HospitalInspections.org

Based on observation, interview, and record review the facility failed to ensure that all essential patient care equipment is maintained in safe operating condition.

Finding includes:

On 02/03/2017at 10:30 AM met with the Maintenance/Housekeeping Supervisor (MAIN) to review the patient care equipment schedule for maintenance. The MAIN stated patient gurneys and wheelchairs are cleaned when soiled and maintained annually. When asked for an inventory of gurneys and wheelchairs the MAIN stated there was none. When asked for a cleaning and maintenance schedule for the gurneys, wheelchairs and other patient care equipment the MAIN stated there was no documented schedule for cleaning and maintenance. The MAIN agreed that there should be an inventory and documentation of cleaning and maintenance for patient care equipment. Permanent personal care equipment should be maintained to ensure their safety, availability and reliability.

Based on observations and interviews the facility failed to provide active surveillance to monitor and evaluate preventive intervention practices of personnel in the control of infections and communicable diseases.

Finding includes:

On 02/01/2016 at 2:17 PM observed the lab room door opened with no personal in the lab. Observed the following in the lab: a sharps container filled to the fill indicator line resting on top of a desk that faced the entrance door; an orange biohazard bag on the floor in front of the desk facing the door entrance about half filled and closed with tape; various random lab equipment; and two refrigerators. Waited at the entrance to the lab until a random person appeared. The random person identified self as a visiting staff. Asked the random staff where the lab tech was and was told would look for the lab tech. Observed outside of the lab door the entrance to the facility with double auto open glass sliding doors and the parking lot. There was no staff observed at the door entrance. The random person returned and said was unable to locate the lab tech but would continue to look and left. Continued to wait at the opened lab door, at 2:22 PM the Lab Tech appeared. When asked the policy on leaving the lab room opened the Lab Tech stated, "I close the lab door only if I am gone for a long time." When asked the policy for storage of biohazard waste the Lab Tech stated, "the other tech forgot to take the biohazard bag this morning and this is where it is stored". When asked about the level of used needles in the sharps container being close to the fill line the Lab Tech shook the sharps container and said "not quite at the fill line". Observed needles sticking upright in the sharps container, near the fill line. Later that afternoon interviewed the ADM on the observation and interview with the Lab Tech. The ADM agreed that the lab door should not be left opened when there is no Lab personal present; the sharps container was mishandled and the biohazard waste needs to be stored. The CAH is responsible to monitor the lab room is a safe, secure, and sanitary environment.

Based on record review and interview with staff members, the facility failed to provide nursing services for 1 (Patient #25) of 28 patients in the sample.

Finding includes:
Cross Reference to C396.

Patient #25 was admitted to the facility on 1/24/17 from an acute facility and was placed in a swing bed. Record review on the afternoon of 2/1/17 found a history and physical dated 1/25/17. The diagnoses included: gait instability; weakness; hypoalbuminemia; decubitus ulcer of coccygeal region, stage 1; peripheral neuropathy; urinary tract infection; degenerative disc disease, lumbar; chronic pain; PTSD; history of stroke; seizure disorder; and meniere disease. The physician recommended the following: physical and occupational therapy evaluation and treatment; further assess the patient's nutritional status in light of the hypoalbuminemia with a pre-albumin level and encourage protein intake which may require further intervention in terms of diet or supplements; and the decubitus ulcer to be treated with topical and frequent shifting of weight as well as good care for incontinence.

A review of Patient #25's plan of care found the facility did not develop goals and interventions to address the Stage 1 decubitus ulcer of the coccygeal region. An interview and concurrent record review with the Licensed Nurse #1 (LN #1)on 2/1/17 at 2:37 P.M. confirmed a care plan to address the treatment and prevention of decubitus ulcer was not developed.

On 2/3/17 at 10:30 A.M. a follow up interview was conducted with the LN #1. The licensed nurse confirmed there is no physician order for the treatment of the decubitus ulcer. The licensed nurse also confirmed nursing has not been doing skin checks for this resident; therefore, the status of the decubitus ulcer on the coccygeal and the patient's overall skin integrity has not been assessed.

The facility failed to provide nursing services to assess and treat Patient #25's decubitus ulcer. The facility also failed to provide nursing services for further prevention of skin breakdown (decubitus ulcer).

Based on record review and interview with staff members, the facility failed to develop a comprehensive care plan for 1 of 28 patients in the sample.

Findings include:
Cross Reference C396.

Patient #25 was admitted to the facility on 1/24/17 to a swing bed from an acute facility. Record review done on the afternoon of 2/1/17 found a history and physical dated 1/25/17. The diagnoses included: gait instability; weakness; hypoalbuminemia; decubitus ulcer of coccygeal region, stage 1; peripheral neuropathy; urinary tract infection; degenerative disc disease, lumbar; chronic pain; PTSD; history of stroke; seizure disorder; and meniere disease. The physician recommended the following: physical and occupational therapy evaluation and treatment; further assess the patient's nutritional status in light of the hypoalbuminemia with a pre-albumin level and encourage protein intake which may require further intervention in terms of diet or supplements; and the decubitus ulcer to be treated with topical and frequent shifting of weight as well as good care for incontinence.

A review of the patient's care plan found interventions for comfort/pain; activities of daily living; potential/history of falls; and decreased mobility. There was no documentation of a care plan developed for the treatment of the decubitus ulcer or to address the hypoalbuminemia. Also, there was no documentation of a care plan to address further breakdown of the patient's skin.

On 2/1/17 at 2:37 P.M. an interview and concurrent record review was conducted with the Licensed Nurse #1 (LN #1). The licensed nurse confirmed there is no order for the treatment of the decubitus ulcer and a care plan was not developed for healing and prevention. The licensed nurse reported the Registered Dietitian (RD) was not consulted regarding the patient's hypoalbuminemia and the patient does not receive supplements. However, the licensed nurse reported another lab was done on 1/25/17 which found the albumin levels within normal limits.

The facility failed to develop a comprehensive care plan to address Patient #25's current needs and prevention of decubitus ulcers and hypoalbuminemia for the patient to maintain the highest practicable physical well-being.

Based on record review and interview with staff members, the facility failed to ensure a comprehensive care plan was developed by an interdisciplinary team for 1 (Patient #25) of 28 sampled patients.

Findings include:
Cross Reference to C395.

Patient #25 was admitted to the facility on 1/24/17 into a swing bed. A record review done on the afternoon of 2/1/17 found a history and physical dated 1/25/16 with diagnoses of hypoalbuminemia. The physician recommended further assessment of the patient's nutritional status related to diagnosis of hypoalbuminemia (encourage protein intake and assess for use of supplements). The physician also made a recommendation for a referral to physical and occupational therapy for evaluation and treatment. On 2/1/17 at 2:37 P.M. an interview and concurrent record review was done with Licensed Nurse #1 (LN #1). Queried the licensed nurse regarding who participates in the development of patient's care plans, the nurse responded the admitting nurse develops the care plan and will make referrals if necessary.

The facility failed to ensure a comprehensive care plan is developed with physician participation and other professional disciplines (Registered Dietitian and therapists) as appropriate to benefit residents.