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.

TRI COUNTY HOSPITAL - WILLISTON 125 SW 7TH ST WILLISTON, FL Sept. 6, 2012
VIOLATION: ORGANIZATION OF NURSING SERVICES Tag No: A0386
Based on record review and interviews the facility failed to have a director of nursing (DON).

Findings:

Review of the facility's employee list failed to reveal a DON.

Interview with Registered Nurse(RN) D on 9/6/12 at 11:40 AM revealed the facility did not have a DON. Further interview revealed that the facility had a nurse manager, but not a DON.

Interview with the Clinical Services Director on 09/06/12 at 12:33 PM revealed that the facility currently does not have a DON. Further interview revealed the facility has not had a DON off and on all summer. According to the Clinical Services Director, he is an RN and has been acting as DON as well.
VIOLATION: PATIENT CARE ASSIGMENTS Tag No: A0397
Based on observation, record review and interview, the facility failed to have a registered nurse assign nursing care of each patient to other nursing personnel.

Findings:

Interview with the Clinical Services Director on 09/06/12 at 12:42 PM revealed that the charge nurse on the floor determines the assignment of which nurse provides nursing services to each patient. When asked which nurse is determined to be the in charge nurse he stated that the nurse with the keys to the medication cart is the in charge nurse.

Review of the board located at the nursing station on 09/06/12 at 9:03 AM revealed facility schedules only RNs to work 12 hour shifts (7 AM - 7 PM and 7 PM - 7 AM) there were a total of ten patients and two Registered Nurse (RN) working that day.

Review of the staffing schedule revealed that when there are two RNs working, there is no distinction as to who was in charge.

Observation of the nursing station on 09/07/2012 at 2:06 PM revealed the Nurse Manager had arrived to the facility and informed RN D that she was in charge.

Interview with RN D on 09/07/2012 at 2:20 PM revealed that this morning her and RN C looked at all of the patients and divided them amongst themselves to ensure the acuity was fair.

Observation of the nurse's station at 2:06 PM, RN D informed RN C that she was in charge and RN C asked why she waited until now to tell her. RN D stated that the Nurse Manager just designated her in charge.
VIOLATION: ADMINISTRATION OF DRUGS Tag No: A0405
Based on observation, interview and record review the facility failed to ensure that one of two (RN C) nurses observed administer medication under acceptable standard of practice.

Findings:

Observation of a Registered Nurse (RN) C on 09/06/2012 at 2:06 PM revealed the nurse putting 4 white pills in her left hand bare. The RN was asked what the medication in her hands were, she stated it was Methadone Asked why she place medication in her bare hand, she stated it was hard to get at of square box. The RN was asked 3 times what she would be doing with the contaminated medication, before she indicated that she would waste it. The RN was then observed to crushed 6 methadone tablets (dropped 2 more pills), and poured it down the sink with running water.

Review of RN C's record revealed a hired date of 05/07/2012. Further review of this RN's record failed to reveal any trainings. Further record review also failed to reveal any competency completed.

Interview with the Clinical Service Director on 09/06/2012 at 12:33 PM revealed the facility does not have a DON. Further interview revealed the facility has not have a DON on and off all summer.

Interview with the Clinical Service Director on 09/07/2012 at 10:$9 AM revealed they have not evaluated RN C's competency yet.

Review of the facility's Policies and Procedures entitled Administration of Medication revised on 06/06/2011 revealed under the procedure section, "5. All Personnel must demonstrate knowledge of the actions, usual dosage range, and potential side effects of the medications that they are authorized to administer."
VIOLATION: FACILITIES Tag No: A0722
Based on observation and interview, the facility failed to maintain the emergency room (ER) ceiling free of stains and growth.

Findings:

During tour of the ER on 09/06/2012 at 11:46 AM revealed a ceiling tile, located to the left of the entrance to the ER room, that had half of the tile covered with brown stain. Further observation revealed several, dime size, gray matter covering half of the brown stained area.

Interview with the ER Registered Nurse on 09/06/2012 at 3:30 PM revealed that the gray matter has been on the tile for a while. Further interview revealed he does not recall there being a leak in that area, but the brown stain appeared and later the gray matter.