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Based on observations and interviews with key personnel on May 23 - 24, 2016, it was determined that the facility failed to provide preventive maintenance programs to insure that all essential mechanical, electrical, and patient care equipment were maintained in a safe operating condition.

Findings include:
1. On May 23, 2016, between1:40 PM - 2:50 PM, the call light pull cord was observed laying on the floor, creating a sanitation hazard in Restroom 2. Restroom 2 is located in the corridor that leads to Physical Therapy, in the Southwest Harbor Family Practice building.
2. On May 23, 2016 between1:40 PM - 2:50 PM, the call light pull cord was observed wrapped around the grab bar in the Restroom located in the vicinity of the Laboratory and Radiology services, in the Southwest Harbor Family Practice building.
Additionally on 5/24/16 between 9:10 AM - 9:25 AM, the call light pull cord was observed wrapped around the grab bar in the Restroom 3 of the Lisa Stewart Women ' s Health Center.
3. On May 23, 2016 between 1:40 PM - 2:50 PM, the exam table in the Osteopathic Manipulative Therapy Room of the Southwest Harbor Family Practice building was observed to have a biomedical equipment inspection sticker indicating that the inspection for this table was due in 2014.4.
4. On May 23, 2016 between 1:40 PM - 2:50 PM, a wall lamp in the Osteopathic Manipulative Therapy Room in the Southwest Harbor Family Practice building was observed not to have an electrical safety inspection sticker indicating that the inspection for safety had not been performed.
5. On May 24, 2016 at approximately 9:30 AM, a standing scale was observed without a biomedical equipment inspection sticker in the Cadillac Mountain Medical Center building.5. On May 24, 2016 at approximately 12:50 PM, an Intravenous Pump in the Oncology Infusion Center of the Mount Desert Island Hospital was observed to have a biomedical equipment inspection sticker indicating that the inspection for this pump was due by January, 2014.
6. On May 24, 2016 between 9:10 AM - 9:25 AM, pull cords for call lights were observed tied up so that they were not within reach of someone on the floor, and rendering them potentially inoperable for their intended purpose, in Rest Room 1 and Rest Room 2 of the Lisa Stewart Women's Health Center.7.
7. On May 24, 2016 at approximately 11:15 AM, the pull cord for a call light in the Laboratory Restroom of the Mount Desert Island Hospital was observed to be approximately 14 inches from floor, rendering it not within reach of anyone who may have fallen on the floor.
8. On May 24, 2016 at approximately 11:35 AM, the pull cord for the call light in the Changing Room Rest Room in the Radiology department of the Mount Desert Island Hospital was observed to be approximately 4 feet from floor, rendering it not within reach of anyone who may have fallen on the floor.
9. On May 24, 2016 at approximately 11:45 AM, the pull cord for the call light in the Ultrasound Rest Room of the Mount Desert Island Hospital was observed to be approximately 3 feet from the floor, rendering it not within reach of anyone who may have fallen on the floor.
All findings were confirmed at the time of the finding with the Physical Plant Director.

Based on tours of the facility on May 23 and 24, 2016, it was determined that the facility failed to keep the premises clean and orderly.

Findings include:
1. On May 23, 2016, between 1:40 PM - 2:50 PM, a torn vinyl covering, exposing the foam underneath and creating an uncleanable surface was observed on a trampoline in the Physical Therapy Gym. A torn vinyl covering on the corner of the exam table in Exam Room 1, of Physical Therapy at the Southwest Harbor Family Practice was observed creating an uncleanable surface.
2. On May 23, 2016, between 1:40 PM - 2:50 PM, a scrape in the wall behind the draw chair, exposing the wallboard, creating an uncleanable surface was observed in the laboratory in the Southwest Harbor Family Practice.
3. On May 24, 2016, at approximately 8:00 AM, an approximately 1 inch diameter area of wall that had paint missing exposing wall board, creating an uncleanable surface was observed at Trenton Family Practice.
4. On May 24, 2016, at approximately 9:10 AM, a one inch tear in the vinyl, creating an uncleanable surface, was observed in the left arm of the exam chair in Exam room 6 of Lisa Stewart Women's Health Center.
5. On May 24, 2016, at approximately 9:25 AM, an unsealed gap between 2 rows of floor tiles, creating an uncleanable surface, was observed in the Rest Room of the Cadillac Mountain Medical Center.
6. On May 24, 2016, at approximately 10:10 AM, loose stitching in the corner of an exam table creating an uncleanable surface, was observed in the Physician's Assistant's Exam Room of Cadillac Mountain Family Health.
7. On May 24, 2016, at approximately 11:15 AM, missing paint which exposed a wallboard, creating an uncleanable surface was observed in the Triage Room in the Emergency Department of Mount Desert Island Hospital.
8. On May 24, 2016, at approximately 11:40 AM, an approximately one foot long strip of wall behind a chair was observed to be scraped down to the wall board, creating an uncleanable surface, in the Bone Density Room in the Radiology Department of Mount Desert Island Hospital.
9. On May 24, 2016, at approximately 11:45 AM, a hole through the vinyl covering of a positioning wedge, exposing foam and creating an uncleanable surface, was observed in the Computerized Tomography Room in the Radiology Department of Mount Desert Island Hospital.
10. On May 24, 2016, at approximately 1:00 PM, a chip in the entrance of the shower, creating an uncleanable surface, was observed in the Shower Room in the Medical Surgical Unit of Mount Desert Island Hospital.
11. On May 23, 2016, between 1:40 PM - 2:50 PM, two stained ceiling tiles were observed, indicating water leakage and creating a potential for mold growth in Radiology at Southwest Harbor Family Practice.
12. Significant deposits of dust were observed on horizontal surfaces, indicating inadequate cleaning of patient areas as follows:
A. May 24, 2016, at approximately 11:15 AM, on the computer monitor support arms, wall-mounted blood pressure dial, and the wall mounted clock in the Triage Room and on the white board in Exam Room 2 in the Emergency Department of Mount Desert Island Hospital.
B. On May 24, 2016, at approximately 1:00 PM, on the top surfaces of the bathroom light that was over the sink, the lamp over the bed and the television monitor in Room 3201 in the Medical/Surgical Unit of Mount Desert Island Hospital.
C. On May 24, 2016, at approximately 1:10 PM, on the top of the light over the sink in the bathroom and on the top surface of the light over bed in Room 3212 in the Medical/Surgical Unit of Mount Desert Island Hospital.
D. On May 24, 2016 at approximately 1:45 PM, on top of the bathroom door, on top of the cabinet, and on the top of the white board frame in Room 3218 in the Intensive Care Unit of Mount Desert Island Hospital.
13. On May 24, 2016, at approximately 1:00 PM, a shower curtain with discolored, mold-like stains along the bottom was observed in the Shower Room in the Medical Surgical Unit of Mount Desert Island Hospital.
14. On May 24, 2016, at approximately 1:35 PM, brownish deposits, on the joints of an Intravenous Pole, indicating insufficient cleaning of this item, were observed in X-Ray Room 1 in the Radiology Department of Mount Desert Island Hospital.

All findings were confirmed at the time of the finding with the Physical Plant Director.

Based on an observation and interviews, the hospital's inventory contained expired intravenous (IV) fluids which were available for patient use. Ten (10) 50 milliliter (ml) bags of dextrose 5% with an expiration date of April 1, 2016 were stored in a bin in the medical-surgical (med-surg) medication room on an inpatient unit.

Finding:

On May 24, 2016, at 9:10AM, the surveyor observed ten expired 50 ml bags of IV fluid dextrose 5% in a bin in the med-surg medication room available for patient use. The expiration date printed on the bags was April 1, 2016. Upon interview with the surveyor, Nurse #1, in the medication room at the time, confirmed this finding.

On May 25, 2016 at approximately 11:00 AM, the surveyor interviewed the Chief Nursing Officer and the Director of Nursing Services. Neither leader could articulate the current monitoring system for removing expired medications and biologicals from patient use.

Based on observation, interviews and a review of the hospital's clinical skills procedure, the hospital failed to ensure one of two dressing changes observed on May 24, 2016, were completed according to infection control and nursing standards of practice. (Patient #ZZ)
On May 24, 2016, at 9:25 AM, the surveyor observed a dressing change performed by Nurse #1. Nurse #1 placed the dressing supplies on Patient ZZ's bed and proceeded to remove the old dressing. Nurse #1 cleansed the incision site and placed a clean dressing without changing her gloves. The nurse used the patient's bed for a clean field and she did not change gloves after removing the soiled dressing and before applying the clean dressing. In addition, hand hygiene was to be performed in between changing the gloves. The nurse violated nursing and infection control standards of practice.
The surveyor reviewed the facility's clinical skills procedure that is used for nursing standards of practice. The dressing change procedure outlined that a clean field is to be prepared for the new dressing supplies by cleaning the patient's overbed table. The disposable gloves are to be changed after removing the soiled dressing and after cleaning the incision. In addition hand hygiene is to be performed each time before donning new gloves.
On May 24, 2016, at 10:30 AM, the Infection Control Nurse and the Director of Nursing confirmed that the dressing was not changed according to the facility's clinical skills procedure published by Mosby's Nursing Standards of Practice for a clean dressing change.