HospitalInspections.org

Based on record review, observation, interviews, Lower Oconee Community Hospital's Governing Body failed to notify the Department thirty (30) days prior to closure of the hospital, failed to request suspension of services from the Department, failed to inform the Department of of planned storage of the medical records, medical staff information, failed to notify the public of how to obtain medical records, and failed to return the permit within ten (10) days of closure of the hospital.

cross refer:
C 0200 - Emergency Services - the facility failed to maintain Emergency Services including emergency medications, staff, laboratory, radiology, and respiratory services in the event of an emergency medical condition;

C 0250 - Staffing and Staff Responsibilities - the facility failed to have implement a staffing system to assure patient needs were met in the event of a medical emergency; and failed to identify out of the one-hundred and two (102) staff members listed on the payroll records, the number of staff that would return to the facility in the event of a medical emergency;

C 0320 - Operating Room - the facility failed to have staff, failed to assure that anesthesia contractors could/would be available and failed to have a plan in the event of a medical emergency.


Findings include:

On 02/17/2014 at 7:27 a.m. the Department received an e-mail with a newspaper article attached () indicating Lower Oconee Community Hospital had closed. The article was from Becker's Hospital Review, dated 02/14/2014, with a headline, "Lower Oconee Community Hospital Closes". Continued review of the article revealed that the hospital may restructure into an urgent care center and only some of the hospitals one-thundered (100) employees had been laid off. The article quoted the Chief Executive Officer (CEO), as stating, the hospital had been struggling financially and did not have "sufficient" volume to support the expense.

On 2/17/ 2014, the Department, telephoned the facility and received no answer to the telephone.

On 2/17/2014 at 8:09 a.m. the Department e-mailed the Chief Executive Officer (CEO), on file requesting communication. On 2/18/2014 at 6:35 a.m. the CEO recorded on file, responded revealing that he left employment at Lower Oconee Community Hospital over a year ago, and that he had no knowledge of how to contact the current CEO, that he heard the hospital was shutting down.

On 2/18/2014 at 4:45 p.m. the Department received an e-mail with a new-cast report (http://www.13wmaz.com/story/news/local/dublin/2014/02/12/lower-Oconee-hospital-closing/5437017)
indicating the hospital was closed. The report dated 2/12/2014 at 7:31 p.m. from WMAZ" titled "Money troubles close Wheeler County Hospital". Review of the report, indicating according to a statement from the CEO, Lower Oconee Community Hospital in Wheeler County has closed while it restructures. The CEO statement says they have laid off some of their approximately 100 staff members. Per the report, reached by telephone the CEO stated the privately owned hospital had been in "Dire financial straits" for years. The CEO revealed in the report she had been the CEO since October 2013. The report revealed that the Glenwood City Hall and the Wheeler County commissioners office said they had heard of the hospital closed but they had not been notified officially.

Continued review of the report quoted the written statement of the CEO:
Lower Oconee Community Hospital located in Glenwood, GA has suspended operations during a period of restructuring. The restructuring has been ongoing for several months now; we have approximately 100 staff members, some of which have been laid off as part of the restructuring. This restructuring is being done to provide sustainable medical service in the Glenwood area.

On 2/18/2014 at 4:47 p.m. the Department was still unable to reach via e-mail, telephone the facility.

On 2/21/2014 at 10:23 a.m. the Department received an e-mail from an individual identified as the current CEO, revealing that the hospital did not plan to close; they temporarily suspended services because they had ran out of supplies, lab reagents and money in addition the census dropped down to two (2), and we were unable to provide care for our patients.

Review of 10 inpatient medical records (1, 2, 3, 4, 5, 6, 7, 8, 9, and 10) during the December 2013- February 2014 time period revealed that six (6) patients (#5, 6, 7, 8, 9 and 10) had been discharged on February 12, 2014, and there had been no other hospital admissions since that time. The nursing notes could not be reviewed because they were electronic, and the system was reported to be down.

Interview on 02/24/14 at 12:58 p.m., via telephone, the facility ' s recorded message came on, after hearing the message, zero (0) was pressed, then an operator answered the call. The operator stated the Emergency Department was closed, and directed to go to another hospital if treatment was needed.

Observation on 02/25/14 at 12:00 p.m., revealed that the lights were dim and the Registration area was empty.

Observation on 02/25/14 at 12:15 p.m. revealed that the facility staff onsite included 2 physicians, Registered Nurse (RN) #2, and the Risk Manager.

Observation on 02/25/14 at 2:00 p.m., prior to a scheduled meeting which consisted of a Risk Manager, Sheriff, Chief of Police, Mayor, and county EMS Director, the Sheriff confirmed that he/she had been notified that the ED had gone on diversion. He/she stated, last Sunday he/she had had a suicidal patient that had to be transported to another hospital because the ED was on diversion. The EMS Director also confirmed that he/she had been notified of the ED's diversion status.

During an interview on 02/25/14 at 12:45 p.m., the Risk Manager stated the ED had gone on diversion status on 02/11/14. The Risk Manager stated that the front entrance to the facility was locked to keep the news reporters out of the facility.

Observation on 02/25/14 at 12:45 p.m. with the Risk Manager and a ED physician #1 revealed the following:

1. Emergency Department (ED):
? All ED lights were off;
? The ED door was locked from the outside, and there was no way to call for assistance;
? A large sign posted on the ED door read:
"Lower Oconee Community Hospital has Suspended Operations, for medical attention contact:
Meadows Regional Medical Center, 1 Meadows Parkway, Vidalia, GA 30474, phone # 912-535- 5559; Fairview Park Hospital, 208 Industrial Boulevard, Dublin, GA 31021, phone # 912-275-2000;
Jeff Davis Hospital, 163 South Tallahassee Street, Hazlehurst, GA 31535, phone # 912-375-7781;
For medical records call 912-523-5113 extension 214. Please allow 5 days for processing."
? There were no staff in the ED;
? The Risk Manager stated that two (2) Registration Clerks were working but were on break;
? All medications had been removed from the ED;
? Emergency drugs were not present in the adult or pediatric crash carts, they both contained intravenous supplies, a thoracotomy tray, working laryngoscopes with extra blades, and various other emergency supplies;
? Cardiac monitors, oxygen, and suction were in each of the 6 bays and;
? The Risk Manager stated that there were ventilators in the Respiratory Department.
Observation of the pharmacy revealed a locked door and the key was unavailable, the Risk Manager stated that the only person who had the key was the pharmacist, who was 77 miles away.

Review of the ED's "Central Log Book" from 09/01/13 through 02/11/14 revealed the last patient was logged into the "Central Log Book" on 02/11/14 at 11:45 p.m. Documentation revealed the last patient was discharged from the Emergency Department on 02/12/14 at 9:30 a.m.

Interview with the ED Medical Director on 02/25/14 at 4:15 p.m., revealed that as of 02/13/14 he/she had understood that the facility was closed, and that he/she had been seeking other employment. The physician explained the ED and/or hospital had had no patients since 02/11/14 or 02/12/14 and that the facility had only a skeletal staff working at the present time. The physician stated that the day before the facility closed the staff were informed of the closure of the facility.

2. Nursing Units:
? Both the pediatric and adult crash carts were stocked with medications and supplies;
? Stock medications, various bags of IV antibiotics, Dopamine (vasopressor), Lidocaine (anti-arrhythmic) and Nitroglycerin (vasodilator) were in the electronic dispensing system;
? The Registered Nurse utilization reviewer was present at the desk;
? Patient rooms beds were unmade, IV pumps, assuasive equipment, wall oxygen and suction were present.
3. Kitchen:
The floors were dirty with scattered food debris; the maintenance person was working on the sink;
A refrigerator contained:
? Dishes of applesauce dated 2/7/14;
? Dishes of Jello dated 2/10/14;
? A pitcher of tea dated 2/9/14;
? A bowl of creamed corn dated 2/3/14 and;
? Various condiments.
? Two (2) freezers which contained:
? 1 package of vegetables;
? 1 package of ground beef (approximately two pounds;
? 4 boxes of single serve apple juices;
? 6 single serve orange juices;
? 1 package of biscuits and;
? 1 package of sausage links.
? Shelves contained:
? (3) large cans (restaurant size) of refried beans;
? (1) large can (restaurant size) of green beans;
? (1) large can (restaurant size) of pork and beans;
? (1) large can (restaurant size) of tomato ketchup;
? Several boxes of raisins;
? Powered sugar;
? (2) bags of tortilla chips;
? (1) box of croutons;
? (1) box of onion rings;
? Approximately 1/3 box of pancake mix and;
? Soft drinks.

Review of the incident report dated 02/11/14 at 10:00 p.m., revealed the decision had been made by the Chief of Staff and the attending provider to place the Emergency Department on diversion status "due to unsafe traveling conditions due to weather - which will not allow for staff to transport blood to other facility." The status was monitored every 2 hours from the time the facility went on diversion until 02/12/14 at 7:00 a.m. On 02/12/14, the Chief Nursing Officer (CNO) notified the nearby hospital Nursing Supervisors and the three Emergency Medical Services of the hospital's "closure".

Observation on 2/26/2014 at 2:50 p.m., with the Risk Manager revealed:

1. Medical Records room:
Four staff included a clerk, a coder, a transcriptions and a manager. Interview revealed that staff had continued to work throughout the "diversion"; and, that the computer system thus medical records could not be accessed.

2. Laboratory:
? Manager was present, and stated that he/she had not been off work;
? That reagent had been obtained;
? Blood was not available, but could be ordered in the morning and received the same afternoon\;
? No lab staff had confirmed availability to return to work yet and;
? The hospital did not have a laboratory specimen transport policy.

Interview on 2/26/14 at 1:29 p.m. the Risk Manager., stated that the facility had been sending out lab specimens (for about 1 month) due to lack of supplies needed to run the results (reagents).

3. Pharmacy:
Interview with the pharmacist revealed:
? His/her being at the hospital daily and on call 24/7;
? The pharmacy was fully stocked; the plan is to restock the nursing unit and Operating Room (OR) narcotics on 2/27/14 and;
? That pharmacy technicians would not be scheduled to work at this time.

4. Respiratory Department:
Interview with the Risk Manager revealed that the manager was not currently present, but had been in every couple of days; two (2) ventilators, five (5) small oxygen tanks, an EKG machine,an arterial blood gas machine with documentation of a control check on 2/22/14, were present; and, the Risk Manager stated that no other respiratory staff had confirmed availability to return to work yet.

5. Physical Therapy: Door was locked, key was not available. Risk Manager stated that this is a contracted service

6. Radiology: Door was locked, key was not available. Risk Manager stated that the manager is on-call and, that no other radiology staff had confirmed availability to return to work yet.

7. Operating Room:
? Door was locked, key was not available;
? The RN supervisor was present, and had been on-call;
? Supervisor stated that the hospital only does simple surgeries/procedures such as colonoscopies, upper endoscopies, and feeding tube insertions;
? He/she prepares and recovers all patients one at a time;
? The nurse anesthetist is a contracted service and;
? Stated one (1) technician had confirmed availability to work.

8. Prep/Recovery Area: Door was locked, key was not available.

9. Nursing unit: Risk Manager states that three (3) RNs have confirmed availability for 2/28/14; that no contact has been made with any Licence Practical Nurses or technicians.

10. Registration: Risk Manager stated that two (2) persons have been confirmed ready to return to work, and that there were also two (2) fill-ins who had been at the hospital daily.

11. Dietary: Risk Manager stated:
? The Dietary director, who does most of the cooking had been in and out;
? The Dietary director is ready to return to work;
? That food had been ordered that day and should arrive the next day and;
? That no other dietary staff had confirmed availability to return to work yet.

12. Environment:
? Kitchen floors and ceiling vent dirty;
? Risk Manager states that the housekeeper's phone was disconnected and;
? No staff had confirmed availability to return to work yet.

13. Employee Health/Infection Control/Trainer:, is confirmed ready to return to work 3/3/14

Review of the facility's employee list revealed that there were one hundred and three (103) staff members who had not been contacted for confirmation of return to work availability.

Based on the above observations, although the CEO stated the hospital had not "closed" the evidence identifies closure of the hospital as a result of no services were available to treat a medical condition, the doors were locked preventing access into the hospital, staff was not present to attend to patients, services including lab services, radiology, respiratory, dietary and medical records were not present.

Based on e-mails, observation, and interviews, Lower Oconee Community Hospital failed to provide emergency care necessary to meet the needs of its inpatients and outpatients.


cross refer:
C 0150 - Compliance W Fed, St, & Loc Laws & Regulation - the facility failed to notify the Department of closure of the hospital, failed to return the permit within ten (10) days of closure, and failed to notify the public of access to the medical records;

C 0250 - Staffing and Staff Responsibilities - the facility failed to implement a staffing system to assure patient needs were met in the event of a medical emergency; and failed to identify out of the one-hundred and two (102) staff members listed on the payroll records, the number of staff that would return to the facility in the event of a medical emergency;

C 0320 - Operating Room - the facility failed to have staff, failed to assure that anesthesia contractors could/would be available and failed to have a plan in the event of a medical emergency.


Findings include:

On 02/17/2014 at 7:27 a.m. the Department received an e-mail with a newspaper article attached () indicating Lower Mooneye Community Hospital had closed. The article was from Becker's Hospital Review, dated 02/14/2014, with a headline, "Lower Oconee Community Hospital Closes". Continued review of the article revealed that the hospital may restructure into an urgent care center and only some of the hospitals one-thundered (100) employees had been laid off. The article quoted the Chief Executive Officer (CEO), as stating, the hospital had been struggling financially and did not have "sufficient" volume to support the expense.

On 2/17/ 2014, the Department, telephoned the facility and received no answer to the telephone.

On 2/17/2014 at 8:09 a.m. the Department e-mailed the CEO, on file requesting communication. On 2/18/2014 at 6:35 a.m. the CEO recorded on file, responded revealing that he left employment at Lower Oconee Community Hospital over a year ago, and that he had no knowledge of how to contact the current CEO, that he heard the hospital was shutting down.

On 2/18/2014 at 4:45 p.m. the Department received an e-mail with a new-cast report (http://www.13wmaz.com/story/news/local/dublin/2014/02/12/lower-Oconee-hospital-closing/5437017)
indicating the hospital was closed. The report dated 2/12/2014 at 7:31 p.m. from WMAZ" titled "Money troubles close Wheeler County Hospital". Review of the report, indicating according to a statement from the CEO, Lower Oconee Community Hospital in Wheeler County has closed while it restructures. The CEO statement says they have laid off some of their approximately 100 staff members. Per the report, reached by telephone the CEO stated the privately owned hospital had been in "Dire financial straits" for years. The CEO revealed in the report she had been the CEO since October 2013. The report revealed that the Glenwood City Hall and the Wheeler County commissioners office said they had heard of the hospital closed but they had not been notified officially.

Continued review of the report quoted the written statement of the CEO:
Lower Oconee Community Hospital located in Glenwood, GA has suspended operations during a period of restructuring. The restructuring has been ongoing for several months now; we have approximately 100 staff members, some of which have been laid off as part of the restructuring. This restructuring is being done to provide sustainable medical service in the Glenwood area.

On 2/18/2014 at 4:47 p.m. the Department was still unable to reach via e-mail, telephone the facility.

On 2/21/2014 at 10:23 a.m. the Department received an e-mail from an individual identified as the current CEO, revealing that the hospital did not plan to close; they temporarily suspended services because they had ran out of supplies, lab reagents and money in addition the census dropped down to two (2), and we were unable to provide care for our patients.

On 2/21/2014 telephone interview with the CEO revealed that the laboratory had no reagent and had been sending laboratory specimens to another facility for a month. The CEO stated the last time there were patients in the hospital was 2/13/2014, and the Emergency Room had been "on diversion" since 2/13/2014.

Observation on 02/25/14 at 12:45 p.m. with the Risk Manager and a physician revealed the following:
1. Emergency Department:
? All ED lights were off;
? The ED door was locked from the outside, and there was no way to call for assistance;
? A large sign posted on the ED door read:
"Lower Oconee Community Hospital has Suspended Operations, for medical attention contact:
Meadows Regional Medical Center, 1 Meadows Parkway, Vidalia, GA 30474, phone # 912-535- 5559; Fairview Park Hospital, 208 Industrial Boulevard, Dublin, GA 31021, phone # 912-275-2000;
Jeff Davis Hospital, 163 South Tallahassee Street, Hazlehurst, GA 31535, phone # 912-375-7781;
For medical records call 912-523-5113 extension 214. Please allow 5 days for processing."

After discovery of the sign, the Risk Manager stated that the sign was supposed to have been removed, and removed it;
? There were no staff in the ED, the Risk Manager stated that two (2) Registration Clerks were working but were on break;
? All medications had been removed from the ED;
? Emergency drugs were not present in the adult or pediatric crash carts, they both contained intravenous supplies, a thoracotomy tray, working laryngoscopes with extra blades, and various other emergency supplies and;
? Cardiac monitors, oxygen, and suction were in each of the 6 bays;

Review of the ED's "Central Log Book" from 09/01/13 through 02/11/14 revealed the last patient was logged into the "Central Log Book" on 02/11/14 at 11:45 p.m. Documentation revealed the last patient was discharged from the Emergency Department on 02/12/14 at 9:30 a.m. The ED "Central Log Book" also revealed that during this time period 3-20 patients were treated each day in the ED.

During February 2014 the following number of patients were treated in the ED:
? 02/01/14 there were 10 patients;
? 02/02/14 there were 13 patients;
? 02/03/14 there were 17 patients;
? 02/04/14 there were 15 patients;
? 02/05/14 there were 13 patients;
? 02/06/14 there were 13 patients;
? 02/07/14 there were 10 patients;
? 02/08/14 there were 7 patients;
? 02/09/14 there were 10 patients;
? 02/10/14 there were 11 patients and;
? 02/11/14 there were 12 patients.

Observation on 02/25/14 at 2:00 p.m., a scheduled meeting which consisted of the Risk Manager, Sheriff, Chief of Police, Mayor, and county EMS Director. During this meeting the Sheriff confirmed that he/she had been notified that the ED had gone on diversion. He/she stated, last Sunday he/she had had a suicidal patient that had to be transported to another hospital because the ED was on diversion. The EMS Director also confirmed that he/she had been notified of the ED's diversion status.

Interview with the ED Medical Director on 02/25/14 at 4:15 p.m., the physician explained that diversion status meant the facility informed people that they were unable to handle emergency situations at the time. He stated that as of 02/13/14, had understood that the facility was closed, and had been seeking other employment. The physician explained the ED and/or hospital had no patients since 02/11/14 or 02/12/14. The physician stated he/she agreed that the sign that had been posted on the ED door gave the impression that the facility was closed and that patients needed to go somewhere else. The physician added that the day before the facility closed the staff were informed of the closure of the facility.

Review of the facility's "Emergency Room Diversion" policy, no policy number, revised 01/27/14, revealed the attending provider was to determine when to move to diversion status. This policy required Wheeler County, Telfair County, and Toombs - Montgomery Emergency Medical Services to be notified of the diversion status. In addition, the policy required the Chief Nursing Officer and the Chief of Staff to be notified. The policy also required nearby hospital's Nursing Supervisors to be notified of the facility's diversion status. The policy required an incident report to be completed and for the diversion status to be re-evaluated every 2 hours by the attending provider. The facility was responsible for notifying the nearby hospital's Nursing Supervisors and the three Emergency Medical Services when the diversion status was removed.

Review of the incident report dated 02/11/14 at 10:00 p.m., revealed the decision had been made by the Chief of Staff and the attending provider to place the Emergency Department on diversion status "due to unsafe traveling conditions due to weather - which will not allow for staff to transport blood to other facility." Documentation revealed the diversion status would be reviewed every 2 hours. In addition, documentation revealed the three Emergency Medical Services and nearby hospital Nursing Supervisors were notified per facility policy. The status was monitored every 2 hours from the time the facility went on diversion until 02/12/14 at 7:00 a.m. The next diversion note was at 11:00 a.m., then at 3:00 p.m. On 02/12/14, the Chief Nursing Officer (CNO) notified the nearby hospital Nursing Supervisors and the three Emergency Medical Services of the hospital's "closure".

Observation on 02/26/2014 at 9:15 a.m. of the Emergency Department with the Business Office Manager revealed the Emergency Department door remained locked but a phone was now available at the door with instructions to contact the nurses at the Emergency Department nurses' desk. Two (2) Registered Nurses were observed sitting at the nurses' desk, and 1 physician was on-site. The ED crash cart and medication bins had been stocked.

Interview and observation on 2/26/14 at 1:29 p.m. the Risk Manager revealed the following:

Laboratory:
? That the facility had been sending out lab specimens (for about 1 month) due to lack of supplies needed to run the results (reagents).

The Department received notice from Laboratory Medical Director on 02/27/2014 at 12:17 p.m. stating his resignation due to the hospital closing on 02/11/2014.

Respiratory Department:
? The manager was not currently present, but had been in every couple of days; two (2) ventilators, five (5) small oxygen tanks, an EKG machine,an arterial blood gas machine with documentation of a control check on 2/22/14, were present; and, the Risk Manger stated that no other respiratory staff had confirmed availability to return to work.

Radiology:
? Door was locked, key was not available. Risk Manager stated that the manager is on-call and, that no other radiology staff had confirmed availability to return to work.

Operating Room:
? Door was locked, key was not available;
? The RN supervisor was present, and had been on-call;
? Supervisor stated that the hospital only does simple surgeries/procedures such as fluoroscopes, upper endoscopies, and feeding tube insertions;
? pre-op and post-op are completed one at a time;
? The nurse anesthesia is a contracted service and;
? Stated one (1) technician had confirmed availability to work.

Prep/Recovery Area:
? Door was locked, key was not available.

Nursing unit:
? Risk Manager states that three (3) RN's have confirmed availability for 2/28/14 and;
? that no contact has been made with any LPN's or technicians.

Environment:
? Risk Manager states that the housekeeper's phone was disconnected and;
? No staff had confirmed availability to return to work.

Medical Records room:
? Four (4) staff included a clerk, a coder, a transcriptions and a manager. Interview revealed that staff had continued to work throughout the "diversion"; and, that the computer system was still down, preventing entering and/or accessing medical records.

Based on observation, and staff interviews, it was determined the hospital failed to keep medication used in treating emergency cases readily available for treating emergency cases.

Findings include::

Observation on 02/25/14 at 12:15 p.m. revealed:
? All medications had been removed from the ED;
? Emergency drugs were not present in the adult or pediatric crash carts
? The pharmacy door was locked, and, the ED physician stated that the only person who had the key was the pharmacist, who was 77 miles away.

Interview with the pharmacist on 2/26/2014 revealed:
? His/her being at the hospital daily;
? On-call 24/7;
? That the pharmacy was fully stocked;
? The plan is to restock the nursing unit and Operating Room (OR) narcotics on 2/27/14
? That pharmacy technicians would not be scheduled to work at this time.

Based on observation, and staff interviews, it was determined the hospital failed to provide, either directly or under arrangement, services for the procurement, safekeeping, and transfusion of blood, including the availability of blood products needed for emergencies on a 24-hours a day basis

Findings include:

Observation on 2/26/2014 at 2:50 p.m. with the Risk Manager revealed:
? Laboratory Manager was present;
? Blood was not available, but according to the manager, could be ordered in the morning and received the same afternoon and;
? No lab staff had confirmed availability to return to work

Interview on 2/26/14 at 1:29 p.m. the Risk Manager., revealed that the facility had been sending out lab specimens (for about 1 month) due to lack of supplies needed to run the results (reagents).

Based on observation and staff interview, it was determined the CAH failed to have housekeeping services to ensure that the premises are clean and orderly.

Findings include:

On 2/25/2014 a kitchen tour revealed:
? The floors were dirty with scattered food debris and the vents were dirty;
? The maintenance person was working on the sink;

The Risk Manager stated that the housekeeper's phone was disconnected, and, that no staff had confirmed availability to return to work.

Based on observation, and staff interview, Lower Oconee Community Hospital failed to the be able to identify of the one-hundred and two (102) staff members listed, the number of staff that would return to the facility in the event of a medical emergency.

cross refer:
C 0150 - Compliance W Fed, St, & Loc Laws & Regulation - the facility failed to notify the Department of closure of the hospital, failed to return the permit within ten (10) days of closure, and failed to notify the public of access to the medical records;

C 0200 - Emergency Services - the facility failed to maintain Emergency Services including emergency medications, staff, laboratory, radiology, and respiratory services in the event of an emergency medical condition;

C 0250 - Staffing and Staff Responsibilities - the facility failed to have implement a staffing system to assure patient needs were met in the event of a medical emergency; and failed to identify out of the one-hundred and two (102) staff members listed on the payroll records, the number of staff that would return to the facility in the event of a medical emergency;

C 0320 - Operating Room - the facility failed to have staff, failed to assure that anesthesia contractors could/would be available and failed to have a plan in the event of a medical emergency.


Findings include:

Observation on 02/25/14 at 12:45 p.m. with the Risk Manager revealed:
? ED: There were no staff present, lights were out, door was locked. Two MD observed in hospital
? Nursing Units: One (1) RN/utilization reviewer was present;
? Operating Room: door was locked, key not available; the supervisor was present, and has been on-call; supervisor states that the hospital only does simple surgeries/procedures such as colonoscopies, upper endoscopies, and feeding tube insertions; that he/she prepares and recovers all patients one at a time; that the nurse anesthesist is a contracted service; and, stated one (1) technician had confirmed availability to work.
? Prep/Recovery Area: door was locked, key not available. Operating room supervisor works in the area;
? Registration: Risk Manager states that two (2) persons have been confirmed ready to return to work, and that there were also two (2) fill-ins who had been at the hospital daily..
? Employee Health/Infection Control/Trainer: The Risk Manager stated the Trainer confirmed ready to return to work 3/3/14.

A second tour of the Emergency Department on 2/26/2014 at 9:15 a.m. with the Business Office Manager revealed two (2) Registered Nurses sitting at the nurses' desk, and one (1) ED Medical Director was on-site.

Risk Manager stated that three (3) Registered Nurses had confirmed availability for 2/28/14; that no contact has been made with any Licensed Practical Nurses or technicians.

Review of the facility's employee list revealed that there were one hundred and three (103) staff members who had not been contacted for confirmation of return to work availability.

Based on interview and observation Lower Oconee Community Hospital failed to assure that supplies was available for over one month, failed to have staff, and failed to have a Laboratory Medical Director.

Findings include:

On 02/17/2014 at 7:27 a.m. the Department received an e-mail with a newspaper article attached () indicating Lower Mooneye Community Hospital had closed. The article was from Becker's Hospital Review, dated 02/14/2014, with a headline, "Lower Oconee Community Hospital Closes". Continued review of the article revealed that the hospital may restructure into an urgent care center and only some of the hospitals one-thundered (100) employees had been laid off. The article quoted the CEO, as stating, the hospital had been struggling financially and did not have "sufficient" volume to support the expense.

On 2/21/2014 at 10:23 a.m. the Department received an e-mail from an individual identified as the current CEO, revealing that the hospital did not plan to close; they temporarily suspended services because they had ran out of supplies, lab reagents and money in addition the census dropped down to two (2), and we were unable to provide care for our patients. Continued interview revealed that the laboratory had no reagent and had been sending laboratory specimens to another facility for a month. The CEO stated the last time there were patients in the hospital was 2/13/2014, and the Emergency Room had been "on diversion" since 2/13/2014.

On 2/27/2014 the Department received a copy of a letter of resignation from the Clinical Laboratory Director, dated 2/17/2014 resigning his position as the Director position, stating that the hospital ceased operations as of 2/11/2014.

Observation on 2/26/2014 at 2:50 p.m. with the Risk Manager revealed:
? Laboratory Manager was present, and stated that he/she had not been off work;
? That reagent had been obtained;
? Blood was not available, but could be ordered in the morning and received the same afternoon;
? No lab staff had confirmed availability to return to work yet and;
? That the hospital did not have a laboratory specimen transport policy.

Based on e-mails, interview and observation, Lower Oconne Community Hospital failed to assure that radiological imaging services was available at all times by qualified x-ray personnel.

Findings include:

On 02/17/2014 at 7:27 a.m. the Department received an e-mail with a newspaper article attached () indicating Lower Mooneye Community Hospital had closed. The article was from Becker's Hospital Review, dated 02/14/2014, with a headline, "Lower Oconee Community Hospital Closes". Continued review of the article revealed that the hospital may restructure into an urgent care center and only some of the hospitals one-thundered (100) employees had been laid off. The article quoted the CEO, as stating, the hospital had been struggling financially and did not have "sufficient" volume to support the expense.

Observation on 2/26/2014 at 2:50 p.m., with the Risk Manager revealed:
? The Radiology door was locked, and the key was unavailable;
? The Risk Manager stated that the manager was on-call and;
? No other radiology staff had confirmed availability to return to work.

Based on medical record review, and staff interviews, it was determined the hospital failed to assure that medical records, in their entirety, were readily accessible.

Findings include:

Review of 10 inpatient medical records (1, 2, 3, 4, 5, 6, 7, 8, 9, and 10) during the December 2013- February 2014 time period revealed that the nursing notes could not be reviewed because they were electronic, and the system was reported to be down.

Observation of the Medical Records room on 2/26/2014 revealed:
? Four staff were present, which included a clerk, a coder, a transcription and a manager.
? Interview revealed that staff had continued to work throughout the "diversion";
? The computer system was unavailable preventing accessibility to the medical records.

Based on observation and interview the facility failed to maintain a surgical department.

C 0150 - Compliance W Fed, St, & Loc Laws & Regulation - the facility failed to notify the Department of closure of the hospital, failed to return the permit within ten (10) days of closure, and failed to notify the public of access to the medical records;

C 0200 - Emergency Services - the facility failed to maintain Emergency Services including emergency medications, staff, laboratory, radiology, and respiratory services in the event of an emergency medical condition;

C 0250 - Staffing and Staff Responsibilities - the facility failed to have implement a staffing system to assure patient needs were met in the event of a medical emergency; and failed to identify out of the one-hundred and two (102) staff members listed on the payroll records, the number of staff that would return to the facility in the event of a medical emergency;

C 0320 - Operating Room - the facility failed to have staff, failed to assure that anesthesia contractors could/would be available and failed to have a plan in the event of a medical emergency.

Findings include:

Observation on 2/26/2014 at 2:50 p.m., with the Risk Manager revealed the following of the surgical services department;:

? Door was locked, key was not available;
? The RN supervisor was present, and had been on-call;
? Supervisor stated that the hospital only does simple surgeries/procedures such as colonoscopies, upper endoscopies, and feeding tube insertions;
? pre-op and post-op are completed one at a time;
? The nurse anesthesia is a contracted service;
? Stated one (1) technician had confirmed availability to work.