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.

RUSK STATE HOSP 805 N DICKINSON DR RUSK, TX 75785 Sept. 24, 2020
Based on observation, interview, and document review the facility failed to ensure policies and procedures were followed and screen visitors and staff members for COVID-19 symptoms per national COVID-19 standards prior to entering the facility to ensure patient safety during a pandemic.

This deficient practice had the likelihood to cause harm to all patients by exposing patients to a highly contagious respiratory virus that could lead to death.

Findings Include:

Upon arrival to the facility, the surveyors were stopped at a guard shack by security personnel and the surveyor's temperature was taken. No further questions were asked regarding COVID-19 symptoms, exposure, or travel outside of the country. The surveyors were instructed to proceed through the gate and directed to the administration building.

On 9/23/2020 at 8:35 AM an interview was conducted with Staff #1 and Staff #3. Staff #1 was asked what the process was for visitors and staff entering the facility. Staff #1 stated, "All employees and visitors are screened for COVID-19. Temperatures are taken at the guard shack before they are allowed on the property." Staff #3 was asked what nationally recognized guidelines the facility was using for the prevention and control of COVID-19. Staff #1 stated, "We follow all CDC (Centers for Disease Control and Prevention) Guidelines and information from the Central Office. We get our guidance from Austin, our Central Office, and Staff #11 regarding protocols that are in place during this pandemic for our facility."

A review of the document titled, "COVID-19 Visitor Screen" was as follows:

" ...Version 4-29-20

Instructions: Verbally ask each visitor, contractor, trainee, or other person seeking entrance to the facility the following questions. If ANY question has a "yes" response, fill out the entire form for that person and DO NOT allow entry onto hospital grounds or if screening at a building entrance, do not allow entrance into the building. There is no need to fill out the form for a negative screen ..."

A review of the Visitors (non-employee) logs dated 9/1/2020-9/21/2020 was as follows:

The visitors log consisted of 6 columns; Visitors name: printed and signed, address, phone number, company/agency, email, and COVID-19 pos. and neg. column. Further review revealed all visitor temperatures taken were written in the "printed name" column. 49 visitors documented as neg. and 1 documented as pos. out of 657 visitors screened. No further documentation was provided for visitor screenings.

An interview was conducted with Staff #5 on 9/24/2020 after 10:00 AM. Staff #5 was asked if the "COVID-19 pos./neg." column was for COVID-19 test results. Staff #5 stated, "No that column is supposed to be used for screening questions such as exposure and symptoms to COVID-19. The security at the gate will deny access to the property if any of the screening questions are confirmed with a yes." Staff #5 was asked to review the visitor logs and confirm only 50 of 657 visitors had documented screening according to CDC Guidelines and the facility COVID-19 Response Plan.

Staff #5 confirmed the above findings.

A review of the document titled, "Daily Temp. Checks" for employees revealed no screening for COVID-19 symptoms, exposure or travel outside of the country was completed for 21 of 21 days. Further review revealed employee screening logs dated 9/1/2020-9/21/2020 only documented a temperature upon arrival to the facility.

An interview was conducted with Staff #3 and #5 on 9/23/2020 at 10:45 AM. Staff #5 was asked to explain the screening process for staff. Staff #5 stated," All employees are screened every time they come onto the property before starting their shift. They have their temperatures taken. They are asked if they have any symptoms of COVID-19 or if they have been exposed to someone that tested positive for COVID-19." Staff #5 was asked if the facility policy outlined the screening process. Staff #5 stated, "We do not have an actual policy. We do have a COVID-19 Response Plan for our facility from Health and Human Services which is our Central Office. The plan does outline in detail how the screening process should be implemented."

Staff#1 and Staff #5 confirmed there was no documentation to ensure all staff was screened according to CDC Guidelines and facility COVID-19 Response Plan between 9/1-9/21/2020. Temperatures were documented for staff, but no other screening was documented.

Staff #1 and #5 confirmed the above findings.

A review of the document titled, "COVID-19 Response Plan" dated April 9, 2020 was as follows:

" ...Screening

All staff and contractors are screened for potential exposure by illness prior to entry to the hospital. This occurs through a written screen and temperature checks that occur for every person who enters the hospital each time they arrive. Anyone who fails any part of the screening or has a temperature of 100.4 degrees F. or higher is denied entry.

All staff are screened for potential exposure by travel prior to entry to the hospital. This includes the list of countries designated with a Level 3 status by the CDC as having widespread transmission. This information is updated and communicated daily to SH's (State Hospitals).

Ongoing self-monitoring of symptoms has been implemented for staff, with notification requirements to supervisory staff for any possible presumptive symptoms or primary or secondary exposure ..."

A review of the CDC's current guidelines revealed:

" ...Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic
Infection Control Guidance

Updated July 15, 2020
Summary of Changes to the Guidance

Below are changes to the guidance as of July 15, 2020:

" ...Screen and Triage Everyone Entering a Healthcare Facility for Signs and Symptoms of COVID-19
Although screening for symptoms will not identify asymptomatic or pre-symptomatic individuals with SARS-CoV-2 infection, symptom screening remains an important strategy to identify those who could have COVID-19 so appropriate precautions can be implemented.

Take steps to ensure that everyone adheres to source control measures and hand hygiene practices while in a healthcare facility
Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide instructions (in appropriate languages) about wearing a cloth face covering or facemask for source control and how and when to perform hand hygiene.

Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand sanitizer (ABHS) with 60-95% alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins.

Limit and monitor points of entry to the facility.
Consider establishing screening stations outside the facility to screen individuals before they enter.
Screen everyone (patients, HCP, visitors) entering the healthcare facility for symptoms consistent with COVID-19 or exposure to others with SARS-CoV-2 infection and ensure they are practicing source control.
Actively take their temperature and document absence of symptoms consistent with COVID-19. Fever is either measured temperature 100.0F or subjective fever.
Ask them if they have been advised to self-quarantine because of exposure to someone with SARS-CoV-2 infection.

Symptoms of Coronavirus

Watch for symptoms
People with COVID-19 have had a wide range of symptoms reported - ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:

Fever or chills
Shortness of breath or difficulty breathing
Muscle or body aches
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting

This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19 ..."

An interview was conducted on 9/24/2020 after 10:00 AM with Staff #11. Staff #11 was asked if the facility followed all CDC Guidelines that related to COVID-19 and who was responsible for monitoring the changes from the CDC when updates were released. Staff #11 stated, "Yes we follow CDC guidelines and recommendations related to COVID-19. I work closely with the Central Office on the updates from the CDC regarding changes related to COVID-19. We share the information with the staff and we work very hard to make sure everyone is safe at this facility." Staff #11 was asked to confirm the employee and visitor process upon arrival to the facility. Staff #11 stated, "All staff and visitors are screened for COVID-19 symptoms and COVID-19 exposure at the guard shack. They all have their temperatures taken before they are allowed on the premises. If they fail the screening questions or have a temperature higher than 100.4 F they are denied access."

Staff #11 confirmed only temperatures were documented on the visitor and staff logs from 9//1-9/21/2020.

After multiple requests, no further documentation was provided for visitor or staff screenings for COVID-19 symptoms, exposure, or travel outside the US.

Staff #1, #3, and #5 confirmed the above findings.