HospitalInspections.org

Based on observation, interview and document review, the facility failed to actively screen patients, staff and visitors at the point of entry in accordance with the Centers for Disease Control (CDC) and Centers for Medicare and Medicaid Services (CMS) COVID-19 guidance. This deficient practice had the potential to affect all patients, visitors and staff of the CAH.

Findings include:

On 4/28/20 at 10:00 a.m. upon entrance to the facility, a licensed practical nurse (LPN)-A was seated just inside the main entrance. LPN-A checked the survey staffs' temperatures, however, did not ask respiratory symptom screening questions related to COVID-19 and allowed entrance to the facility.

Interview on 4/28/20, at 11:08 a.m. with the housekeeper (H)-A indicated facility staff checked her temperature when she arrived for work at the employee entrance. H-A stated the facility did not ask her questions related to COVID-19 symptoms when she arrived for work.

Interview on 4/28/20, at 11:15 a.m. with the unit coordinator (UC)-A indicated facility staff checked her temperature when she arrived for work at the employee entrance. UC-A stated the staff did not routinely ask her questions related to COVID-19 symptoms when she arrived for work and indicated the staff asked her "once in a while" and was not able to provide a frequency.

Interview on 4/28/20, at 11:20 a.m. with the UC-B indicated facility staff checked her temperature and logged it onto a form when she arrived for work at the employee entrance. UC-B stated the staff asked her questions related to COVID-19 symptoms on average about "once a week" when she arrived to work.

Interview on 4/28/20, at 11:28 a.m. with the registered nurse (RN)-A indicated facility staff checked her temperature at the employee entrance when she arrived to work and documented it on a log. RN-A stated the facility staff did not ask her questions related to COVID-19 symptoms. RN-A stated after hours and on weekends, facility staff were not present at the employee entrance and staff entered the facility, walked down the hallway, up the stairway to the nurse's station to have their temperature checked. RN-A indicated there was a different log kept at the nurses station for staff to document on and there was a column marked for symptoms. RN-A believed the column was meant for identification of COVID-19 symptoms. RN-A verified the column lacked the specific symptoms to be monitored for and indicated staff should have been aware of what symptoms to look for. RN-A stated licensed nurses were allowed to check their own temperatures and logged if they had any respiratory symptoms. RN-A stated staff were trusted to self-monitor for COVID-19 symptoms and to stay home if they had any of the symptoms. RN-A stated the patients admitted to the acute unit were not routinely screened for symptoms of COVID-19 since they had been screened in the emergency room (ER) prior to admission. RN-A stated a general assessment of all systems was completed every shift on all patients.

Interview on 4/28/20, at 11:49 a.m. with the LPN-A confirmed she did not ask COVID-19 screening questions of the surveyor staff upon arrival to the facility earlier that day. LPN-A indicated she checked employee temperatures when they arrived at the doorway and confirmed she did not ask employees questions regarding COVID-19 symptoms. LPN-A confirmed the log she used to document employee, visitor and patient visits only had temperatures logged and lacked any COVID-19 symptoms monitoring.

Interview on 4/28/20, at 12:28 p.m. with housekeeper H-B indicated staff were not present at the employee entrance on the weekends and stated staff were expected to report to the nurse's station at those times to have their temperature checked.

Interview on 4/28/20, at 12:30 p.m. with the nursing assistant (NA)-A indicated staff were not present at the employee entrance on the weekends and stated she reported to the nurses station, checked her own temperature and documented it. NA-A stated if she needed a new facemask at that time she would obtain one at the nurse's station.

In a follow-up interview on 4/28/20, at 12:33 p.m. with UC-B indicated staff were not present at the employee entrance on the weekends and staff were expected to report to the nurse's station to have their temperature checked. UC-B stated she would obtain a new facemask at the nurse's station at that time if she needed a new one.

Interview on 4/28/20, at 12:34 p.m. RN-B indicated staff were not present at the employee entrance on the weekends or after hours and staff were expected to report to the nurse's station to have their temperatures checked.

Interview on 4/28/20, at 12:53 p.m. with the infection preventionist (IP) indicated the employee entrance was staffed Monday through Friday from 6:00 a.m. to 8:00 p.m. and confirmed staff were expected to report to the nurses station to have their temperature checked after those hours. IP confirmed the facility did not ask or track employees for symptoms of COVID-19. IP stated employees have been instructed via the facility's website and by signs posted to not report to work if they have any symptoms of COVID-19 and indicated the facility relied on staff to self-monitor and report. IP stated the facility had a COVID-19 hotline staff could call if they had any questions.

Interview on 4/28/20, at 1:29 p.m. with RN-C indicated inpatients were screened for COVID-19 symptoms in the ER prior to admission to the acute unit. RN-C confirmed a COVID-19 screening was not completed on inpatients.

Medical record (MR) review on 4/28/20, at 2:05 p.m. with RN-A revealed the following:

-P1 presented to the ER on 4/25/20, and was admitted to the acute unit with a deep vein thrombosis. RN-A confirmed P1 did not present with respiratory symptoms and therefore had not been screened for COVID-19 symptoms. RN- A confirmed the provider ER note and nursing triage note lacked a respiratory assessment and COVID-19 symptom screening.

-P2 presented to the ER on 4/27/20, and was admitted to the acute unit with a head injury after sustaining a fall at home. RN-A confirmed P2 did not present with respiratory symptoms and therefore had not been screened for COVID-19 symptoms. RN-A confirmed the provider ER note and the nursing triage note lacked a respiratory assessment and COVID-19 symptom screening.

-P3 presented to the ER on 4/27/20, and was admitted to the acute unit with weakness and an underlying diagnosis of pancreatic cancer. RN-A stated the provider ER note indicated a lung assessment was completed, was negative, however, confirmed the provider note lacked a COVID-19 symptom screening. RN-A verified the nursing triage note lacked a COVID-19 symptom screening.

-P4 presented to the ER on 4/24/20, and was admitted to the acute unit with a pelvic fracture. RN-A confirmed the provider progress note listed a complete respiratory assessment, however, lacked screening questions related to COVID-19 exposure or travel. RN-A stated the nursing triage assessment lacked a COVID-19 symptom screening.

The medical records lacked an assessment of COVID-19 signs and symptoms.

In a follow-up interview on 4/28/20, at 2:52 pm. with the IP indicated the facility had obstetrical (OB) visitors in the past month and the facility lacked any visitor COVID-19 screening forms of the visitors. The IP confirmed the logs used at the entrances had a column for temperature checks and lacked columns for symptoms checks. The IP confirmed the facility screened patients who presented to the ER when they had respiratory symptoms or symptoms of COVID-19, staff completed the COVID-19 symptom form and scanned it into the patient's MR. IP confirmed if the patient did not have respiratory symptoms, a COVID-19 screening assessment was not completed at all.

Interview on 4/28/20, at 4:10 p.m. with the director of nursing (DON) stated the employee screening for COVID-19 symptoms consisted of staff having their temperatures checked Monday through Friday 8:00 a.m. to 6:00 p.m. at the employee entrance and DON confirmed no other screening symptoms were assessed at those times. DON confirmed after hour's staff were not present at the employee entrance and staff were expected to go to the nurse's station to check their temperatures and to write down on the log if they had any symptoms. DON confirmed licensed staff could take their own temperatures and stated the lead nurse would review the log at some time during the shift, in the morning and afternoon. DON confirmed the lead nurse would not review the temperature and symptom checks at the time they had been checked. DON stated staff had been instructed to not report to work if they had a fever or respiratory symptoms and trusted staff to self-monitor and report accordingly. DON confirmed the log utilized at the employee entrance and main entrance contained an area for temperatures and lacked a column for other COVID-19 symptom monitoring questions. DON confirmed the log kept at the nurses station for after-hours had a column marked for symptoms and verified the log lacked information on what symptoms staff were expected to report. DON confirmed the facility completed a COVID-19 screening assessment when a patient presented with positive symptoms and verified the COVID-19 screening assessment was not completed on all patients who presented to the facility.

Review of untitled log form from 4/6/20, 4/28/20, revealed the following columns present: last name, first name, and date. The logs had temperatures registered. The log lacked any columns for COVID-19 symptoms.

Review of untitled log form from 4/6/20, to 4/20/20, revealed the following columns present: date, employee, department temp and symptoms. The form had a statement at the top which stated to notify department manager for any illness symptoms or temp over 100.4, if symptoms or temp, employee should not report for work. The log lacked identification of COVID-19 symptoms.

A facility policy for COVID-19 symptom screening for patients, staff and visitors was requested and not provided.



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During an interview on 4/28/20, at 1:20 p.m. RN-E stated the facility screened the patients in the Emergency Department (ED) with the assessment but did not keep track of COVID-19 screening questions unless the patient would be positive with symptoms only. RN-E stated she typically do not ask COVID-19 screening questions of patients. RN-E stated when coming into the facility to work staff were given a mask and their temperature was taken however, there were no questions asked about any symptoms of COVID-19.

MR review on 4/28/20, at 2:13 p.m. with RN-C revealed the following:

-P5 presented to the ED on 4/28/20, and was admitted to the acute unit with chronic obstructive pulmonary disease (CODP) with acute bronchospasm. RN-C confirmed P5 did have difficulty breathing. The provider note and the ED notes lacked a COVID-19 symptom screening. RN-C stated no COVID-19 screening questions were asked of P5 when admitted.

-P6 presented to the ED on 4/26/20, and was admitted to the acute unit with a concussion and scalp laceration. RN-C confirmed P6 had no COVID-19 screening in P6's MR. RN-C stated on the acute unit they do not screen patients when they come from the ED. RN-C stated we did do neurological screening on P6.