HospitalInspections.org

Based on interview and record review, the facility failed to develop and implement policy/procedure for additional precautions for all non-immunized COVID-19 health care exempt staff that included 6 out of 6 Staff (U, V, W, X, Y and Z) that were not fully vaccinated for COVID-19 infection, resulting in the potential for the transmission and spread of COVID-19 infections for all 276 patients being served by the facility. Findings include:

On 3/24/2022 at 1340 a review of COVID-19 vaccination exemptions records for Staff U, V, W, X, Y and Z revealed the following:

Staff U was granted her request for religious exemption on 12/1/2021.
Staff V was granted his request for religious exemption on 11/23/2021.
Staff W was granted her request for medical exemption on 1/6/2021.
Staff X was granted her request for religious exemption on 1/25/2022.
Staff Y was granted her request for medical exemption on 11/23/2021.
Staff Z was granted his request for religious exemption on 12/1/2021.

On 3/23/2022 at 1445, Staff E was asked if unvaccinated staff were required to use a NIOSH (N-95) mask or undergo weekly COVID-19 testing. She replied, we have N-95 available for all staff. She said COVID testing was not required. She explained we (staff) do "passive screening for COVID 19 screening."

Review of the facility's "CMS Mandatory COVID-19 Vaccination" policy effective date 12/3/2021 documented the following:

"...V. Procedures:
I. Requirements Upon Receiving an Exemption: If an exemption is granted, the individual
receiving the exemption will be required to comply with all infection prevention requirements of the facility including always wearing a procedural mask while in the facility unless wearing a N95 respirator per COVID respirator guidelines. Mask can only be taken off when the individual is by themselves (including but not limited to restroom, eating in secluded break area, desk or cubicle, etc.)."
The policy did not address additional precautions for unvaccinated staff.

Based on record review and interview, the facility failed to ensure effective discharge planning and coordination of care for one (#3) of 5 patients reviewed for discharge planning, resulting in the potential for unmet care need for all patients (276) served by the facility.
Findings include:
(See A-813)

Based on record review and interview, the facility failed to implement an effective discharge plan and a timely referral for durable medical equipment (DME) and supplies for one (#3) of 5 patients whose records were reviewed for discharge planning, resulting in the potential for unmet care needs for patient #3. Findings include:

On 3/24/2022 at 1130 a review of the medical record for discharge planning for patient #3 was reviewed with the Director of Case management (Staff O) and the following was revealed:

The patient (#3) was a 45-year-old female admitted to the facility with left sided numbness on 1/9/2022.
A discharge evaluation was performed on 1/9/2022. At that time, the patient denied having home health care (HHC) or subacute rehab (SAR) in the past. The patient reported she was willing to receive HHC if it was recommended. The patient was noted to be independent with all functional activities of daily living (ADL's) except for her bowel and bladder incontinence, an ostomy, and a catheter prior to her admission.

The patient reported she had family support for those activities. The anticipated "Transition plan": Home with Home Health.
The Discharge plan was updated on 1/14/2022 and 1/19/2022 and documented the patient was not stable for discharge planning.

Further record review for discharge planning revealed the patient was stable for discharge planning on 2/10/2022. It was recommended for the patient to go to a skilled nursing facility when medically stable. However, on 2/16/2022 the discharge plan was home with HHC per patient/family request.

On 2/24/2022, SW documented the patient's daughter was aware of the patient's pending discharge to home with Home Health Care services.

On 2/25/2022, Registered Nurse Case Manager (RNCM) documented a follow up phone call was conducted with the patient's daughter. The daughter requested a bedside commode, a walker, and a wheelchair. RNCM documented she contacted the physician who agreed to provide the equipment. RNCM documented the daughter was aware and was in agreement with the discharge for today.

Review of the patient's discharge instructions dated 2/25/2022 documented:
Discharge disposition: Home with home health.
Mode of transportation: Ambulance
Designated Care giver: (name of patient's daughter)
Discharge Diagnosis: Acute CVA (cerebrovascular accident)
Surgical Procedure(s): included incision and drainage of an abdominal wall infection
Nursing Instructions included patient education provided...dressing changes daily for an abdomen wound with normal saline, ABD pad, and tape.

Further record review revealed there was no evidence that documented the patient or responsible party were provided with any wound care supplies for the daily wound care dressing changes. There was no evidence in the medical record that documented the patient or responsible party were provided with the name of the company that would be delivering the bedside commode, the wheelchair and the walker.
There was no evidence in the medical record that documented the patient or responsible party were made aware of a potential delay in the delivery of the requested DME.

On 2/27/2022 SW staff noted, "DME (durable medical equipment) referral sent to (name of company)".
However, the patient was discharged 2 days earlier on 2/25/2022.
There was no evidence in the medical record that documented why the referral was delayed and not sent to the DME on 2/25/2022.

A phone interview was conducted with Staff P on 3/24/2022 at 1210. Staff P was asked to explain why the DME referral was not sent out until 2 days after the patient's discharge and asked to explain what prompted her to send out the referral for DME, 2 days after the patient's discharge. At that time, she (Staff P) replied, "that was when I got the request." Additionally, at that time, Staff P was asked if she had spoken with the patient or the patient's daughter after the patient was discharged and she replied she had not.

A review of the facility's "Hospital Case Management Transition Planning" policy, dated 3/9/2021 documented:
I. Procedure:
G. Case Management staff will provide the patient and/or the patient's representative post-acute care options and available resources. Case Management staff will document the transition planning evaluation(s) and plan(s) patient choice or preferences and referrals, if applicable, in the Case Management documentation system and in the patient's medical record as appropriate.
However, that was not done.