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Based on observation, it was determined that the facility failed to ensure the safety of its patients in all patient areas.

Findings were:

In the patient bathing area next to the nurses ' station, there was no emergency pull cord. In a patient/staff restroom located near the laundry room, there again was no emergency pull cord.

In an interview with the RN Risk Manager on 3/24/10, it was confirmed that the above mentioned patient restroom and bathing area lacked emergency pull cords.

Based on observation and interview, it was determined that the facility failed to ensure that outdated medications and supplies were not available for patient use.

Findings were:

Facility policy entitled " Hospital Pharmacy Outdated Drugs " stated " The pharmacy will remove all medications that will expire by the end of or before the end of the current month. "

When asked how long a multi dose vial of medication was usable after it was opened, staff members #20 (LVN) and #15 (RN) stated " The vials should be discarded 30 days after opening. "

The following expired medications were found in the nurses ' station medication preparation area:

? Multidose injection vial of Cyanocobalamin opened 2/16/10 (expired 3/16/10)
? Multidose vial of Lidocaine opened 2/19/10 (expired 3/19/10)
? Open multidose vial of Maracaine 0.5% with no label indicating the date the vial was opened or of the nurse who opened it.

The following expired medications were found in the Emergency Room:

? 2% Xylocaine expired 2/09
? 2% Lidocaine expired 6/08
? 1% Lidocaine expired 1/10

The following expired medication was found in Central Supply:

? 70% Isopropyl expired 10/08

The above expired medications were confirmed by the Chief Executive Officer in an interview on 3/24/10.

Review of documentation revealed that the facility ' s medical staff failed to authenticate verbal orders in a timely manner.

Findings were:

? Patient # 6 had unsigned physician ' s orders noted 3/21/10 and an unsigned radiology report dated 3/19/10
? Discharged patient # 8 had an unsigned physician ' s order noted on 3/4/19
? Patient # 11 had unsigned physician ' s orders noted on: 3/18/10 and 3/19/10
? Patient # 12 had an unsigned physician ' s order noted 2/18/10
? Patient # 13 had an unsigned physician ' s order noted 3/11/10

In an interview with the Chief Executive Officer, the RN Risk Manager and the Assistant Director of Nurses, the above unsigned orders were acknowledged.

Based on review of documentation, it was determined that the facility failed to maintain complete medical records.

Findings were:

Facility policy entitled " Completion of Records " stated " A History and Physical is expected to be on the medical record within 24 hours of admission. "

Review of the medical records for patients #6 and 11 revealed no evidence of a History and Physical.

In an interview with the RN Risk Manager and the Assistant Director of Nurses on 3/24/10, the above findings were acknowledged.

Based on review of documentation, it was determined that the facility failed to conduct an annual review of its policies and procedures.

Findings were:

Policy and procedure manuals for Nursing, Pharmacy and Physical Therapy had not been reviewed since 2008.

In an interview with the Chief Executive Officer on 3/24/10, it was confirmed that the facility had not reviewed all of its policies since 2008.

Based on review of records, it was determined that the facility did not provide complete comprehensive assessments that addressed the resident's needs.

Findings were:

Facility Policy entitled " Swing Bed Admission " stated " The Activity Director will complete the activity admission. " The same policy further stated " Dietary services will complete the nutritional assessment. All assessments will be completed within 72 hours of admission."

Patient # 12 (swing bed) had no nutritional or dental assessment
Patient # 14 (swing bed) had an incomplete activities assessment
Patient # 18 (swing bed) had an incomplete dental assessment

In an interview with the Chief Executive Officer, the Assistant Director of Nurses and the RN Risk Manager on 3/24/10, the above incomplete assessments were acknowledged.