for a while, we switch the shackle to the other ankle. Patient 3 can move while in the shackles. Patient 3 can stand." CO 2 stated further, "I don't think Patient 3 does any activities. No, he has not done any activities while I've been here." During an interview with Certified Nursing Assistant (CNA 2) on September 22, 2022, at 1:07 PM, CNA 2 stated, Patient 3 has shackles because he is a prisoner. The Shackles come off when we change, shower, or reposition him or when he goes to Therapy. Nothing else. If they go to the restroom (located in his room) then the shackles come off. CNA 2 stated that he does not go to activities. "Patient 3 just goes to therapy." A review of patient 3's, Care plans indicated, 1.Focus: Patient 3 has limited ability to participate in Activities program Related to (name of state hospital) and corrections protocol. Needs in room activities visits. Goal: will accept one to one visit of interest for 15 minutes for 3 days a week. Interventions: Before giving anything to patient 3 get consent from bedside corrections officer per (name of state hospital) instruction. Only provide writing m