HospitalInspections.org

Based on review of Medical Staff Rules and Regulations, review of policies and procedures and interview, it was determined the Chief Nursig Officer failed to assure nursing policies and procedures were reflective of current nursing practices. Failure to assure policies reflected current practices did not assure staff had current policies to follow for the delivery of patient care. Findings follow:

A. Review of the first page in the nursing policies and procedures revealed "The policies and procedures contained in the Nursing manual have been reviewed and approved on January 7, 2014" and was signed by the CEO (Chief Executive Officer), the Medical Director and the Department Director.
B. Review of policy, "Outdoor Access for Patients" revealed a therapeutic environment for patients at (named) hospital ...which was not the name of the facility.
C. Review of policy, "Moderate (Conscious) Sedation" revealed Purpose, Definitions, Policy and Procedure for administering sedation. On interview with the Quality Coordinator on 09/23/14 at 1210 she confirmed nursing staff did not perform sedation in the facility.
D. Review of policy, "Emergency Services Process" revealed EMTALA (Emergency Medical Treatment and Active Labor Act) and included the policy, definitions, indications and procedures.
E. Review of Medical Staff Rules and Regulations provided by the Quality Coordinator on 09/25/14 at 1010 revealed Hospital does not have an Emergency Department.
F. On interview with the Quality Coordinator on 09/23/14 at 1210, she confirmed the facility (a Long Term Acute Care Hospital) did not have an Emergency Department and leased space from a host hospital located on the first floor.
G. Review of policy, "Patient Identification" revealed patient identifiers included 1. Patient Name, 2. Date of Birth, 3. Photo - back up if the patient is non-verbal. On interview with the Quality Coordinator on 09/23/14 at 1210, she confirmed pictures of patients were not taken for use as identification.
H. During interview with the Chief Nursing Officer on 09/22/14 at 1040, she confirmed Lippincott was used for nursing protocols. Review of the Nursing Policies and Procedures Manual and review of LNPS (Lippincott Nursing Procedures and Solutions) Jul (July) 2014 Release Existing Procedure Updates revealed policies to include nursing care for pediatric patients. During interview with the Quality Coordinator on 09/23/14 at 1210, she confirmed pediatric patients were not cared for in the facility.

Based on policy review, clinical record review, and interview, it was determined the facility failed to follow established care plans in regards to documentation of turning patients every two hours for 25(#1-#4, #6, #7, #9-#14, #17-#21, #23-#26, #28-#30) of 30 (#1-#30) patients. The failed practice created the potential for patients to develop bedsores as a result of not having been turned; and could affect any patient admitted to the facility. Findings follow.

A. Review of policy titled "Multidisciplinary Care Plan" stated, "A multidisciplinary care plan requires that each discipline must collaborate in the assessment and reassessment of the patient, and then strive to integrate interdisciplinary documentation of needs, goals, strategies and interventions."
B. Review of the care plan for Patient #1 revealed they were to be turned every two hours beginning on 08/22/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/14/14 through 09/18/14, and 09/21/14 through 09/23/14.
C. Review of the care plan for Patient #2 revealed they were to be turned every two hours beginning on 09/03/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/05/14 through 09/07/14, 09/09/14 through 09/25/14.
D. Review of the care plan for Patient #3 revealed they were to be turned every two hours beginning on 08/26/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 08/26/14 through 08/28/14, 08/30/14, 09/04/14 through 09/06/14, and 09/13/14 through 09/24/14.
E. Review of the care plan for Patient #4 revealed they were to be turned every two hours beginning on 09/18/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/18/14 through 09/23/14.
F. Review of the care plan for Patient #6 revealed they were to be turned every two hours beginning on 09/06/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/06/14 through 09/08/14, 09/11/14, and 09/13/14 through 09/25/14.
G. Review of the care plan for Patient #7 revealed they were to be turned every two hours beginning on 09/04/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/06/14, 09/07/14, 09/10/14, 09/12/14 through 09/21/14, and 09/23/14 through 09/25/14.
H. Review of the care plan for Patient #9 revealed they were to be turned every two hours beginning on 08/29/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/03/14, 09/04/14, 09/07/14 through 09/10/14, 09/13/14 through 09/16/14, and 09/18/14 through 09/21/14.
I. Review of the care plan for Patient #10 revealed they were to be turned every two hours beginning on 09/10/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/13/14, 09/14/14, and 09/16/14 through 09/25/14.
J. Review of the care plan for Patient #11 revealed they were to be turned every two hours beginning on 09/03/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/05/14 through 09/08/14, 09/12/14 through 09/15/14, and 09/17/14 through 09/25/14.
K. Review of the care plan for Patient #12 revealed they were to be turned every two hours beginning on 09/10/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/10/14 through 09/15/14, 09/17/14, 09/18/14, 09/22/14 and 09/24/14.
L. Review of the care plan for Patient #13 revealed they were to be turned every two hours beginning on 09/03/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/18/14, 09/20/14, 09/24/14, and 09/25/14.
M. Review of the care plan for Patient #14 revealed they were to be turned every two hours beginning on 08/28/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/14/14 through 09/19/14, 09/21/14, 09/22/14, 09/24/14, and 09/25/14.
N. Review of the care plan for Patient #17 revealed they were to be turned every two hours beginning on 09/21/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/21/14, 09/22/14, 09/24/14, and 09/25/14.
O. Review of the care plan for Patient #18 revealed they were to be turned every two hours beginning on 09/12/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/13/14, 09/17/14, 09/19/14, and 09/21/14 through 09/25/14.
P. Review of the care plan for Patient #19 revealed they were to be turned every two hours beginning on 09/12/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/13/14, 09/14/14, 09/18/14, and 09/22/14 through 09/24/14.
Q. Review of the care plan for Patient #20 revealed they were to be turned every two hours beginning on 07/17/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/16/14 through 09/18/14, and 09/20/14 through 09/23/14.
R. Review of the care plan for Patient #21 revealed they were to be turned every two hours beginning on 07/02/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 07/02/14 through 07/04/14, 07/07/14, 07/09/14 through 07/13/14, 07/18/14, 07/19/14, 07/24/14, 07/25/14, 07/28/14, 07/30/14 through 08/02/14, 08/04/14 through 08/07/14, 08/09/14 through 08/11/14, 08/16/14 through 08/18/14, 08/21/14, 08/22/14, 08/24/14 through 08/30/14, 09/06/14, 09/09/14, 09/10/14, 09/13/14, 09/14/14, and 09/21/14.
S. Review of the care plan for Patient #23 revealed they were to be turned every two hours beginning on 08/08/14 through 09/26/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/15/14 through 09/19/14.
T. Review of the care plan for Patient #24 revealed they were to be turned every two hours beginning on 08/14/14 through 09/15/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 09/09/14 through 09/14/14.
U. Review of the care plan for Patient #25 revealed they were to be turned every two hours beginning on 08/27/14 through 09/15/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 08/28/14 through 09/01/14, 09/03/14 through 09/07/14, and 09/09/14 through 09/15/14.
V. Review of the care plan for Patient #26 revealed they were to be turned every two hours beginning on 06/10/14 through 07/02/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 06/11/14, 06/12/14, 06/15/14, 06/16/14, and 06/18/14 through 07/01/14.
W. Review of the care plan for Patient #28 revealed they were to be turned every two hours beginning on 03/06/14 through 03/16/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 03/07/14 through 03/13/14, and 03/15/14.
X. Review of the care plan for Patient #29 revealed they were to be turned every two hours beginning on 06/10/14 through 07/01/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 06/11/14, 06/21/14 through 06/25/14, 06/27/14, 06/28/14, and 07/01/14.
Y. Review of the care plan for Patient #30 revealed they were to be turned every two hours beginning on 06/19/14 through 07/25/14. Review of Activity Flowsheets revealed there was no evidence the patient was consistently turned every two hours on 06/20/14, 06/21/14, 06/23/14, 06/25/14 through 06/29/14, 07/01/14 through 07/04/14, 07/07/14 through 07/09/14, 07/11/14 through 07/21/14, 07/23/14, and 07/25/14.
Z. Findings were verified by the Chief Nursing Officer and Charge Nurse #1 from 1230 to 1245 on 09/26/14.

Based on review of Hour Daily Care Records and interview, it was determined the facility failed to assure nurses did not document events prior to them occurring for four (#4, 5, 6, and 7) of five (#4-8) patients. Failure to assure nurses did not document events prior to occurrence did not assure records were accurate or that events occurring after the time of documentation, were captured or included and was likely to affect all patients admitted to the facility. Findings follow:
A. During review of four (#4, 5, 6, and 7) Hour Daily Care Records dated 09/26/14 at 1235 revealed Nurse #1 documented no emesis, ID band, side rails up, call light in reach, bed low position, and brakes locked from 0700 through 1859 which was 5 hours and 25 minutes prior to the end of her shift at 1900.
B. During interview with the Chief Nursing Officer on 09/26/14 at 1235, she confirmed the findings.

Based on review of Medical Staff Rules and Regulations, clinical record review and interview, it was determined the facility failed to ensure physician ' s verbal orders were timed, dated, and authenticated for 24 (#1, #3, #6-#12, #14-#16, and #18-#25) of 30 (#1-#30) patients. Failure of the physician to sign the orders did not ensure physician had reviewed the orders to determine they were carried out as desired; failure to date and time the signature did not ensure the physician authenticated the order within the time frame of 72 hours as stated in the Medical Staff Rules and Regulations. The failed practice created the potential to affect any patient in the facility. Findings follow.

A. Review of the Medical Staff Rules and Regulations stated, " All orders, including telephone orders, must be dated, timed, and authenticated by the ordering practitioner or another practitioner who is responsible for the care of the patient and authorized to write orders by Hospital policy ...Telephone orders must be authenticated in accordance with state laws or regulations. "
B. Review of physician orders revealed the following verbal orders were not dated, timed, and/or authenticated by the physician within the time frame as stated in the Medical Staff Rules and Regulations:
1) Patient #1 - 14 of 14 orders were not dated, timed, or authenticated.
2) Patient #3 - 10 of 10 orders were not dated or timed; 7 of 10 not dated, timed, or authenticated.
3) Patient #6 - two of two orders were not dated, timed, or authenticated.
4) Patient #7 - 11 of 11 orders were not dated or timed; 10 of 11 were not authenticated.
5) Patient #8 - eight of eight orders were not dated, timed, or authenticated.
6) Patient #9 - 12 of 12 orders were not dated or timed; 11 of 12 were not authenticated.
7) Patient #10 - one of one order was not dated, timed, or authenticated.
8) Patient #11 - 11 of 11 orders were not dated or timed; 5 of 11 were not authenticated.
9) Patient #12 - 2 of 2 orders were not dated or timed; 1 of 2 was not authenticated.
10) Patient #14 - 6 of 6 orders were not dated or timed; 4 of 6 were not authenticated.
11) Patient #15 - 5 of 5 orders were not dated or timed; 4 of 5 were not authenticated.
12) Patient #16 - 7 of 7 orders were not dated or timed; 1 of 7 was not authenticated.
13) Patient #18 - 1 of 1 order was not dated, timed or authenticated.
14) Patient #19 - 3 of 3 orders were not dated, timed, or authenticated.
15) Patient #20 - 11 of 11 orders were not dated, timed, or authenticated.
16) Patient #21 - 34 of 34 orders were not dated or timed; 28 of 34 were not authenticated.
17) Patient #22 - 10 of 10 orders were not dated or timed; 9 of 10 were not authenticated.
18) Patient #23 - 4 of 4 orders were not dated or timed; 3 of 4 were not authenticated.
19) Patient #24 - 15 of 15 orders were not dated or timed; 10 of 15 were not authenticated.
20) Patient #25 - 9 of 9 orders were not dated or timed; 5 of 9 were not authenticated.
21) Patient #27 - 18 of 18 orders were not dated or timed; 14 of 18 were not authenticated.
22) Patient #28 - 9 of 9 orders were not dated or timed; 2 of 9 were not authenticated.
23) Patient #29 - 9 of 9 orders were not dated or timed.
24) Patient #30 - 13 of 13 orders were not dated or timed; 2 of 13 were not authenticated.
C. Findings were confirmed by the Chief Nursing Officer and the Charge Nurse on 09/26/14 from 1230 to 1245.

Based on review of discharge summaries and interview, it was determined the facility failed to assure a final diagnosis was included in 9 (#1, 9, 15, 23, 25-28, and 30) of 11 (#1, 9, 15, 21, 23, 25-30) discharge summaries reviewed. Failure to include a final diagnosis in the discharge summary did not assure the medical record was complete or accurate and was likely to affect all patients discharged from the facility. Findings follow:

A. Review of the discharge summaries for Patients #1, 9, 15, 23, 25-28, and 30 revealed they did not have evidence of a final diagnosis.
B. Findings were verified with the Chief Nursing Officer on 09/26/14 from 1230-1245.

Based on review of policy, observation and interview, it was determined two of two crash carts were not maintained with an easily broken locking system that detected access of its contents in that there was a key hanging on the handle. By allowing the crash carts to be easily accessed, it did not assure there was a system in place to detect if the cart had entered and anything removed. The failed practice had the likelihood to affect all patients. Findings follow:

A. Review of policy titled Crash Carts and Emergency Drug Supply stated "These carts are locked with a plastic/metal device which is easily broken to allow unrestricted, but detectable access to the contents."
B. During a tour on 09/22/14 from 1300 to 1420, observation revealed two locked crash carts with the key hanging from the crash cart handle in plain sight.
C. Findings were verified, through interview, with the Director of Pharmacy on 09/22/14 at 1414.

Based on review of policy, review Medication Variance forms and Incident reports and interview, it was determined the facility failed to report all medication errors to the attending physician or covering physician in 19 of 24 reported medication errors in the last 12 months (October 2013 through September 2014). By not reporting medication errors to the physician responsible for the patient's care, the physicians were not kept abreast of the patient's condition and were not involved in the decisions of what to do after the error occurred. The failed practice had the likelihood to affect all patients in the facility. Findings follow:

A. Review of policy titled Medication Errors: Definition and procedures stated "Medication errors should be reported immediately to the physician responsible for the patient."
B. Review of Medication Variance forms and incident reports revealed 24 medication errors had been reported in the previous 12 months (October 2013 through September 2014) and of the 24, 19 had no evidence physician notification occurred.
C. Findings were verified, through interview, with the Director of Pharmacy on 09/24/14 at 1320.


Based on review of policy, Pharmacy and Therapeutics Committee Meeting Minutes and interview, it was determined the Pharmacy and Therapeutics Committee failed to review the medication errors for 3 (December 2013, January and April 2014) of 4 (December 2013, January, April and August 2014) quarterly Pharmacy and Therapeutics Committee Meetings (per policy). By not reviewing Medication Errors, the facility was not utilizing the expertise of the Pharmacy and Therapeutics Committee to analyze and identify system vulnerabilities. The failed practice had the likelihood to affect all the patients. Findings follow:

A. Review of policy titled Medication Errors: Definition and Procedures stated "Medication Error reports are reviewed by the Pharmacy and Therapeutics Committee at least quarterly.".
B. Review of the previous 4 quarters of Medication Error reports revealed the Pharmacy and Therapeutics Committee failed to review the medication errors for December 2013, January and April 2014.
C. Findings were verified, through interview, on 09/24/14 at 1320 with the Director of Pharmacy.

Based on observation and interview, it was determined the facility did not maintain the condition of the walls, ceilings, floors free from damage, and failed to repair water leaks above the ceiling to prevent injury and harm to health. The failed practice had the potential to affect all patients, staff, and visitors due to the potential harm to health and safety presented by the observed physical conditions. The facility had a census of 24 patients on 09/22/14. The findings follow:

A. On a tour of the facility on 09/25/14 at 0915 with the Maintenance Director, Interim Chief Executive Officer, Chief Nursing Officer, and Quality Coordinator, the following observations were made:
1) In the three comparment sink area of the Kitchen, an approximate foot long section of the ceiling and a section by a light fixture was damaged with peeling paint.
2) In the Northeast Exit stairwell, the following observations were made:
a) Black mold was observed on the ceiling tiles around the ceiling mounted air-conditioning equipment.
b) Large sections of the paint on the walls was cracked and peeling throughout the stairwell.
c) Two ceiling tiles were missing.
3) In the Exit Stairwell located near the Sleep Disorders Center, the following observations were made:
a) All floor tiles were missing on the stair landings.
b) Three ceiling tiles were missing
c) Three ceiling tiles were stained brown.
d) The walls had large sections of cracked and peeling paint. Paint chips were swept into piles on the stairwell landings.
e) The exterior wall of the stairwell was constructed of glass. A large pane of this glass was cracked, but was still intact.
3) Observation above the ceiling at 0945 on 09/25/14 revealed plastic basins placed above the ceiling under piping to catch water leakson the nursing unit as follows (The presence of the basins was evidence of catching liquid rather than making necessary repairs):
a) Three basins located near Doctor's Dictation room.
b) Three basins located at the Nurse Station.
c) Seven basins in the southeast corner of the unit near Telemetry.

B. The Maintenance Director verified the observations of the Kitchen and Stairwells at the time each condition was observed on the tour.

C. In an interview on 09/25/14 at 1000, the Maintenance Director verified the plastic basins were placed above the ceiling to catch condensation from air-conditioning piping.

D. On 09/25/14 at 1050, the Maintenance Director provided two work orders related to the placement of the plastic basins above the ceiling, as follows:
1) Worker Order #4065 for "Leaks and Pans" dated 09/01/14. The Job Request read " Ck each shift and empty as needed-½ full or more. (1) OPS c/w valve (2) 2E hall by Room 228 and small office (3) Sipu Rm #1 and end of hall (4) Gero above RN desk, Rm 128, speaker and smoke det by east double doors. (5) 1E hall between Rms 111 and 113, Rms 107, 109, 108, and hall by Rear RN desk. (6) Sleep Lab Utility rm at hatch and old med room at hatch (7) GI Lab at RN desk." The work order documented checks on the pans at least twice daily from 09/01/14 through 09/25/14.
2) Work Order #4375 for "Tiles" dated 09/23/14. The Job Request read "Fresh big wet ceiling tiles near 219 in the hall. Stain ceiling tile in nurses station and 201." Under the Comments section was written "The leak is due to steam being off, Put pan under valves. Will change tiles out once steam is back on. I replaced the ceiling tiles but we still need to keep an eye on the pans. 09-24-14 Empty pans ins ceilings and replace tiles. Also in front of Room 201." The work order was evidence of ongoing temporary measures to correct the water leaks rather than a permanent repair.

E. In an interview on 09/25/14 at 1040, the Interim Chief Executive Officer made the following comments concerning the plastic basins and ceiling leaks:
1) "became aware of the issue about two years ago."
2) "about a year ago a bucket collapsed on a patient."
3) "when I first saw the stairwells, I called the host and president of the company."
4) "the Pharmacy had a major leak."
5) "part of the reason we are looking into moving to a new location."
6) "when it rains it comes through tiles in some areas."
7) "it is an ongoing battle, the host tells us repairs will be made 'when we get funding'."

Based on observation, inspection documentation review and interview, it was determined the facility did not meet Life Safety Code standards related to fire alarm system inspection, damper testing documentation, maintenance of smoke barrier walls and exit stair lighting, and fire drills. The failed practices had the potential to affect all patients, staff, and visitors. See K-025, K-045, K050, K-052, and K-067.

Based on review of Hour Daily Care Records, observation and interview, it was determined the Infection Control Officer failed to control infections by assuring visitors wore personal protective equipment (PPE) when visiting patients on contact isolation and failed to encourage/remind visitors to wear PPE for one (#22) of one patient observed. Failure to assure visitors wore PPE did not prevent cross contamination from visitors leaving an isolation room and spreading infection/contamination to persons/objects in which they came in contact. This failed practice was likely to affect all persons in the facility. Findings follow:

A. Review of Infection Control Education and Tracking for Patient #22 revealed he was placed on isolation on 09/18/14 and was given instructions/information regarding educational topics on 09/17/14. On 09/20/14, the wife was given information regarding isolation. There was no documentation of instructions for use of PPE, importance of why to wear PPE or follow-up throughout his hospitalization.
B. Review of Hour Daily Care Record for Patient #22 dated 09/22/14 revealed, "Instructed family in room on isolation and to wear gowns and gloves".
C. On observation 09/24/14 at 1420 revealed a yellow supply caddy hanging on the door of Room #231 for Patient #22. A visitor was standing next to the bed reading a newspaper and was not wearing PPE. On interview with the Infection Control Officer at 1425 on 09/24/14, she confirmed the patient had a diagnosis of VRE (Vancomycin-Resistant Enterococci). During interview with the visitor at the time of observation, she stated she was not aware she should be wearing any protective gear, that no one had instructed her to do so.
D. Review of the clinical record for Patient #22 from 08/31/14 to 09/17/14, 09/18/14 to 09/19/14 and 09/23/14 to 09/26/14 revealed no evidence visitors had been instructed, reminded or encouraged to wear PPE.
E. On observation 09/25/14 at 1530 revealed three visitors for Patient #22 in Room #231. None were wearing PPE. During interview with the visitors, they stated they had not been instructed to wear protective clothing. There were no gowns available in the yellow caddy hanging on the door.
F. Findings were confirmed with the Chief Nursing Officer on 09/25/14 at 1545.


Based on observation and interview, it was determined the facility failed to assure the microwave was clean in one of one Patient Nutrition Area observed. Failure to assure the microwave was clean did not prevent food from being contaminated when placed inside for heating and was likely to affect all patients admitted to the facility. Findings follow:

During tour of the facility on 09/22/14 from 1310-1400 with the Chief Nursing Officer (CNO), in the Patient Nutrition Area, a microwave was noted to have stains and debris on all interior surfaces. Findings were confirmed with the CNO at the time of observation.


31039

Based on review of policy, observation and interview, it was determined the Infection Control Officer failed to assure dirty equipment was separated from clean equipment in that clean rehabilitation equipment was being stored with contaminated rehabilitation equipment. Failure to assure clean and dirty equipment were separated did not prevent cross contamination from patient to patients and staff. This failed practice was likely to affect all persons in the facility. Findings follow:

A. Review of policy titled "Management of Equipment, Devices and Supplies" stated "Equipment is cleaned, bagged and left in the room by environmental services. Clean and Dirty equipment, devices and supplies will be kept in separate areas at all times if they are taken out of the patient room. Clean verses dirty areas should be appropriately labeled."
B. During a tour of the Rehabilitation Department on 09/25/14 from 1000 to 1100, observation revealed a storage room that housed Rehabilitation equipment, some covered with plastic and some not. A clean shower chair (clear plastic covered it, indicating clean) was stored in the commode room along with 3 empty biohazard trash cans and next to a very dirty toilet that had a sign posted above it stating the water was not running to the toilet.
C. Findings were verified through interview, at the time of observation with Physical Therapist #1.