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Based on observations, clinical record review, and staff interviews, the facility failed to receive care in a safe setting by not having the call lights available in the Emergency Room for two of eight patients directly interviewed. (Patients #1 and #2)

The findings include:

1. Patient #1's Emergency Room (ER) medical record documented complaints of back, hip, and abdominal pain. She was admitted to the hospital on 1/27/2014 after her visit in the ER with an elevated white blood cell count and Atrial Fibrillation (heart rate above 160 beats/minute).

On 1/27/2014 at 11:13 a.m. Patient #1 was observed in the ER bed without the call light within her reach. The nursing staff were not visible. When asked how she would call the nurse, she did not know. She stated she had not been given a call light to summon the nurse. She was 78 years old and appeared very thin and frail. She was cognitively alert and oriented, answering questions appropriately.

2. Patient #2's Emergency Room (ER) medical record documented head pain per physician referral. He was discharged to home after his visit with antibiotics for cellulitis of the left thigh.

On 1/27/2014 at 11:19 a.m. Patient #2 was observed in the ER bed without the call light within reach. The nursing staff had just arrived at the bedside prior to my interview and observations. Patient #2 was very alert and oriented and answered questions appropriately. When asked how he would call the nurse, he did not know. He stated he had not been given a call light to summon the nurse. The call light was against the wall entwined around a metal holder behind the patients head.

On 1/28/14 at 11:22 a.m., the nurse caring for Patient #2 stated the call light should be within reach of the patient, but the nursing station is very close to the stretcher rooms. It was noted that the stretcher rooms were close to the nursing station, but there was a lot of conversations happening. Some of the rooms had curtains pulled, where a patient may not be able to convey his/her wishes without shouting.

Based on observation, documentation, and interview the facility failed to secure supplies and medications in a proper manner.

The findings included:

Observations and interviews were conducted on January 27, 2014 and January 28, 2014. The facility's policy (Policy # 3.15) relating to the Storage and Security of Medications was reviewed on January 29, 2014 at approximately 9:15 a.m. The hospital's policy states "after removal, the drug must remain with the provider at all times and should not be left unattended."

1. Four pre-filled syringes of normal saline were found unsecured in the hall on a table on the Medical/Oncology unit on January 28, 2014. This area is accessible to the public. Staff #32 was handed the four syringes of normal saline by the surveyor.

2. Two supply carts with wheels containing sterile syringes and needles were found unsecured in the nursing station of the medical/oncology unit on January 28, 2014. One of the unsecured carts had a broken lock. One supply cart containing sterile syringes was found unsecured in the nursing station on the Rehabilitation Unit.

An interview was conducted with Staff #32 and Staff #3 while on the Medical/Oncology unit on January 28, 2014. Staff #3 verified the lock on the supply cart was not functioning properly. Staff #3 and Staff #18 verified the supply cart on the Rehabilitation Unit was not locked.

3. Observation and interviews were conducted on January 28, 2014, at 10:40 a.m. with Staff #33 while touring the Cardiac Critical Care Unit. A supply care was noted to have keys that were unlocked. The supply cart contained bags of intravenous fluids and various needles that were unsecured. Observations during a tour of a supply room that contained intravenous fluids and various needles contained two keys in the cart. Staff #33 left the supply room, and stated during interview that the supply room was unlocked. This interview occurred on January 28, 2014, at 10:52 a.m.

Based on the Life Safety Code Validation survey, completed on January 30, 2014, the Condition of Physical Environment is not met. Those deficient practices and the associated regulations can be found in the respective Life Safety Code survey (IUHL21).

Based on observations and a review of facility policy it was determined the facility staff failed to ensure infection control techniques were used in the handling of food in the kitchen and medication when passing medicine to two (2) of five (5) patients on the units, patients #39 and #40) .

The findings were:

On 1/28/2014 at 11:00 am observation of lunch tray assembly revealed two employee's preparing tray's for delivering to the patient care units. Employee #31 had gloves on and moved from his/her primary spot placing food on the trays to the microwave oven and to a free standing storage cart holding food. The employee failed to change gloves or wash hands between touching the door handles (dirty area) and returning to the patient tray line and preparation of food. The employee proceeded to pick up plates and bowls with the contaminated glove and his/her thumb would be inside of the clean plate or bowl where the food was then placed. This practice continued throughout the observation period.
Employee #32 had gloves on and passed clean plates to employee #31. Employee #32 moved to review a menu that was suspended by chains hanging from the ceiling over the food. The employee used the same gloved hands to thumb through the laminated menus and then returned to the end of the line and resumed picking up clean plates with contaminated gloves. The potential also exists for the chain and menus to gather dust and dirt that would drop onto the food when manipulated during food service.

The agency policy on hand hygiene states in part: " 1. Hand hygiene by hand washing or alcohol-based hand rub must be performed:... before eating, handling medications or preparing food."




33323

Observations were conducted on January 27, 2014 though January 28, 2014 of seven medication passes with five patients and five nurses.

An observation was conducted on January 28, 2014 at approximately 11:00 a.m. with Staff #19. Staff #19 did not perform hand hygiene prior to putting gloves on and then administering a medication to patient #40.

An observation was conducted on January 28, 2014 at approximately 1:15 p.m. with Staff #28. Staff #28 did not perform hand hygiene prior to touching patient #39, to take his/her blood pressure.

A review of the facility's policy entitled, "Hand Hygiene" revealed that hand hygiene by hand washing or alcohol -based hand rub must be performed:
a. Before and after each patient encounter
b. Before and after contact with patient's, client's, or resident's intact skin (e.g., taking a pulse or blood pressure, performing physical examinations, lifting the patient)...
f. Before eating, handling medications or preparing food ...
h. Before donning sterile or nonsterile gloves.

Based on observations and a review of facility policy it was determined the facility staff failed to ensure infection control techniques were used in the handling of food in the kitchen and medication when passing medicine to two (2) of five (5) patients on the units, patients #39 and #40) .

The findings were:

On 1/28/2014 at 11:00 am observation of lunch tray assembly revealed two employee's preparing tray's for delivering to the patient care units. Employee #31 had gloves on and moved from his/her primary spot placing food on the trays to the microwave oven and to a free standing storage cart holding food. The employee failed to change gloves or wash hands between touching the door handles (dirty area) and returning to the patient tray line and preparation of food. The employee proceeded to pick up plates and bowls with the contaminated glove and his/her thumb would be inside of the clean plate or bowl where the food was then placed. This practice continued throughout the observation period.
Employee #32 had gloves on and passed clean plates to employee #31. Employee #32 moved to review a menu that was suspended by chains hanging from the ceiling over the food. The employee used the same gloved hands to thumb through the laminated menus and then returned to the end of the line and resumed picking up clean plates with contaminated gloves. The potential also exists for the chain and menus to gather dust and dirt that would drop onto the food when manipulated during food service.

The agency policy on hand hygiene states in part: " 1. Hand hygiene by hand washing or alcohol-based hand rub must be performed:... before eating, handling medications or preparing food."




33323

Observations were conducted on January 27, 2014 though January 28, 2014 of seven medication passes with five patients and five nurses.

An observation was conducted on January 28, 2014 at approximately 11:00 a.m. with Staff #19. Staff #19 did not perform hand hygiene prior to putting gloves on and then administering a medication to patient #40.

An observation was conducted on January 28, 2014 at approximately 1:15 p.m. with Staff #28. Staff #28 did not perform hand hygiene prior to touching patient #39, to take his/her blood pressure.

A review of the facility's policy entitled, "Hand Hygiene" revealed that hand hygiene by hand washing or alcohol -based hand rub must be performed:
a. Before and after each patient encounter
b. Before and after contact with patient's, client's, or resident's intact skin (e.g., taking a pulse or blood pressure, performing physical examinations, lifting the patient)...
f. Before eating, handling medications or preparing food ...
h. Before donning sterile or nonsterile gloves.