Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 670072 (X3) Date Survey Completed 04/07/2017
Name of Provider or Supplier Hopebridge Hospital Street Address, City, State 5556 Gasmer Drive, Houston, TX
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
A0396 NURSING CARE PLAN
CFR(s): 482.23(b)(4)

The hospital must ensure that the nursing staff develops, and keeps current, a nursing care plan for each patient. The nursing care plan may be part of an interdisciplinary care plan


This STANDARD is not met as evidenced by:
Based on record review, observation, and interview, the hospital failed to keep current a nursing care plan according to hospital policy for one of one patient (Patient #15) whose fear of receiving poison in his hospital food was not addressed by the treatment team. Findings included: Patient #15's Psychiatric Evaluation dated 04/01/17 at 11:54 p.m. , unsigned as of 04/05/17 at 3:15 p.m., reflected the patient's admitting diagnoses that included Disorganized Schizophrenia and Mild Intellectual Disability. Prior to his hospital admission, Patient #15 had decreased his food intake and lost 50 pounds. On 04/05/17 at 11:15 a.m. Patient #15 was observed in the adult unit's dining room. He refused his lunch meal. On 04/05/17 at 4:35 p.m., Patient #15 was observed eating only his plastic wrapped dinner roll and refused to eat the rest of the meal. On 04/07/17 at 1:45 p.m., Patient #15 stated through an interpreter that he thought his food was "poisoned" and staff put medicine in his food. Patient #15 stated he would "die soon." Patient #15's Multidisciplinary Treatment Plan dated 04/05/17 did not address the patient's statements regarding hos food had 'poison" or staff adding medicine to it. Personnel #5 denied on 04/06/17 at 2:00 p.m. that Patient #15's treatment plan addressed the patient's fear. Clinical Services Policy # 608, undated, reflected the hospital policy to "provide documentation ...of the care and treatment ...that is planned and provided ..."