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Based on interview and record review, the facility's registered nurse (RN) did not supervise and evaluate the nursing care for Patient # 5 in that the RN (Personnel #9) did not document the discontinuation of Patient #5's Intravenous (IV) and the subsequent attempts to restart the IV without success.

Findings included:

On 10/22/2020 Patient #5's IV was was discontinued by the patient. The Physical Assessment dated 10/22/2020 at 0720 reflected ..."Notified in report pt. (patient) has no IV, talked to patient complains of pain 8/10. notified patient will be back and will try to start a IV ..."

During an interview on 10/26/2020 at 1315 Personnel #8 stated they "were informed during morning huddle that Patient #5 had pulled out his IV during the night and the staff had been unable to restart it. Personnel #8 stated the physician had order a PICC line peripherally inserted central catheter). Personnel #8 stated he went in and started a new IV on the patient, and the patient already had two pieces of gauze on his hand were the night nurse had tried to restart the IV."
During a chart review on 10/26/2020 ending at approximately 1330 Personnel #1, Personnel #6 and Personnel #8 verified there was no documentation the IV had been discontinued, attempted to be restarted or restarted in the medical record.

The Policy titled Documentation Guidelines Effective 03/04/2013 reflected..." Documentation of patient care will be uniform according to the following guidelines...record any unusual incidents, including:...Address all interventions/treatments on the clinical path plan, include patient response..."

Based on Observation and record review the hospital failed to employ methods for preventing and controlling the transmission of infections within the hospital and between the hospital and other institutions and settings in that 4 personnel( Personnel #4, #5, #6, and #7) either did not wear a mask or were wearing their mask improperly while on duty in the hospital. The hospital failed to clean the Emergency Room waiting room chairs on 10/25/2020. The hospital failed to have personnel in the Emergency Room waiting area to screen patients and visitors prior to entrance into the hospital.

Findings included.:

On 10/26/2020 at approximately 0912 the surveyor entered the hospital through the Emergency Room door. There was no personnel assessing visitors for signs and symptoms of Covid-19, to encourage the use of hand sanitizer, or make sure visitors were wearing a face covering. The surveyor was screened when taken into the patient care area of the Emergency Room after spending approximately 15 minutes in the Emergency Room waiting area.
The Crescent Medical Center Lancaster Disinfecting of Waiting Room Chairs documentation that was attached to the wall in the Emergency Room waiting area was noted to have last been documented on 10/24/2020.
During a tour of the facility with Personnel #2 on 10/26/2020 ending at 1025 the following was observed. Personnel #4 was observed pushing medical equipment down the hallway on the third floor with their mask under their nose. Personnel #5 was noted to be walking in the hallway on the third floor with no mask in place and sitting in their office with the door open with no mask in place. Personnel #6 was noted in the first floor hallway with their mask under their nose and Personnel #7 was sitting at the Emergency Room nurses station without a mask in place.

During the tour of the facility on 10/26/2020 ending at 1025 Personnel #2 verified the above findings. During an interview on 10/26/2020 at 1355 in the Conference Room Personnel #2 stated the hospital followed the CDC guidelines for infection control

The Policy titled COVID-19 Interim Guidance-Universal Masking effective 07/2020 reflected..." The CMCL
(Crescent Medical Center Lancaster) organization shall implement COVID-19 source control that requires universal masking.

The Policy titled Interim Infection Prevention and Control Recommendations for Patients with Known or Suspected COVID-19 Effective reflected..."Implement Environmental Infection Controll...This facility shall ensure that environmental cleaning and disinfection procedures are followed consistently and correctly..."

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html reflected..."HCP (health care professionals) should wear a facemask at all times while they are in the healthcare facility, including in break rooms or other spaces where they might encounter co-workers...Screen and Triage Everyone Entering a Healthcare Facility for Signs and Symptoms of COVID-19...Limit and monitor points of entry to the facility...Consider establishing screening stations outside the facility to screen individuals before they enter..."