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Base on record review and interview the governing body failed to ensure medical staff appointments were current and up to date on 1 out of 7 medical staff records reviewed. These finding have the potential to have a member of the medical staff to admit to the hospital without current privileges and ensuring the physician was reviewed as outlined in the appointment letter. .

Review of physician # 20 credentialing file in the facility on March 23, 2001, indicated as an emergency department physician he was granted admission privileges to last for 6 months and that the governing body would re-review the extension of the privileges to admit patient at the end of 6 months. The period of admission privileges was from April 28, 2009 -October 28, 2009.

Review of in patient admissions for physician # 20 indicated he admitted 1 patient patient # 1 on November 8, 2009, after his privileges for admission had expired.

Interview with staff # 1 confirmed that physician # 20 had been granted admission privileges to last for 6 months and that physician # 20 had admitted patient # 1 on November 8, 2009 after his privileges for admission had expired as stated in the letter of appointment granted by the governing body. Staff # 1 stated the ED physician had been granted admission privileges during a time when the hospital had only two physician to cover in patient admissions and that the privileges was not renewed after the facility had recruited other physician to the medical staff.

Based on observation, record review and interview the facility failed to maintain the patents right to privacy as evidenced by a board in a main hall way just in front of the entrance to the medical unit of the hospital that contained names of 9 out of 10 patients admitted on the medical unit. . The board contained nine names of patients and the room location where they could be found. In review of 9 out of 9 of the medical records of the patients listed found no evidence they were provided informed consent and consented to the release of their name on a board visible to anyone passing by in the hall way. Release of patients names to the public in a small rural area could result in adverse occurrences to them by providing persons with information that they are away from their homes which could lead to burglary or other occurrences. These findings have the potential to cause harm to all person receiving inpatient care at the facility.

On tour of the facility on 03/22/2010 the surveyor found a board located in a man hallway used to move to one area of the hospital to another location, the board listed names of the patiens on the medical unit of the hospital. This board was visitable to anyone walking in the hallway.

In review of patient 9 out of 9 medical records records of patients # 17-25 there was no evidence that the patients were provided informed consent to the publishing of their names on the inpatient unit on a board located out in the main corridor of the hospital, that was visible to all persons passing by the board. The board listed the names ages, and room # where the patient was located on the medical unit.

Interview with staff # 1 on 03/22/2010 at approximately 11:30 a.m., confirmed that the facility posted all patients except children on a common board located in the hall way of the hospital, and that there was no evidence in the 9 out of 9 records reviewed that the hospital had obtained informed consent from the patient to release their names to anyone passing by the board.

Based on record review and interview there was no evidence the facility provided the staff with the initial and annual training to ensure the staff had the ability to identify and had the appropriate knowledge for the identification and knowledge on how to report the to the appropriate agency all episodes of abuse and neglect. These findings have the potential to cause harm to patients being treated at the facility by the lack of staff knowledge and understanding of the reporting requirements for all forms of abuse and neglect for all ages.

Review of personnel record for 8 out of 8 clinical staff there was no evidence the facility had provided the staff with the required raining on initial hire and annually for the identification and reporting requirements for all forms of abuse and neglect for all ages.

Interview with staff # 1 confirmed the facility had not conducted the required training for abuse and neglect for all ages of patients served by the facility.

Based on record review and interview the facility failed to ensure the staff providing care to the patient, was competent to provide the care based on the specialized qualifications and competence of the nursing staff available. These findings have the potential to cause harm to all patients receiving these procedures at the hospital.

In review of nursing records in the facility on 03/24/2010, of the staff providing respiratory therapy including nebulizer treatments and the recording of electrocardiograms 3 out of 3 records reviewed of staff # 9, 10 and 15 there was no evidence the staff providing this care had been provided and checked off to ensure they had the appropriate education and skills to provided the non-nursing related procedures.

Interview with staff # 1 in the facility on 03/23/2010 at approximately 2:30 p.m. confirmed the facility had not provided the required initial training and annual competency for these procedures.

Based on observation and interview the facility failed to ensure that all supplies and biologicals were with in correct date range, if opened discarded within 30 day of opening as stated in facility policy and all solution used for cleaning was discarded with in the acceptable date of opening. These findings have the potential to adversely affect the health and safety off all patients being treated in the facility by using expired medications, supplies, blood collection tubes, and cleaning with expired cleaning solution which could increase their risk of infection and increase thier risk of have incorrect reading of laboratory results due to using expired collection tubes.

During tour of the facility on 03/22/2010 , In the radiology area there was a bottle labeled Vesphen that was open and taken out of the original bottle and the bottle was not dated to indicate the date the solution was place in the bottle. In the same area there was a bottle of solution labled as a 1 to 10 clorax solution, that was not dated to indicate the date of mixing. In the radiology hallway area there were cabinets found unlocked and unmonitored which contained radiological injectables that were stored with boxes and other non medications items. The area was unkept and unclean. There was a syringe of magnevist found opened and lying in the unclean environment. There was no date to indicate the dated the substance was opened. In the radiology area there was a bottle of sterile water with approximately 200 ml remaining, the bottle was not dated to indicate when it was opened.

In The Emergency Department in the treatment room 2, there was 1 green top tube expired on 2/2010. There was 2 bottles of Bacic Plus 30 ml opened. In the crash cart there was a 5% dextrose bag Lot # 6522&JT, opened with no seal to indicate the solution was not used. In room 6 there was 1 green top blood collection tube expired on 2/10, 3 blue top blood collection tubes expired on 1/10, and 3 red top blood collection tubes expired on 1/10.

In the pediatric room the pediatric emergency cart revealed multiple expired kits. The expired kits included an expired IV delivery system expired 11/06, an expired intubation module Lot # X 019 expired on 11/07, a levin size 8 tube expired on 12/08, and endotracheal tube Lot # 04ae19 expired on 12/08. In the pink red drawer there was an IV set expired on 7/207 and an intubation kit X336 expired on 7/08.

In the Orange drawer there was a intubation set lot # x019 expired on 11/07 and Intraosseus kit expired on 10/7. In the green dawer there was a intubation kit X012 expired on 11/07, and Intraosseus kit 014, expired on 10/09 and an IV kit expired on 11/06..

In the refrigerator located in the nursing station there was a mixed bottle of oral amoxicillin dated as opened on 03/15/07.

Interview with staff # 5 during the tour confirmed the items found were expired and the items were all immediately removed from the treatment areas.