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Based on interview and record review the facility failed to ensure the Dietary department manager met continuing education requirements to maintain professional certification as a Certified Dietary Manager (CDM). This deficient practice had the potential to permit outdated diet therapy and/or food service sanitation and safety practices to be used in patient meal service. The facility census was 11.

Findings included:

1. Record review of the Association of Nutrition and Foodservice Professional's (the credentialing organization for CDMs) web site showed food service management professionals who complete the CDM's course work and take the examination, were then required to earn 45 hours of continuing education (CE) every three years. At least five of the continuing education hours must be in sanitation and food safety.

2. Record review of a certificate of completion dated 11/17/78 showed Staff C, Dietary department manager, completed course work and passed the examination to be a CDM.

During an interview on 05/04/15 at 1:10 PM, Staff C stated that she had never attended any continuing education to earn CE hours to maintain certification because she did not know that was a requirement.

Based on observation, interview, and policy review the facility failed to ensure that staff followed infection control policies and standards when they failed to:
- Perform hand hygiene (wash hands with soap and water or use hand sanitizer) for four patients (#3, #20, #26 and #36) of four patients observed;
- Follow high-level disinfection procedures for endoscope (instrument for examination of the interior of the body) cleaning, for one of one scope cleaned, facility surgery log showed an average of 20 endoscopes cleaned per month;
- Limit immediate use steam sterilization (IUSS, formerly known as flash sterilization, a shorter dry time) for an average of six of eight eye surgeries per month;
- Maintain the cleanliness of laryngoscope blades (equipment used to insert a breathing tube in the mouth and throat) stored in one of one anesthesia cart in the Operating Room (OR).
These deficient practices had the potential to increase the risk of cross contamination and placed all patients, visitors, and staff at risk for infection. The facility census was 11.

Findings included:

1. Record review of the facility's policy titled, "Hand Washing," reviewed 01/2015, showed directives for staff to perform hand hygiene:
- Before and after giving care to a patient;
- Before and after performing invasive (entry into the body) procedures;
- After situations during which microbial (germs) contamination of hands is likely to occur, especially those involving contact with mucous membranes, blood or body fluids, secretions, or excretions; and
- After removing gloves.

2. Observation, with interview immediately following, on 05/04/15 at 2:25 PM showed Staff UU, Licensed Practical Nurse (LPN), emptied Patient #3's urinal, removed gloves, and documented the patient's output. Staff UU failed to perform hand hygiene after he removed his gloves. Staff UU confirmed he failed to perform hand hygiene after he removed his gloves. Staff UU stated that he was not sure what the facility policy instructed staff to do after gloves were removed.

3. Observation, with interview immediately following, in the wound clinic on 05/05/15 at approximately 9:33 AM showed Staff S, Director of Wound Clinic, held Patient #20's leg, then removed gloves, and removed supplies from the counter. Staff S failed to perform hand hygiene after she removed her gloves. Staff S stated that she failed to perform hand hygiene immediately after she removed her gloves because the supplies she removed were clean.

4. Observation on 05/05/15 at 9:15 AM showed Staff Z, Certified Registered Nurse Anesthetist (CRNA), placed an intravenous (IV, in the vein) tube for Patient #26. Staff Z removed his gloves, touched environment of the patient, the patient's medical record and then left the patient's surgery room. Staff Z failed to perform hand hygiene after removing his gloves.

5. Observation on 05/05/15 at 1:00 PM showed Staff Z, with gloved hands wiped patient's nose, administered medication into Patient #36's IV, and assisted with patient positioning. Staff Z failed to remove gloves and perform hand hygiene after wiping patient's nose and before administering medication and assisting with patient positioning (going from tasks where contamination of hands or gloves was likely.)

During an interview on 05/06/15 at 9:15 AM, Staff Z, stated that he needed to perform hand hygiene more often.

6. Observation on 05/05/15 at 1:15 PM showed Staff AA, Surgical Technician, with gloved hands assisted with skin cleaning for Patient #36's left hand surgery. Staff AA removed her gloves after washing the patient's arm. Staff AA failed to perform hand hygiene after glove removal.

During an interview on 05/06/15 at 11:10 AM Staff AA, stated that she should have performed hand hygiene after glove removal.

During an interview on 05/06/15 at 8:30 AM Staff H, Infection Prevention (IP), stated that she expected all staff to perform hand hygiene after staff removed gloves.

7. Record review of the facility's policy titled, "Endoscope Cleaning," reviewed 01/2015, showed directives for staff to:
- Irrigate and brush the channels (hollow tube inside endoscope);
- Conduct leak testing (check for internal leaks-holes in operating channels) on flexible endoscopes prior to immersion into cleaning solution and remove endoscope from service, if it leaks; and
- Wear protective gear, i.e., gown, gloves, mask and goggles, when cleaning and disinfecting the endoscopes.

8. Observation, with immediate interview following, on 05/05/15 at 9:00 AM showed Staff X, LPN/Instrument Technician cleaning an endoscope, Staff X:
- Failed to wear protective gear.
- Failed to perform leak test on the endoscope.
- Used a disposable brush (package labeled "do not reuse") and placed the brush in the solution to re-use for the next endoscope cleaning.
- Staff X stated that she did not wear personal gear.
- She did not have to do a leak test on the scope, that a product representative had told her this. and
- She checked the package for the scope brush and stated she should not re-use it.

During an interview on 05/06/15 at 8:35 AM, Staff H, stated that Staff X should have worn protective gear when cleaning endoscopes.

9. Record review of the facility's policy titled, "Sterilization," reviewed 01/2015, showed the directive for staff to use flash sterilization only when time did not permit sterilization on a regular sterilization cycle.

10. During an interview on 05/05/15 at 8:20 AM, Staff W, Registered Nurse (RN), Surgical Supervisor, stated that staff followed American Association of periOperative Nurses (AORN) and Centers for Disease Control (CDC)
guidelines in the OR department.

11. Record review of AORN "periOperative Standards and Recommended Practices," 2013 showed that use of flash sterilization (IUSS; Immediate Use Steam Sterilization) should be kept to a minimum. Flash sterilization should be used only in selected situations and in a controlled manner and should not be used as a substitute for sufficient instrument inventory.

Review of the CDC Healthcare Infection Control Practices Advisory Committee (HICPAC), "Guideline for Disinfection and Sterilization in Healthcare Facilities," 2008 showed:
-Flash sterilization is used when there is insufficient time to sterilize an item by the preferred package method.
-Flash sterilization should not be used for reasons of convenience, as an alternative to purchasing additional instrument sets, or to save time.
-It is not recommended as a routine sterilization method because of the lack of timely biological indicators (a device used to indicate that all the parameters necessary for sterilization were present) to monitor performance and the sterilization cycle parameters (time, temperature, pressure) are minimal.

12. During an interview on 05/05/15 at 3:50 PM Staff W, stated that the facility had only one eye instrument set and that the eye surgeon would bring one set for appropriate steam sterilization the night before monthly eye surgery day. She stated that after the first two cases, all other cases for the day were done with instruments that were flash sterilized. Staff W stated that the facility averages eight to 10 eye cases on each eye surgery day.

During an interview on 05/05/15 at 4:00 PM, Staff X, stated that eye instruments were flash sterilized for each consecutive eye surgery after the first two cases on each eye surgery day.

13. Record review of the 2014 sterilization and packaging guidelines by AORN showed laryngoscope blades required high level disinfection and individualized, sealed packaging to ensure continued sterility after disinfection.

14. Observation on 05/05/15 at 3:50 PM showed six laryngoscope blades in the top drawer of the anesthesia machine in OR #1. The laryngoscope blades were not in individual packaging that indicated they had been disinfected.

During an interview on 05/06/15 at 9:05 AM, Staff Z, stated that the blades needed to be in individual packages and he just hadn't gotten to it.

During an interview on 05/06/15 at 8:25 AM, Staff H, IP, stated that she did not know the policy for laryngoscope blade storage.

During an interview on 05/06/15 at 9:30 AM, Staff B, RN, Director of Nursing, stated that she was unaware that laryngoscope blades needed to be placed in individual packages after being disinfected.


29117

Based on observation, interview and record review the facility failed to establish and maintain policy to ensure two staff (C and D) of two Dietary department staff observed wore effective hair restraint that completely covered all hair. This deficient practice had the potential to permit unrestrained hair to cross contaminate food, clean dishes, utensils, and equipment during patient meal preparation. The facility census was 11.

Findings included:

1. Record review of the "Missouri Food Code for the Food Establishments of the State of Missouri," dated 06/03/13 showed, in Chapter 2-402.11, that food employees shall wear hair coverings that covered body hair, and were worn to effectively keep hair from contact with exposed food, clean equipment and utensils.

Record review of the facility's Dietary department policy titled, "Personnel," reviewed 01/2008 showed directives for the properly attired food handler to wear hair covering; for all personnel directly involved with food production to wear a hair restraint; however, the policy failed to direct staff to wear their hair restraint to effectively cover all hair.

2. Observation on 05/04/15 at approximately 1:10 PM showed Staff C, Director of Dietary and Staff D, tray line staff, both wore hair restraint that incompletely covered their hair (uncovered hair across the forehead or also called bangs).

During an interview on 05/05/15 at 1:35 PM, Staff E, Consultant Registered Dietitian, confirmed that the Dietary department staff should cover all hair and currently Staff C and Staff D's hair restraint allowed their bangs to be uncovered.

Based on interview and record review the facility failed to ensure medical records were completed within 30 days of the discharge date for two (#21 and #23) of three patients reviewed. This failure increased the risk for substandard care for all patients due to incomplete patient information. The facility census was 11.

Findings included:

1. Record review of the facility's document titled, "Rules and Regulations of Medical Staff," dated 10/28/14, showed all orders shall be considered to be in writing if dictated to authorized staff and signed by the physician. At the next visit the attending physician shall sign such orders. At the time of discharge the attending physician shall see that the record was completed. Records not completed in 30 days were delinquent.

2. Record review of Patient #21, discharged 04/02/15, physician's orders in the electronic medical record (EMR), showed Staff DD, Physician, failed to sign, date, and time orders past 30 days of Patient #21's discharge including:
- Two orders that had not been signed for 43 days;
- Eight orders that had not been signed for 44 days;
- Fifteen orders that had not been signed for 45 days; and
- Thirty three orders that had not been signed for 46 days.

During an interview on 05/06/15 at 10:37 AM, Staff DD, stated that she rarely admitted or rounded in the hospital and had forgotten to go into the EMR and sign orders.

3. Record review of Patient #23, discharged 04/01/15, physician's orders in the EMR showed three physicians (Staff WW, CC and VV), failed to sign, date, and time orders past 30 days of Patient #23's discharge including:
- Staff WW had one order not signed for 35 days.
- Staff CC had two orders not signed for 35 days and one order not signed for 36 days. and
- Staff VV had two orders not signed for 40 days.

During an interview on 05/06/15 at 11:10 AM Staff CC stated that he was not sure why he failed to sign the orders because he had a deficiency list he checked to ensure EMR were complete.

During an interview on 05/06/15 at 10:30 AM Staff B, Chief Nursing Officer (CNO), confirmed that two of the three medical records (Patients #21 and #23) had physicians that failed to sign their orders within 30 days.

During an interview on 05/06/15 at 10:53 AM Staff A, Chief Executive Officer (CEO), stated that he was not aware that there were physician's who failed to sign their orders within 30 days of patient discharges. Typically, if not completed, the physician was notified and had seven days to complete.

During an interview on 05/05/15 at approximately 1:40 PM Staff T, Director of Medical Records, stated that medical records should be completed within 30 days.

During an interview on 05/06/15 at 10:55 AM Staff T, stated that she failed to notify the physicians that failed to sign their orders.

During an interview on 05/06/15 at 11:55 AM Staff EE, Chief of Medical Staff, stated the following:
- Staff DD worked part-time and he was not sure if she received messages to sign orders.
- Any attending physician could have signed Staff DD's orders.
- He was not sure if the new Director of Medical Records (Staff T) sent out notification to physicians by e-mail as had been completed in the past.
- He stated he expected physicians to be notified of orders not signed and
- He expected his medical staff to follow the "Rules and Regulations for Medical Staff."

Based on observation, interview, and policy review the facility's Medical Record department failed to ensure that the confidentiality of paper patient medical records was maintained by failing to establish safeguards against unauthorized access of the paper medical records in the main Medical Records department office and in one of one storage areas. This failure to safeguard the confidentiality of paper medical records put all patient's health information at risk for unauthorized access by staff who did not have a need to know. The facility census was 11.

Findings included:

1. Record review of the facility's document titled, "Accessing Patient Information," dated 01/08/15, showed directives for staff that patient information may only be accessed by hospital staff. The access will be limited on a need to know basis. The Medical Record department will not be left unattended during open hours, locked after hours, and only staff properly trained will be allowed access.

Record review of the facility's document titled, "Confidential and Release of Information Guidelines," dated 01/08/15, showed directives for staff that medical records were considered privileged information that cannot be disclosed without the patient's consent, statutory authorization for disclosure, or proper legal process. All information from the patient records shall be kept confidential and secure.

2. During an interview on 05/06/15 at 1:30 PM, Staff T, Director of Medical Records, stated that the Medical Records department was secured at night and there was limited access (only by authorized personnel on nights, weekends and holidays). She stated that housekeepers had access to the Medical Records department main office because they cleaned the room during evening hours when no medical records staff were present.

3. Observation on 05/05/15 at 2:48 PM showed a bookshelf of paper patient medical records in a storage area located in the basement. Equipment elsewhere in the room indicated that the majority of the room was being used by the Maintenance department for various building projects and equipment repairs.

During an interview on 05/05/15 at 2:48 PM, Staff N, Plant Operations (Maintenance department) Manager, stated that the basement storage room (used to store some paper patient medical records and some equipment) was kept locked and the only people with keys were Medical Records staff and Maintenance staff (so, Maintenance staff had access to the stored paper patient medical records in that room).

During an interview on 05/05/15 at approximately 10:25 AM Staff T, stated that there were approximately 650 patient paper records stored in the Maintenance department storage room. She stated that all Maintenance Department staff had access but, would not need to have access to the patient records.

During an interview on 05/06/15 at 9:50 AM Staff A, Chief Executive Officer, stated that he was aware the records were in the Maintenance store room and the facility had planned to move them.


04467

Based on interview and record review the facility failed to ensure the Quality Improvement (QI) plan was reviewed annually to establish that there was evaluation of the facility's entire program. This deficient practice had the potential to permit unevaluated practices and procedures to be used in patient care. The facility census was 11.

Findings included:

Record review of the facility's document titled, "Continuous Quality Improvement (CQI)," dated 04/12/06, showed the following directives for staff:
- The document was developed as a plan for quality improvement in health care services provided by the facility.
- The facility Administrator (Chief Executive Officer, CEO) was named as the Quality Improvement (QI) Coordinator.
- The CQI program was to be evaluated annually.
- The process of annual evaluation was done by the QI Coordinator through review of individual department assessment reports describing actions taken during the previous year. and
- The QI Coordinator was to determine the effectiveness of each department's actions.

During an interview on 05/05/15 at approximately 11:00 AM, Staff A, Administrator (CEO), confirmed the following:
- He had served as the facility QI Coordinator until very recently.
- He had not reviewed the QI plan annually as directed by the plan. and
- The last reviewed QI plan (describing the QI program) was dated 04/12/06.

Based on observation, interview, record review and policy review, the facility failed to develop and maintain an ongoing Activities program based on a patient's comprehensive assessment of leisure interest and abilities with goals for three (#5, #1 and #2) of three Swing Bed patients records reviewed (Swing Bed is a program with a change in reimbursement status where the patient goes from acute care services and reimbursement status to receiving skilled nursing services and reimbursement). This deficient practice had the potential to negatively impact the quality of life for the Swing Bed patient during their admission to the facility. The total facility census was 11. The Swing Bed census was six.

Findings included:

1. Record review of the facility's undated document titled, "Swing Bed Program: Patient Activities," showed directives for staff to provide for an Activities program, appropriate to the needs and interest of each patient, to encourage self care, resumption of normal activities, and maintenance of an optimal level of psychosocial functioning.

2. Record review of the facility's undated job description for Skilled Nursing Activity Director showed the following directives:
- Develops and administers a comprehensive activity program to meet, in accordance with the comprehensive assessment, the interest and the physical, mental, and psychosocial well-being of each skilled nursing client;
- Facilitates programs and activities with an individually-based focus;
- Communicates weekly activity schedule via posted calendars;
- Evaluates the quality of activities and patient response on an individual basis; and
- Demonstrates flexibility in scheduling activities related to patient response.

3. Record review of the facility's undated document titled, "Recommended Activities for Swing Bed Patients," showed directives including the following:
- Reading (books on tape, read to, provide books, magazines, newspaper and Bible);
- Music (listening to, discussions, piano, hymns, Big Band, Country/Western);
- Nature (go outdoors, bird watching);
- Games (Yahtzee, checkers/chess, cards and dominoes); and
- Drawing/painting/coloring.

4. Observation on 05/04/15 at 3:25 PM, showed Swing Bed Patient #5's room did not have an activity calendar posted in her room.

During an interview on 05/04/15 at 3:25 PM, Swing Bed Patient #5 stated that the facility had not given her an activity calendar and she did not know if activities were provided during the weekend. She stated that she enjoyed going outside but staff had not offered to take her.

5. Record review of Patient #5's electronic medical record (EMR), showed staff assessed and documented her activity preferences were television, magazines, and visiting. Staff did not include that she liked to go outside.

6. During an interview on 05/05/15 at 1:55 PM, Swing Bed Patient #1 stated that the facility had not provided her with a weekly or monthly activity calendar. She stated that she did not know what activities the facility provided during the week or weekend. She stated that if she wanted to find out about activities she would have to ask staff. She stated that she liked to read, listen to classical music, and the outdoors.

Record review of Patient #1's EMR, showed staff assessed and documented her activity preferences were television, magazines, newspaper, and visiting. Staff did not include that she liked to read, listen to classical music or the outdoors.

7. Observations on 05/05/15 from 8:45 AM to 8:55 AM showed six out of six current Swing Bed patients did not have activity calendars posted in their rooms that informed them when activities were offered by activity staff.

8. During an interview on 05/05/15 at 8:50 AM, Swing Bed Patient #2 stated that staff had not provided him with an activity calendar and he did not know what activities were offered by the facility.

9. During an interview on 05/06/15 at 8:45 AM, Staff B, Registered Nurse (RN), Chief Nursing Officer (CNO) stated that she expected staff to document Swing Bed patients' individual activities that they enjoyed to participate in. Staff B stated that Swing Bed patients activity assessments did not seem individualized to the patient's.

During an interview on 05/06/15 at 9:10 AM, Staff K, RN, stated that activity staff posted the activity calendar on the nurse's break room door. Staff K stated that she felt like staff did not always assess the patient for their individual activity likes. Staff K stated that she worked on Sundays and the facility did not offier activities on Sunday during her shift. Staff K stated that she found out about patients' likes by talking with them.

10. Record review of the past three months of activity calendars showed no activity had been scheduled for the weekend or on holidays. The activity calendar also did not show when activities were being offered.

During an interview on 05/06/15 at 9:30 AM, Staff F, RN, stated that the activity technician usually came to the unit between 3:00 PM and 5:00 PM. Staff F stated that the time activities were offered was not included on the activity calendar posted on the nurse's break room door. Staff F stated that the Activity department was responsible for performing the activity assessment when patients were admitted to the Swing Bed program. Staff F stated that the facility did not provide for specific planned activities for the weekend or holidays.

During an interview on 05/06/15 at 2:00 PM, Staff FF, Activity Assistant stated that she provided activities for Swing Bed patients Monday through Friday from 3:00 PM to 5:00 PM. Staff FF stated that she did not know that she needed to offer or post the monthly Activity calendar to Swing Bed patients. Staff FF stated that she did not inform Swing Bed patients of what activities were or when they were offered.

During an interview on 05/06/15 at 2:00 PM, Staff X, Licensed Practical Nurse (LPN), Activity Director, stated that she was responsible for performing Swing Bed patients activity assessments. Staff X stated that she tried to complete the activity assessment within 24 hours after the patient was admitted to the facility's Swing Bed program. Staff X stated that she interviewed patients related to what they liked and if they would like to participate in the facility's activities provided. Staff X confirmed that Swing Bed patients' did not have activity calendars posted in their rooms and were not offered a calendar to refer to. Staff X stated that the Swing Bed patient activity assessments did not reflect individualized likes of the patient. Staff X stated that the Activities program did not offer Swing Bed patients activities during the weekend or on holidays.

During an interview on 05/06/15 at 2:00 PM, Staff G, RN, Medical-Surgical/Swing Bed Manager, stated that Swing Bed patients' activity assessments did not reflect their individual interest or likes.

Based on interview, record review, and policy review, facility staff failed to develop nursing care plans that addressed Swing Bed patient needs that included measurable goals, interventions, and timetables for two (#1 and #5) of two Swing Bed patients' electronic medical records (EMR) reviewed for care plans. (Swing Bed is a program with a change in reimbursement status where the patient goes from acute care services and reimbursement status to receiving skilled nursing services and reimbursement). This deficient practice had the potential to permit inappropriate or incomplete care to be provided to Swing Bed patients during their admission to the facility. The total facility census was 11. The Swing Bed census was six.

Findings included:

1. Record review of the facility's policy titled, "Nursing Documentation and Care Planning," dated 12/2010, showed the following directives for staff:
- Following assessment, the registered nurse will identify a nursing care plan, utilizing nursing diagnoses, for the patient's hospital stay. The care plan will identify the focus of nursing care for the patient, including interventions which relate to the nursing assessment of the client, and expected outcomes.
- The care plans will be kept with the nursing assessment and utilized on every shift. and
- Just as nursing care plans no longer needed should be discontinued, additional nursing care plans should be added as the client's condition changes. Interventions on existing care plans should also be updated as condition changes.

2. During an interview on 05/05/15 at 1:55 PM, Swing Bed Patient #1 stated that she liked to read, listen to classical music, and being outdoors.

3. Record review of Patient #1's History and Physical showed she was admitted to the facility's Swing Bed Program on 05/02/15 with complaints of fatigue, no energy, back pain and headaches.

Record review of Patient #1's Patient Care Plan Report dated 05/02/15 showed staff did not include a care plan with measurable goals, interventions and timetables that addressed the patient's individual activity preference of reading, listening to classical music, being outdoors and her back pain. (The patient was started on a Fentanyl patch, which is medication used for chronic pain management on 05/02/15.)

4. During an interview on 05/04/15 at 3:25 PM, Swing Bed Patient #5 stated that she enjoyed going outdoors but to date staff had not offered to take her.

Record review on 05/05/15 at 3:10 PM of Patient #5's Patient Care Plan Report dated 04/23/15 showed staff did not include a care plan with measurable goals, interventions and timetables that addressed the patient's individual activity preference of being outdoors.

Record review of Patient #5's History and Physical showed she was admitted to the facility's Swing Bed Program on 04/24/15 with complaints of pelvic abscess (a pus-filled cavity in the pelvis due to infection).

Patient #5's Patient Care Plan Report showed staff documented that they initiated her activity care plan on 04/23/15 one day before her documented admission date of 04/24/15.

During an interview on 05/05/15 at 2:30 PM, Staff G, Registered Nurse (RN), Medical-Surgical/Swing Bed Manager, stated that staff were expected to add/delete problems to patient care plans. Staff G stated that since Patient #1 had a Fentanyl patch ordered for pain, she would expect to see a care plan for pain.

During an interview on 05/06/15 at 2:00 PM, Staff G, RN, Medical-Surgical/Swing Bed Manager, stated that Swing Bed patients' care plans were not individualized to reflect their needs (care plan for pain for Patient #1) or their activity preferences.

During an interview on 05/05/15 at 2:45 PM, Staff U, RN, stated that she was taking care of Patient #1 today. Staff U stated that she would expect to see a care plan that addressed pain on the patient's care plan since it was acute new pain and she was started on a Fentanyl patch for pain.

During an interview on 05/06/15 at 8:45 AM, Staff B, RN, Chief Nursing Officer (CNO) stated that Swing Bed patients' care plans do not seem individualized to reflect their activity preference or pain management.

During an interview on 05/06/15 at 9:10 AM, Staff K, RN, stated that:
- Care plans were to be based on patient needs.
- Staff were expected to look at care plans each shift, so they reflect the current patient needs
- Swing Bed patients should always have included in their care plan discharge planning and social isolation (the facility used social isolation for activity care planning).

During an interview on 05/06/15 at 9:30 AM, Staff F, RN, stated that:
- Swing Bed patients will always have two standard care plans initiated that were discharge planning and social isolation.
- Care plans were developed based on what the patient was admitted to the facility for.
- Nursing staff were responsible in putting in the social isolation care plan for Swing Bed patients.
- She did not know if the social isolation care plan could be individualized to reflect the patient's activity preferences.

During an interview on 05/06/15 at 2:00 PM, Staff X, Licensed Practical Nurse (LPN), Activity Director, stated that she was responsible in performing Swing Bed patients' activity assessments. Staff X stated that Swing Bed patients' activity care plans were not individualized to reflect their personal preferences or needs.