HospitalInspections.org

Based on document review, policy review and staff interview, it was determined that for 14 of 93 hospital beds utilized by patients, the hospital failed to ensure a safe hot water temperature level. Findings included:

The hospital policy entitled "Domestic Hot Water Testing" stated, "...It is the policy of Bayhealth Medical Center to provide a safe hot water temperature level throughout all patient care areas...The Plant Operations Mechanic assigned to daily rounds is responsible for ensuring that the domestic hot water used in patient and public area does not exceed the temperature of 120 °F (Fahrenheit)...In the event that the temperature exceeds...the Plant Operations Mechanic immediately takes the appropriate actions to correct the situation..."

On 3/20/17 at 3:30 PM, review of the March 2017 daily water test logs for the 4th floor rehabilitation unit entitled "Daily Rounds Checklist" revealed the following water temperatures checked at the opening or closing of shift exceeded 120 °F:

3/4/17: 126 °F (opening)
3/11/17: 124 °F (opening)
3/13/17: 122 °F (closing)
3/16/17: 125 °F/122 °F (opening/closing)
3/18/17: 122 °F (closing)
3/19/17: 124 °F (closing)

During an interview on 3/20/17 at 4:07 PM, Supervisor of Plant Operations A:
- confirmed these findings
- reported that the facility failed to address the water temperatures greater than 120 °F

Based on observation, policy review and staff interview, it was determined that the hospital failed to ensure an acceptable level of safety and cleanliness for 2 of 14 patient rooms located in the 4th floor rehabilitation unit. Findings included:

The hospital document entitled "Environmental Services Department 2017 Plan for the Provision of Care" stated, "...An effective Housekeeping department is essential in the maintenance of a clean, safe and attractive health care setting for all who occupy the facility..."

During an environmental tour of the 4th floor rehabilitation unit on 3/20/17 from 11:37 AM to 12:35 PM, the following was observed:

A. Room #463
- bottom of the metal cabinet under the sink was dirty with brown stains and rust
- bathroom drywall behind the toilet was damaged with cracks

B. Room #464
- ceiling paint was chipped and hanging above the door
- plastic base wall molding was detached from the wall

These findings were confirmed with Corporate Compliance Risk Specialist A, Nurse Manager A and Assistant Director of Environmental Services A during the tour on 3/20/17 from 11:37 AM to 12:35 PM.