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Based on review of medical records, policy and procedure, and staff interview, the facility failed to ensure that a registered nurse evaluate and document the review of EKG strips for patients on continuous cardiac monitoring.

The findings include the following:

1. Review of medical records on 3/24/14 at the facility nurse's station revealed that patients receiving continuous cardiac monitoring did not have consistent documentation that a registered nurse reviewed the patient's EKG rhythm strip. Also the patients receiving continuous cardiac monitoring did not have consistent documentation that a registered nurse reviewed the patient's EKG rhythm strip when out of parameter alarms occurred. The following was noted:

a. (P31) admitted 3/16/14 with a physician order for telemetry monitoring. Review of the patient's telemetry folder for 3/21/14 to 3/24/14 did not provide evidence that the registered nurse assigned to the patient or the charge nurse reviewed/interpreted the patient's EKG rhythm strip.

b. Review of EKG Alarm Table for (P31) from 3/21/14 to 3/24/14 revealed at 09:19 a.m. on 3/22/14 that the patient experienced a 13 beat run of Ventricular Tachycardia. There was no documentation that the registered nurse was notified. There was no documentation that the EKG rhythm strip was reviewed and no documentation found that the out of parameters alarm was addressed. No documentation found that the physician was notified.

2. Policy and Procedure Cardiac Monitoring stated The monitor tech will be under the supervision of the telemetry charge nurse and the charge nurse will serve as a clinical resource to the monitor tech. Any EKG changes will be documented and reported to the charge nurse and or the patient's nurse. The monitor tech will print and interpret monitor strips initially and every four hours. Any changes to patient's baseline will be printed immediately and charge nurse or patient's registered nurse will be notified. All strips are posted in the patient folder.

3. Staff interview with (S5) after her own review of the findings confirmed that the nurses do not routinely review/interpret the EKG rhythm strips every four hours. (S5) stated that the monitor tech interprets the strips. (S5) could not produce documentation that the RN was notified of out of parameter alarm and or documentation that the RN addressed the out of parameter alarm.

Based on observations, record reviews, and interviews, the facility failed to ensure a clean and sanitary environment for the kitchen.

Findings included:

Observations on 03/24/14 from 1145 AM to 1203 PM during a tour of the kitchen in the facility revealed the following:

1. Serving carts had accumulated grease on the edges of the cart.

2.. Serving trays had accumulated grease on the trays.

3. Ceilings in the walk-in refrigerators were dusty and dirty.

4.. Accumulated dirt was on the kitchen floor where food was stored.

5.. A bag of tortilla was noted on the floor of one of the food storage areas.

6. Open trash can with trash were observed near food preparation areas.

7. Water heating machines had been delimed the night before and the lime scale had not been removed from the trough.

8. Ovens were observed to have caked on grease.

Record review on 03/24/14 of Walk-In Cooler Cleaning Schedule revealed the following: "1. Make sure wrap date and label correct, no expired stuff in the cooler. 2. Law meat at bottom shelf, ready to eat food on top shelf. 3. 18" below ceiling and 6" from bottom. 4. Floor mob and clean."

Interview on 03/24/14 at 1200 PM with facility's Food Services Director (Staff #10)confirmed these findings.