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Based on observation and interview, it was determined that the facility had expired supplies in the emergency department.

Findings were:

A tour of the facility on 3/4/13 revealed the following expired supplies:
? 25 red top lab tubes expired 2/2013, located in emergency room D.
? 3 red top lab tubes expired 5/2012, located in emergency room 1.

The above findings were confirmed with the Chief Nursing Officer during the above tour.

Based on observation and interview, it was determined that the facility failed to maintain the premises.

Findings were:

A tour of the facility on 3/4/13 revealed the following:
? The lower area of the wall was damaged, and there was a dried red substance splattered on the wall in emergency room B.
? The floor and wall-base under a sink was damaged and warped, and tiles around a toilet were warped in a restroom in the emergency room.
? The lower area of the wall was damaged in emergency room C.
? The lower area of the wall had two holes, one of which was around an electric socket, in patient room #204.
? There was dust on high horizontal surfaces in the following area: emergency room B, emergency room 1, kitchen/food preparation area, and patient room #204.

The above findings were confirmed with the Chief Nursing Officer during the above tour.

Based on review of clinical records on March 5, 2013 and interview with facility personnel, it was determined that the facility failed to maintain clinical records in accordance with written policies and procedures.

Findings were:

Review of clinical records and more specifically under the Physician's Order Sheets, revealed that several orders for patient # 19 were not authenticated in accordance with the facility's policy titled "Physician's Orders" . This policy states the following under section I:
D. Verbal or Telephone Orders:
1. Verbal or telephone orders require a verification "read-back" of the complete order by the person receiving the order.
2. "Read-back" means that the qualified person taking the order should write down the order and then read it back, word for word, to the clinician who initiated it. The clinician should verbally confirm that the order is correct.
3. The "read-back" process applies to all verbal (including face to face)/telephone orders. This policy applies to all verbal orders, not just verbal orders for medications. However, medication orders are the primary focus.
4. Providers at the Scott and White Taylor Hospital are encouraged to write orders in the patient medical record, in the "Physician Order" section, and are discouraged from routine use of verbal or telephone orders.
5. Verbal/Telephone orders are used in urgent situations demanding immediate action when provider cannot immediately provide written orders and/or when provider is not immediately available to write orders.
6. Verbal/Telephone orders are to be countersigned (with date and time of countersignature) promptly. It is preferred that providers sign their own verbal/telephone orders; however, it is acceptable that providers participating in the care of the patient may countersign verbal/telephone orders from another provider.

Review of Physician's orders for patient # 19 revealed the following:

? Order dated 12/21/12 at 1700 stated: Cont: Bactoban Topically to open sores on feet Bid. T.O.R.B (personnel # 21). No authentication was found on this closed record.
? Order dated 12/21/12 at 2120 stated: Zosym 3-375gm IV q 8hrs. T.O.R.B Dr. (personnel # 21). No authentication was found for this order.
? Order dated 12/22/12 at 0005 stated: Lovenox 40mg SQ q day. T.O.R.B Dr. (personnel # 21). No authentication was found for this order.
? Order dated 01/02/13 at 1050 stated: Pt to be seen 1x/day Tues-Fri-Sat when OT on call for self care (sic) ... T.O.R.B. Dr. (personnel # 21) No authentication was found for this order.

During interview on March 06, 2013, the Chief Nursing Officer confirmed that the orders above were not authenticated as per facility policy.

Based on review of clinical records and interview with hospital staff on the morning of March 5, 2013, it was determined that the facility failed provide evidence of properly executed informed consent forms.
Findings were:
Review of patient's records on March 5, 2013 in the facility's conference room revealed that the Scott and White form titled: Conditions of Admission, which include the authorization and consent to care were not presented to patients on 6 of 20 records reviewed. Furthermore, the Scott &White Healthcare form titled "General Consent for Treatment/Financial Responsibility/ Advance Directive was not presented to patients on 6 of 20 records reviewed. Facility's policy # X.2002.11.100 paragraph I states the following:
"Scott & White Healthcare (S&W) will, to the best of its ability, comply with federal and state laws and regulations pertaining to informing patient and securing their consent for treatment, patient rights, and related issues, through delivery, explanation and patient signature of and on the General Consent for Treatment (GCT)."
The following patients were not provided an opportunity to review and sign the form titled "General Consent for Treatment":
Patients # 2, 3, 12, 13, 17, and 18.
During interview with the Chief Nursing Officer on March 6, 2013, no evidence was given that this policy has been enforced and it was confirmed that the records reviewed were closed records.

Based on review of clinical records and interview with facility ' s personnel, It has been determined that the facility has failed to provide patients with information regarding advance directives.

Findings were:
Review of 20 patient records on March 05, 2013 and March 06, 2013 revealed that 6 of 20 did not receive advance directives information contained on facility form titled: General Consent for Treatment/Financial Responsibility/ Advance Directive. Facility's policy # X.2002.11.100 states the following on page 1 under Policy heading: " The GCT form will apply to any procedure, treatment or diagnostic testing provided in a S&W Healthcare facility. It will inform patients and family members in multiple areas, including: Assignment of benefits; Authorization for direct payment; Consent for treatment; Control over decisions ... "
An interview with the Chief Nursing Officer on March 6, 2013 in the facility ' s conference room confirmed that the documents were not signed by the patients and offered no evidence that the facility enforced its policy regarding advance directives.
The following patients were not provided an opportunity to review and sign the form titled "General Consent for Treatment" and under section 15 (Patient Rights and Advance Directives):
Patients # 2, 3, 12, 13, 17, and 18.

Based on review of clinical records and interview with hospital personnel it was determined that the facility failed to inform residents of their Medicaid benefits and which services are covered under the program.
Findings were:
Review of patient ' s records on March 05, 2013 and March 6, 2013 revealed that 6 of 20 records did not provide evidence that the patients had been given the opportunity to review and sign the document titled: Conditions of Admission which contains the heading: Medicaid Acknowledgement. The paragraph under this heading states the following: " I have been informed that I may be held responsible for payment of the following___________________ if it is determined by NHIC that these services are not a benefit for the Medicaid program or if it is determined that these services were not medically necessary for my condition." Furthermore, the facility failed to provide patients with explanation regarding Medicare and Medicaid and the patient's financial obligations prescribed by law for 6 of 20 records reviewed. Paragraph number eight of the Scott&White Healthcare form titled General Consent for Treatment/Financial Responsibility/Advance Directive Information states the following: " If I have Medicare or Medicaid, my financial obligations may be limited by law. Other insurance carriers may limit my obligations by contract or policy benefit guidelines. If I do not have insurance coverage, I may ask for help to determine programs for which I may be eligible."
The following patients were not provided an opportunity to review and sign the Conditions of Admission document:
Patients # 2, 3, 12, 13, 17, 18, and 19.
The following patients were not provided an opportunity to review and sign the form titled "General Consent for Treatment/Financial Responsibility/Advance Directive Information":
Patients # 2, 3, 12, 13, 17, and 18.
During interview, the Chief Nursing Officer confirmed that the documents where not signed by the patients as stated above.

Based on record review and interview, it was determined that the facility failed to ensure that 5 out of 5 swing bed patients received a complete "comprehensive assessment" upon admission to the swing bed.

Findings were:

The following swing bed patients had no evidence indicating that an assessment of their "activity pursuit" was included in their "comprehensive assessment":
? Patient #2; physician orders to admit the patient to swing bed on 1/25/13.
? Patient #3; physician orders to admit the patient to swing bed on 2/14/13.
? Patient #17; physician orders to admit the patient to swing bed on 12/31/12.
? Patient #18; physician orders to admit the patient to swing bed on 2/20/13.
Patient #1 was a current inpatient during the survey and had orders to admit the patient to swing bed on 2/20/13. Patient #1 had an activity pursuit assessment; however this was completed on the final day of the survey on 3/6/13.

The above findings were confirmed with the facility's social worker/activities coordinator on 3/6/13.

In an interview with the Chief Nursing Officer on 3/6/13, she stated that the facility had no specific policy for a "comprehensive assessment" for swing bed patients. She stated that the facility policy entitled "Nursing Assessment, Reassessment and Admission ...Number 601.185" was used for both swing bed and acute-care/non-swing bed patients.