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January health inspection of Renaissance Hospital Terrell

January health inspection of Renaissance Hospital Terrell

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Published by milesmoffeit
This report outlines care failures leading up to death of Virginia Rose McCallum (patient #60) of Wills Point, Texas. The hospital is now closed.
This report outlines care failures leading up to death of Virginia Rose McCallum (patient #60) of Wills Point, Texas. The hospital is now closed.

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Published by: milesmoffeit on Jul 15, 2013
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03/08/2014

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 A. BUILDING(X1) PROVIDER/SUPPLIER/CLIAIDENTIFICATION NUMBER:STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X3) DATE SURVEYCOMPLETED
PRINTED: 01/28/2013FORM APPROVED
(X2) MULTIPLE CONSTRUCTIONB. WING _____________________________ 
 ______________________ 
DEPARTMENT OF HEALTH AND HUMAN SERVICESCENTERS FOR MEDICARE & MEDICAID SERVICESOMB NO. 0938-0391
450683
01/09/2013
C
TERRELL, TX 75160
STREET ADDRESS, CITY, STATE, ZIP CODENAME OF PROVIDER OR SUPPLIER
RENAISSANCE HOSPITAL TERRELL
1551 HWY 34 S
PROVIDER'S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)
(X5)COMPLETIONDATE
IDPREFIXTAG(X4) IDPREFIXTAGSUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULLREGULATORY OR LSC IDENTIFYING INFORMATION)
 A 000INITIAL COMMENTSA 000An unannounced complaint survey,TX00171872, was conducted from 01/07/2013through 01/10/2013. An entrance conference was held with the Administrator and the Director of Nurses in thePhysician's Lounge on 01/07/2013 at 9:30 am.The purpose and process of the survey wasexplained and an opportunity was given for questions and discussion.The following was determined:The Immediate Jeopardy previously citedremained unabated on the following Conditions of Participation:42 CFR 482.13 Patient Rights42 CFR 482.23 Nursing Services42 CFR 482.42 Infection Control42 CFR 482.51 Surgery Services CFRIn addition, it was determined ImmediateJeopardy situation existed in the followingConditions of Participation:42 CFR 482.12 Governing Body42 CFR 482.41 Physical Environment .Based upon the findings of the investigation, thefacility was not in compliance with the followingConditions of Participation:42 CFR 482.13 Patient Rights42 CFR 482.23 Nursing Services An exit conference was conducted on 1/10/13 at
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURETITLE
(X6) DATE
 Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined thatother safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 daysfollowing the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continuedprogram participation.
FORM CMS-2567(02-99) Previous Versions ObsoleteIEGE11
Event ID:
Facility ID:810260
If continuation sheet Page 1 of 20
 
 A. BUILDING(X1) PROVIDER/SUPPLIER/CLIAIDENTIFICATION NUMBER:STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X3) DATE SURVEYCOMPLETED
PRINTED: 01/28/2013FORM APPROVED
(X2) MULTIPLE CONSTRUCTIONB. WING _____________________________ 
 ______________________ 
DEPARTMENT OF HEALTH AND HUMAN SERVICESCENTERS FOR MEDICARE & MEDICAID SERVICESOMB NO. 0938-0391
450683
01/09/2013
C
TERRELL, TX 75160
STREET ADDRESS, CITY, STATE, ZIP CODENAME OF PROVIDER OR SUPPLIER
RENAISSANCE HOSPITAL TERRELL
1551 HWY 34 S
PROVIDER'S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)
(X5)COMPLETIONDATE
IDPREFIXTAG(X4) IDPREFIXTAGSUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULLREGULATORY OR LSC IDENTIFYING INFORMATION)
 A 000Continued From page 1 A 0002:30 pm in the physician's lounge with the Administrator and the Director of Nurses. Thepreliminary findings were discussed and anopportunity was given for discussion and toprovide additional information. A 115482.13 PATIENT RIGHTS A hospital must protect and promote eachpatient's rights.This CONDITION is not met as evidenced by: A 115Based on observation, document review andinterview the governing body: A. Failed to provide Registered Nurses for supervision, patient assessments and timelyinterventions of patient care for 1of 1 (#60 )patient experiencing changes in condition thatresulted in the patient's death.The facility failed to provide Registered Nursesfor supervision and assessment and to beimmediately available to the nursing units.Licensed vocational nurses (LVN) were allowed towork in Intensive care unit (ICU), andMedical-Surgical unit without Registered Nursesupervision.Refer to Tag 144, 0392, 397B. Failed to provide and maintain a safe andclean environment for patient care.Refer to Tag 0144It was determined that this deficient practicecreated an Immediate Jeopardy situation andplaced patients at risk of potential harm, seriousinjury, and subsequent death. These failures had
FORM CMS-2567(02-99) Previous Versions ObsoleteIEGE11
Event ID:
Facility ID:810260
If continuation sheet Page 2 of 20
 
 A. BUILDING(X1) PROVIDER/SUPPLIER/CLIAIDENTIFICATION NUMBER:STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X3) DATE SURVEYCOMPLETED
PRINTED: 01/28/2013FORM APPROVED
(X2) MULTIPLE CONSTRUCTIONB. WING _____________________________ 
 ______________________ 
DEPARTMENT OF HEALTH AND HUMAN SERVICESCENTERS FOR MEDICARE & MEDICAID SERVICESOMB NO. 0938-0391
450683
01/09/2013
C
TERRELL, TX 75160
STREET ADDRESS, CITY, STATE, ZIP CODENAME OF PROVIDER OR SUPPLIER
RENAISSANCE HOSPITAL TERRELL
1551 HWY 34 S
PROVIDER'S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BECROSS-REFERENCED TO THE APPROPRIATEDEFICIENCY)
(X5)COMPLETIONDATE
IDPREFIXTAG(X4) IDPREFIXTAGSUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULLREGULATORY OR LSC IDENTIFYING INFORMATION)
 A 115Continued From page 2 A 115the potential to affect all patients admitted to thefacility. A 144482.13(c)(2) PATIENT RIGHTS: CARE IN SAFESETTINGThe patient has the right to receive care in a safesetting.This STANDARD is not met as evidenced by: A 144Based on documents review and interviews, thefacility failed to provide registered nurses tosupervise patient care and provide assessments.These actions posed an unsafe environment for patients. A review of the documents titled "AssignmentSheets" revealed 4 dates, (12/24/2012,12/25/2012, 12/27/2012, 12/28/2012), on the 7PM to 7 AM where there were no RNsimmediately available to the Intensive Care Unitto supervise LVN staff and patient care. An attempt was made to review the AssignmentSheets for the dates of 12/09/2012, 12/29/2012and 12/30/2012 for the 7 AM to 7 PM shift toverify the RN staffing, but the facility did not havethese staffing sheets for the surveyors to review. An interview on 01/08/2013 at approximately11:30 AM with staff #42 and staff #57 confirmedthat there were 19 dates on the AssignmentSheets for the Medical Unit where there was noRN coverage. The hospital staff confirmed duringthe interview that there was no RN coverage inthe Intensive Care unit during the 4 dates inquestion. A review of patient #60's medical record revealed
FORM CMS-2567(02-99) Previous Versions ObsoleteIEGE11
Event ID:
Facility ID:810260
If continuation sheet Page 3 of 20

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