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Based on document review and staff interviews it was revealed the pharmacy failed to ensure outdated, unusable drugs were not available for patient use. This failure was identified in one (1) of two (2) outpatient rehabilitation facilities. This failure has the potential to adversely affect all patients.

Findings include:

1. A tour of the rehabilitation facility/Webster Springs was conducted on 8/20/19 at 12:30 p.m. The physical therapy assistant accompanied the surveyors on the tour. Medications at the facility for patient use had expired. Six (6) Dexamethasone 100mg/10cc vials expired 4/2019, five (5) Dexamethasone 10mg/1cc vials expired 2/2019, ten (10) Acetic Acid 5% vials expired 5/2019 and one (1) acetic acid vial was dated as opened 12/21/18 and expired 5/2019.

2. An interview was conducted with the Director of Business Operations, Ancillary Services and Corporate Compliance on 8/20/19 at approximately 2:00 p.m. She concurred the pharmacy failed to ensure that outdated, unusable drugs were not available for patient use.

Based on a tour of the facility and staff interviews it was revealed the facility failed to ensure a sanitary environment and provide active surveillance for the prevention, early detection and control of infections and communicable diseases. This failure has the potential to adversely affect all patients.

Findings Include:

1. A tour of the facility was conducted on 8/19/19 at 11:20 a.m. The Director of Business Operations, Ancillary Services and Corporate Compliance accompanied the surveyor on the tour of the Central Supply area. Sixteen (16) IV pumps were located on the floor. Multiple cardboard boxes were sitting on the floor in the Central Supply area. A bag of adult diapers was lying on the floor and three (3) small plastic bags of crushed soda cans and computer boxes were located on the floor in the Central Supply area. A tour of the Central Supply area was conducted on 8/19/19 at 1:30 p.m. with the Infection Control Officer. During the tour four (4) lumbar puncture sterile kits were noted as expired on 6/2019, fourteen (14) debridement trays expired on 2/2019 and eight (8) drainage bottles expired on 7/2018..

2. A tour of the rehabilitation facility/Webster Springs was conducted on 8/20/19 at 12:30 p.m. The physical therapy assistant (PTA) accompanied the surveyors on the tour. Two (2) gait belts were noted at the facility. The PTA was asked about the cleaning of the gait belts and she stated, "The gait belts are not cleaned between patients. They are difficult to clean."

3. During the tour on 8/19/19 an interview was conducted with the Infection Control Officer. When asked if the IV pumps had been cleaned prior to being taken to Central Supply, she stated, "Probably not." She stated the IV pumps were exchanged with new IV pumps on the floor. She stated cardboard boxes are not to be located on the floor and unsure why there are multiple cardboard boxes on the floor. She stated the crushed soda cans are not to be stored in the Central Supply area due to they are not clean. She concurred active surveillance was not conducted.

4. An interview was conducted with the Director of Business Operations, Ancillary Services and Corporate Compliance on 8/20/19 at approximately 3:30 p.m. She concurred the rehabilitation facility was not following proper cleaning of the gait belts. She stated they are ordering new gait belts.

Based on surveyor tour and staff interviews it was revealed the facility failed to ensure a small sample of food was preserved for twenty-four (24) hours after each food service in case a food borne disease outbreak happens and that it will be available for laboratory evaluation. The facility does not have a policy that follows this regulation.

Findings include:

1. A tour of the facility kitchen was conducted on 8/20/19 at approximately 11:10 a.m. The kitchen manager accompanied surveyors on the tour. When the tour was completed, the kitchen manager was asked where the twenty-four (24) hour food samples are held and she replied, "I didn't know I had to do that. We don't do that here."

Based on document review and a staff interview it was revealed the facility failed to provide supervision of care on the nursing units. This failure has the potential to adversely affect all patients.

Findings include:

1. A tour of the Nursing Unit was conducted on 8/19/19 at 11:30 a.m. It revealed six (6) purple top vacutainers expired, four (4) green top vacutainers expired, nine (9) red top vacutainers expired, two (2) blue top vacutainers expired and eight (8) twenty-four (24) gauge intravenous (IV) cathlons expired 5/20/19. All expired vacutainers and IV cathlons were located in the phlebotomy tray for patient use. One (1) bottle of betadine was dated as opened 10/21, dust was located on the top of the betadine bottle and it was for patient use.

2. During the tour the Director of Nursing stated nursing staff are responsible for verifying expiration dates on the nursing unit. She stated the phlebotomy tray at the nurse's station is for nursing only. She concurred the nurses were using expired supplies.

Based on document review and staff interviews it was revealed the rehabilitation staff failed to follow their policy for cleanliness of physical therapy equipment. This failure was identified in one (1) of two (2) outpatient rehabilitation facilities. This failure has the potential to adversely affect all patients.

Findings include:

1. A tour of the rehabilitation facility/Webster Springs was conducted on 8/20/19 at 12:30 p.m. The physical therapy assistant (PTA) accompanied the surveyors on the tour. Two (2) gait belts were noted at the facility. The PTA was asked about the cleaning of the gait belts and she stated, "The gait belts are not cleaned between patients. They are difficult to clean."

2. A review of the policy titled Physical Therapy Department Policy For Cleanliness of Physical Therapy Equipment dated 10/2011 stated in part: "All equipment is to be cleaned with the hospital approved disinfectant at the end of the day."

3. An interview was conducted with the Director of Business Operations, Ancillary Services and Corporate Compliance on 8/20/19 at approximately 3:30 p.m. She concurred the rehabilitation facility was not properly cleaning the gait belts between patients. She stated they are ordering new gait belts.