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Based on review of facility policy, medical records (MR), and interviews with staff (EMP), it was determined that Gettysburg Hospital failed to obtain physician orders for the use of restraints for one of five restraint records reviewed (MR34).

Findings include:

A review on November 22, 2011, of facility policy "Restraints/Seclusion for use with Medical Management and/or for Violent or Self Destructive Behavior" last reviewed August 2011, revealed, "...In these emergency application situations the order must be obtained either during the emergency application of the restraint or immediately 'without time interval' after the restraint was applied. The order must be timed limited, not to exceed 24 hours. ... Orders may subsequently be renewed for a calendar day.... "

A review of MR34 on November 22, 2011, revealed the patient was placed in bilateral soft wrist restraints on August 20, 2011, at 9:55 PM. Further review revealed there was no physician order for the use of restraint until August 21, 2011, at 3:48 AM.

An interview was conducted with EMP5 on November 22, 2011, 1:20 PM. EMP5 confirmed there was no physician order on MR34 for the use of restraint that was initiated on August 20, 2011, at 9:55 PM, until August 21, 2011, at 3:48 AM.

Based on Life Safety Code Recertification survey, the Condition for Physical Environment is not met based on the results of Department of Safety Inspection survey completed on December 21, 2011. See Life Safety Code 2567 for deficiencies.

Based on review of facility policy, observation and interview with staff (EMP), it was determined that the facility failed to ensure that the facilities, supplies and equipment were maintained to ensure an acceptable level of safety and quality in the Dietary Department.

Findings include:

1) A review on November 23, 2011, of facility policy "Nutrition Management Services Company, Policy No.: SAN-134 Cleaning Procedure: Walls, Floors & Ceilings," (no date of last review) revealed, "Procedure: ... 3. Floors: ...b. Wash with hot water and non-sudsing cleaning solution .... Frequency of cleaning: Weekly"

A tour conducted on November 21, 2011, of the Dietary Department main kitchen, revealed the portion of the floors next to the walls had brown dust and patches of oily residue.

An interview conducted on November 21, 2011, at 10:15 AM with EMP6 confirmed the edges of the floor were dirty, and revealed that the schedule indicated the floors should have been cleaned the previous day, Sunday.

2) A review on November 23, 2011, of facility policy "Nutrition Management Services Company, Policy No.: SAN-132 Policy: Operation & Cleaning Procedures Range & Grill," (no date of last review) revealed, "... Cleaning: ... 3. Wash the exterior of range when oven is cool. Rinse well. Wipe with sanitizing solution. Let air dry. 4. Drip pans should be run through the dish machine daily."

A tour conducted on November 21, 2011, of the Dietary Department main kitchen, revealed the grill had thick layer of dark brown grease with crusty specks on the side of the grill support, and the drip pan was encrusted with dark brown grease and food residue.

An interview was conducted with EMP6 on November 21, 2011, at 10:15 AM, revealed that the cleaning log indicated the grill had been cleaned the day before, Sunday, and confirmed the grill had thick layer of dark brown grease with crusty specks on the side of the grill support, and the drip pan was encrusted with dark brown grease and food residue.

3) A review on November 23, 2011, of facility policy "Nutrition Management Services Company, Policy No.: SAN-134 Cleaning Procedure: Ingredient Bin," (no date of last review) revealed, "Procedure: 1. Transfer ingredients to a clean container. 2. Wash interior, exterior, and wheels with hot, soapy water. Rinse well. 3. Wipe with sanitizer and permit to air dry. 4. Replace ingredients.... Frequency of Cleaning: Weekly"

A tour conducted on November 21, 2011, of the Dietary Department main kitchen, revealed two storage bins on wheels. One storage bin contained whole, fresh onions, and the other contained a rack of clean cups. The outer surfaces of the bins and the wheel attachment surfaces were encrusted with dark brown grease and food residue.

An interview was conducted with EMP6 on November 21, 2011, at 10:30 AM. It was revealed that the cleaning log indicated the two storage bins were cleaned the day before, Sunday, and confirmed the outer surfaces of the bins and the wheel attachment surfaces were encrusted with dark brown grease and food residue.

4) A tour conducted on November 21, 2011, of the Dietary Department main kitchen, revealed dry food storage, refrigerator food storage, and frozen food storage that contained the foods that were improperly labeled, expired, or covered. The dry storage area contained the following: large containers of flour, sugar and rice without identification label or expiration date; Cream of Rice and chocolate chips without expiration date. Refrigerator storage included the following: Broccoli Spears and sundried tomatoes without expiration date, and fresh green peppers that were past the expiration date. Freezer storage included the following: gluten free rolls that expired August 9, 2011, pecan pie, open rolls, vege patties, bread, and six pie crusts without expiration date. The freezer storage also contained the following foods in opened containers that were not covered or resealed, and had no expiration date: carrots, peas, fried potatoes, and chicken nuggets.

An interview was conducted with EMP6 on November 21, 2011, at 10:30 AM. EMP6 confirmed that dry food storage, refrigerator food storage, and frozen food storage contained foods that were improperly labeled, expired, or uncovered.

The facility did not provide policy and procedure that addressed the labeling of foods and expiration dates, or resealing opened packages.