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Based on observations, record reviews, and interviews, the hospital failed to meet the requirements of the Condition of Participation of Patient Rights. The hospital failed to ensure patients received care in a safe setting as evidenced by:

1) Observation of the hospital's Glucometer Quality Control Log failed to reveal any documentation for quality controls (See all findings in A-0144)

47397

Based on record review and interview the hospital failed to inform the patients or patients' representative of the patients' rights in advance of providing patient care for 4 (#2, #4, #6, #8) of 7 (#1, #2, #3, #4, #6, #7, #8) patients reviewed for patient rights in a patient sample of 8 (#1,#2,#3,#4,#5,#6,#7,#8).
Findings:

A review of hospital policy titled, "NS (Nursing Service). Subject: "Nursing Admission Assessment", revealed, in part:
In addition to conducting the assessment, the registered nurse will obtain signatures from the patient (or the patient's representative) on the documents required for admission. NOTE: If the patient is unable or unwilling to sign any of the documents, the registered nurse will note the refusal.

Review of the facility policy titled "PR (Patient Rights)" revealed, in part:
On admission to Beacon Behavioral Hospital, the patient is informed of his/her rights according to State and Federal regulations and laws. Patient Rights are also included in the Patient Handbook, which is provided to each patient upon admission.

Patient #2
Review of medical records on 02/22/2023 at 11:00 a.m., revealed no documented evidence of a signed acknowledgment of Patient Rights.

In an interview on 02/22/2023 at 11:00 a.m., S8SW confirmed there was no evidence of a signed acknowledgment of Patient Rights in the medical record.

Patient #4

Review of medical records on 02/22/2023 at 11:30 a.m., revealed no documented evidence of a signed acknowledgment of Patient Rights.

In an interview on 02/20/2023 at 11:30 a.m., S8SW confirmed there was no evidence of a signed acknowledgment of Patient Rights in the medical record.

Patient #6
Review of medical records on 02/20/2023 at 03:02 p.m., revealed no documented evidence of a signed acknowledgment of Patient Rights.

In an interview on 02/20/2023 at 03:05 p.m., S8SW confirmed there was no evidence of a signed acknowledgment of Patient Rights in the medical record.

Patient #8
Review of medical records on 02/22/2023 at 09:42 a.m., revealed no documented evidence of a signed acknowledgment of Patient Rights.

In an interview on 02/022/2023 at 9:42 a.m., S8SW confirmed there was no evidence of a signed acknowledgment of Patient Rights in the medical record.

Based on observations and interviews, the hospital failed to ensure patients received care in a safe setting when:

1) Observation of the Glucometer Quality Control Log on 02/20/2023 at 1030 a.m. revealed daily controls not completed for 2/16-2/19/2023.
2) Observation of Patient Rooms a, d, and e on 02/20/2023 at 9:50 a.m. revealed a toilet seat not adhered to the rim, toilet with gap between wall and back of toilet, and a chair in shower with non-tamper resistant screws with multiple bars, all creating a ligature risk.
3) Observation of Dayroom A on 02/20/2023 at 9:43 a.m. revealed a cabinet below the refreshment area with pull handles attached with 4 Philips-head type exposed screws creating a patient safety risk.
4) Observation of Patient Room b on 02/20/2023 at 10:05 a.m. revealed a toothbrush with patient belongings in closet creating a patient safety risk.
5) Observation of laundry room on 02/20/2023 at 09:38 a.m. revealed the dryer with a lint catcher overflowing with lint creating a fire hazard.
6)Observation of daily log not completed on the Daily Code Blue/Emergency Equipment Inspection Documentation for 02/16-02/19/2023;
7)Observation of daily log not completed on the Lab/Exam Room Refrigerator/Freezer Cleaning and Temperature Log for 2/16-2/19/2023;

Findings:

A Review of facility policy titled "PR (Patient Rights), revealed, in part:
In accordance with Louisiana Licensing Regulations for Hospitals §9319 every patient has the right to:
19. Receive care in a safe setting.

A review of facility policy titled "EC (Environment of Care) revealed, in part:
Beacon Behavioral Hospital inspects, tests, and maintains utility systems to ensure proper functioning.
Procedure, in part:
The hospital inspects and maintains utility system components on the inventory in accordance with manufacturer recommendations and/or more frequent, as indicated.

1) Observation of the Glucometer Quality Control Log on 02/20/2023 at 1030 a.m. revealed daily controls not completed for 2/16-2/19/2023.

In an interview on 02/20/2023 at 1030 S2 and S4 verified there was no documentation showing the glucometer quality controls have been performed on 2/16-2/19/2023.

2) Observation of Patient Rooms a, d, and e on 02/20/2023 at 9:50 a.m. revealed a toilet seat not adhered to the rim, toilet with gap between wall and back of toilet, and a chair in shower with non-tamper resistant screws with multiple bars, all creating a ligature risk.

In an interview on 02/20/2023 at 10:08, S3Main confirmed the gap between the toilets and the walls and the seat rims not adhered to the base causing a ligature risk. S3Main stated there should be no gap between the back of the toilet and the wall and that the toilet seat should be adhered to the rim of the base.

3) Observation of Dayroom A on 02/20/2023 at 9:43 a.m. revealed a cabinet below the refreshment area with pull handles attached with 4 Philips-head type exposed screws creating a patient safety risk.

In an interview on 02/20/2023 at 9:43 a.m., S3Main stated there should be no exposed screws and that the facility should remove the exposed screws.

4) Observation of Patient Room b on 02/20/2023 at 10:05 a.m. revealed a toothbrush with patient belongings in closet creating a patient safety risk.

In an interview, on 02/20/2023 at 9:52 a.m., S3Main confirmed the toothbrush was a ligature risk and the facility should remove the toothbrush from the patient room.

5) Observation of laundry room on 02/20/2023 at 09:38 a.m. revealed a dryer with a lint catcher overflowing with lint creating a fire hazard.

Observation of laundry room on 02/20/2023 at 09:38 a.m. revealed a washer and dryer. Further observation of the dryer revealed a lint catcher overflowing with lint creating a fire hazard.

In an interview on 02/20/2023 at 09:38 a.m., S3Main stated the lint catcher should not be overflowing and the facility should remove lint from the lint catcher regularly because of the potential for fire hazard.

6) Observation of daily log not completed on the Daily Code Blue/Emergency Equipment Inspection Documentation for 02/16-02/19/2023.

An observation of the Daily Code Blue/Emergency Equipment Inspection Documentation log on 02/20/2023 at 1026 a.m. revealed no documentation of daily checks being performed on 02/16-19/2023

In an interview on 02/20/2023 at 1030 S2 and S4 verified there was no documentation on the Daily Code Blue/Emergency Equipment Inspection Documentation log showing daily checks being performed on 2/16-2/19/2023.

7) Observation of daily log not completed on the Lab/Exam Room Refrigerator/Freezer Cleaning and Temperature Log for 2/16-2/19/2023.

An observation of the Lab/Exam Room Refrigerator/Freezer Cleaning and Temperature Log on 02/20/2023 at 1026 a.m. revealed no documentation of daily checks being performed on 02/16-19/2023

In an interview on 02/20/2023 at 1030 S2 and S4 verified there was no documentation on the Lab/Exam Room Refrigerator/Freezer Cleaning and Temperature Log showing daily checks being performed on 2/16-2/19/2023.







48051

Based on observation, record review, and interview, the hospital failed to ensure that the visitation rights were protected and promoted in 4 (#1,#6, #7, #8) of 4 (#1,#6, #7, #8) patients in a patient sample of 8 (#1, #2, #3, #4, #5, #6, #7, #8). This was evidenced by failing to permit family/friend visitation and failing to document restrictions or limitations to visitation were clinically necessary or reasonable.
Findings:

Review of the facility policy titled "PR (Patient Rights)" revealed, in part:
On admission to Beacon Behavioral Hospital, the patient is informed of his/her rights according to State and Federal regulations and laws. Patient Rights are also included in the Patient Handbook, which is provided to each patient upon admission.
Additionally, in accordance with La R.S. 28:171 patients at behavioral health hospitals have the right to:
2. Use the phone, receive mail, and receive visitors daily, unless your doctor has written a sufficient reason to limit this right in your medical records.

Review of LA R.S. 28:171 Part VI. Rights of Persons Suffering From Mental Illness and Substance Abuse revealed, in part:
That reasonable times and places for the use of telephones and for visits may be established in writing by the director of any treatment facility. However, the times and places must allow patients, at a minimum, reasonable daily communication by telephone and visitation. These rights may be restricted by the director of the treatment facility if sufficient cause exists and is so documented in the patient's medical record. The patient's legal counsel, as well as his/her next of kin or responsible party, must be notified in writing of any such restrictions and the reasons therefore. When the cause for any restriction ceases to exist, the patient's full rights shall be reinstated.

Review of medical records on 02/20/2023 at 02:45 p.m. revealed, in part:
No visitation from family and friends in 4 (#1,#6, #7, #8) of 4 (#1,#6, #7, #8) patients reviewed in a patient sample of 8 (#1, #2, #3, #4, #5, #6, #7, #8).
Further review revealed no evidence of documentation as to why restrictions or limitations to visitation were clinically necessary or reasonable.

In an interview on 02/20/2023 at 02:56 p.m., S1Admin stated that the facility has not allowed visitors due to COVID restrictions. When asked if the facility had a document indicating a "No Visitor" policy, S1Admin stated on 02/22/2023 at 02:56 p.m. that she could not find a "No Visitor" policy.

Based on record review and interview, the hospital failed to ensure a registered nurse supervised and evaluated the nursing care of each patient as evidenced by failing to monitor the urine output in 2 (#1, #7) of 4 (#1,#6, #7, #8) patients and failing to monitor the blood gluose in 1(#4) of 3(#2,#3,#4) patients reviewed in a patient sample of 8(#1, #2, #3, #4, #5, #6, #7, #8).

Findings:

A review of facility policy titled "NS (Nursing Service); Ongoing Nursing Assessments", revealed, in part:
Each patient admitted to an inpatient program is comprehensively assessed by a registered nurse on each shift, and more often as needed. The registered nurse is required to make rounds on and observe each patient at least every two hours. In addition to the comprehensive assessment conducted on each shift, the registered nurse will conduct focused assessments in response to the patient:
Exhibiting signs of illness or a significant change in condition (either with regard to clinical condition, vital signs, or level of consciousness, etc.).
Procedure:
1. The registered nurse conducts an assessment of the patient in accordance with the reason for the assessment, the patient's signs and symptoms, hospital policy, prudent nursing practice, the current version of Lippincott Nursing Procedures.
6. The registered nurse is responsible for ensuring that the physician on duty is notified of any findings of an assessment or re-assessment that represents a negative change in the patient and/or physician's orders.
9. Intermittent documentation shall be entered in the medical record describing the patient's status in relation to the precipitating event and in response to any treatment provided.

Patient #1:
A review of medical records on 02/22/2023 revealed Patient #1 admitted to facility with a urinary tract infection on 2/17/2023 and placed on the antibiotic Macrobid. Further review revealed no evidence that Patient #1's urine output was monitored since admit (5 days).

Patient #7:
A review of medical records revealed Patient #7 admitted to facility with a urinary tract infection on 12/29/2022 and placed on the antibiotic Diflucan. Further review revealed no evidence that Patient #7's urine output was monitored from 12/29/2022 until discharge on 01/02/2023.

Patient #4:
A review of medical records on 02/20/2023 at 01:24 p.m. revealed patient #4 was admitted on 02/07/2023 at 1:09 p.m. The admit history and physical on 02/07/2023 at 4:35 p.m. revealed the patient was a diabetic, with one of the admitting medical diagnosis being Type 2 Diabetes Mellitus with Hyperglycemia. The nursing plan of care on 02/07/2023 revealed one of the admission plan of care nursing problems as Endocrine/Metabolic related to Diabetes: Established. A physician order for a Finger-Stick for Blood Glucose and Insulin Administration per sliding scale was entered into electronic medical record on 02/14/2023. Patient #4 first finger-stick blood glucose reading was obtained on 02/14/2023 at 07:30 a.m.

In an interview on 02/20/2023 at 03:05 p.m., S8SW confirmed that there was no documented evidence the facility was monitoring the urine output for Patient #1 and Patient #7. On 02/23/2022, S6RN stated that Patient #2 and Patient #7's urine output should have been monitored per nursing practice standards.

In an interview on 02/22/2023 at 1:24 p.m. S6 verified patient #4 was admitted on 02/07/2023 and there was no documented evidence the facility was monitoring the blood glucose for Patient #4 from 02/07-13/2023. S6 stated Patient #4 glucose should have been monitored per nursing practice standards.




48051

Based on record review and interview, the hospital failed to ensure medical records included a properly executed informed consent for procedures and treatments. This deficient practice was evidenced by informed consents that were not completed per hospital policy for 2 (#6, #8) out of 4 (#1,#6, #7, #8) in a patient sample of 8 (#1, #2, #3, #4, #5, #6, #7, #8) medical records reviewed.
Findings:

A review of hospital policy titled, "NS (Nursing Service). Subject: "Nursing Admission Assessment", revealed, in part:
In addition to conducting the assessment, the registered nurse will obtain signatures from the patient (or the patient's representative) on the documents required for admission. NOTE: If the patient is unable or unwilling to sign any of the documents, the registered nurse will note the refusal;

A review of hospital policy titled, "PR (Patient Rights) General Consent to Treat" revealed, in part:
Beacon Behavioral Hospital requests that all patients or their representatives (as authorized) sign a general Consent to treat at the time of admission.

Patient #6
Review of medical record on 02/20/2023 at 03:02 p.m., revealed no documented evidence of a signed Consent for Treatment.

In an interview on 02/20/2023 at 03:02 p.m., S8SW confirmed there was no evidence of a signed Consent for Treatment form in the medical records.

Patient #8
Review of medical records on 02/22/2023 at 09:45 a.m., revealed no documented evidence of a signed Consent for Treatment.

In an interview on 02/23/2023 at 09:45 a.m., S8SW confirmed there was no evidence of a signed Consent for Treatment in the medical records and stated there should be documented evidence of a Consent for Treatment form in the records.

Based on record reviews and interviews, the hospital failed to ensure a patient discharge summary was completed within 30-days of discharge for 1 (#5) of 3 (#5, #7, #8) discharged patients in a patient sample of 8 (#1, #2, #3, #4, #5, #6, #7, #8).
Findings:

Review of Patient #5's medical record revealed an admit date of 12/29/2022 and a discharge date of date of 12/31/2022. Further review revealed there was no documented discharge summary in the medical record.

In an interview on 02/20/2023 at 1:58 p.m., S2RN confirmed Patient #5's medical record did not contain a discharge summary.

Review of the hospital's medical and professional staff bylaws revealed, in part:
Medical Records: Practitioner's must complete their patients' medical records within 30-days of each patient's discharge or such period as the Medical Executive Committee may prescribe.

In an interview on 02/20/2023 at 3:07 p.m., S1Administrator confirmed discharge summaries should be completed within 30-days of discharge.

Based on observation and interview the hospital failed to store controlled substances locked within a secure area.
Findings:

A review of facility policy titled "PS (pharmaceutical Services) Automated Medication Dispensing System" revealed, in part:
The contracted pharmacy and Beacon Behavioral Hospital staff members adhere to the manufacturers' recommendations for use of the Automated Medication Dispensing System, as well as hospital and pharmacy policies and procedures, regulations, and state and federal laws regarding, in part:
Accountability of controlled substances and other medications.
Medication security.

Observation of medication room on 02/20/2023 at 10:38 a.m. revealed a medication refrigerator containing an unlocked "Lockbox" with 19 full bottles of IV Lorazepam.

In an interview on 02/20/2023 at 10:45 a.m., S2RN confirmed the "Lockbox" of 19 full bottles of IV Lorazepam was unlocked. S2RN further stated the lockbox was broken and the facility should ensure that a functioning "Lockbox" was available.

In an interview on 02/22/2023 at 02:40 p.m., S7Pharm stated the pharmacy had a lockbox available for facility use.

Based on record review and interview, the hospital failed to meet the Condition of Participation for Utilization Review as evidenced by failing ensure a UR committee, including two physician members, who were doctors of medicine or osteopathy, was established. (See findings in tag A-0654).

Based on record review and interview, the hospital failed to ensure the UR committee included two members who were doctors of medicine or osteopathy. This deficient practice was evidenced by failure to have an established UR committee that included two physician members who were doctors of medicine or osteopathy.

Findings:

Review of the UR documentation presented by S1Adm revealed no documented evidence of an established UR committee that included two physician members who were doctors of medicine or osteopathy.

In an interview on 02/22/2023 at 1:00 p.m. S1Adm verified the hospital does not have a formal Utilization review Committee including two physician members, Plan or meeting minutes. She stated UR is discussed at the Committee of the Whole meetings only.

Based on observations and interviews the hospital failed to ensure the hospital environment was maintained in a sanitary condition and to ensure all equipment was maintained in a manner to ensure an acceptable level of safety and/or quality as evidenced by:
1) Failing to ensure expired supplies were not available for patient use.
2) Failing to ensure the hospital environment was maintained in a sanitary condition.

Findings:

1) Failing to ensure expired supplies were not available for patient use.
Observation of supply room on 02/20/2023 at 9:25 a.m. revealed 2 boxes of 50 each, Megellan Hypodermic needles labeled with the expiration date of 01/31/2023.
Further observation revealed Evencare Proview Glucose Control Solution bottles with one bottle labeled with the expiration date of 12/9/2022 and 4 bottles labeled with the expiration date of 01/17/2023.

In an interview, S3Main confirmed the expiration dates and the availability for patient use and further stated the facility should discard the expired needles and Glucose Control Solution.

Observation of the Lab Room on 02/20/2023 at 10:30 a.m. revealed 3 blood collection tubes with the expiration date of 09/30/2022 and 95 blood collection tubes labeled with the expiration date of 12/31/2022. Further observation revealed 6 bags of 0.9% Normal Saline labeled with the expiration date of 12/2022. Continued observation revealed 4 Covid-19 Ag Positive Control Swabs labeled with the expiration date of 03/29/2022 and 2 labeled with the expiration date of 01/20/2022.

In an interview on 02/20/2023 at 10:20 a.m., S2RN confirmed the expiration dates and availability for patient use and further stated the facility should discard the blood collection tubes, Covid Swabs, and Normal Saline.

Observation of the nourishment room on 02/20/2023 at 10:10 a.m., revealed a refrigerator. Observation of the refrigerator freezer revealed a fruit cup labeled with expiration date of 11/18/2022.
Further observation of the refrigerator revealed a partially filled bottle of PowerAde without a label containing the name of the patient or the date opened. Continued observation revealed a partially filled jug of distilled water without a label containing the name of the patient or the date opened.

In an interview on 02/20/2023 at 10:11 a.m., S3Main confirmed the expiration dates and availability for patient use. S3Main stated the facility should discard the expired fruit cup, PowerAde and Distilled water and that the facility should have put labels on the PowerAde and the distilled water.

An observation of the supply closet on 02/20/2023 at 9:25 a.m., revealed Povidone Iodine Swab Sticks, individual packs in boxes of 50, 2 boxes-expired.

In an interview on 02/20/2023 at 9:25 a.m. S3Main verified the swab sticks were expired.

An observation of Lab/Exam room on 02/20/2023 at 10:34 a.m., revealed expired lab tubes: 2 green tops, 2 purple tops, 1 speckled red/gray top, 1 speckled red/yellow top.

In an interview on 02/20/2023 at 10:34 a.m. S2RN verified the lab tubes were expired.

2) Failing to ensure the hospital environment was maintained in a sanitary condition.
A review of facility policy titled "IC (Infection Control)" revealed, in part:
All hospital personnel are responsible for:
Maintaining a safe and sanitary environment.

Observation of Patient Room a on 02/20/2023 at 9:50 a.m. revealed a mattress, torn and wet through to the frame foundation with unknown liquid.
Continued observation revealed a chair, torn and with exposed stuffing.
In an interview, on 02/20/2023 at 9:52 a.m., S3Main confirmed the wet and torn mattress and torn chair and stated the facility should replace the mattress and discard the chair.

Observation of bathroom for patient rooms d and e on 02/20/2023 at 10:08 a.m., revealed the toilet filled to the rim with feces and paper.

In an interview on 02/20/2023 at 10:08, S3Main stated the facility would put an out of order sign on the door until repaired.

Observation of Patient Room k on 02/20/2023 at 10:15 a.m. revealed a severely stained and worn mattress.

In an interview on 02/20/2023 at 10:16 a.m., S3Main stated the facility would replace the mattress.



48051

Based on record review and interviews the hospital failed to meet the Condition of Participation related to infection control by failing to ensure the multi-use glucometer was cleaned per the manufacturer's guidelines between patients for the prevention of infectious diseases as evidenced by:

1) Failure to ensure the glucometer was appropriately cleaned between patient use. (See findings A-0749)

Based on observations, record review and interview the hospital failed to employ methods for preventing and controlling the transmission of infections. This deficient practice was evidenced by:
1) Failure to ensure the glucometer was appropriately cleaned between patient use per the manufacturer's guidelines;
2) Failure to ensure the patient ice scoop was properly stored;
3) Failure to ensure all equipment was maintained to prevent the spread of infection;
4) Failure to ensure the sharps container was not overflowing with sharps;
5) Failure to ensure a single use clipper head is disposed of after each patient use on the multi-use battery operated handle.

Findings:

1) Failure to ensure the glucometer was appropriately cleaned between patient use per the manufacturer's guidelines.

A review of the Evencare ProView Blood Glucose Monitoring System User's Guide revealed in part: The meter must be disinfected between patient uses by wiping it with a CaviWipe towelette or EPA-registered disinfecting wipe in between test and be cleaned prior to disinfecting.

In an interview on 02/20/2023 at 10:46 a.m. S2RN and S4LPN explained the method of cleaning the Evencare ProView Blood Glucose Monitor between patient-use by wiping the glucometer with cotton balls soaked with 3% hydrogen peroxide and then wiping with alcohol swab.

In an interview on 02/20/2023 at 10:50 a.m. S5MHT also confirmed that she has witness nursing staff cleaning the glucometer with alcohol.

In an interview on 02/20/2023 at 11:00 p.m. S4LPN stated she could not locate the appropriate wipes for cleaning the multi-use patient glucometer; therefore, she cleaned it with other unapproved wipes.

In an interview on 02/20/2023 at 1:05 p.m. S4LPN stated she located the appropriate wipes for cleaning the multi- use glucometer and cleaned it per manufacturer's guidelines.

2) Failure to ensure the patient ice scoop was properly stored.

An observation on 02/20/2023 at 10:11a.m. of the Ice Machine utilized for patient use, revealed ice scoop buried in the ice.

In an interview on 02/20/2023 at 10:11a.m. S3Main verified the ice scoop was buried in the ice and he also verified that the ice scoop should be stored in the provided holder.

3) Failure to ensure all equipment was maintained to prevent the spread of infection.

An observation of the Lab/Exam Room revealed one wheelchair with cracked vinyl covering on the arm rests. Which cannot be effectively cleaned between patients.

In an interview on 02/20/2023 at 10:34a.m. S2RN verified the condition of the wheelchair in the Lab/Exam Room.

In an observation of the Equipment Closet revealed one wheelchair with cracked vinyl covering on the arm rests. Which cannot be effectively cleaned between patients.

In an interview on 02/20/2023 at 10:15a.m. S3Main verified the condition of the wheelchair in the Equipment Closet. He also stated the equipment located in this closet, is ready for use.

4) Failure to ensure the sharps container was not overflowing with sharps.

An observation of the Lab/Exam Room revealed the sharps container was overflowing with disposed sharps.

In an interview on 02/20/2023 at 10:28a.m. S3Main confirmed the sharps container was overflowing and stated it was a hazard.

5) Failure to ensure a single use clipper head is disposed of after each patient use on the multi-use battery operated handle.

An observation of the Lab/Exam Room revealed a single use clipper head on the multi-use, battery powered handle while standing on charger.

In an interview on 02/20/2023 at 1034 a.m. SRN verified that the single use clipper head was on the multi-use battery powered handle. SRN4 also verified the clipper head should be disposed of after each patient use and stored without a clipper head attached.


48051

Based on observations, records review and interview, the hospital failed to limit the transmission of communicable disease, infections and/or pathogens as evidenced by not having an accessible sink for staff to wash their hands.
Findings:

A review of facility policy titled "IC (Infection Control)" revealed, in part:
Beacon Behavioral Hospital limits the transmission of communicable disease, infections and/or pathogens by:
Limiting exposure to pathogens.
Maintaining compliance with hand hygiene guidelines.

Observation of Laboratory Room on 02/20/2023 at 10:23 a.m. revealed a hospital bed completely blocking the sink making it inaccesible for staff hand-washing use.

In an interview on 02/20/2023 at 10:25 a.m., S2RN stated the bed has always been there for patients needing an EKG. S2RN further stated the facility should move the bed from in front of the sink making the sink accessible for staff to wash their hands.