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Based on observation and staff interview, the facility failed to have a working audible alarm system on the blood bank refrigerator.

Findings included:
1. 42 CFR part 493, Subpart K, D5555, 493.1271(c): Blood and blood products must be stored under appropriate conditions that include an adequate temperature alarm system that is regularly inspected. (c)(1): An audible alarm system must monitor proper blood and blood product storage temperature over a 24-hour period. (c)(2) Inspections of the alarm system must be documented.
2. On 1/20/10 between 1:00 p.m. and 3:00 p.m. during laboratory tour, it was observed that there was a refrigerator containing blood products in the laboratory area.
2. Upon request for documented inspections i.e. alarm checks, laboratory staff person #10 conveyed the audible alarm system was not at present working and the search for parts to repair the audible alarm system had so far proved to be unsuccessful.

Based on document review and interview, the hospital failed to document annual preventive maintenance (PM) for 2 pieces of mechanical equipment and 1 piece of patient care equipment in accordance with the manufacturer's recommended maintenance schedule.

Findings:

1. Review of the manufacturer's recommended maintenance schedule for the V1710 Series Diesel Engine (emergency generator) indicated that the annual PM recommended items including, but not limited to, lubrication of electrical equipment, lubrication of water pump and fan hub and steam cleaning of the engine.

2. Review of the Maintenance Schedule Check List of the Cummins generator Model Number 6D500F indicated it did not include some of the annual items indicated in the manufacturer's recommended maintenance schedule, including but not limited to lubrication of electrical equipment, lubrication of water pump and fan hub and steam cleaning of the engine.

3. On 1-20-10 at 3:00 pm, employee #A8 was requested to provide documentation of the above emergency generator PM activities and none was provided prior to exit.

4. Review of the manufacturer's manual for scheduled maintenance for the 2006 Ford E450 van V8-363 6.0L Diesel indicated maintenance items at 37,500 miles included, but were not limited to, tire rotation and inspection of air filter restriction gauge.

5. Review of the Service Invoice from Exhaust Plus dated 9-30-09, mileage 43542, indicated the tire rotation and inspection of the air filter restriction gauge were not performed.

6. On 1-21-10 at 10:15 am employee #A1 was requested to provide documentation of the vehicle having tire rotation and inspection of air filter restriction gauge on or about mileage of 37500 and none was provided prior to exit.

7. Review of the manufacturer's recommendation shell for Set-Up and Check-out Procedure for the automated external defibrillator (AED) indicated to check AED Plus unit periodically to ensure that green check symbol (Checkmark) appears in status indicator window.

8. On 1-20-10 at 3:30 pm, employee #A1 was requested to provide documentation of the facility's policy and procedure and evidence of PM on the AED. No documentation was received prior to exit.

Based on policy/procedure review, patient transfusion record review, and staff interview, the facility failed to follow approved medical staff policies/procedures for three (#1, #3, and #5) of six transfusion records reviewed.

Findings included:
1. A policy/procedure titled "Blood and Blood Product Administration, Section Number 1113" which contains: "I. E. 20. If there are no adverse reactions during this 30 minute observation time, increase rate so that no more than 4 hours will pass from the time the blood was removed from the refrigerator to the completion of the transfusion."
2. During transfusion record review on 1/20/10 between 1:00 p.m. and 3:00 p.m., patient transfusion records #1, #3, and #5 were found to exceed the four hour limit by 15 minutes, 10 minutes, and 15 minutes respectively.
3. In interview, during transfusion record review, staff person #9 conveyed the above documentation is as found in the records and facility policy/procedure was not followed in the three of six patient transfusion records reviewed.

Based on observation, document review and interview, the hospital failed to store outdated drugs in a separate area from general inventory in 1 instance and failed to follow its policy to ensure the monthly inspection of 3 areas where drugs were stored.

Findings:

1. On 1-19-10 at 2:10 pm in the presence of employees #A1 and #A8, the following outdated drugs were observed in a drug cabinet in Physical Therapy:
1% lidocaine HCl 50 ml - 7 vials, expiration date 10-08
.9% NaCl 30 ml, - 6 vials - expiration date 10-09

2. Review of hospital policy NO: PH-25, entitled APPROVED FLOOR STOCKS, RECORDKEEPING, AND ACCOUNTABILITY, indicated the pharmacist or his designee will make monthly inspections of all floor stock areas. It further indicates inspections will be documented.

3. On 1-19-10 at 11:50 am, employee #A10 was requested to provide documentation of monthly inspections of 2 areas in the Medical Office Building and the RMH Pediatrics building where drugs were stored. No documentation was provided prior to exit.

Based on document review and interview, the facility failed to inform each resident who is entitled to Medicaid benefits, in writing, at the time of admission to the nursing facility or, when the resident becomes eligible for Medicaid of the items and services that are included in nursing facility services under the State plan and for which the resident may not be charged; those other items and services that the facility offers and for which the resident may be charged, and the amount of charges for those services and inform each resident before, or at the time of admission, and periodically during the resident's stay, of services available in the facility and of charges for those services, including any charges for services not covered under Medicare or by the facility's per diem rate for 2 of 2 swing bed medical records (MR) reviewed.

Findings include:

1. Review of patient #6's MR indicated that the patient was admitted to the swing bed unit on 11-25-09 and lacked documentation that the patient or the patient's legal representative was informed of what items may have charges.

2. Review of patient #7's MR indicated that the patient was admitted to the swing bed unit on 11-10-09 and lacked documentation that the patient or the patient's legal representative was informed of what items may have charges.

3. On 01-21-10 at 0915 hours, staff #42 confirmed that the facility does not provide documentation to the patients or the patient's legal representative of what items are not covered by either Medicaid or Medicare.

Based on document review and interview, the facility failed to ensure that before a facility transfers or discharges a resident, the facility must notify the resident and, if known, a family member or legal representative of the resident of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand and record the reasons in the resident's clinical record for 2 of 2 swing bed medical records (MR) reviewed.

Findings include:

1. Review of patient #6's MR indicated the resident was admitted as a swing bed patient on 11-25-09 and was discharged on 12-01-09. Patient #6's MR lacked documentation that the resident or a legal representative of the resident was notified of the reasons for the discharge in writing.

2. Review of patient #7's MR indicated the resident was admitted as a swing bed patient on 11-10-09. Patient #7's MR lacked documentation that the resident or a legal representative of the resident was notified of the reasons for the discharge in writing.

3. On 01-20-10 at 1505 hours, staff #42 confirmed that the facility does not give written notice of transfer/discharge to swing bed residents.