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Based on observation, interview and record review, the facility failed to ensure that staff followed the facility policy for source control for Covid 19 prevention for two of two housekeeping staff ( #G, #L) observed during daily cleaning of patient rooms, failed to ensure that patient and visitor screening criteria for symptoms of Covid 19 was updated to reflect currently known symptoms of Covid 19, and failed to incorporate comprehensive screening for symptoms of Covid 19 into daily patient assessments for 10 of 10 patients (#1, #2, #3, #4, #5, #6, #7, #8, #9, #10) reviewed, resulting in the potential for transmission of infection in the facility with the potential to effect all patients. Findings include;

On 9/2/20 at approximately 0900 Staff B was observed during screening of visitors and staff. The screening questions for symptoms of Covid 19 did not contain all currently known symptoms. The Screening form was reviewed at this time and revealed the questions were the same as those asked by Staff B and were questions related to travel to China or other international destinations, recent exposure to someone with Covid 19 or someone with severe acute lower respiratory distress, fever, cough or trouble breathing.

On 9/2/20 at approximately 1000 Housekeeper Staff G was observed as she cleaned a patient room. Staff G was wearing a mask that did not cover her nose. Staff G was asked about this at the time of observation and said that she wore the mask like that because if she wore it to cover her nostrils her glasses would steam up.

On 9/2/20 at approximately 1100 Housekeeper Staff L was observed as she cleaned a patient room while the occupants were in the unit dayroom. Staff L was not wearing a mask. Staff L was asked about this at this time and stated that her supervisor told her that she didn't need to wear a mask while she was cleaning.

On 9/2/20 at approximately 1130 the Director of Facilities Staff S was interviewed and stated that housekeeping staff were expected to wear source control masks at all times inside the facility.

On 9/2/20 at approximately 1135 the facility infection control program was reviewed with the Infection Control Coordinator Staff C who was interviewed at that time. Staff C reported that the Facility used the Center for Disease control (CDC) as it's reference for developing the Infection control Program and all it's policies and procedures. Two patients (#8 and #10) on the infection log for June through August 2020 were noted to have Positive (+) tests for Covid 19 at discharge. These patients were added to sample and their clinical records and Infection Control follow-up were reviewed. The following information was noted:

Patient #8 was admitted to the Behavioral Health Unit (BHU) on 6/2/20 with a diagnosis of Psychosis. Patient #8 did not have any of the risk factors/symptoms for Covid 19 per the facility's current assessment tool on admission and did not have any fever during his stay at the facility. There was no documentation to indicate that Patient #8 was screened for Covid 19 symptoms other than fever during his admission. Patient #8 had a test for Covid 19 ordered at discharge because the facility where he was due to be transferred required him to have a negative (-) Covid test before they would accept him. Patient #8 tested positive (+) for Covid 19 on 6/11/20.

Patient #10 was admitted to the BHU on 6/23/20 with a diagnoses of Psychosis and Schizoaffective Disorder. Patient #10 did not have any of the risk factors/symptoms for Covid 19 per the facility's current assessment tool on admission and did not have any fever during his stay at the facility. There was no documentation to indicate that Patient #10 was screened for Covid 19 symptoms other than fever during his admission. Patient #10 had a test for Covid 19 ordered at discharge because the facility where he was due to be transferred required him to have a negative (-) Covid test before they would accept him. Patient #10 tested positive for Covid 19 on 7/7/20.

On 9/2/20 at approximately 1330 the Covid 19 screening tool for patients, staff and guests was reviewed with the Director of Regulatory and Compliance Staff A who was also interviewed during that time. Staff A reported that the screening tool was not updated since March 2020. There was no mention of other currently known symptoms (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html) such as Chills, Fatigue, Muscle or Body Aches, Headache, New Loss of Taste or Smell, Sore Throat, Congestion or Runny Nose, Nausea or Vomiting, Diarrhea.

On 9/2/20 from approximately 1400 to 1700 clinical records of Patients #1 through #7 and #9 were reviewed for infection control and screening for Covid 19. No daily assessments for symptoms other than temperature were noted. The Chief Nursing Officer Staff D was interviewed regarding this on 9/2/20 at approximately 1630 and stated that daily patient temperature checks and the (outdated) pre-admission screening questionnaire done at admission were how the facility screened for Covid 19 infection in the facility.

On 9/3/20 at approximately 1300 the Chief Medical Officer Staff Q was interviewed and stated that the Covid 19 screening tool should be updated to include currently known symptoms of Covid 19, patients should be screened for Covid 19 symptoms daily, and documented with the daily Nursing Assessment for each patient.

On 9/4/20 at 0800, review of the facility policy entitled "Source Control During the Covid 19 Pandemic", revised 4/24/20 revealed the following:

"Source control measures implemented will comply with CDC (Center for Disease control) guidelines and recommendations to date."
"As part of source control measures ALL STAFF IN PATIENT CARE AREAS WILL WEAR A FACEMASK AT ALL TIMES."

On 9/4/20 at 1340 review of the CDC guidelines for prevention of Covid 19 in health care facilities entitled, "Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic", updated 7/15/20 (https://www.cdc.gov/Coronavirus/2019-ncov/hcp/infection-control-recommendations.html) revealed the following guidelinesfor acute care facilities:

"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." and

"While screening should be performed upon entry to the facility, it should also be incorporated into daily assessments of all admitted patients".

On 9/4/20 at 1350 review of the CDC information on symptoms of Covid 19 entitled, "Symptoms of Coronavirus" updated 5/13/20 (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html) revealed the following:

"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
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19."




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