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Based on MR review and staff interview, this facility failed to develop comprehensive nursing care plans that reflect the needs of the patients in 4 out of 15 MR reviewed (Pt. #1, 2, 3, and 4). Failure to develop nursing care plans that address the needs of the patients has the potential to affect all 24 patients on the day of the survey.

Findings by Surveyor #26711:

A MR review was completed on Pt. #4's closed MR on 5/16/2012 at 2:20 p.m. accompanied by Dir. J and Interim CNO B. Pt. #4 was admitted to the facility on 5/1/2012 and had surgery for two fractured bones in the lower leg. To prevent blood clots the physician ordered Lovenox-a medication that is injected into the body with a needle.

Although there is a standardized teaching plan in the MR for the Lovenox, there is no evidence within the care plan, or other documentation, that Pt. #4 was at risk for blood clots or was taught and could demonstrate competence in giving the injection independently prior to discharge on 5/4/2012.

These findings were confirmed by Interim CNO at 3:10 p.m. on 5/16/2012.




29963


Findings by Surveyor #29963:

A MR review was completed by surveyor # 29963, on Pt. #1's closed record on 5/16/12 at 2:40 p.m., Pt. # 2's closed record on 5/16/12 at 3:05 p.m. and Pt. # 3's closed record on 5/16/12 at 2:20 p.m. in the presence of HIM staff I and J.

There was a problem added on Pt. # 1's care plan that addressed hip surgery, Pt. # 1 was admitted for an acute cholecystectomy.

Interim CNO B stated that the care plan may have carried over from previous hospitalization, upon review of History and Physical, there was no mention of previous hip surgery. When asked Interim CNO B if it was expected that nurses update care plans with current diagnosis, Interim CNO B stated the care plan should have been updated.

There were no nursing care plans for Pt. #2 (admitted following displacement of lumbar intervertebral disc) established during hospitalization.

There were no problems addressing pain on Pt. # 3 care plan for an admission to the hospital following a C-section. Upon review of medication administration record, Pt. #3 had been utilizing pain medication in an attempt to control pain.

These findings were confirmed at the time of the MR review with HIM staff I, J, Interim CNO B and Surveyor # 26711.

In an interview with Interim CNO B on 5/16/2012 at 3:20 p.m., the facility's policy is to initiate actual problems within 24 hours of admission to the hospital and to review care plans every 24 hours.

On 5/16/12 at 4:05 p.m. Interim CNO B provided copies of care plans for Pt. #1, 2, and 3 without any rebuttal or additional information presented. The printed copy of Pt. #1's care plan no longer addressed hip surgery as a problem. Pt. # 3's printed copy of care plan reflected a problem addressing pain. No dates available on printed care plans.

Based on observation, staff interview and the Wisconsin Food Code, this facility fails to maintain clean and sanitary equipment in the kitchen, and fails to ensure that kitchen staff are covering their hair. Failure to maintain a sanitary environment and contain hair has the potential to affect all patients, staff, and visitors who obtain food from the kitchen.

Findings include:

According to the 2009 FDA Food Code, food employees shall wear hair restraints such as hats, hair coverings or nets, beard restraints and clothing that covers body hair, that are designed and worn to effectively keep their hair from contacting exposed food, clean equipment, utensils, and linens; and unwrapped single-service and single-use articles.

The 2009 FDA Food Code also states that nonfood-contact surfaces of equipment shall be cleaned at a frequency necessary to preclude accumulation of soil residues.

A tour of the kitchen was conducted on 5/16/2012 at 1:30 p.m. accompanied by RS E and Dir. H.

In the area of the dry storage, kitchen volunteer G was noted not to have a hair cover over G's hair. When prompted by Dir. H to put hair cover on, volunteer G removed the cover from G's pocket and put it on.

Dir. H verbalized understanding that all who enter the kitchen need to have all hair covered.

In the area of the stove/grill a free standing deep fryer was noted to have an increased amount of greasy build up on the outside of the walls of the device. Debris was adhering to the grease as well.

Dir. H stated that the deep fryer is on a cleaning schedule but was in agreement that the device was not being cleaned frequently enough.

These findings were confirmed at the time of discovery with Dir. H and RS E.