HospitalInspections.org

Based on a Center Medicare and Medicaid Services (CMS) memo review, facility policy review, facility brochure review, medical record review, observation, and interview, the facility failed to ensure the families of Senior Care Unit patients had accurate information and access to visitation for 3 (Patients #1, #3, #4) of 4 patients reviewed for visitation access throughout their hospitalizations, except for notification of a patients' medical concern.

The findings included:

Review of CMS memo "Guidance for the Expiration of the Covid-19 Public Health Emergency (PHE)" dated 5/1/2023, showed "...emergency waivers for health care providers will terminate with the end of the Covid-19 Public Health Emergency (PHE) on May 11, 2023..."

Review of the facility policy "Visitation", dated 1/2023, revealed "...[named facility] will provide patients with the opportunity to have visitors...the hospital allows for the presence of a support individual...Senior Care Unit Visiting Guidelines...visiting hours Monday - Friday 5:00 pm to 6:00 pm, Saturday - Sunday 12:30 pm to 1:30 pm...all visitors are required to sign in on arrival and sign out on departures...".

Review of the facility's Senior Care Program's brochure, undated, revealed "...family support is encouraged every step of the way to help achieve healthy outcomes...Visiting Hours 6 pm - 7 pm daily, Saturday and Sunday - 2:00 - 3:00 pm, Special visitation on holidays..."

Medical record review showed Patient #1 was admitted to the Senior Care Unit on 4/28/2023 with diagnoses including Unspecified Dementia, Unspecified Severity, with Agitation, Cardiovascular Disease, Hypertension, Chronic Obstructive Pulmonary Disease (COPD), and Diabetes Mellitus Type 2. Patient #1 was discharged home 5/14/2023 with hospice services.

Medical record review showed Patient #1's consent for treatment was signed, via telephone consent, by her Power of Attorney (POA)/sister. The telephone consent, by the POA, was also given for her voluntary consent to the secured entry Senior Care Unit, of Patient Rights "...to see visitors each day..."

Medical record review of Patient #1's Patient Care Notes, dated 5/13/2023 at 7:50 AM, showed Patient #1 developed a nonproductive cough, lungs on auscultation (listening with a stethoscope) with crackles (lung sounds occurring when small air sacs in the lungs fill with fluid) and wheezes, and decreased urinary output. The POA/sister was notified with arrangements to visit the same day. The POA/sister and 1 other family member visited Patient #1 the same day. Patient #1 was discharged home 5/14/2023 on Hospice Services.

Observation on 6/6/2023 at 9:15 AM, of the Senior Care Unit, with the Director of Quality and Risk Management and Chief Nursing Officer (CNO), showed a waiting room outside the coded, secured doors of the unit. Located on the wall in the waiting room, next to the secured doors, was a large sign "Visiting Hours". The sign posted the following visitation hours: Monday - Friday 5:00 - 6:00 pm; Saturday - Sunday 12:30 PM - 1:30 PM. On a table, centrally located around the waiting room chairs, was a stack of Senior Care Program brochures with the following visitation hours: 6:00 PM - 7:00 PM daily, Saturday and Sunday - 2:00 PM - 3:00 PM, Special visitation on holidays. Inside the Senior Care Unit revealed an 18-bed unit with a current census of 10 patients. A tour of the unit revealed visible staff and patients. There were no visitors present.

During a review of the brochure, posted visitation sign, observation, and interview, on 6/6/2023 at 9:25 AM, in the waiting room of the Senior Care Unit, the Senior Care Unit's Nurse Manager stated the locked unit's visitation was Monday - Friday 5:30 PM to 6:30 PM, and Saturday -Sunday 12:30 PM to 1:30 PM. She stated the Senior Care Unit followed CMS Covid-19 guidance for visitation. She stated she was aware the waivers were expired but was unable to provide a date for the expired waivers. She said Patient #1 had visitation after the facility notified the family of the patient's medical and physical decline. She confirmed the unit failed to maintain a visitor log.

During staff interviews on 6/6/2023 from 9:45 AM to 10:15AM, in the Senior Care Unit, with Registered Nurses (RN) #1, #2, #3, Licensed Practical Nurse (LPN) #1, Mental Health Technicians (MHT) #1, #2, the Social Service Director, and the Social Service Assistant, all interviewed staff stated visitation had not occurred since the Covid-19 pandemic. RN #3 stated if a family asked about visitation "...we aren't doing it..." RN #1 stated "...we don't do visitors for a reason...if 1 patient gets Covid, they all get Covid-19..." She stated she could not remember when she stopped wearing Personal Protective Equipment (PPE), including masks, in the facility. The Social Service Director confirmed families had complained to her about the visitation "...we can't have visitors because of Covid-19...I tell families no one is visiting right now...I don't make those decisions..."

During an interview on 6/6/2023 at 11:17 AM, in the Conference Room, the CNO confirmed the facility did not follow their visitation policy for the Senior Care Unit. He confirmed the Senior Care Unit posted Visitation hours, the Senior Care Unit brochure visitation hours available to all visitors, and interview from the Senior Care Unit's Nurse Manager stated visitation hours were not consistent and only the posted visitation sign followed the facility's policy. He confirmed he was aware the CMS Covid-19 PHE waivers were expired for visitation limitation. He confirmed the Senior Care Unit was unable to provide a visitor logbook to review for family visitation.