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Occurrence Summary Reports for:
COLORADO MENTAL HEALTH INSTITUTE AT PUEBLO-PSYCH
Sunday, November 19, 2017 12:45 PM

Facility: COLORADO MENTAL HEALTH INSTITUTE AT PUEBLO-PSYCH
Date of Occurrence: 9/23/2015
Report Timely: Yes
Type of Occurrence: Neglect

DESCRIPTION OF OCCURRENCE:
On 09/23/15 a male patient, in his 50s, was allegedly left soiled by a staff member.

FACILITY ACTION:
The facility conducted an internal investigation. The facility notified the physician, police department, and appropriate facility administration and personnel. Staff member (2) was assisting staff member (1) with changing the patient's brief. Staff member (2) alleged staff member (1) became frustrated and told the patient he could lie in his urine because of his behavior and walked away while instructing staff member (2) not to touch the patient. Staff member (1) was placed on administrative leave. The patient was assessed and there was no evidence of any adverse effects. Staff member interviews revealed the patient was attended to three to five minutes after staff member (1) walked away. Staff member (1) reported the patient was becoming assaultive, verbally aggressive and made threats towards staff member (1). At that time, staff member (1) chose to step out and allow another staff member to provide the patient care. Staff member (2) was a travel staff member and unavailable for further interview. A pre-disciplinary meeting was held with staff member (1). Staff member (1) was retrained in verbal skills and educated on the adult abuse and neglect policy and facility code of conduct. Staff member (1) was reinstated. The facility will reinforce appropriate patient interactions with staff member (1) through weekly meetings for a period of three months to evaluate compliance with education and training.

DEPARTMENT FINDINGS:
The Department reviewed the facility's report and supplemental documentation and found that the facility acted appropriately by reporting the occurrence, notifying the appropriate persons and agencies, suspending staff member (1), assessing the patient, conducting an investigation, providing staff member (1) with education and retraining on tactical communication skills and abuse and neglect, reinstating staff member (1), and scheduling weekly meetings for three months with staff member (1) to reinforce and evaluate compliance with education and training.

The Department will review this occurrence prior to any survey or upon receipt of any complaint that may be filed against this facility.



Sent to Facility: 11/19/2015

FACILITY COMMENT: Following receipt of the above summary, no additional comments were submitted by the facility.


Released to Public: 11/30/2015

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