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.

CROSSROADS COMMUNITY HOSPITAL 8 DOCTORS PARK ROAD MOUNT VERNON, IL 62864 March 28, 2018
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
Based on document review and staff interview, it was determined the Hospital failed to ensure compliance with 42 CFR 489.20 and 42 CFR 489.24 as evidenced by:

Findings include:

1. The Hospital failed to ensure all individuals who presented to the ED (Emergency Department) were entered in the ED log. (Refer to tag A-2405)

2. The Hospital failed to ensure all individuals who presented to the ED were provided a MSE (Medical Screening Examination). (Refer to tag A-2406)
VIOLATION: EMERGENCY ROOM LOG Tag No: A2405
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on document review and staff interview, it was determined for 1 of 1 (Pt # 21) unnamed Patient that presented to the Emergency Department, the Hospital failed to ensure all patients were tracked on a central log. This has the potential to affect all patients receiving care in the ED.

Findings include:

1. On 03/26/18 at 10:00 AM, the Emergency Department (ED) log on 03/19/18 (date of self reported EMTALA violation) was reviewed for 03/19/18. The log only contained one patient between the hours of 9:40 PM and 12:00 AM.

2. On 03/26/18 at 1:25 PM, an interview with the Quality Director (E #1) was conducted. E #1 confirmed another patient (Pt #21) (MDS) dated [DATE], between the hours of 9:40 PM and 12:00 AM, and was not logged into the "Emergency Department Log".

3. On 03/26/18 at 2:50 PM, an interview with the Registration/Access Clerk (E #3) was conducted. E #3 confirmed that a patient (Pt), whose name was not requested, (MDS) dated [DATE] between the hours of 9:40 PM and 12:00 AM. The patient was not logged into the "Emergency Department Log" and was not seen. E #3 stated that E #3 was notified the Hospital was on a Code Lake (lockdown) and stated "At the time, as I understood it, no one was allowed in or out of the hospital." E #3 stated " I informed the Pt that no Pts were allowed in, and if (Pt) felt (Pt) needed to be seen, there was another hospital in town and (Pt) could be seen there."
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on staff interview and document review, it was determined for 1 of 1 (Pt #21) unnamed Patient that presented to the Emergency Department, the Hospital failed to ensure all patients were provided an appropriate medical screening examination. This has the potential to affect all patients receiving care in the ED.

Findings include:

1. On 03/26/18 at 1:25 PM, an interview with the Quality Director (E #1) was conducted. E #1 confirmed another patient (Pt #21) (MDS) dated [DATE], between the hours of 9:40 PM and 12:00 AM, and was not provided with a medical screening examination.

2. On 03/26/18 at 2:50 PM, an interview with the Registration/Access Clerk (E #3) was conducted. E #3 confirmed that a patient (Pt), whose name was not requested, (MDS) dated [DATE] between the hours of 9:40 PM and 12:00 AM. The patient was not logged into the "Emergency Department Log" and was not seen. E #3 stated that E #3 was notified the Hospital was on a Code Lake (lockdown) and stated "At the time, as I understood it, no one was allowed in or out of the hospital." E #3 stated " I informed the Pt that no Pts were allowed in, and if (Pt) felt (Pt) needed to be seen, there was another hospital in town and (Pt) could be seen there."

3. On 03/27/18 at 2:00 PM, the Hospital "By Laws", (revised October 2015), were reviewed. Under "5.1(a) Screening: it indicated "Any individual who presents to the Emergency Department of this hospital for care shall be provided with a medical screening examination to determine whether that individual is experiencing an emergency medical condition".