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Based on observation, interview and record review, the facility failed to ensure contracted Physical Therapy staff are provided with ongoing training/ in- service training on infection control in 2 of - contracted staff files reviewed. Contracted staff #s J10 and I9


Findings:

Observation on 11/29/2016 at 8:55 a.m revealed Physical Therapist (J10) and Physical Therapy Assistant (I9) were observed at the bedside of Patient #8. The direct care staff were providing wound care to Patient # 8 who had a skin tear to the posterior aspect of her left leg and a stage two pressure sore to her right ankle.

Observation revealed Contracted Physical Therapist (#J10) donned a pair of clean gloves, which she secured from the boxes of gloves stored on the wall. She then used her gloved hands to remove the soiled dressings that was covering the the skin tear to the Patient's left leg. After removing the soiled dressing, Contracted Physical Therapist (#J10) removed the contaminated gloves, walked over to the clean box of gloves and picked up a clean pair of gloves which she wore while cleaning the Patient's wound to her left leg. Physical Therapist #J10 debrided the skin from the wound, removed her contaminated gloves, removed clean gloves from the box of gloves which she donned .
The Contracted Physical Therapist did not wash or sanitize her contaminated hands in between removing the dirty dressings and securing clean gloves from the box of gloves stored on the wall.

Subsequent observation revealed Contracted Physical Therapist Assistant (#I9) was observed on 11/29/2016 at 9:05 a.m. The Contracted Physical Therapist Assistant was providing wound care to Patient #8 who had a Stage 2 pressure sore to her right ankle.
Contracted Physical Therapist (#I9) walked into the room and placed the dressings directly on the bedside table beside the telephone and other personal effect belonging to the patient. He did not create a clean field on the table to accommodate the dressings. He then donned a pair of clean gloves, removed the soiled dressing that was covering the patient's rights ankle, dispose of it in the garbage, soaked the 4 x 4 swab with Skin Integrity solution, wiped the patient's wound using the contaminate gloves used to remove the soiled dressing. He then removed his contaminated gloves , walked over to the clean box of gloves stored on the wall and picked up clean gloves with his contaminated hands.

Contracted Physical Therapist Assistant # I9 did not remove his contaminated gloves and wash/sanitize his contaminated hands in between removing the soiled dressing from the patient's wound and cleaning of the patient's wounds and securing clean gloves from the box of gloves.

During an interview on 11/29/2016 at 9:15 a.m in the presence of the Facility's Director of Nursing, the Surveyor informed Contracted Physical Therapist #J10 and Contracted Physical Therapist Assistant #I9 that she the Surveyor had observed that during wound care of Patient #8, they did not wash, or sanitize their contaminated hands and change gloves when moving from dirty area to the clean wounds. Contracted Physical Therapist #J10 stated " Thanks for telling me. I appreciate the feedback"

Physical Therapist Assistant (I9)
Review on 11/30/2016 of Contracted Physical Therapist Assistant (#I9) Personnel and Training file revealed no documentation that the staff had training or in service on infection control and wound management.
Review of a an Initial Competency Assessment Skills Check List Physical Therapist Assistant , completed 12/18/2015 revealed documentation of the following: " Recognize signs and symptoms of infection. "


Review on 11/30/2016 of Contracted Physical Therapist (#J10) personnel and training file revealed no documentation that the staff had training or in- service on infection control and wound management.
Review of a an Initial Competency Assessment Skills Check List Physical Therapist, completed 12/29/2015 revealed documentation of the following: " Recognize signs and symptoms of infection. "

Interview with Contracted Physical Therapist (#J10) on 11/30/2016 at 10: 55 a.m. revealed she is a contracted staff who has been working in the facility for approximately 15 years.
She said she attends outside training approximately every two years but she has not had any recent training on infection control. She said she had not attended any facility specific training.

Interview on 11/30/2016 at 11:15 a.m. with the Facility's Director of Nursing revealed there is an online program which is available to staff which includes infection control. She said the Director of Physical Therapy said she did not utilize the program.

Based on observation, interview and record review, the Facility's Registered Nurse failed to implement the Physician's order to strain and filter the Patient's urine in - sampled Patients # 4

Findings:

Patient #4
On 11/28/2016 at 10:10 a.m. Patient #4 was observed on the unit. The Patient was alert and oriented to person, place and time.

Interview on 11/28/2016 at 10:10 a.m with Patient #4 revealed she was admitted because she was nauseated with history of vomiting and pain. She said she was told in the emergency room that she had kidney stones but her Primary Care Physician was not aware of it.

Review of the Patient's clinical record revealed a History and Physical dated 11/27/2016 with a diagnosis of nephrolithiasis (Kidney stones).

Review on 11/28/2016 of the Patient's clinical record revealed a Physician's order, dated 11/27/2016 at 1536 p.m. to " Strain filter urine. "
Further review of the Patient's clinical record revealed documentation on the Patient's flow sheets dated 11/27/2016 and 11/28/2016 which indicated that the Patient voided 300 mls of urine at 3:00 a.m., 800 mls of urine at 1200 midnight and 1000 mls on 11/28/2016., the time was not documented.
There was no indication that the urine was strained and filtered as ordered by the physician.

Interview on 11/28/2016 at 11:50 a.m. with the Assistant Director of Nursing revealed the Patient ' s urine was not strained. She said the Patient did not have a strainer in her room.

Based on observation, interview and record review the facility failed to ensure dietary staff handling and preparing meals for patients and the community, have food handlers permit to ensure the safe handling of food in the facility.

Citing four (4) of five (5) dietary staff (#s C28,C 29 , C 30 and C 41).

Findings:

Observation on 11/29/2016 at 9:25 am in the dietary suite revealed five (5) staff members in the kitchen handling and preparing foods for the lunch meal. The Staff were also observed handling clean and dirty dishes.

Review of personnel files for 4 of the five staff revealed there was no documentation the staff had certification training in food handler ' s practices.

Staff (#C 30 ) was classified as cook and staff #s C 28, C 29 and C41 as dietary aides.
Review of the facility ' s dietary policy/procedure revealed there was no information on food handler ' s requirement.
During an interview on 11/30/2016 at 10:30 am with the Dietary District Manager he stated it was required for the staff to have a food handlers permit, however the staff did not have food handlers training, they were signed up for the training since September 2016 but it was difficult getting them to complete the training.
The District Manager stated there was no policy on food handler ' s permit for the Dietary staff.

Based on observation, interview and record review, the facility's direct care staff failed to wash/ sanitize hands after direct contact with patients; after handling biological specimen and when moving from contaminated areas to clean areas during wound care and in the laboratory.
Failed to clean and disinfect contaminated chairs between patient usage; failed to follow manufacturers recommendations for products used for endoscope reprocessing.
Citing 3 of 3 patients observed (#s 8,19 and 20) and 5 of 5 staffs observed (#s J10, I9,Z26,Y25, and R 18).

Findings:

Review of the Facility's current policy and procedure on Infection Control Standard Precaution, Policy # A 11128 cal, directs staff as follows:
" Handwashing,- Wash hands after touching blood , body fluids, secretions, excretions, and contaminated items even when gloves are worn.
Wash hands immediately after gloves are removed, between patients contacts and when otherwise indicated to avoid transfer of microorganisms to other patients or environments. It may be necessary to wash hands between tasks and procedures on the same patients to prevent cross contamination of different body sites."

On 11/29/2016 at 8:55 a.m. Patient #8 was observed in her room. The Patient was alert and oriented to person place and time.

Observation on 11/29/2016 at 8:55 a.m. revealed Physical Therapist (J10) and Physical Therapy Assistant (I 9) were observed at the bedside of Patient #8. The direct care staff were providing wound care to Patient # 8 who had a skin tear to the posterior aspect of her left leg and a stage two pressure sore to her right ankle.

Observation revealed Contracted Physical Therapist (#J10) donned a pair of clean gloves, which she secured from the boxes of gloves stored on the wall. She then used her gloved hands to remove the soiled dressings that was covering the the skin tear to the Patient's left leg.
After removing the soiled dressing, Contracted Physical Therapist (#J10) removed the contaminated gloves, walked over to the clean box of gloves and picked up a clean pair of gloves which she wore while cleaning the Patient's wound to her left leg. Physical Therapist #J10 debrided the skin from the wound, removed her contaminated gloves, removed clean gloves from the box of gloves which she donned .
The Contracted Physical Therapist did not wash or sanitize her contaminated hands in between removing the dirty dressings and securing clean gloves from the box of gloves stored on the wall.

Subsequent observation revealed Contracted Physical Therapist Assistant (#I 9) was observed on 11/29/2016 at 9:05 a.m. The Contracted Physical Therapist Assistant was providing wound care to Patient #8 who had a Stage 2 pressure sore to her right ankle.
Contracted Physical Therapist (#I 9) walked into the room and placed the dressings directly on the bedside table beside the telephone and other personal effect belonging to the patient. He did not create a clean field on the table to accommodate the dressings.

He then donned a pair of clean gloves, removed the soiled dressing that was covering the patient's rights ankle, dispose of it in the garbage, soaked the 4 x 4 swab with Skin Integrity solution, wiped the patient's wound using the contaminate gloves used to remove the soiled dressing.
He then removed his contaminated gloves , walked over to the clean box of gloves stored on the wall and picked up clean gloves with his contaminated hands.

Contracted Physical Therapist Assistant # I 9 did not remove his contaminated gloves and wash/sanitize his contaminated hands in between removing the soiled dressing from the patient's wound and cleaning of the patient's wounds and securing clean gloves from the box of gloves.

During an interview on 11/29/2016 at 9:15 a.m. in the presence of the Facility's Director of Nursing, the Surveyor informed Contracted Physical Therapist #J10 and Contracted Physical Therapist Assistant #I 9 that she the Surveyor had observed that during wound care of Patient #8, they did not wash, or sanitize their contaminated hands and change gloves when moving from dirty area to the clean wounds.
Contracted Physical Therapist #J10 stated " Thanks for telling me. I appreciate the feedback"




17028

During observation on 11/29 /2016 between the hours of 9:15 am and 10:10 am in the Laboratory the following observations were made:

Staff (Z26) Phlebotomist

Staff # (Z26) was observed drawing blood from a patient. After the blood draw The staff removed one hand of glove and used his pen to document on the patient' s paper record.
After removing the blood specimen from the work station the staff removed his gloves, handled paper record and did not wash/sanitize his hands.

Staff (Z26) proceeded to prepare supplies for another patient who was present for blood draw.

Staff (Y25) Medical Technologist

Staff( Y25) was observed at 9:50 AM handling tubes of specimen with gloved hands. The staff was also touching the computers and fax machine and paper records with the same dirty gloved hands.

Staff Y25 stored the tubes of specimens removed her gloves and did not wash/sanitize her hands.

Other staffs in the laboratory were observed handling the same paper records, fax machine and computers without gloved anddid not wash their hands afterwards.

During the observation four (4) patients who came into the laboratory for blood draw used the same chair/chair arm for their blood draws without staff sanitizing the chair after each patient use and prior to using the chair for the other patients.

During an interview on 11/29/2016 at 10:10 am with the Laboratory Manager who was present during the observation, she stated staff should not be interchangeably using dirty gloves to handle computers, fax machine and paper records. She stated staff usually use clean hands to handle these items.

The Manager stated staff should be cleaning the chair and arm after each patient use.
Review of the Laboratory Infection Control Policy/Procedure # 702-1-3 dated April 2016 revealed the following information:

'Intact gloves should be worn by all personnel processing biological specimens and when entering computer data at a "dirty" keyboard.(keyboard without plastic protective cover).
Hands must be washed when gloves are removed .

Gloves must be removed when answering the telephone or entering computer data at a ''clean'' keyboard(keyboard without plastic protective cover"




















37322


Three patients were observed on 11/29/2016 in the computed tomography (CAT scan) suite getting off the CAT scanner and walking back to the waiting room after the scan was completed. It was noted the CAT scan table was not cleaned/sanitized after each patient use with an appropriate disinfectant.
The findings include:
· CAT Scan Technician # R 18 completed the CAT scan 11/29/2016 @ 0930 with patient #19 and did not sanitize the CAT scan table after the patient left the scanner.
· CAT Scan Technician # R 18 completed the CAT scan 11/29/2016 @ 0953 with patient #18 and did not sanitize the CAT scan table after the patient left the scanner.
· CAT Scan Technician # R 18 completed the CAT scan on 11/29/2016@ 1000 with patient #20 and did not sanitize the CAT scan table after the patient left the scanner.

The interview with staff #P16, the Radiology Director, on 11/29/2016@ 1120 stated " all stretchers and beds should be cleaned before and after each patient, and a clean sheet should also be applied " .

Review of the Infection Control policy # 721-1-3 for radiology, revised 4/2016 stated:
"All tables are cleaned after each patient with a germicidal solution. All radiology equipment and surfaces should be cleaned after each patient with an appropriate disinfectant, approved by the Infection Control Committee " .






37490

Observation of the endoscope processing area on 11/28/2016 at 11:45 AM revealed that there were no dates recorded for the opening of the Rapicide PA High Level Disinfection Test Strips or the Rapicide PA Part A and Part B.
During an interview with Sterile processing technician (ID# E 5) on 11/28/2016 at 11:50 AM she stated "I don't write down when I open the products. I opened the test strips sometime last month and the Rapicide Part A and B, I am not sure when I changed those out".
Record review of the product insert for the Rapicide PA High-Level Disinfection Test Strips state that the test strips are good for four (4) months once opened.
Record review of the product label for the Rapicide PA Part A and Part B revealed that the product may be used for twenty-one (21) days after the product has been opened.

Observation of the endoscope processing area on 11/28/2016 at 11:45 AM revealed there was a Scope Buddy machine. There was no documentation regarding use or testing present in the area.
Interview with sterile processing technician (ID# E 5) on 11/28/2016 revealed the scope buddy was used during the process of decontaminating endoscopes. There is a daily check that is done each day.
Record review of the Quality Assurance Procedure for the Scope Buddy revealed that to ensure correct Scope Buddy operation, the Quality Assurance Flow Validation Test must be performed prior to the first use of the day. There is no documentation that the quality test was done on a daily basis.