HospitalInspections.org

.
Based on observation, Medical Record review, and interview, in two (2) of five (5) Medical Records reviewed, the facility did not ensure that patients placed in non-violent restraints were consistently monitored and reassessed per facility Policy.

This lack of timely reassessment of patients places them at risk for injury.

Findings include:

The facility Policy and Procedure titled "Restraint Policy" last revised February 6th 2017, contained the following statements: "Standard of Care: Non-Violent Restraints .... Assessments (circulation and psychological status) are conducted every 30 minutes and documented in nonviolent flow document in the Electronic Health Record (EHR) .... range of motion, fluids, nutrition, elimination and release from restraint are documented in the nonviolent flow document in the (EHR) at the minimum of every two hours."

Review of Patient #14's Medical Record on 08/21/17, identified the following: Patient #14 was admitted on 08/10/17 and placed on non-violent restraints on 08/12/17 at 1:34AM.

A review of the restraint monitoring flow document revealed missing documentation of the half (1/2) hour and two (2) hour assessments on 08/12/17 from 2:05PM to 7:00PM, missing half (1/2) hour assessment on 08/12/17 at 11:00PM, missing documentation of the half (1/2) hour and two (2) hour assessments on 08/13/17 from 5:30AM to 7:05AM and 4:16PM to 7:00PM.

These observations were made in the presence of Staff Members L and K who acknowledged that the staff should have documented the half (1/2) hour and two (2) hour assessments per facility Policy.

Review of Patient #43's Medical Record identified that on 08/19/17, the restraint flow document lacked a recorded half (1/2) hour assessment for 6:30PM and on 08/20/17 at 2:00AM the two (2) hour assessment wasn't documented.

These observations were made in the presence of Staff Members L and K who confirmed the findings.
.

.
Based on Medical Record review, document review, and interviews in four (4) of five (5) Medical Records reviewed, the facility did not ensure that the Medical Records were complete. This was evident by the inconsistent documentation by the Respiratory Therapy Staff regarding Patient Assessments when receiving nebulizer treatments.

These lapses in documentation has the potential to adversely affect the provider's ability to monitor and provide appropriate patient care.

Findings:

The facility Policy and Procedure titled "Department: Medication Management - Nebulizer Treatments" last revised on 12/28/15 states: "The Respiratory Therapist administers aerosolized medications via nebulizers on all inpatients."

The Policy further states under "Procedures: (#5) Assess vital signs and breath sounds, then (#9) When medication has been nebulized, discontinue therapy and assess patient for response to therapy or advise reactions; and (#12) Chart all appropriate information on the respiratory medication administration record."

Review of Patient #48's Medical Record revealed that the patient was admitted on 08/10/17 with a diagnosis of COPD (Chronic Obstructive Pulmonary Disease). The patient was started on hand held nebulizers every six (6) hours when awake. The Respiratory Therapy Staff documented that the patient was receiving the treatments, which where tolerated well, but there is no assessment of the patient breath sounds on 08/10/17 at 8:05AM and 8:48PM or on 08/11/17 at 8:37AM, 1:45PM and 7:18PM. The Medial Record then lacks the same documentation of breath sound assessments or if the patient tolerated the treatments on 08/12/17 and 08/13/17.

The same lack of documented regarding Patient Assessments before and after nebulizer treatments were found in the Medical Records for Patients #14, #46 and #47.

These findings were confirmed by Staff Members O and P during review of the Medical Records on 08/24/17.
.

.
Based on observations, staff interview, and review of documents, it was determined that the Director of the Food and Dietetic Services was not responsible for the daily management of the Dietary Services. The Food Service Director failed to monitor all areas of the Kitchen including, sanitation, safety practices for food handling and preparation.

This represents a high risk for cross-contamination.

Findings include:

1. A tour of the Kitchen was conducted on 08/21/17 at 10:50AM. During the tour the following observations were noted:

a) There was no separation between clean and dirty in the Manual Pot Washing Area of the Kitchen. Two (2) shelves with clean pots and pans were observed stored next to the pot washing sink that was filled with dirty pots, pans. Clean pots and pans were also stored on the counter at the end of the three (3) compartment dishwashing sinks.

During the tour a Dietary Staff Member placed a cart with dirty pans alongside the shelves with clean pots and pan. These clean pots, pans and trays were inappropriately stored, which expose these items to splash from dirty water and food debris.

b) A dirty spatula was observed in the hand washing sink.

c) Pizza and Blodgett Oven exteriors were observed to be dirty with a grease build up.

d) Two (2) bags of rolls were observed stored in a Hobart Mixer that was sitting on the top of a preparation table.

e) Unwrapped utensils were observed sitting in a dirty pan with food debris on the lower shelf of a preparation table.

g) Two (2) fans located near clean pots and pans were observed to be heavily laden with dirt and grime.

h) Three (3) containers of prepared foods were found with outdated use by dates:

--- Cooked turkey meatballs with a use by date of 08/20/17.

--- Bolognese sauce with a use by date of 08/20/17.

--- Tartar sauce with a use by date of 08/01/17.

i) Inconsistent compliance with hair covering:

--- An outside vendor was observed walking through the Kitchen to deliver to the Café without any head covering.

--- A Dietary Aide with a goatee was observed serving on the tray line without facial hair covering.

--- A Dish Washer with full beard was also observed without facial hair covering.

The facility Policy and Procedure titled "Infection Control Procedures (Nutritional Services Department Specific)" last revised October 2015 contained the following statements:

"Purpose: To prevent and control contamination and the spread of infection within the department and the hospital.

Responsibilities: The Nutritional Services Director and Manager shall:

Ensure clean and sanitary work areas, storage areas and equipment.

Develop written standards and work procedures (job breakdown) for daily operations that minimize the contamination of food by microorganism or by chemical".

The findings as noted above were confirmed during interviews with the Food Service Director and Executive Chef who were all present during the inspection tour.