The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

KERN VALLEY HEALTHCARE DISTRICT 6412 LAUREL AVE LAKE ISABELLA, CA 93240 Nov. 22, 2011
VIOLATION: DRUG AND BIOLOGICALS Tag No: C0886
Based on observation and interview, the hospital failed to ensure expired medications were not available for patient use which had the potential for adverse patient outcomes.

Findings:

During an inspection of the emergency department (ED) medication room with the Chief Nursing Officer (CNO) on 11/22/11 at 10:20 AM, two expired medications were found. A vial of insulin (a medication used to treat high blood sugar) with the expiration date of 11/19/11 and a vial of tuberculin (a serum used to test for tuberculosis) with the expiration date of 9/2011 were found in the medication refrigerator. The CNO stated the medications should be discarded when they are expired.

During an interview with the Pharmacist on 11/22/11 at 11 AM, he stated he goes through each area of the hospital checking the medications once a month. He was uncertain how he missed the expired medications found in the ED medication room.
VIOLATION: NURSING SERVICES Tag No: C1046
Based on interview and record review, the hospital failed to meet the needs of two patients (1, 2) when the emergency department (ED) staff were rude and insensitive to their needs resulting in both patients experiencing emotional stress.

Findings:

During an interview with Patient 1 on 11/21/11 at 2:30 PM, she stated she went to the hospital's ED often because she had multiple medical problems. When she was there in 8/2011, she was talking to another patient while she was waiting for a ride home and the nurse told her to go sit down. She felt the nurse was very rude. On a second visit on 9/30/11, she had fainted then fell at home and hit her head. She was transported to the hospital's ED by ambulance. She stated the ED medical doctor (MD) told her the only thing wrong with her was she had a panic attack. Both her and her husband tried to tell him the paramedics said her blood sugar was very low and caused her to faint. She stated the MD walked out and she heard him laughing about her with the ED staff. She stated she felt the MD and ED staff were very rude and condescending which caused her emotional stress.

The clinical record for Patient 1 was reviewed on 11/22/11 at 12:08 PM. Face sheets were found for ED visits 8/17/11 and 9/30/11. The ambulance service documentation dated 9/30/11 at 10:55 PM, indicated Patient 1 was found on the floor when paramedics arrived. Her blood oxygen level was 93% (normal is >96), and her blood sugar was 60 milligrams per deciliter (normal is 80-110). The emergency physician record dated 9/30/11 at 11:15 PM, read "Multiple visits to the ED for similar complaints. Dx (diagnosis): acute anxiety."

During an interview with Patient 2 on 11/22/11 at 1 PM, she stated the ED staff and medical doctors were very rude and they would always talk down to her when she or her boyfriend came there. She stated the ED staff would say she and her boyfriend were drug seeking when they had pain. She would hear the staff when they were out of the room laughing and making rude comments about patients including her. She stated it made her upset and added more stress to her situation.