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Based on observation and interview the Critical Access Hospital (CAH) failed to assure the premises are clean and orderly in six of six patient rooms observed( #'s 102, 104, 108, 110, 112 and 119).

Findings included:

- Observation of patient room 102 on 7/19/10 revealed a rusted faucet, spray hose, and foot pedal in the bathroom, chipped and rusted countertop beside the sink of the room, chipped areas on the shelf below the window. The chipped and rusted areas render the surfaces non-cleanable.

- Observation of patient room 104 on 7/20/10 revealed a large chipped area on counter around sink. The chipped counter renders the surface non-cleanable.

- Observation of patient room 119 on 7/21/10 revealed chipped areas around the sink, peeled wallpaper, chipped paint, and blue tape holding tile on in the bathroom. The chipped paint and counter top, peeling wallpaper, and tape render the surfaces non-cleanable.

On 7/21/10 at 8:35am staff F acknowledged patient rooms were in need of repairs.

Based on document review and staff interview the governing body and the designated administrator failed to assure the Critical Access Hospital (CAH) carried out or arranged an annual evaluation of its total program, failed to conduct and document an annual evaluation of the health care policies, failed to periodically evaluate the appropriateness of services provided and assure established policies were followed.

Findings included:

- The CAH failed to monitor policies governing the CAH's total operation and to ensure those policies are administered to provide quality health care in a safe environment as evidenced at C-0241, CFR 485.627 (a).

Based on document review and staff interview the governing body and the designated administrator failed to assure the Critical Access Hospital (CAH) carried out or arranged an annual evaluation of its total program, failed to conduct and document an annual evaluation of the health care policies, failed to periodically evaluate the appropriateness of services provided and assure established policies were followed.

Findings included:

- On 7/20/10 at 8:20am the CAH failed to provide documentation of a periodic evaluation of the total program for 2009 and lacked evidence of an evaluation that included a review of health care policies. The CAH lacked evidence of reports or meetings that included ongoing monitoring and data collection with measures to improve patient health and safety.

- Review of the policy and procedure manuals provided during the survey between 7/19/10 and 7/22/10 lacked evidence the documents were reviewed annually by a group of professional personnel that included at least one doctor of medicine or osteopathy, at least one midlevel practitioner (Advanced Registered Nurse Practitioner or Physician Assistant) and at least one member that is not on staff at the CAH.

- Review of the by-laws lacked documentation to direct staff to specify who would be responsible for monitoring and evaluating the care and services for their assigned departments and report to the medical staff and communicate those finding to the Governing Body.

- Review of the policy titled "Quality Assurance Monitoring" states under "Purpose: To establish guidelines that serve to provide ongoing monitors for quality services for all departments...4. Criteria shall be evaluated for continued appropriateness on an annual basis". The CAH lacked evidence of a Quality Assurance (QA) and Improvement (QI)program.

Interview with administrative staff B on 7/19/10 at 12:45pm revealed the administration failed to communicate to the Governing Body that a periodic evaluation of the total program and QA committee meeting minutes had not been completed since 2008.

On 7/20/10 at 11:50am administrative staff A acknowledged the CAH lacked a periodic evaluation for their total program or review of health care policies for 2008 and 2009. Staff A confirmed the CAH failed to report or communicate to the Governing Body a periodic evaluation of the total program or review of the health care policies and the appropriateness of their services since new management in 2008.

Based on observation document review and interview the Critical Access Hospital (CAH) failed to develop a policy that included a process for reporting adverse drug reactions and errors in administration of drugs, develop and initiate an active infection control program with surveillance that included measures to prevent, identify, investigate and provide staff education regarding infectious disease, and failed to designate a coordinator for outpatient services.

Findings included:

- The CAH failed to develop a policy that included a process for reporting adverse drug reactions and errors in administration of drugs as evidenced at C-277, CFR 485.635(a)(3)(v).

- The CAH failed to develop and initiate an active infection control program with surveillance to prevent infections, identify and investigate areas of potential infection transmission and ensure hospital personnel followed basic infection control practices as evidenced at C-278, CFR 485.635(a)(3)(vii).

- The CAH failed to ensure policies were reviewed by a group of professional personnel on an annual basis to ensure adequate patient care as evidenced at C-0280, CFR 485.635(a)(4).

- The CAH failed to designate a coordinator of outpatient services as evidenced at C-281, CFR 485.635(b)(1).

Based on document review and staff interview the Critical Access Hospital (CAH) failed to develop and implement a process to report serious adverse drug reactions to the Food and Drug Administration (FDA).

Findings included:

- Review of the CAH's policy entitled "Adverse Drug Reactions" on 7/21/10 revealed the policy lacked direction for nursing staff to report adverse drug reactions to the FDA.

On 7/21/10 at 11:00am nursing staff B acknowledged policy entitled "Adverse Drug Reactions" lacked direction for nursing staff to report adverse drug reactions to the FDA.

Based on observation, document review and interview, the Critical Assess Hospital (CAH) failed to develop and initiate an active infection control program with surveillance to prevent infections, identify and investigate areas of potential infection transmission and ensure hospital personnel followed basic infection control practices.

Findings included:

- The CAH provided a list of key personal at surveyor request. The document listed staff F as the infection control officer. Staff F acknowledged on 7/20/10 at 1:00pm they were assigned the title of the infection control officer in December of 2009. Staff F verified in December they were given the infection control manual but lacked time to read or develop the program. Staff F recieves the results of all cultures and they compiles a list of the organisms grown from the cultures. Staff F failed to develop a system to identify patients with infections and monitor their treament and appropriateness of care.

- Review of the "The Quality Risk and Accountability Manual, Infection Control-Appendix F", dated 1998, provides staff guidelines to follow to prevent infection and exposure control procedures. Review of the "Infection Control Cultures Procedure", dated 1/20/99, instructs staff to monitor areas of potential sources of bacteria on a quarterly basis and submit the samples to the Infection Control Coordinator and the Medical Staff Committee.

On 7/21/10 at 1:00pm staff G acknowledged prior to the new management and administrator in 2008 they used The Quality Risk and Accountability Manual for infection control guidance. Staff G confirmed they were told by the new management that committee meetings were unnecessary and they did not have funds to pay staff to attend committee meetings.

On 7/20/10 at 2:00pm confirmed staff F is the designated infection control officer. Staff B revealed they were given a Infection Control Program in November 2009 by consultant but had failed to implement the program. Staff B acknowledged there is no additional information regarding the CAH's infection control program. Staff B confirmed the CAH failed to initiate the infection control program and to perform active surveillance for the prevention and detection of infections.


28996

- Observation of the terminal cleaning of room 102 on 7/19/10 at 3:25pm revealed housekeeping staff J and K apply gloves and enter the room. Staff K entered the bathroom and poured Marcicide IV (a one-step disinfecting cleaning agent) into the toilet. Staff K immediately scoured the toilet with a cleaning tool and flushed the toilet. Staff K, wearing the same gloves, used a blue cloth saturated with Marcicide IV to wash the sink and wipe down the shower. The Marcicide IV applied to the sink and shower dried in four minutes. Staff J, wearing the same gloves they wore as they entered the room, used Marcicide IV to wipe the bedside table and the arms of the chair but failed to apply the cleaning product to any other part of the chair. Observation revealed the Marcicide IV applied to the bedside table dried in four minutes and the chair arms dried in three minutes. Staff J wiped down the nightstand and the ledge under the window with Marcicide IV. The nightstand and the window ledge were dry within two minutes. Staff J and staff K, wearing the same gloves, wiped down the mattress and frame of the bed with Marcicide IV that dried in four minutes. Staff J then swept the room and both staff J and staff K left the room without removing gloves or washing their hands. Staff J and staff K, wearing the same gloves they cleaned with, went to the linen storage in the hall to obtain clean linen, returned to the room and made the bed. The CAH's housekeeping staff failed to properly clean and disinfect the room and cross-contaminated the bed linens and the linens in the hall storage. Staff J and staff K failed to perform hand hygiene when entering or exiting the room.

- Review on 7/21/10 of the CAH's cleaning procedure revealed the procedure does not direct the housekeeping staff on what cleaner to use or directions for use. The procedure does not direct housekeeping staff to follow manufacturer's directions for cleaning products. The procedure does not direct staff on hand hygiene, or correct procedure to avoid cross-contamination. Review of the manufacturer's directions for Marcicide IV reveals the cleaner requires a 10 minute contact time (time that cleaner is to remain wet on surface) for the cleaner to disinfect and kill all viruses.

- Document review of the CDC (Centers for Disease Control and Prevention) Guidelines for Hand Hygiene in Healthcare Settings- 2002 requires healthcare workers to wash their hands after removing gloves.

On 7/19/10 at 2:55pm housekeeping management staff G acknowledged staff J and staff K cross-contaminated the bed linens and the linens in the hall linen storage.

On 7/21/10 at 11:00am housekeeping management staff G acknowledged manufacture's directions for Marcicide IV require a 10 minute contact time and the CAH's housekeeping staff did not follow the manufacturer's directions. Staff G acknowledged manufacturer's directions for cleaning the toilet with Marcicide IV direct the user to empty the bowl before applying the cleaner. Staff G acknowledged the CAH's housekeeping staff did not follow the manufacturer's directions for cleaning the toilet. Staff G acknowledged the CAH's procedure for cleaning is not available to housekeeping staff and does not direct the staff to follow manufacturer's instructions for cleaning products Staff G acknowledged the procedure does not direct staff on hand hygiene and avoiding cross-contamination.

Based on document review and interview the Critical Access Hospital (CAH) failed to ensure policies were reviewed by a group of professional personnel on an annual basis to ensure adequate patient care. Four of four patient care policy manuals were lacking review by group of professional personnel annually. This deficient practice had the potential to affect patient care provided at the CAH.

Findings included:

- Review of the policy and procedure manuals provided during the survey between 7/19/10 and 7/22/10 lacked evidence the documents were reviewed annually by a group of professional personnel that included at least one doctor of medicine or osteopathy, at least one midlevel practitioner (Advanced Registered Nurse Practitioner or Physician Assistant) and at least one member that is not on staff at the CAH.

- Review of Swing bed policies on 7/20/10 revealed they were last reviewed and approved by a group of professional personnel on 6/23/08.

- Review of Surgical services policies on 7/20/10 revealed they were last reviewed and approved by a group of professional personnel on 6/23/08.

- Review of Acute care policies on 7/20/10 revealed they were last reviewed and approved by a group of professional personnel on 6/23/08.

- Review of Emergency room policies on 7/20/10 revealed review and approval by a group of professional personnel last occurred on 6/23/08.

On 7/20/10 at 4:10pm administrative staff A acknowledged policy and procedure manuals lacked annual review by a group of professionals.

On 7/20/10 at 4:10pm nursing staff B acknowledged policy and procedure manuals lacked annual review by a group of professionals.

Based on document review and staff interview the Critical Access Hospital (CAH) failed to designate an outpatient coordinator to be responsible for all out-patient services provided by the CAH.

Findings included:

- On 7/19/10 the "Hospital Information Sheet" (a staff roster requested by the surveyor) completed by the CAH lacked the name of a staff member in charge of the outpatient services.

On 7/21/10 at 1:00pm administrative staff A acknowledged the CAH failed to appoint an out-patient coordinator to be responsible for all outpatient services.

Based on interview the Critical Access Hospital (CAH) failed to carry out or arrange for a periodic evaluation of the total program at least once a year, conduct and document a periodic evaluation of the health care policies, periodically evaluate the appropriateness of services provided and to assure established policies were followed, evaluate the appropiateness of the diagnosis and treatment and outcomes furnished, evaluate all patient care services affecting health and safety and failed to evaluate nosocomial infections and medication therapy.

Findings included:

- The CAH failed to carry out or arrange for a periodic evaluation of its total program, at least once a year as evidenced at C-0331, 485.641(a).

- The CAH failed to conduct and document a periodic evaluation of the health care policies as evidenced at C-0334, 485.641(a)(1)(iii).

- The CAH failed to periodically evaluate the appropriateness of services provided and to assure established policies were followed as evidenced at C-0335, 485.641(a)(2).

- The CAH failed to evaluate the quality and appropriateness of the diagnosis and treatment furnished in the CAH and of the treatment outcomes as evidenced at C-0336, 485.641(b).

- The CAH failed to evaluate all patient care services and other services affecting patient health and safety as evidenced at C-0337, 485.641(b)(1).

- The CAH failed to evaluate nosocomial infections and medication therapy as evidenced at C-0338, 485.641(b)(2).

Based on interview the Critical Access Hospital (CAH) failed to carry out or arrange for a periodic evaluation of its total program at least once a year.

Findings included:

- On 7/20/10 at 8:20am the CAH failed to provide documentation of a periodic evaluation of the total program for 2009.

Review on 7/21/10 of the by-laws direct the Governing Body to complete a annual evalution of its total program.

On 7/20/10 at 11:50am administrative staff A acknowledged the CAH lacked a periodic evaluation for their total program for 2008 and 2009. Staff A confirmed the CAH failed to carry out or arrange a periodic evaluation of the total program, at least once a year since new management in 2008.

Based on interview the Critical Access Hospital (CAH) failed to conduct and document a periodic evaluation of the health care policies.

Findings included:

- On 7/20/10 at 8:20am the CAH failed to provide documentation of an evaluation that included a review of the CAH's health care policies.

On 7/20/10 at 11:50am administrative staff A acknowledged the CAH lacked an evaluation that included a review of the health care policies for 2008 and 2009.

Based on interview the Critical Access Hospital (CAH) failed to periodically evaluate the appropriateness of services provided and to assure established policies were followed and changed as needed.

Findings included:

- On 7/20/10 at 8:20am the CAH failed to provide documentation of an evaluation to determine if services was appropriate, policies were followed and if changes were needed.

On 7/20/10 at 11:50am Administrative staff A acknowledged the CAH lacked a program evaluation to determine the appropriateness of services provided and identify changes that were needed.

Based on interview the Critical Access Hospital (CAH) failed to implement an effective Quality Assurance (QA) program to evaluate the quality and appropriateness of the diagnosis and treatment furnished in the CAH and of patient treatment outcomes.

Findings included:

- On 7/20/10 at 8:20am the CAH failed to provide documentation of reports or meetings that included ongoing monitoring and data collection, problem prevention, identification and data analysis, identification and implementation of corrective action, evaluation of corrective action and measures to improve quality on a continuous basis.

Review of the policy titled "Quality Assurance Monitoring" , dated 8/3/98, states under "Purpose: To establish guidelines that serve to provide ongoing monitors for quality services for all departments...4. Criteria shall be evaluated for continued appropriateness on an annual basis".

On 7/21/10 at 11:15am administrative staff C acknowledged the CAH failed to implement a effective QA program to evaluate patient diagnosis, treatment and treatment outcomes. Further interview confirmed the CAH quit the QA meetings in 2008 when new the administrator started their position.

Based on interview the Critical Access Hospital (CAH) failed to implement a effective Quality Assurance (QA) program to evaluate all patient care services and other services affecting patient health and safety.

Findings included:

- On 7/20/10 at 8:20am the CAH failed to provide documentation of a QA program evaluation of patient care services and other services affecting patient health and safety.

Review of the policy titled "Quality Assurance Monitoring" states under "Purpose: To establish guidelines that serve to provide ongoing monitors for quality services for all departments...4. Criteria shall be evaluated for continued appropriateness on an annual basis".

On 7/21/10 at 11:15am administrative staff C acknowledged the CAH failed to implement the QA program. Staff C verified the CAH has not had a QA program since 2008 when the new administrator started their position. Staff C confirmed the CAH failed to monitor or collect data related to the patient care services.

Based on interview the Critical Access Hospital (CAH) failed to implement a Quality Assurance program (QA) to monitor and evaluate nosocomial infections and medication therapy.

Findings included:

- On 7/20/10 at 1:00pm review of the Infection Control program lacked evidence of an evaluation of nosocomial infections and medicatons therapy.

Review of the policy titled "Quality Assurance Monitoring" states under "Purpose: To establish guidelines that serve to provide ongoing monitors for quality services for all departments...4. Criteria shall be evaluated for continued appropriateness on an annual basis".

On 7/20/10 at 11:50am administrative staff F acknowledged the CAH failed to monitor and evaluate nosocomial infections and medication therapy. Staff F confirmed they do not report to the QA program. Staff C on 7/21/10 at 11:15am confirmed the CAH failed to implememt a QA process to monitor and evaluate nosocomial infections and medication therapy.

Based on document review and interview, the Critical Access Hospital (CAH) failed to follow their policy and procedure to report one of two deaths that occurred at the CAH to the Midwest Transplant Network (MTN), patient #25.

Findings included:

- Review of patient #25's clinical record revealed they arrived by EMS (emergency medical transport) on 5/26/10 at 4:26am to the ER (Emergency Room) in "extremeous" condition with "multiply stab wounds resulting in death with probably hemopneumothorax". The provider, after assessing the patient, stopped the emergency treatment and pronounced the patient dead at 4:37am. The clinical record lacked evidence of the death notification to MTN.

Review of the CAH's nursing policy titled "Care of Body After Death" states under "5. Every death shall be reported to Midwest Transplant Network (MTN)...Complete form will be kept on the chart...".

Review of the contract between the CAH and MTN stated under "3. notify MTN in a timely manner of every death that occurs...".

On 7/21/10 at 12:30pm staff B acknowledged the CAH failed to notify MTN of the patient's death.

The hospital reported a census of three swing bed patients with five medical records reviewed. Based on observation, document review and staff interview the hospital failed to develop a process for transfer and/or discharge of swing bed patients, establish an on-going activity program directed by a qualified staff member for the swing bed programs, assure all swing bed patients received a comprehensive assessment, develop a comprehensive plan of care for swing bed patients and implement the required guidelines to direct their swing bed program, assuring the needs of all swing bed patients are met.

Findings included:

- The hospital failed to develop a process to assure the swing bed patient had appropriate and complete transfer, and discharge rights as evidenced at C-373, CFR 483.12 (a).

- The hospital failed to establish an on-going activity program directed by a qualified staff member as evidenced at C-385, CFR 483.15 (f).

- The hospital failed to assure all swing bed patients had a comprehensive nursing assessment as evidenced at C-388, CFR 483.20.

- The hospital failed to assure all swing bed patients had a comprehensive plan of care to meet their needs as evidenced at C-395, CFR 483.20 (b) (2).

The Critical Access Hospital (CAH) reported a census of three swing bed patients with five medical records reviewed. Based on document review and staff interview the hospital failed to develop a swing bed transfer process and policy required by this regulation.

Findings included:

- Review of the swing bed policy and procedure manual on 7/20/10 provided by administrative nursing staff B revealed the CAH lacked a policy for swing bed transfer/discharge process.

On 7/20/10 at 10:30am administrative nursing staff B revealed the CAH lacked a specific policy and process for transfer/discharge of swing bed patients.

The hospital reported a census of three swing bed patients with five medical records reviewed. Based on observation, document review and staff interview the hospital failed to establish an activity program to meet the needs of the swing bed patients (patient #'s 33, 34, 35, 36 and 37).

Findings included:

- Review of patient #33's medical records on 7/20/10 revealed and an admission date of 7/1/10. The medical record lacked evidence of an activity assessment or comprehensive plan of care with an activity assessment. Review of patient #33's medical record revealed it lacked evidence of staff providing activities listed on a care plan or an activity calendar with scheduled events.

- Review of patient #34's medical records on 7/20/10 revealed and an admission date of 7/2/10. The medical record lacked evidence of an activity assessment or comprehensive plan of care with an activity assessment. Review of patient #34's medical record on 7/20/10 revealed it lacked evidence of staff providing activities listed on a care plan or an activity calendar with scheduled events.

- Review of patient #35's medical records on 7/20/10 revealed and an admission date of 7/9/10. The medical record lacked evidence of an activity assessment or comprehensive plan of care with an activity assessment. Review of patient #33's medical record on 7/20/10 revealed it lacked evidence of staff providing activities listed on a care plan or an activity calendar with scheduled events.

- Review of the hospital's Swing Bed policy dated 8/8/98 revealed the policy directed the Activities Designee to ..."Formulate, implement, and evaluate activities plan for each patient through:
a. Interview with patient and completion of patient interest profile within four (4) days admission to Swing Bed program.
b. Formulation of activities plan through collaboration with other disciplines and patient.
c. Documentation of activities plan in integrated care plan.
d. Implementation of activities plan.
e. Documentation of progress in meeting activities objectives in each patient's integrated progress notes weekly.
f. Documentation of participation, capacities, tolerance, and responses to activities for each patient.
g. Ongoing evaluation and modification of activities plan..."
The CAH failed to follow any part of their policy for Swing Bed activities.

On 7/20/10 at 10:30am nursing staff L reported the swing bed patients "can go to the nursing home in another part of the building for activities." Staff L reported the activities director at the nursing home is available to the swing bed patients but does not perform an activities assessment or form individual activity plans for Swing Bed patients.

On 7/20/10 at 10:30am administrative nursing staff B confirmed the hospital failed to follow their policy for activities for Swing Bed patients and lacked an ongoing activities program for Swing Bed patients.

The Critical Access Hospital (CAH) reported a census of three swing bed patients with five medical records reviewed. Based on observation, document review and staff interview the hospital failed to assure the staff completed comprehensive assessments of the patient's customary routine, cognitive patterns, communication, vision, mood and behavior patterns, psychosocial well-being, dental status, activity interests, discharge potential and documentation of participation in assessment to meet the needs for swing bed patient #'s 33, 34, 35, 36 and 37. Failure to properly assess the patients has the potential to affect all swing bed patients at the CAH.

Findings included:

- Review of patient # 33's medical record revealed an admission date of 7/1/10 after hospitalization for a fall at home. Review of the initial nursing assessment lacked evidenced of the following: customary routine, cognitive patterns, ability to communicate, mood and behavior patterns, psychosocial well-being, dental status, activity interests, discharge potential and documentation of participation in assessment. The assessment in the chart was a copy of the hospital assessment from 6/28/10.

- Review of patient #34's medical record revealed an admission date of 7/2/10 with a diagnosis of a fractured right hip. Review of the record lacked evidence of a comprehensive admission assessment that included the following: customary routine, cognitive patterns, ability to communicate, mood and behavior patterns, psychosocial well-being, dental status, activity interests, discharge potential and documentation of participation in assessment.

- Review of patient #35's medical record revealed an admission date of 7/9/10 with diagnosis of osteoperosis and hypertension. Review of the record lacked evidence of a comprehensive admission assessment that included the following: customary routine, cognitive patterns, ability to communicate, mood and behavior patterns, psychosocial well-being, activity interests, discharge potential and documentation of participation in assessment.

- Review of the CAH's Swing Bed Policy and Procedures on 7/20/10 revealed lack of a policy for comprehensive assessment for Swing Bed patients.

On 7/20/10 at 10:30am administrative staff B and nursing staff L revealed the records lacked evidence of a comprehensive assessment to meet the needs and interests of the patients that included the following: customary routines, cognitive patterns, ability to communicate, mood and behavior patterns, psychosocial well-being, activity interests, discharge potential, and documentation of participation in assessment.

The Critical Access Hospital (CAH) reported a census of three swing bed patients with five records reviewed. The CAH failed to assure the staff completed a comprehensive plan of care for 5 of 5 swing bed patients (# 33, 34, 35, 36 and 37).

Findings included:

- Review of patient #33's medical record revealed an admission date of 7/1/10 with a diagnosis of bilateral hip arthroplasty. Review of the record on 7/20/10 revealed the record lacked evidence of a Comprehensive Plan of Care addressing the needs, strengths and weaknesses of the patient. The record lacked documentation of the patient's participation in forming their plan of care.

- Review of patient #34's medical record revealed an admission date of 7/2/10 with a diagnosis of right hip fracture. Review of the record on 7/20/10 revealed the record lacked evidence of a Comprehensive Plan of Care addressing the needs, strengths and weaknesses of the patient. The record lacked documentation of the patient's participation in forming their plan of care.

- Review of patient #35's medical record revealed an admission date of 7/9/10 with a diagnosis of osteoporosis and hypertension. Review of the record on 7/20/10 revealed the record lacked evidence of a Comprehensive Plan of Care addressing the needs, strengths and weaknesses of the patient. The record lacked documentation of the patient's participation in forming their plan of care.

- The deficient practice of failing to complete a comprehensive care plan for each swing bed patient also affected patient #'s 36 and 37.

- Review of the care plan utilized by the CAH for swing bed patients revealed the care plan is a generic care plan used for their hospital patients. Review of the generic care plan revealed it does not address activities and psychosocial needs of the swing bed patient.

- Review of the CAH's swing bed policy manual on 7/20/10 revealed the CAH lacked a policy for comprehensive plan of care for swing bed patients.

- Review of the hospital's policy "Multidisciplinary Care Planning for Swing Bed Patients" dated 9/6/99 revealed the policy directed the staff that a care conference will be held weekly, including the patient and their family. The CAH failed to include patient and families with their care plan meetings.

On 7/20/10 at 10:30am administrative nursing Staff B revealed the CAH does not include swing bed patients and /or families in care planning. Staff B acknowledged the care plan used by the CAH does not address activities and/or psychosocial well-being of their swing bed patients.