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A. Based on observation, policy and procedure, record review, and staff interview it was determined that the Critical Access Hospital (CAH) failed to ensure that food was maintained and served at appropriate temperature.

Findings include:

1. During a tour of the dietary department on 10/26/09 at 2:30 PM, it was observed that the temperature log was incomplete for 10/1/09, 10/2/09, and 10/3/09.

2. The CAH policy titled, "MEAL SERVE OUT LINE", under "PROCEDURE: 3. Temperatures are taken of perishable foods, cold or hot on the line and documented and kept in supervisor's office."

3. During an interview with the Director of Nursing on 10/27/09 at 3:00 PM, the above findings were confirmed.

B. Based on observation, policy and procedure, and staff interview it was determined that the CAH failed to ensure that food is properly stored and labeled.

Findings include:

1. During a tour of the dietary department on 10/26/09 at 2:30 PM, it was observed in the refrigerator that one plastic bag of cooked bacon, one plastic bag of rolls, and several containers of potato salad had no preparation dates. Also observed in the walk-in freezer were 2 opened and unsecured bags of shredded cheese with no dates. Also observed in the pantry were several items including boxed, canned, and partially open powdered mixes that were not dated.

2. The CAH policy titled, "PREPARING/HOLDING SERVING FOODS", under "PROCEDURE: 8. All stored foods are covered. All leftovers are covered, labeled, and dated."

3. During an interview Dietary Aide on 10/27/09 at 2:30 PM, she stated that it was the normal practice to date all items when food supplies are received. During an interview with the Director of Nursing on 10/27/09 at 3:00 PM, the above findings were confirmed.

A. Based on policy, record review and staff interview, it was determined that the CAH failed to maintain clinical records in accordance with written policies and procedures.

Findings include:

1. The CAH policy titled, "Medical Staff By-Laws Rules and Regulations" page 34, "16. The patient's medical record shall be completed within a period of time that in no event exceeds 30 days following discharge."

2. A review of the Deficiency Report by Physician was reviewed on survey date 10/28/09. The report indicated a total of 113 delinquent records as of 10/27/09.

3. During an interview with the Director of Nursing on 10/28/09 at 3:00 PM, the above finding was confirmed.

A. Based on record review and staff interview, it was determined that in 1 of 19 records reviewed (Pt.# 4), the physician signatures were incomplete.

Findings include:

1. The medical record of Pt. #4 was reviewed on survey date 10/27/09. Pt. #4 was admitted to the Critical Access Hospital (CAH) on 2/11/09 with diagnosis of Suicidal Ideation. Documentation indicated that the Medical Stability statement on the Psychiatric Medical Stability Checklist was not signed by the physician.

2. During an interview with the Director of Nursing on 10/28/09 at 3:00 PM, the above finding was confirmed.


B. Based on record review and staff interview, it was determined that in 3 of 19 records reviewed, (Pt. #5, #16, 17) the physician signatures did not include the date and time.

1. The medical record of Pt. #5 was reviewed on survey date 10/26/09. Pt. #5 was admitted the CAH on 10/20/09 with diagnoses of Abdominal Pain, Vomiting and Abdominal Distention. Documentation indicated that 7 verbal orders dated from 10/21/09- 10/25/09 failed to include dates and times with physician signatures.

2. The medical record of Pt. #16 was reviewed on survey date 10/28/09. Pt. #16 was admitted to the CAH on 4/22/09 with diagnosis of Compression Fracture-T8 and Osteoporosis. Documentation indicated that verbal orders written on 4/22/09 and 4/23/09 failed to include dates and times with physician signatures.

3. The medical record of Pt. #17 was reviewed on survey date on 10/27/09. Pt. #17 was admitted to the CAH on 4/5/09 with the diagnoses of Pneumonia and Stage 4 Cancer of Lung with Metastasis. Documentation indicated that phone orders written on 4/6/09 failed to include date and time of the physician signature.

3. During an interview with the Director of Nursing on 10/28/09 at 3:00 PM, the above findings were confirmed.