HospitalInspections.org

Based on observation, interview, and document review, the facility failed to consistently actively screen staff, patients, and visitors in accordance with the Centers for Disease Control (CDC) and Centers for Medicare and Medicaid Services (CMS) COVID-19 guidance. This practice had the potential to affect all patients, visitors, and staff of the critical access hospital (CAH).

Findings include:

On 6/1/20, at 10:17 a.m. an interview was conducted with health unit coordinator (HUC)-A, and the DON. The HUC-A stated she checked her own temperature when reporting to work. HUC-A stated when she checked her own temperature it needed to be rechecked at the nurses' station. HUC-A stated COVID-19 symptom screening was completed employee's computers. HUC-A stated COVID-19 signs and symptoms were listed in a red box within the computer monitor, prior to logging on a computer. HUC-A stated when employees log on a computer, they are attesting they do not have COVID-19 symptoms. The DON stated employees checked their own temperature when staff were not assigned to the screening station.

On 6/1/20, at 10:32 a.m. receptionist (R)-A was interviewed and stated she checked her own temperature when staff was not present at the main entrance screening station. R-A stated when she checked her own temperature, she needed to proceed to the nurses' station to have her temperature verified.

On 6/1/20, at 10:38 a.m. the facility main entrance screening station was observed. Log sheets, an oral thermometer and temporal (forehead) thermometer were observed on the screening station table. Registered nurse (RN)-A was seated at a desk within the main entrance. A sign was on the screening station table which directed, "At ANY time, if there is not someone present at the main entrance check-in station, check and log your temperature as usual, then proceed to nurses station for a witnessed temperature re-check. There will be a tracking form readily available." The DON stated the main entrance was staffed from 6:00 a.m. to 9:00 a.m., and also during afternoon shift change. The DON stated dependent upon staff availability, sometimes the main entrance screening station was staffed all day. The DON stated the facility main entrance was continuously locked until last week. The DON stated the main entrance was currently locked at 5:00 p.m. The DON stated physical therapy (PT) patients were not screened at the main entrance screening station, but were screened upon arrival to the PT department.

On 6/1/20, at 10:45 a.m. a tour from the facility main entrance to the PT department was conducted. A stairwell was used to access the lower level of the facility. An elevator was also available. Upon exiting the stairwell entries to the following departments/areas were observed prior to accessing the PT department: acupuncture, large dining room, maintenance, kitchen, lower level entrance, and an administrative suite. The lower level entrance was adjacent to the facility kitchen. The lower level entrance was unlocked and no personal were present. The DON stated PT patients could use the lower level entrance, but "mostly" used the facility main entrance. The DON stated Meals on Wheels were also served from the lower level entrance.

On 6/1/20, at 11:04 a.m. dietary aid (DA)-A was observed standing near the lower level entrance with several packaged meals on a table. DA-A stated Meals on Wheels pickup time was 11:00 a.m. to 11:20 a.m. DA-A stated some individuals arrived early, but she had not observed anyone come into the facility. DA-A confirmed the lower level entrance was unlocked, and staff was not regularly posted at the entrance. DA-A stated her shift started at 5:30 a.m. and she consistently took her own temperature. DA-A stated her temperature was then verified at the nurses' station. DA-A stated no one asked her COVID-19 screening questions, however, verified she did not have symptoms when logging on any computer.

On 6/1/20, at 10:48 a.m. physical therapy assistant (PTA)-A was interviewed and stated PT patients and visitors were screened upon arrival to the PT department. PTA-A stated PT patients were not screened at the facility main entrance. PTA-A stated visitors were also screened once they arrived to the PT department.

On 6/1/20, at 11:11 a.m. RN-A stated she was assigned to work as a screener today because no surgical cases were scheduled. RN-A stated screeners being staffed were dependent on patient census. RN-A stated she was reassigned at times from the screening station to assist with patient cares. RN-A stated staff were instructed to call the PT department when vacating the screening station. RN-A stated staff was not always present at the screening station during shift changes. RN-A stated she took her own temperature and had her temperature re-checked the nurses' station when this occurred. RN-A stated COVID-19 symptoms were reviewed when logging on any computer.

On 6/1/20, at 11:40 a.m. housekeeper (H)-A stated she took her own temperature when staff was not present at the main entrance screening station. H-A stated when she took her own temperature she then reported to the nurses' station and had her temperature rechecked. H-A stated COVID-19 signs and symptoms were reviewed when logging on to any computer.

On 6/1/20, at 11:40 a.m. nursing assistant (NA)-A stated when she reported to work she took her own temperature while the DON watched. NA-A stated when staff was not present at the screening station, she also took her own temperature and proceeded to the nurses' station to have it verified. NA-A stated COVID-19 signs and symptoms were reviewed on any computer prior to logging on.

On 6/1/20, at 1:02 p.m. the DON stated the original intent was to have PT patients enter through the lower level entrance, however, parking was challenging. The DON stated the facility did not have the manpower to staff a screening station during all hours. The DON stated there was a "hiccup" in the screening process. The DON stated there could always be the potential a patient or visitor could enter the facility through unmanned and unlocked entrances.

Facility policy COVID-19 Screening and Temperature Standards revised 5/29/20, directed, "All patients and visitors (if allowed per visitor policy) will be screened with standard screening questions which may be updated periodically as needed according to COVID-19 guidance." The policy further directed employees, "At ANY time, if there is not someone present at the main entrance check-in station, check and log your temperature as usual, then proceed to nurses station for a witnessed temperature re-check. There will be a tracking form readily available." The policy lacked indication where screenings were to be completed.