HospitalInspections.org

Based on record review and interviews with key personnel on June 17, 2015, it was determined that the facility failed to ensure that applicable State laws and regulations were followed for patient rights.

Finding include:

1. 10-144 CMR (Code of Maine Regulations) Chapter 119, Section 3.2 states 'Patient Rights in Critical Access Hospitals. A critical access hospital must protect patient rights and comply with the conditions for patient rights contained in 42 CFR (Code of Federal Regulations) subsection 482.13, revised as of October 1, 2007, which is incorporated herein by reference as described in section 3.1.

2. The facility lacked evidence of written notice on discharge requiring an itemized bill, if requested by the patient, as required in patient rights. This information would be found on the patient's right document. See State Tag P-0116.

Based on a tour of the facility, review of records, and interviews with key personnel on June 16 and 17, 2015, it was determined that the facility failed to maintain the facility to ensure the safety of patients.

Findings include:

1. On June 16, 2015, at 9:00 AM, a cracked floor tile near the base the toilet in the patient bathroom in the Day Surgery waiting room was observed, resulting in an uncleanable surface. This finding was confirmed at that time with the Boiler Engineer.
2. On June 16, 2015, from 9:07 AM, to 9:15 AM, the Laboratory was toured. The following was observed. In the Chemistry area of the Laboratory, a wooden cabinet, labeled " vitros supplies " was observed missing paint down to the wood, in a number of areas, creating an uncleanable surface. Additionally the wall under the counter had a greater than one foot long gouge into the wallboard, creating an uncleanable surface. In the Hematology area of the Laboratory, the cabinet doors were made out of uncoated paneling which is absorbent, creating an uncleanable surface (as evidenced by many dark stains on the doors). In the microbiology area of the Laboratory, the window sill had missing paint and exposed wood, creating an uncleanable surface. Additionally a white shelf was observed to have a pitted surface on the top of the shelf unit which had petri dishes stored on it, creating an uncleanable surface. These findings were confirmed at that time with the Boiler Engineer.
3. On June 16, 2015, during a tour of the Emergency Department (E.D.) from 9:31 AM to 9:50 AM, the following was observed: In the area of bed number 4 rusty casters were observed on the trash can cart. Two IntraVenous (I.V.) poles in the hall, outside of the area of bed number 4 in the E.D. were observed to have rusty casters. In the area of room number 5, rusty casters were observed on the trash can cart. These rusty casters created uncleanable surfaces. In the area of room number 1 of the, the vinyl floor under the coat hook where the floor meets the wall was split, creating an uncleanable surface. These findings were confirmed at that time with the Boiler Engineer.
4. On June 16, 2015, from 9:55 AM to 10:15 AM, the Radiology area was toured. The following were observed:, X-Ray room 1 had a 1 inch diameter shallow hole in the floor, creating an uncleanable surface. The coving in the 2nd changing room in the Radiology area was pulled away from the wall, creating an uncleanable surface. The door to the Ultrasound room was observed to have broken and splintered wood on the outside edge of the door below the handle and along the bottom edge of the door, creating uncleanable surfaces. These findings were confirmed at that time with the Boiler Engineer.
5. On June 16, 2015, from 2:20 PM to 2:45 PM, the Urgent Care and nearby areas were toured. The following were observed: The door to the Oncology Infusion room had 8 holes and numerous scrapes and gouges, creating uncleanable surfaces. The bathroom of the Diabetes Education room had a loose ceiling tile being supported only on the corner by a pipe running under that part of the ceiling, creating a potential safety hazard. Exam rooms number 1 and number 3, as well as the patient bathroom in the Urgent Care and the Bone Density room were observed to have stained ceiling tiles, indicating water damage and creating a habitat for mold growth. The bathroom in the waiting room of the Urgent Care had a crack in the wall behind the toilet creating an uncleanable surface. In room number 206, Diagnostic Cardiac testing, seven cracked floor tiles were observed in the bathroom, creating uncleanable surfaces. The bathroom in the Bone Density room was observed to have 3 damaged wall tiles and 3 shallow holes in the floor tiles, creating uncleanable surfaces. These findings were confirmed at that time with the Boiler Engineer.
6. On June 17, 2015, from 8:30 AM to 9:00 AM, during a tour of the Operating Room (O.R.) area, the following were observed: O.R. room number 1 had a small hole in the ceiling above and near to the operating table, creating an uncleanable surface. A corner of the top of the Medication Cart was cracked and opened, creating an uncleanable surface. In the Post Anesthesia Care Unit (PACU), the sink cabinet was observed to have cracked, loose, veneer, creating an uncleanable surface. Additionally, the wall to the left and to the right below the electrical outlet was scraped down into the wall board, creating an uncleanable surface. In O.R. room number 2, the 2 light supports over the O.R. table were missing paint and rusting in numerous small areas, creating uncleanable surfaces. Additionally, there was a ½ inch area of missing paint and rust on the lower edge (on the patient left side of the table when the table is in the normal position) of the O.R. table, creating an uncleanable surface. In the Ambulatory Surgical Unit, to the left of bed number 6 a stained ceiling tile was observed, indicating a water leak and a habitat for potential mold growth. These findings were confirmed at that time with the Manager of the O.R.
7. On June 17, 2015, from 9:10 AM to 9:20 AM, during a tour of Rumford Surgical Associates, the following were observed: The upper outside corner of the closet door in room number 256 was broken and splintered, creating an uncleanable surface. Room number 255A and room 255B were observed to have the edges where the floor meets the wall not sealed along the outside wall, creating uncleanable surfaces. These findings were confirmed at that time with the Boiler Engineer.
8. On June 17, 2015, from 9:25 AM to 9:30 AM, during a tour of the Phlebotomy area, the following were observed: In Outpatient Laboratory number 1, the floor was split at the outside corner of the base of the sink cabinet, creating an uncleanable surface. In the hall to the right of the door of Outpatient Laboratory number 1, there were 4 broken tiles near the edge of the floor where it meets the wall, creating an uncleanable surface. These findings were confirmed at that time with the Boiler Engineer.
9. On June 17, 2015, from 9:45 AM to 9:55 AM, during a tour of the Physical Therapy area, the following were observed: There was a stained ceiling tile in the Balance room, indicating a water leak and a potential habitat for mold growth. In room number 140 a wedge bolster had torn vinyl corners, creating unclean able surfaces. It was disposed of immediately by the Physical Therapy Director. Outside of the Bariatric Room approximately 3 feet of coving was missing from the bottom of the wall, creating an uncleanable surface. These findings were confirmed at that time with the Boiler Engineer.
10. On June 17, 2015, at 10:00 AM, during a tour of the Medical/Surgical patient area, the following was observed: There was a deep scrape into the wall board above the toilet in room number 24, creating an uncleanable surface. This was confirmed at that time by and the Boiler Engineer.

Based on observations and interviews with key personnel on June 15-17, 2015, it was determined that the facility failed to provide preventive maintenance programs to insure that all essential mechanical, electrical, and patient care equipment were maintained in a safe operating condition.

Findings include:

1. During a tour of the surgical suite on June 16, 2015, at approximately 10:00-11:30 AM, the following expired medical care devices were observed in the surgical suite.
a. One (1) bottle of cetacaine spray, expired "5/15", located in Operating Room 1 supply cabinet.
b. One (1) tube of silver nitrate swabs, expired "5/15", located in the "outside sterile closet."
c. One (1) 5.0 mm endotracheal tube, expired "01-2015", located in Anesthesia Closet, Difficult Airway Cart.
d. Twenty-six (26) sterile tongue depressors expired "02-2015", located in Anesthesia Closet, neuraxial analgesic cart.
e. Forty-seven (47) EKG electrodes, expired "3/2014", located on Defibrillator Crash Cart.
f. One (1) portex tracheal tube introducer, expired "3/2012", located on Defibrillator Crash Cart.
g. Two (2) Easy-Cap CO2 detector, expired "9-2013", located on Defibrillator Crash Cart.
h. This was confirmed with the Operating Room Manager on June 16, 2015, at approximately 11:45 AM. The items were immediately removed from the unit and replaced with unexpired items

2. During a tour of the kitchen on June 15, 2015, at 1:30 PM, the blade of the meat slicer was observed to be pitted and rusty. This was confirmed by the Food Service Supervisor at that time and immediately taken out of service.

3. During a tour of the facility on June 17, 2015, at approximately 10:30 AM, it was observed that one Intravenous (I.V.) Pump (Sodexo # 00DF-01013) on the Medical/Surgical wing, had no date of inspection. Information obtained by the facility from the contracted medical equipment inspection company indicated that this I.V. pump had not been inspected for safety since 2013. This was confirmed by the Director of Maintenance on June 17, 2015, at approximately 1:00 PM who removed it from service.

Based on a tour of the facility on June 16 and 17, 2015, it was determined that the facility failed to keep the premises clean and orderly.
Findings include:
1. On June 16, 2015, at 9:00 AM, in the patient bathroom in the Day Surgery waiting room, a ¼ inch brown stain all around the base of the toilet was observed. This was confirmed at that time by the Boiler Engineer.
2. On June 16, 2015, at 9:05 AM, a cardboard box of "Wings" absorbent pads were observed stored on the floor in Linen Closet 1. These were immediately taken off the floor and placed on a stool by the Linen Technician. This was confirmed at that time by the Linen Technician and the Boiler Engineer.
3. On June 16, 2015, from 9:07 AM, to 9:15 AM, the Laboratory was toured. The ceiling vent on the Laboratory ceiling near the exterior wall was observed to have an accumulation of black debris. Additionally the ceiling vent over the door was observed to be dusty. The floor of the entire Laboratory was observed to have many stains. Additionally an accumulation of dirt was observed near the cabinets in the Chemistry area of the Laboratory. 2 cardboard boxes were observed stored on the floor in the Laboratory supply room. These findings were confirmed at that time with the Boiler Engineer.
4. On June 16, 2015, during a tour of the Emergency Department (E.D.) from 9:31 AM to 9:50 AM, the following was observed: in the area of room 1 of the Emergency Department (E.D.), an accumulation of dust was found on the top of the door frame inside the room. In the area of room 5, dust was found on the top of the door frame, on the top surface of the clock, and on the top of the picture frame. The ceiling vent in the bathroom waiting room in the E.D. was dusty. These findings were confirmed at that time with the Boiler Engineer.
5. On June 16, 2015, from 2:22 PM to 2:40 PM, the Urgent Care area was toured. The following were observed: The floor in the bathroom in exam room 5 had an accumulation of dirt in the corner behind the door. The floor in the bathroom in exam room 5 had an accumulation of dirt in the corner behind the door. Exam room 4 in the Urgent Care was observed to have dust over the lockers. These findings were confirmed at that time with the Boiler Engineer.
6. On June 16, 2015, at 2:45 PM, in the Diagnostic Cardiac Testing room, dust was found on the top of the lockers. This finding was confirmed at that time with the Boiler Engineer.
7. On June 17, 2015, at 8:30 AM during a tour of the Operating Room (O.R.) area, the ceiling vent in the Washer-Sterilizer room was observed to be dusty. This finding was confirmed at that time with the Manager of the O.R.
8. On June 17, 2015, at 10:00 AM, in the Medical/Surgical area, bed 2 in room 10 was missing the rubber bumpers on each side of the head of the bed. There was a sticky, glue-like residue in this area on each side of the bed, creating an uncleanable surface. This finding was confirmed at that time with the Boiler Engineer.

Based on a tour of the facility, record review, and interviews with key personnel on June 18, 2015, it was determined that the facility failed to assure that a sufficient emergency water supply was available.

Findings include:

1. A review of the facilities Disaster policy, revealed that the amount of water needed to have on hand and the amount of water to be delivered was not documented in the facility Disaster Plan. Additionally the amount of water on hand was not sufficient to supply potable water to patients and staff until emergency water supplies were delivered per facility policy. This was confirmed with the Director of Maintenance and the Food Service Supervisor (F.S.S.) on June 18, 2015, at approximately 9:30 AM.

Based on review of information provided and interviews with key personnel June 17 and 18, 2015, it was determined that the facility failed to ensure that the policies were developed with the advice of members of the CAH's professional healthcare staff, including one or more doctors of medicine or osteopathy and one or more physician assistants, nurse practitioners, or clinical nurse specialists, if they were on staff.

Findings include:

1. A review of the Clinical Policy and Procedure Manual documentation of its review/revision for Fiscal Year 2014, was dated May 6, 2014. This form contained only one signature, that of a Registered Nurse.

2. During an interview with the Director of Nursing, on June 18, 2015, at approximately 9:10 AM, it was stated that prior to March 2015, the advisory group did not include a physician or a physicians assistant or a nurse practitioner. It was confirmed at this time that only nurses had attended the advisory group meetings until March 2015.

3. Interviews were conducted on June 18, 2015, at approximately 9:40 AM, with the Nurse Manager Inpatient Unit (in person) and a Special Care Registered Nurse (via telephone) who had participated in the policy review for Fiscal Year 2014. Both stated that they participated in the 2014 policy reviews and revisions and stated that no physicians, physicians assistants or nurse practitioners participated with them or were present at the meetings that were held.

Based on a tour of the facility, policy review, and interview with key personnel on June 16, 2015, it was determined that the facility failed to have procedures in place to assure that outdated food was not available for use for patient units.
Findings include:
1. On June 16, 2015, at 11:00 AM, the surveyor observed, in the Day Surgery, patient refrigerator, 2 expired containers of orange juice. This was confirmed with the Food Service Supervisor (F.S.S.) who immediately disposed of them. The F.S.S., at that time, stated that the day surgery patient refrigerator is only checked for outdates when it is stocked. The F.S.S. also stated that they only stock that refrigerator when the unit requests stock to be resupplied.

Based on record review and interviews with key personnel on June 16, 2015, it was determined that the facility failed to ensure that medical records were complete for 20 of 45 sampled records.

Finding include:

1. Review of the medical records F, G, L, P, V, W, X, Z, AA, BB, DD, EE, FF, HH, YY, ZZ, AAA, BBB, CCC, and DDD, revealed that they all lacked evidence that the patient had received a copy of their patient rights. This finding was confirmed by the Out Patient Clinic and Oncology Manager on June 16, 2015, at approximately 2:30 PM.

Based on review of medical records for surgical cases, randomly selected from the Surgery Log, completed on June 17, 2015, at approximately 4:00 PM, it was determined that the hospital failed to assure that each surgical patient who received anesthesia was evaluated by a qualified practitioner for anesthesia recovery before discharge.
Findings include:
1. Department of Anesthesia Departmental Parameters states: "10. In the absence of an anesthesiologist, the nurse anesthetist shall approve the discharge of the patient from PACU [Post Anesthesia Recovery Unit]., 11. Discharge of patients from the PACU shall be in accordance with the PACU policies and scoring system."

2. One of four surgical records reviewed of surgical patients who received administration of anesthesia, (Record OO), failed to include documentation that the Nurse Anesthetist or Surgeon evaluated the patient for recovery from the anesthesia prior to discharge from the Critical Access Hospital. This finding was confirmed by the Operating Room Manager on June 17, 2015, at approximately 4:00 PM, who stated "I couldn't find any documentation in the record showing the CRNA [Certified Registered Nurse Anesthetist] evaluated the patient before discharge."

Based on review of medical records for surgical cases, randomly selected from the Surgery Log, completed on June 17, 2015, at approximately 4:00 PM, it was determined that the hospital failed to assure that each surgical patient was discharged to a responsible adult unless exempted by the surgeon.
Findings include:
1. Hospital Policy "Discharge Criteria for ASU [Ambulatory Surgical Unit]" stated under section "Procedure": "8. Post-OP [Operative] instructions to be given to patient or responsible adult with documentation that they have received and understand the information., ...11. Patient must have responsible driver. Patient may not drive if they received any sedation or anesthesia."
2. Three of five surgical records reviewed of surgical patients, (Records OO, PP, and QQ), failed to include documentation that the patient was discharged from the Post Anesthesia Care Unit to the care of a responsible adult, or documentation that the patient was exempted from this requirement by the practitioner performing the surgical procedure. This finding was confirmed by the Operating Room Manager on June 17, 2015, at approximately 4:00 PM, who along with a surgical nurse noted that the records did not indicate who the patient was discharged to and that one record stated "private vehicle".

Based on document review and interviews with key personnel on June 16, 2015, it was determined that the facility failed to inform the swing bed patients of their rights in advance of care.

Findings include:

1. A review of Record A revealed that the patient was admitted on June 4, 2015, and the patient rights form was not signed until June 5, 2015.

2. A review of Record B revealed that the patient was admitted on June 6, 2015, and the patient rights form was not signed until June 8, 2015.

3. A review of Record D revealed that the patient was admitted on June 12, 2015, and the facility has failed to inform the patient of their Medicaid benefits. These findings were confirmed during the chart review with the Obstetrics Registered Nurse. The findings were also confirmed with the Swing Bed /Inpatient Coordinator on June 17, 2015, at approximately 12:00 PM.

Based on document review and interviews with key personnel on June 16, 2015, it was determined that the facility failed to include all the required elements in the comprehensive assessment.

Findings include:

A review of swing bed records revealed that the comprehensive assessment failed to address dental status in two of the five records (Records C and E). These findings were confirmed during the chart review with the Obstetrics Registered Nurse. The findings were also confirmed with the Swing Bed /Inpatient Coordinator on June 17, 2015, at approximately 12:05 PM.

Based on document review and interviews with key personnel on June 16, 2015, it was determined that the facility failed to develop a comprehensive care plan that included timeframes.

Findings include:

A review of swing bed records revealed that the nursing care plan failed to include timeframes in four of the five records (Records B, C, D, and E). These findings were confirmed during the chart review with the Obstetrics Registered Nurse. The findings were also confirmed with the Swing Bed /Inpatient Coordinator on June 17, 2015, at approximately 12:10 PM.

Based on document review and interviews with key personnel on June 16-17, 2015, it was determined that the facility failed to inform patients of their visitation rights.

Findings include:

A review of thirty medical records was conducted. Fourteen medical records failed to contain documentation that the patients received notice of these rights (Records F, G, L, P, V, W, X, Z, AA, BB, DD, EE, FF, and HH). These findings were confirmed during the chart review with the Obstetrics Registered Nurse. The findings were also confirmed with the Inpatient Nurse Manager on June 17, 2015, at approximately 4:40 PM.