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NORTH METRO MEDICAL CENTER 1400 BRADEN STREET JACKSONVILLE, AR 72076 Feb. 28, 2013
VIOLATION: FACILITIES, SUPPLIES, EQUIPMENT MAINTENANCE Tag No: A0724
Based on observation, review of policy and procedures and interview, it was determined the facility failed to assure equipment, supplies and furnishings were clean and in repair in seven of seven areas toured (Medical Intensive Care Unit, Emergency Department, Geriatric Psychiatric Unit, Medical Surgical Unit, Laundry, Materials Management and the Dietary Department). The safety and comfort of the patients in the environment could not be assured. The failed practice affected the inpatient census of 32 patients and had the potential to affect any patient treated at the facility. The findings were:

A. Observation of the physical environment of the Facility from 0915 through 1150 on 02/28/13 revealed:\

1) Medical Intensive Care Unit (MICU):
a) MICU bed #1 was occupied. There were two soiled fans, a chair with two torn areas in the vinyl covering that had a porous tape covering it. The fitted sheet on the patient's bed had 14 holes in it.
b) MICU bed #4 was occupied. The fitted sheet had four holes noted in it.
c) The supply and linen room contained a metal cabinet with shelves with a two inch by five foot strip of cloth type tape running along the side on the edge, a portion had become unattached and the metal end enclosure was protruding. A laminate cabinet that held linen had a section of laminate missing along the second shelf that exposed the wood surface beneath.

2) Emergency Department:
a) The Cardiac room had an accumulation of dust on the high touch surfaces. The cabinets in the room had multiple areas of missing and cracked laminate that exposed the wood surface beneath.
b) The Trauma room had an accumulation of dust on the high touch surfaces. The stretcher bed in the room had dust and hair on the under surface of the stretcher. The cabinets in the room had areas of missing laminate.

3) Geriatric Psychiatric Unit:
a) Room 128 A & B beds had multiple holes in the bottom fitted sheet.
b) Room 125, bed B foot board had the laminate finish cracked and broken exposed the wood surface beneath.
c) A patient lift was stationary in the hallway across from the nursing station. The lift had an accumulation of dust across the surface.
d) The Day Activity Area had seven of seven dark blue vinyl chairs with the arm rests torn in three to four places on each.
e) The love seat in the day area was a dark color and had multiple places of overall soiling. The cushions were removed for observation and 12 plastic wrappers, crumbs and white tissue was noted on the love seat beneath the cushions.
f) The couch was a dark color and had multiple areas of overall soiling. The cushions were removed for observation and trash and crumbs were noted beneath the cushions.
g) The laundry room, used for patient clothing only, was observed. The overhead dryer vent had an accumulation of dryer vent residue along the outer surface.
h) A dark blue vinyl chair was observed in the area outside the nursing station with the arms rests torn in three places each.
i) A dark blue vinyl type chair was observed in the hallway with a rip in the seat area, approximately three inches long.
j) A tour of a group room, used if census required, revealed a love seat with an accumulation of crumbs, board game pieces, and tissue beneath the two cushions.
k) Located outside Seclusion Room #2, identified by the Program Director as being used for "Clean Storage", a white shower chair with blue mesh was noted. The blue mesh was frayed along the back support area. A cushion was noted in one of the chairs and the cushion was soiled.
l) There were four ceiling tiles with brown circled areas located 11 feet from the Unit entrance doors.

4) Medical Surgical Unit (1 E) and the following rooms were identified as ready for occupancy:
a) Room 102, the fitted sheet had 12 holes and one corner of the sheet was ripped. The bathroom was observed with spattered brown material on the wall surface around the toilet.
b) Room 131, in the shower area, a beside commode was noted with no tips on the legs supporting the chair. A single use specimen container was noted positioned in the bedside commode.
c) Rooms 101, 130, 134, and 133 were observed with holes in the fitted sheet on the bed.

5) Laundry (Environmental Services)
There were 12 fitted sheets available on the cart for use in the facility. A sample of the fitted sheets were unfolded by and viewed and two of the six had one or more holes in the material.

6) Materials Management and the area for receiving, storage and distribution of supplies was toured.
a) A wire rack on the floor was used for the storage of boxes, which included sterile supplies for use in the operating room. The area beneath the wire rack had a thick accumulation of dust and debris, and small black areas that appeared to be rodent excrement. The entire area had dust, dirt and debris on the floor. The back receiving area was open, and allowed direct access to the storage area.

7) The findings were confirmed by the Director of Nursing at the time of each observation.

8) Observation of the Dietary Department and Kitchen Storage room was performed on 02/28/13 from 1330 through 1400 and revealed:
a) A ceiling vent above the three compartment sink had an accumulation of black material on the outer surface.
b) The floor in front of the fryer had multiple open areas in the flooring that exposed the concrete subfloor.
c) The floor under the side preparation tables had a thick accumulation of dark brown substance.
d) There were five pieces of equipment with a sign that said "out of order". The Director stated the broken items had been reported.
e)The Catering Closet revealed an open area in the sheet rock with pipe visible. Overhead, there were two large ceiling tiles missing. The area was open directly above serving pieces.
f) An open pipe from floor to ceiling and laterally behind the cook stove, fryer, and ovens was noted with a thick accumulation of brown substance. The fryer had a thick accumulation of a greasy substance along the sides.
g) The findings were confirmed at the time of observation by the Director of Dietary.