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Based on observation, interview and document review, the facility failed actively screen staff, patients, and/or visitors for symptoms prior to entrance to the facility, or require source control masks to patients and visitors upon entrance in accordance with Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control (CDC) guidelines for COVID-19.

Findings include:

Observation on 4/30/20, at 10:20 a.m. of an unidentified patient (P)-1 entering the facility at the hospital main entrance and walked to the front receptionist desk. P1 was verbally screened by the hospital receptionist. The screening performed included asking P1 if he had a temperature, respiratory symptoms or if he had traveled out of the country in the past 14 days. P1's temperature was not taken. While P1 was sitting on his four wheel walker at the receptionist desk, a second patient (P2) entered and walked within a few feet of P1.

Review of the Patient/Contractor/Vendor Primary Infectious Disease Screening tool dated 4/20/20, included verbal questions for fever, cough, difficulty breathing, close contact with someone know/suspected to have COVID-19, rash, and international travel within the last four weeks. The screening process did not included active screening by a staff person to obtain the temperature of the entering person.

Interview with hospital receptionist (HR)-A on 4/30/20, at 10:40 a.m. confirmed patient and visitors who enter the hospitals main entrance during business hours are screened according to the observation above, and only are further screened if the visitor or patient states yes to any of the screening questions. HR-A indicated staff are only required to ask the patients or visitors if they have a temperature. The receptionist desk does not possess a thermometer.

Interview with hospital receptionist HR-B on 4/30/20, at 10:58 a.m. indicated only a verbal screening is performed at the receptionist desk and if someone indicates yes on any of the questions, a nurse is called. The receptionist desk does not possess a thermometer.

Interview with registered nurse (RN)-A on 4/30/20, at 12:05 indicated employees enter through the emergency department doors and go to the emergency department receptionist desk area and self-screen at the Kronos Time Clock. They answer the screening question posted in Kronos Time Clock and if they answer no to all the questions, they go to the triage room, nurse's station or the supply cart in the emergency department hallway to get a mask. There are no masks available at entrance to the hospital or at the receptionist desk. No temperatures or active assessment is performed prior to entering the hospital.

Interview with physical therapist (PT)-E on 4/30/20, at 12:12 p.m. confirmed that patients are verbally screened at the outpatient desk but not all patients must wear a source control mask. Some patients enter the physical therapy room without a mask. PT-A also confirmed they do not screen residents coming from the nursing home because she thought they were being screened before they entered the physical therapy gym.

Follow up interview with PT-E on 4/30/20, at 12:30 p.m. confirmed temperature checks were not included in the screening process before a patients presented to the physical therapy room.

Interview with vice president, regional operations (VP) and director of nursing (DON) on 4/30/20, at 1:14 p.m. confirmed staff are completing passive self-screening upon entering the facility and are completing the COVID-19 questionnaire in Kronos Time and Attendance Time Clock. Staff and do not obtain their temperature. VP and DON indicated they were unaware of the active screening process. The VP confirmed that a face mask is required for everyone that comes into the facility. Additionally, they were in agreement that staff should have a mask available just inside the facilities entrances and not have to walk to another area to obtain a mask.

Review of the 4/9/20 Emerging Threats- Acute Respiratory Syndromes- Coronavirus policy identified screening criteria steps for ambulatory and emergency department patients. Screening questions included if the patient has respiratory symptoms and if they had traveled outside the United Stated. If there is a suspected case then a patient is given a surgical mask to leave on throughout their visit in the hospital. The policy did not include obtaining a temperature check. The policy also included steps for screening facility staff. The policy directed staff to use the employee screening log to gather and record employee criteria to determine suitability to work. The log only included temperature checks, it did not include symptom screening related to respiratory symptoms.