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Based on policy review, medical record review and interview, the facility failed to ensure a safe environment by failing to provide documentation of bathing for two of three (Patient #6 and Patient #7) patients reviewed for personal hygiene related care and failed to document turning and repositiong for one of three (Patient #6) patients reviewed for skin breakdown prevention measures.

The findings included:

1. Review of the facility's "Personal Hygiene" policy revealed, "...2. Bathing- provided daily and PRN [as needed]...DOCUMENTATION: Document in the medical record care delivered...".

2. Review of the facility's "NO ULCERS BUNDLE and Skin Care Policy" revealed, "...Reposition at least every 2 hours rotating sides and back as clinically indicated..."

3. Medical record review revealed Patient #6 was admitted to Satellite Hospital #3 on 1/21/2021 with diagnoses that included Altered Mental Status, Acute on Chronic Kidney disease and positive test for COVID-19. Patient #6 was discharged from the facility on 1/25/2021. There was no documentation Patient #6 received bathing care on 1/22/2021.

Review of Patient #6's "Safety/ADL [Activities of Daily Living]" flowsheets from 1/21/2021 through 1/25/2021 revealed the following:

1/22/2021- No documentation of turning or repositioning from 12:13 AM until 1:49 PM.
1/24/2021- No documentation of turning or repositioning from 11:41 AM until midnight on 1/25/2021.

4. Medical record review revealed Patient #7 was admitted to Satellite Hospital #3 on 1/28/2021 with diagnoses that included Respiratory Failure secondary to COVID-19 Pneumonia, Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF). Patient #7 was hospitalized until she expired on 3/8/2021. There was no documentation Patient #7 received bathing care on 2/2/2021, 2/9/2021, 2/16/2021, 2/17/2021 and 2/22/2021.

In an interview on 4/7/2021 at 10:30 AM in the conference room, Quality Director #1 and Risk Manager #1 verified the missing documentation for Patient #6 and Patient #7.

Based on policy review, medical record review and interview, the facility failed to ensure the family of a gravely ill patient was allowed visitation for a family meeting for one of three (Patient #7) patients reviewed for visitation access.

The findings included:

1. Review of the facility's "Visitation Policy During COVID-19 Pandemic" policy revealed, "...recognizes the importance of family support in the healing process and limited visitation is being implemented...Patients at end-of-life may have a very limited number of visitors who must remain in the room for the duration of the visit...For any other unusual situations, the house supervisor or clinical director/manager of the unit will determine if visitors are allowed..."

2. Medical record review revealed Patient #7 was admitted to Satellite Hospital #3 on 1/28/2021 with diagnoses that included Respiratory Failure secondary to COVID-19 Pneumonia, Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF). The patient was intubated due to poor respiratory status on 1/31/2021. Patient #7's prognosis was documented as "grave" throughout the remainder of her hospital course, until she expired on 3/8/2021.

Review of a 2/12/2021 attending physician's progress note revealed the physician spoke on the phone with Patient #7's daughter-in-law. It was determined the patient's daughter would arrive in town the following week. The daughter-in-law would let the patient's nurse know the day of arrival, so a family meeting could be arranged with the daughter and medical staff.

In an interview on 4/7/2021 at 11:30 AM in the conference room, Patient Advocate #1 verified Patient #7's daughter traveled to the facility from out of state. The daughter arrived at the facility on 2/19/2021. The city was undergoing a winter storm and boil water advisory. Due to these factors, the facility had closed to visitors. Patient Advocate #1 admitted there was a break-down in communication between the physician, nursing staff and screeners that work at the front entrance of the hospital, related to the daughter arriving for a family meeting. Patient Advocate #1 stated there could have been exceptions made for the daughter, since she came from such a long distance away.

In an interview on 4/8/2021 at 11:25 AM per telephone, Palliative Nurse Practitioner #1 verified Patient #7's daughter traveled from out of state (California) and arrived at the facility during a snowstorm. The daughter was turned away, and not allowed in the hospital. Palliative Nurse Practitioner #1 stated she knew the daughter was very upset and didn't blame her. The Nurse Practitioner stated, "I would have been very upset too". The daughter returned to the hospital on 2/20/2021 and was only allowed a one hour visit with Patient #7. No family meeting occurred.

Based on policy review, medical record review, and interview, the hospital failed to ensure the registered nurse inventoried a patient's valuables and personal belongings upon admission for 2 of 3 (Patient #3 and 4) sampled patients admitted to Satellite Hospital #1.

The findings included:

1. Review of the hospital's policy, "[Abbreviation for healthcare system] Patient Valuables Policy," revealed, "...Purpose: To ensure that patient valuables are properly and safely collected, stored, tracked, and dispositioned...General Information...Valuables are any item having a value of over $50, or otherwise deemed to be of significant value (electronics, jewelry, cash, weapons, vehicle keys, medications, etc. [and so forth]....Collection/Receiving of Patient Valuables...Upon receiving a patient, the responsible care provider shall ask the patient if they are in possession of any valuables..."

2. Medical record review revealed Patient #3 was admitted to Satellite Hospital #1 on 1/13/2021 with diagnoses that included Acute Encephalopathy, New Onset Seizure Disorder, Newly Diagnosed Diabetes Mellitus, and Hypertension.

The Adult Admission History Form dated 1/14/2021 at 11:06 AM revealed there was no documentation whether Patient #3 had personal belongings/valuables or not. There was no documentation Patient #3's personal belongings/valuables were inventoried during the hospital stay.

In an interview on 4/7/2021 at 10:55 AM in the conference room, Director of Quality Management #1 stated Patient #3's son brought two hearing aids for Patient #3 while in the emergency department. Director of Quality Management #1 stated Patient #3 had both hearing aids when the Adult Admission History Form was completed, and the nurse should have documented the hearing aids on the form as valuables.

3. Medical record review revealed Patient #4 was admitted to Satellite Hospital #1 on 1/9/2021 with diagnoses that included Coronavirus Infection, Rhabdomyolysis, Altered Mental State, Dehydration, Cocaine Use, Abdominal Pain, Hypertension, Coronary Artery Disease, and History of Traumatic Brain Injury.

The Adult Admission History Form dated 1/10/2021 at 12:00 PM revealed there was no documentation whether Patient #4 had personal belongings/valuables or not. There was no documentation Patient #4's personal belongings/valuables were inventoried during the hospital stay.

In an interview on 4/7/2021 at 11:05 AM in the conference room, Director of Quality Management #1 stated Patient #4's daughter complained that Patient #4 had clothes and a set of keys missing. Director of Quality Management #1 stated these items were not confirmed or inventoried by the registered nurse upon admission.

4. In an interview on 4/7/2021 at 11:39 AM in the conference room, Director of Quality Management #1 stated there was a place on the Adult Admission History Form to document whether a patient had personal belongings or valuables. Director of Quality Management #1 stated the registered nurse should ask the patient if they have any personal belongings or valuables when completing the admission assessment. Director of Quality Management #1 confirmed the registered nurse for Patient #3 and Patient #4 did not document whether the patient had any personal belongings or valuables.