HospitalInspections.org

Based on observation, record review and interview the facility failed to ensure that the kitchen was free of dust on high horizontal surfaces.

Findings were:

Facility policy entitled "Sanitation and Safety," reviewed on 3/9/11, stated "the food service manager is responsible for supervising sanitation and housekeeping within the department ...the food service director prepares a cleaning schedule and it is followed in a satisfactory manner."

During a tour of the facility's kitchen on 3/9/11 a substantial amount of dust was observed on top of the ice machine, coffee maker, a non-operational refrigerator and around one of the air conditioning vents on the ceiling.

The above findings were confirmed in an interview with the Dietary Manager and CEO during the same tour.

Based on record review and interview the facility failed to follow its own policies by failing to ensure that physicians co-signed verbal orders within 24 hours of prescribing the order in 4 of 20 patient medical records reviewed.

Findings were:

Facility policy entitled "Verbal and Written Medication Orders by the Physician," reviewed on 3/10/11, stated "Verbal Orders:...The prescriber shall co-sign the order within 24 hours."

The following patient medical records were reviewed on 3/10/11:

? Patient #14 had two unsigned physician surgical orders dated 3/7/11.
? Patient #16 had one unsigned physician order dated 12/3/10.
? Patient #17 had one unsigned physician order dated 3/7/11 and two unsigned physician surgical orders dated 3/7/11.
? Patient #19 had one unsigned physician order dated 3/6/11, and two unsigned physician orders dated 3/7/11.

During an interview on 3/10/11 the Director of Nursing confirmed the above findings.

Based on observation, record review, and interview the facility failed to maintain patient equipment which could potentially result in the spread of infection among patients and staff on the Medical/Surgical nursing floor and in the Physical Therapy Department.

Findings were:

During a tour of the Physical Therapy department, on 3/8/11, multiple tears of varying length were observed in the vinyl of a headrest attached to a weight machine, and two large tears were observed in the vinyl of a matt attached to a plinth table.

During a tour of the Medical/Surgical nursing floor, on the same day, multiple small tears of varying length were observed in the vinyl of the seat of a chair in a patient room.

Facility policy entitled "Standard Precautions ...Medical/Surgical Unit," stated "Make sure reusable equipment has been cleaned and reprocessed appropriately, prior to use on another patient."

The above findings were confirmed in an interview with the CEO during the same observation period.

Based on document review and interview the facility's nursing services failed to meet the needs for 3 of 20 patient records reviewed.

Findings were:

Facility policy entitled "Assessment and Reassessment of the Medical Surgical Unit Patient," reviewed on 3/10/11, stated "Any change in the patient's condition shall require an immediate reassessment."

Facility policy entitled "Blood Pressure - Brachia or Popliteal," reviewed on 3/10/11, stated "The physician shall be notified of any sudden marked drop or increase in blood pressure."

The following patient records were reviewed on 3/10/11:

? Patient #16 had marked changes his blood pressure and heart rate on 11/29/10 at 11:05pm, on 11/30/10 at 3:00am and at 6:00am. There was no documentation of an immediate reassessment or documentation of physician notification after any of the changes in the patient's condition at the above times.

Patient #16's condition changed as follows: His blood pressure dropped from 107/67 to 88/58 at 11:05pm; at 3:00am the patient's blood pressure rose slightly from 88/58 to 95/67 although the patients heart rate increased from 98 bpm to 151 bpm; at 6:00am the patient's blood pressure dropped again from 95/67 to 87/57 with a further increase of the heart rate from 151 bpm to 178 bpm.

? On 9/15/10 Patient #11's blood pressure dropped from 89/63 to 76/53 at 7:00am. There was no documentation found indicating that the nurse conducted an immediate reassessment of the patient's blood pressure after this change; and there was no documentation found indicating that the nurse notified the patient's physician of the change.

? On 3/6/11 Patient #14's blood pressure dropped from 105/64 to 90/54 at 7:00pm, and then further dropped from 90/54 to 83/54 at 11:00pm. There was no documentation found indicating that the nurse conducted an immediate reassessment of the patient's blood pressure after this change; and there was no documentation found indicating that the nurse notified the patient's physician of the change.

During an interview on 3/10/11 the Director of Nursing confirmed the above findings.