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Based on observation, interview, and review of facility policy, it was determined the facility failed to ensure garbage was properly disposed. This failure has the potential to affect all patients and staff at the facility.

Findings included:

An observation on 07/25/18 at 9:00 AM revealed two (2) garbage dumpsters located outside the kitchen area of the hospital that were left open. Garbage bags full of refuse were visible inside the dumpster at the time of the observation.

During an interview with the Director of Environmental Services (DES) on 07/25/18 at 10:30 AM, the DES stated that the outside dumpster lids should be closed after garbage is placed in the dumpsters. At the time of the interview, the DES stated he did not know if the hospital had a policy related to the proper disposal of garbage.

A review of the facility policy, "Trash/Waste Management," dated 07/25/18, revealed the facility required hospital staff to transport garbage to the dumpsters located outside the service area of the hospital. In addition, the policy required the facility staff to maintain a sanitary and safe environment at the facility by ensuring trash properly bagged and required dumpster lids to be closed.

During an interview with the Chief Executive Officer (CEO) on 07/25/18 at 4:00 PM, the CEO stated that he approved the facility policy, "Trash/Waste Management," on 07/25/18. The CEO further stated that the DES informed him the policy was developed on 07/25/18 and submitted to him for approval after a request was made for the hospital's policy related to the proper disposal of garbage. In addition, the CEO confirmed that the lids should be closed on the dumpsters located on the grounds of the hospital.

Based on staff interview, and review of facility documents, the facility failed to have the Critical Access Hospital (CAH) professional health care staff review all the health care policies on an annual basis. This failure could lead to missed opportunities to evaluate and update references used by all nursing, technical, and supporting staff providing care to patients in this facility.

Findings include:

Upon entrance to the facility on 07/25/18, a request was made to the Chief Nursing Officer to provide documentation of the facility's yearly program evaluation, and review of policies.

Review of the documents provided showed the document titled, "Policy Review and Approval Committee," was signed by a physician, a mid-level practitioner, and the Chief Nursing Officer (CNO and a mid-level practitioner) and was dated 02/08/17.

During an interview with the CNO on 07/26/18 at 8:45 AM, the CNO reported that there was no documentation of a policy review since 02/08/17 and acknowledged the requirement for an annual review and update of all policies in the facility.

Based on observation, interview and review of the facility's policy, the facility failed to ensure staff followed appropriate infection control procedures maintaining supplies in a clean and secure area in two rooms on the Obstetrics (OB) Unit. This failure could lead to cross contamination from pathogens (bacteria and viruses) and placed all 16 in-patients at this facility at risk of infection.

Findings include:

Observation in Room 1 of the OB Unit on 07/25/18 at 9:35 AM revealed an unlocked cupboard containing multiple supplies used during and after delivery of a newborn in the room. Several of the items were in sterile packaging: one pair of scissors, one speculum (a device used to conduct visual exam of a patient's vaginal area), and 4 cotton tipped swabs. Observation in Room 3 of the OB unit revealed an unlocked cupboard containing the same items.

During an interview with the Clinical Nurse Specialist (CNS) in charge of the OB Unit, on 07/25/18 at 9:40 AM, the CNS observed the unlocked cupboards and stated the supplies should be locked. The CNS stated visitors, including children, are permitted unsupervised in the rooms and could access the supplies.

Review of the facility's policy titled, "OB Closing and Storage," dated 07/25/18, revealed, "The following will be stocked and locked, and checked for security every shift by the OB nurse/designee: Cabinets and drawers containing equipment in the patient rooms."

Based on patient interview, staff interview, review of medical records, and review of the facility's policy, the facility failed to provide a trained Activities Director and physician ordered Activity Assessments for 11 of 11 swing bed patients (in-patient requiring longer term skilled nursing care) sampled, Patient (P)1, P2, P4, P5, P6, P7, P8, P9, P10, P11, and P12. Failure to provide a trained professional to evaluate and provide activities could lead to missed opportunities to meet the psychosocial needs of all swing bed patients in the facility.

Findings include:

During an interview with P10 on 07/25/18 at 10:40 AM, P10 was asked if he/she had received a visit and interview from a staff member designated to evaluate his/her interests and desires for activities while a patient at this facility. P10 replied no staff member had interviewed him/her on that subject. When asked if he/she had been provided with a calendar of activities offered by the facility, P10 stated, "No." P10 voiced no complaints or concerns about the level of activities offered by the facility nursing staff.

During an interview with P5 on 07/25/18 at 10:55 AM, P5 was asked if he/she had received a visit and interview from a staff member designated to evaluate his/her interests and desires for activities while a patient at this facility. P5 replied no staff member had interviewed him/her on that subject. When asked if he/she had been provided with a calendar of activities offered by the facility, P5 stated, "No." P5 voiced no complaints or concerns about the level of activities offered by the facility nursing staff.

During an interview with P8 on 07/25/18 at 11:25 AM, P8 was asked if he/she had received a visit and interview from a staff member designated to evaluate his/her interests and desires for activities while a patient at this facility. P8 replied no staff member had interviewed him/her on that subject. When asked if he/she had been provided with a calendar of activities offered by the facility, P8 stated, "No." P8 voiced no complaints or concerns about the level of activities offered by the facility nursing staff.

During an interview with P1 and a family member on 07/25/18 at 11:45 AM, P1 was asked if he/she had received a visit and interview from a staff member designated to evaluate his/her interests and desires for activities while a patient at this facility. P1 replied no staff member had interviewed him/her on that subject. When asked if he/she had been provided with a calendar of activities offered by the facility, P1 stated, "No." P1 and his/her family member voiced no complaints or concerns about the level of activities offered by the facility nursing staff.

During an interview with the facility Clinical Nurse Supervisor (CNS) on 07/25/18 at 12:45 PM, the CNS was asked the name of the facility's Activities Director. The CNS replied, "We don't have one, that's in progress." When asked how the facility was meeting the activities needs of the swing bed patients, the CNS stated the facility currently had the Certified Nursing Assistants (CNAs) provide activities to patients. When asked if the CNAs had professional training in this field, the CNS replied, "No, we would like to send one of our CNAs to state-approved training. "The CNS stated no calendar of activities was currently being provided to swing bed patients.

During an interview with the Chief Nursing Officer (CNO) on 07/25/18 at 11:50 AM, the CNO was asked if the facility currently employed an Activities Director for swing bed patients, and the CNO replied, "No." The CNO added the facility had hired an Activities Director in February 2018, but the individual had resigned. The CNO stated the facility was advertising and actively recruiting for a qualified Activities Director.

Review of medical records for swing bed patients P1, P2, P4, P5, P6, P7, P8, P9, P10, P11, and P12 all revealed physician admission orders for an Activities Assessment. In all records reviewed, no Activities Assessment was completed. All records reviewed revealed daily documentation by CNAs of leisure time activities enjoyed by all the patients listed above.

Review of the facility's policy titled, "Patient Activities," last revised 07/18, showed, "Activities will be directed by a person (Activities Director) who has completed a training course approved by the state. A monthly activities calendar will be provided to each skilled patient."