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Based on observation, interview, and document review, the facility failed to 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 CAH.

Findings include:

Review of COVID-19 Employee Monitoring Logs dated 5/15/20, to 5/21/20, indicated the following documentation was required prior to staff starting their shift:
-Name, date, and time; and,
-temperature prior to work; and,
-presence of respiratory symptoms which included a cough or shortness of breath; and,
-presence of two symptoms which included: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, and a new loss of taste or smell.

Employee responses indicated the following:
-3 employees failed to document their temperature and subsequent screening questions.
-1 employee failed to document a temperature.
-14 employees failed to document the presence of respiratory symptoms which included a cough or shortness of breath.
-4 employees failed to document if they had of two of the following symptoms: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, and a new loss of taste or smell.
-2 employees documented "yes" to the presence of two of the following symptoms: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, and a new loss of taste or smell.

Review of the facility Patient/Visitor Log dated 5/12/20, to 5/19/20, lacked indication temperatures were taken.

On 5/21/20, at 10:23 a.m. the facility COVID-19 screening station, located near the oncology entrance, was observed. The screening station was located immediately inside the facility, and screening log sheets were placed on a table. The screening station lacked a thermometer. The screening station lacked staff presence. An interview was conducted with the director of nursing (DON). The DON confirmed a thermometer was not kept at the oncology COVID-19 screening station. The DON stated employees who utilized the oncology entrance, were required to take their temperature prior to arriving to the facility, and document their results on the screening log once they arrived to work. The DON stated an additional COVID-19 screening station was located near the facility emergency department, and had a thermometer. Patient (P)-1 was also observed standing outside the outer glass sliding door which was locked. Health unit coordinator (HUC)-A opened a sliding glass door and escorted P1 down a hallway, past the cafeteria, and to the oncology department. HUC-A brought P1 to a room 1783. HUC-A then instructed P1 a weight needed to be obtained. P1 exited room 1783, had his weight taken, and returned to the room. The DON stated she assumed patients were screened at the oncology entrance.

On 5/21/20, at 10:31 a.m. HUC-A stated oncology patients were screened twice for COVID-19. HUC-A stated the first screening occurred prior to patient appointments. HUC-A stated the secondary screening occurred when patients arrived, over telephone, at the oncology entrance. HUC-A stated she asked patients if they had signs and symptoms which she read from a document. HUC-A confirmed patients did not have their temperature taken at the oncology entrance. HUC-A stated patient temperatures were taken after a patient was placed in a room.

On 5/21/20, at approximately 10:40 a.m. the facility main entrance was observed. A receptionist desk and registration desk were present in the area. A receptionist and registration clerk were staffed. The DON stated patients and visitors were screened for symptoms and provided a mask at the receptionist desk. The DON stated patients and visitors were "subjectively" asked if they had a fever. The DON confirmed patients did not have their temperature taken until they arrived to a department within the hospital.

On 5/21/20, at 10:44 a.m. an observation of the COVID-19 employee screening station, near the facility emergency department, was conducted. No staff were observed at the screening station. The screening station contained screening logs and a temporal (forehead) thermometer. The DON stated employees took their own temperature, and documented on the screening log. The DON stated if employees had COVID-19 symptoms they would not start their shift, and were expected to contact a supervisor. The DON stated when employees failed to correctly complete the screening log or documented they had symptoms, she would contact them via telephone. The DON confirmed the facility did not have staff assigned to perform active employee screenings.

On 5/21/20, at 11:14 a.m. receptionist (R)-A was observed reading screening questions to a patient who requested to be seen in the emergency department, at the facility main entrance screening station. R-A instructed the patient to be seated in a waiting area which was immediately adjacent to the screening station. R-A did not take the patient's temperature.

On 5/21/20, at 11:15 a.m. staff was observed escorting the patient from the waiting area to the emergency department.

On 5/21/20, at 11:44 a.m. RN-A stated she performed COVID-19 self-screenings prior to reporting to the nursing unit. RN-A stated she took her own temperature at home, and recorded her results on a screening log once she arrived to the facility.

On 5/21/20, at 12:13 p.m. RN-B stated she performed COVID-19 self-screenings prior to her scheduled shifts.

On 5/21/20, at 12:28 p.m. LPN-A stated she performed a COVID-19 self-screening, at the emergency department screening station, when she arrived to work.

On 5/21/20, at 12:35 p.m. R-B stated she was not screened by anyone when she arrived to work. R-B stated she took her own temperature at home. R-B also stated she documented her screening responses on a running log sheet located at the emergency department screening station.

On 5/21/20, at 1:17 p.m. housekeeper (H)-A she performed a COVID-19 self-screening prior to coming to work.

On 5/21/20, at 2:01 p.m. the DON stated she reviewed COVID-19 Employee Screening Logs twice daily. The DON stated the facility followed up with employees who did not complete the log appropriately, or documented they had symptoms. The DON stated the facility believed reviewing screening logs was active screening.

The facility standard operating procedure (SOP) titled Screening Visitors and Outpatients revised 4/7/20, directed, "Identify all persons entering the hospital. Complete COVID-19 log for all patients and anyone that is allowed entrance to the facility. Ask screening questions. The following will be allowed access to the hospital after passing the screening questions; patients with scheduled appointments, ER patients, visitors required to provide patient care or assistance." The SOP lacked indication of taking patient or visitor temperatures.