The Florida Agency for Health Care Administration (AHCA) cited the Vines Hospital for failing to uphold patient rights to periodic reassessments based on patient changes and responses. AHCA found that the facility failed to reassess and treat a patient after she experienced a change in condition and developed a bump on her forehead. According to the patient’s grievance, she developed the bump after a staff member allegedly slammed a door on her head, but there was no evidence in the patient’s medical record to indicate that she was assessed by medical personnel following the incident. AHCA also cited the facility’s governing body for failing to ensure that patient grievances were reviewed and resolved in five of eight sampled grievances. One grievance revealed that a patient was disturbed by a red light that was turned on in his room at night, since he was a combat veteran and the light caused flashbacks and insomnia. Further review of the grievance form showed that it provided no information as to whether/when the grievance was resolved, whether the complainant was satisfied with the outcome, or whether the grievance needed to go to a hearing panel for further review. Interviews with the Interim Risk Manager further revealed that he had not reviewed grievances, while the facility Administrator stated that “the facility had not followed their policy for grievances.” As a result, the facility had to submit a plan of correction to address its cited deficiencies, which included re-training of staff on reassessment and complaint reporting policies and adopting new policies and procedures around who is responsible for responding to patient and family grievances.