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Based on observation, staff interview and facility record review the facility (1) failed to provide appropriate temperature controls in refrigerator/freezers used to supply nutrition/food items in the Family Birthing Place and 4th floor (west) orthopedic units, for the patient, staff and community visitor population; (2) failed to provide an environment to promote and prevent the spread of infection for the patient, staff and the community visitor population.

The findings include:

A tour of the Family Birthing Center was conducted in the morning of 12/4/2012. The tour included the nutritional pantry area. The ice machine located in the pantry was observed with a spotted white residue on the backsplash and on the clear plastic ice flow section/piece of the machine. An observation of milk colored liquid build up was observed in the drip tray. There is rust color moisture/residue build up underneath the machine. The cupboards and drawers were found with coffee ground like debris, crumb like debris and dust like debris observed. The cupboard doors were observed with black/brown drip like stains from the top of the doors to the bottom of the cupboard doors. The Staff member 2 stated,"Yes, I see that." Staff member 2 continued and commented that it seemed like there needed some housekeeping to be done in this area. The refrigerator in the pantry revealed hair like debris at the bottom of the refrigerator. There is debris on the shelves in the refrigerator and on the shelves on the refrigerator door. Staff Member 3 commented the refrigerator needed to be cleaned. She stated, "That will be taken care of immediately."

The tour also included a storage room. The charge nurse on duty explained this area stored clean equipment. The room contained multiple equipment/devices. A fetal head extractor was observed in the storage area. The device was not covered and there was a collection of dust like material noted on the top surface.

A locked anesthesia cart was observed outside the storage room in the hallway. The cart was noted with black brown debris dripped down the side of the cart by the trash receptacle mounted to the cart. There is a pullout drawer on the opposite side of the cart. This was opened and revealed a clip board. The clip board had a dust like material around the edge of the clipboard. The dust like particle build up was observed on the edges of the drawer. The front of the cart was observed with multiple spots on the front of the cart. Staff member 3 commented this cart would be cleaned.

During a tour of 3 East on 12/03/2012 at 1:15PM, it was observed that the grate in the ice machine had white sediment coating the grate. In addition, the side of the sink had green sediment on the side of the sink down to the floor.
During the 12/4/2012 tour of the 4th floor Orthopedic Unit (4 north) an examination of the Accu Chek (Blood Glucose Testing Device) was conducted. The device with the inventory/control # UJ50047264 has a missing piece of plastic at the bottom portion of device. The device has clear tape wrapped around the device at the bottom. The tape is matted with a black residue on the frayed edges of the tape. The device is cracked at base where the bottom fits into docking station. This missing plastic piece exposes the inside of the device and two lateral parallel wires are exposed at this part of the device. A crack approximately 1/4 inch is observed on the front of the device at the portion of the docking station area. Another crack in the plastic is noted at the bottom right side adjacent to the LCD screen. There are visible rust colored stains in the seams of the device.

The Accu Chek device # UJ66039854 was also examined. This device had visible rust colored stains/residue in the seams of the device. There is a crack in the plastic at the bottom of the device where the device would be placed into the docking station area. Staff Member 4 explained the condition of the Accu Chek devices was not appropriate and stated "I am not liking these either at the moment." Docking stations for both devices contained black /dust like debris in the bottom of the docking station.

The medication cart is located in the medication room. Staff Member 1 explained the cart surface is used for medication preparation. The surface is observed with black like dust and debris with brown spots.

A Bladder Scan Machine was observed and a crack was visible on the right side of the machine.
Oxygen tank holder cart located on the 4th floor storage area was observed on 12/4/2012. The cart contained several oxygen tanks. The cart floor was observed with various types of debris including not limited to card board box top, plastic tabs from used oxygen tanks and there is dirt/dust like colored debris observed on the cart floor. Staff Member 4 explained that the Respiratory Department is responsible for these carts.

An interview with Staff Member 5 was conducted at approximately 11:00AM on 12/4/12. He commented the oxygen supply contractor supplies the oxygen tank holders. He also explained he had not observed the condition of the carts. He stated, " I will contact the company for a replacement cart." He continued by commented the condition of the cart was not what he would expect.

A tour of the orthopedic unit identified as 4th Floor West was conducted in the afternoon of 12/4/2012. The tour revealed the medication refrigerator was located in a locked/secured medication room. The medication refrigerator was opened by the charge nurse. The refrigerator contained IV medication. The refrigerator was observed with staples at the bottom of the refrigerator, several of the staples were rust colored and silver colored staples were also observed. The side door shelves were observed with a yellow colored substance and with debris on both door shelves. The refrigerator had black dust-like material noted at bottom rubber gasket area. The air vent area was observed with dust /debris on the vent slats.

During the 12/4/2012 tour of the 4th floor Orthopedic Unit (4 north) an examination of the Accu Chek (Blood Glucose Testing Device) was conducted. The device with the inventory/control # UJ50047264 has a missing piece of plastic at the bottom portion of device. The device has clear tape wrapped around the device at the bottom. The tape is matted with a black residue on the frayed edges of the tape. The device is cracked at base where the bottom fits into docking station. This missing plastic piece exposes the inside of the device and two lateral parallel wires are exposed at this part of the device. A crack approximately 1/4 inch is observed on front of the device at the portion of the docking station area. Another crack in the plastic is noted at the bottom right side adjacent to the LCD screen. There are visible rust colored stains in the seams of the device.

The Accu Chek device # UJ66039854 was also examined. This device had visible rust colored stains/residue in the seams of the device. There is a crack in the plastic at the bottom of the device where the device would be placed into the docking station area. Staff Member 4 explained the condition of the Accu Chek devices was not appropriate and stated, "I am not liking these either at the moment." Docking stations for both devices contained black /dust like debris in the bottom of the docking station.

The medication cart is observed in the 4 North medication room. Staff Member 1 explained the cart surface is used for medication preparation. The surface is observed with black like dust and debris with brown spots. A Bladder Scan Machine was observed and a crack was visible on the right side of the machine.
A medication administration observation was conducted at 1:24 PM. on 12/4/2012 in the Family Birthing Place. The nurse was observed obtaining the appropriate medication per the physician order from the medication delivery device (Pyxis). The nurse was observed entering the patient room and administering the medication. After the medication administration the nurse explained she did not wash her hands before or after the medication administration. She stated "I did not."

A medication administration observation was conducted at 9:05 AM on 12/4/2012 on 3 East. Nurse #10 was observed entering the patient's room without sanitizing her hands and flushing a heparin lock line without wearing gloves.

On 12/4/12 at 9:30 AM, a family member of the patient in Room 359 was observed without PPE attire in a room where the patient was on contact isolation.

On 12/6/12 at 8:20 AM, a family member of the patient in Room 457 was observed without personal protective equipment (PPE) attire in a room where the patient was on contact isolation.

Based on observation and interview, the facility failed to (1) maintain equipment; (2) failed to provide and ensure suction/crash cart equipment on the orthopedic floor is appropriately inspected to ensure safety and functioning of the suction equipment.

The findings include:

During the 12/4/2012 tour of the 4th floor Orthopedic Unit (4 north) an examination of the Accu Chek (Blood Glucose Testing Device) was conducted. The device with the inventory/control # UJ50047264 has a missing piece of plastic at the bottom portion of device. The device has clear tape wrapped around the device at the bottom. The tape is matted with a black residue on the frayed edges of the tape. The device is cracked at base where the bottom fits into docking station. This missing plastic piece exposes the inside of the device and two lateral parallel wires are exposed at this part of the device. A crack approximately 1/4 inch is observed on front of the device at the portion of the docking station area. Another crack in the plastic is noted at the bottom right side adjacent to the LCD screen. There are visible rust colored stains in the seams of the device.

The Accu Chek device # UJ66039854 was also examined. This device had visible rust colored stains/residue in the seams of the device. There is a crack in the plastic at the bottom of the device where the device would be placed into the docking station area. Staff Member 4 explained the condition of the Accu Chek devices was not appropriate and stated "I am not liking these either at the moment." Docking stations for both devices contained black /dust like debris in the bottom of the docking station.

The medication cart is located in the medication room. Staff Member 1 explained the cart surface is used for medication preparation. The surface is observed with black like dust and debris with brown spots. A Bladder Scan Machine was observed and a crack was visible on the right side of the machine.

Oxygen tank holder cart located on the 4th floor storage area was observed on 12/4/2012. The cart contained several oxygen tanks. The cart floor was observed with various types of debris including not limited to card board box top, plastic tabs from used oxygen tanks and there is dirt/dust like colored debris observed on the cart floor. Staff Member 4 explained that the Respiratory Department is responsible for these carts.

An interview with the Staff Member 5 was conducted at approximately 11:00 a.m on 12/4/12. He commented the oxygen supply contractor supplies the oxygen tank holders. He also explained he had not observed the condition of the carts. He stated," I will contact the company for a replacement cart." He continued by commenting the condition of the cart was not what he would expect.

A tour of the orthopedic unit identified as 4th Floor West was conducted in the afternoon of 12/4/2012. The tour revealed the medication refrigerator was located in a locked/secured medication room. The medication refrigerator was opened by the charge nurse. The refrigerator contained IV medication. The refrigerator was observed with staples at the bottom of the refrigerator, several of the staples were rust colored and silver colored staples were also observed. The side door shelves were observed with a yellow colored substance and with debris on both door shelves. The refrigerator had black dust-like material noted on the bottom rubber gasket area. The air vent area was observed with dust /debris on the vent slats.

A tour of the 4th floor Orthopedic (West) was conducted on the afternoon of 12/4/2012. The crash cart was opened by Staff Member 9. The bottom drawer contained suction equipment (Wall suction device) which attaches to the suction receptacle. An inspection of the suction equipment revealed there was no biomedical sticker on the equipment. Staff Member 9 explained the suction equipment is not checked daily to ensure function. She continued to explain the equipment should have a bio medical inspection sticker which would indicate the equipment was checked and in working condition.

An interview with the Biomedical Director was conducted at 11:45 a.m on 12/4/12. He commented the suction equipment did not have a sticker and the equipment "got put through" and placed on the crash cart, without the appropriate inspection. Staff Member 9 later explained the process would be changed. The new process would include routine/daily checking of the suction equipment on the crash cart to ensure the appropriate inspection and functioning of the suction equipment.

Based on observation, staff interview and facility record review, the facility failed to provide appropriate temperature controls in refrigerator/freezers used to supply nutrition/food items in the Family Birthing Place and 4th floor ( west) orthopedic units, for the patient, staff and community visitor population.

The findings include:

A tour of the Family Birthing Place was conducted on 12/4/2012 at 11:30 AM. During the tour the nutrition room refrigerator/freezer was observed. The freezer thermometer was observed with a temperature reading of 52 degrees Fahrenheit (Temperature above appropriate temperature for freezer). The daily freezer log on the refrigerator documents temperatures between 34-37 degrees Fahrenheit for 12/1-4/2012. The last entry was documented at 0000 hour (midnight) on 12/4/2012. The temperature documented was 34 degrees Fahrenheit.

On 12/04/12 at 11:35AM Staff Member 2 commented the items in the freezer were frozen in spite of the thermometer readings. She continued commenting the items were in the freezer for the patients on the floor. She stated she would obtain a " working thermometer for the freezer."

A tour of the 4th floor (north) Cafe area was conducted on 12/4/2012 in the afternoon. This area is open to patients, family and staff. There is a refrigerator in the Cafe. The freezer contained small individual cups of ice cream and sherbet type items. The freezer did not contain a thermometer. The nurse coordinator explained the digital thermometer attached to the refrigerator monitored the refrigerator section only. The nurse coordinator commented the appropriate hospital staff to obtain a thermometer for the freezer and initiate a freezer temperature log.