HospitalInspections.org

Based on observation, interview and document review, the facility failed to follow Centers for Medicaire and Medicaid Services (CMS) and Centers for Disease Control (CDC) guidelines for COVID-19 by appropriately screening staff, patients, and or visitors for symptoms upon entrance to the facility, or require source control masks to patients and visitors upon entrance to hospital.

Findings include:

Observation on 4/13/20 at 10:30 a.m., of a unidentified patient (P)-1 entering the facility at the front entrance identified this patient entered the facility and walked to the front desk to check in without being screened. P1 walked passed a waiting room where was another patient (P2) was seated (within 6 feet of P1). P2 was not wearing a source control mask. P1 checked in and then screened by a hospital receptionist (HR)-A. The screening performed included asking P1 if he had a temperature, respiratory symptoms or if he had traveled out of the country in the past 14 days. P1's temperature was not actively taken. A source control mask was offered, but the P1 declined. P1 was not required to wear a source control mask.

Review of 4/9/20.Nurses Monthly Staff Meeting notes identified staff direction for the COVID-19 screening process of patients and visitors. The screening process included 3 questions: does the patient/visitor have any respiratory symptoms, has the patient/visitor had contact with a COVID-19 patient and if the patient/visitor had a temperature. The process had not included active screening by a staff person for temperature checks nor did it include the required use of a source mask. The meeting notes included the process for screening facility staff as well. This process included: all employees will have their temperature taken actively at the start of their shift. (Monday through Friday from 7:30 a.m. to 8:30 a.m.). After 8:30 a.m and on weekends, staff were required to walk down a patient hall to the nurses station to actively have their temperature taken. The process made no mention of symptom screening for staff related to respiratory symptoms. Review of the daily staff screening log only included temperature checks but those checks were noted to be "blank".

Interview with hospital receptionist (HR)-A on 4/13/20, at 11:30 a.m. confirmed patient and visitors who enter the hospitals front entrance during business hours, do not actively get their temperatures taken. HR-A indicated staff are only required to ask the patients or visitors if they have a temperative. HR-A also confirmed source face masks were offered to patients/ visitors, but not required to be worn while in the hospital if their questionaire screening was negative.

Interview with registered nurse (RN)-A on 4/13/20, at 12:30 p.m. confirmed the above current screening process for staff. Temperatures were only documented on the screening log if the staff exhibited a temperature of 100.4 degrees Fahrenheight (F) or above. After the hours of 8:30 a.m. each day and on weekends, the staff would walk through the patient hallway of patient rooms to the nurses station to have their temperature taken.

Interview with registered nurse (RN)-B on 4/13/20, at 1:00 p.m. confirmed the above current screening process for staff. Temperatures were only documented on the screening log if the staff exhibited a temperature of 100.4 degrees F or above. The questions for respiratory symptoms were not being activily asked during the screening process or documented on the log prior to staff working thier scheduled shift.

Interview with the facility infection control nurse (ICN) on 4/13/20 at 1:15 p.m., confirmed the above information related to screening of staff/patients/visitors. The ICN was unsure of the current requirement for screening and indicated the staff were directed by the facility regional office when implementing processes.

Interview with the director of nursing (DON) on 4/13/20, at 1:30 p.m.confirmed the above criteria for screening staff, residents and patients. This included source masks not being required for patients or visitors upon entrance to the facility in addition to not actively taking their temperature. The DON indicated screening required at the emergency department (ED) entrance only included 2 screening questions: if the patient has any respiratory symptoms and if the patient has had contact with a COVID-19 patient. The DON indicated a temperature check is not actively taken until the patient is taken to a triage room.

Review of the facility policy Emerging Threats- Acute Respiratory Syndromes- Coronavirus dated 4/9/20, included screening criteria steps for ambulatory and ED patients. Screening questions included if the patient has respiratory symptoms and if they had traveled outside the united stated (US). If there is a suspected case then a patient is given a surgical mask to leave on throughout their visit in the hospital. The policy did not include temperature checks. The policy also included steps for screening facility staff. The policy directed staff to use the employee screening log to gather and record employee criteria to determine suitability to work. The log only included temperature checks, it did not include symptom screening related to respiratory symptoms.