HospitalInspections.org

Based on record review and staff interview, the hospital failed to provide adequate numbers of qualified staff trained to care for patients on a ventilator (A-0392); failed to ensure that nursing staff was competent to care for a patient utilizing specific life sustaining equipment (A-0395); failed to provide care and assessment, in accordance with the plan of care in one of one patient record reviewed (A-0396); failed to ensure that nursing staff was qualified and assigned care, in accordance to the needs of the patient, requiring ventilator services (A-0397); and failed to develop a mechanism to ensure that nursing preceptors were trained and competent to provide clinical education to novice nursing staff(A-0397).

The cumulative effect of these systemic practices, resulted in the hospital failure to comply with conditions of participation, for Nursing Services.

Based on reviews of records and staff interviews, the Governing Body failed to develop an effective monitoring mechanism, to ensure the Chief Executive Officer managed the hospital, in accordance with acceptable standards of practice.

Findings included ...

The Chief Executive Officer failed to:

A. Ensure adequate numbers of qualified staff were trained to care for patients requiring ventilator services (A-0392)

B. Ensure that nursing staff was competent to care for a patient utilizing specific life sustaining equipment (ventilator)(A-0395)

C. Failed to provide care and assessment, in accordance with the plan of care, in one of one patient record reviewed (A-0396)

D. Ensure that nursing staff was qualified and was assigned to care, in accordance to the patient's needs (A-0397)

E. Develop a mechanism to ensure that nursing preceptors were trained and competent to provide clinical education to novice nursing staff (A-0397)

Based on record review and staff interview, the hospital failed to provide adequate numbers of qualified staff, trained to care for four of 14, patients requiring ventilator services (Patients #1, 2, 3 and 11).

Findings included...

Patient #1 was admitted on to the hospital on 08/16/18 for continuation of intravenous antibiotic use and Respiratory Failure. He had a history of Chronic Respiratory Failure, Tracheal Mass and Acute on Chronic Renal Failure. Patient #1 underwent a tracheostomy at an acute care hospital on 07/11/18, prior to admission to the long term acute care (LTAC) hospital. The patient was made DNR on 09/01/18.

Review of the admission history and physical showed that Patient #1 was receiving oxygen via a tracheostomy mask at 40% fractured of inspired oxygen (FI02), to maintain his oxygen saturation. On 08/19/18 at 10:30 PM, the physician wrote an order to place Patient #1 on mechanical ventilation, secondary to Hypoxia.

Review of the medical record showed a nursing note, written by Employee #1, Patient #1's Primary Nurse, dated 09/04/18 at 11:18 AM. The note revealed EMployee #1 was walking down the hall and heard the ventilator alarming. She entered the room and observed Patient #1 awake, and the ventilator showed, "back-up battery low." Employee #1 notified respiratory therapy (RT), who verbalized she would be there immediately to check the ventilator. She then went to the medication room to pull medications, for another patient. According to the note, when she exited the medication room, she was told that a rapid response was called. The patient was pronounced dead at 12:04 PM.

On 09/05/18 at approximately 10:00 AM, the surveyor conducted a tour of the Education office where the ventilator used for Patient #1 was housed, in the presence of Employee #10, Chief Executive Officer. Employee #10 explained that at the time of the incident, Patient #1 was using an Esprit Respironics ventilator. After the incident, the hospital pulled all of the Respironics ventilators out of service, and placed patients on the newer Hamilton C1 ventilators. There were a total of four Esprit Respironics ventilators in use, on 09/04/18.

The surveyor conducted a face to face interview on 09/05/18 at 2:47 PM, with Employee #3, RT, regarding her knowledge of the incident with Patient #1. Employee #3 stated that she was working with another patient with a tracheostomy, when Employee #1, Patient #1's Primary Registered Nurse, came in the room and said that the patient's ventilator was alarming and showing low battery. Employee #3 said that she finished doing what she was doing with the other patient and ran down to the room. She stated that as she approached Patient #1's room, she saw Employee #5, Respiratory Therapist, running into the room. When they got into the room, Patient #1 was unresponsive and they began to administer oxygen, via the ambu bag. At that time, Employee #5 yelled, "it's not plugged," indicating that the ventilator was not plugged into the wall socket. Employee #3 said that she did not know how the ventilator became unplugged.

The surveyor conducted a face to face interview on 09/06/18 at 9:17 AM, with Employee #1. She confirmed what she wrote in her nursing note. When asked how long she worked at the hospital, Employee #1 stated that she had been working at the hospital for three months, and had been a registered nurse for a little over a year. The surveyor asked what experience Employee #1 had with patients on a ventilator; she stated that her only experience prior to working at the facility was during clinical rotation in nursing school. The surveyor asked Employee #1 if she was trained on the use of the Esprit Respironics ventilator, she stated that she was not. She went on to say that her preceptor told her that if she had trouble with the ventilator to call the respiratory therapist, since the Esprit ventilators are older. The surveyor asked Employee #1 if she checked to see if the ventilator was unplugged, when she saw the message about the low backup battery. She stated that she checked and she couldn't see where the ventilator was unplugged. When asked if she knew the life of the back-up battery on the Esprit Respironics ventilator, she stated, "No".

The surveyor conducted a telephone interview on 09/06/18 at 11:10 AM with Employee #4, Registered Nurse and the former preceptor for Employee #1. Employee #4 stated that she had been working at the hospital for four years. The surveyor asked how long she had been a preceptor. Employee #4 stated that she started precepting this year and she did not take the preceptor class. The surveyor asked what she teaches the nurses that she is training about the Esprit Respironics ventilators, she stated that she teaches them what she knows about the old ventilators. If there is a problem with those ventilators, she calls the RT, immediately and places the patient on 100% FIO2. She stays with the patient until RT arrives. When asked if she was trained to use the Esprit Respironics ventilators, she stated that she didn't think she had been trained. When asked if she knew the life of the back-up battery on the Esprit Respironics ventilator, she stated, "No."

Review of the Esprit Respironics Ventilator Service Manual, showed, "The 24 [volt] battery can power the ventilator for approximately 30 minutes at nominal settings, in case of AC [Alternating Current] power loss."

Review of the list of patients requiring mechanical ventilation on 09/05/18 showed a total of 14 patients. Three of the patients were using the Esprit Respironics ventilator, Patients #11, 2, and 3.

Review of nursing staffing from 08/29/18 to 09/05/18 showed a total of 11 nurses that cared for the patients on the Esprit Respironics ventilators. Of the 11 nurses, five did not complete training and competency for the use of the Esprit ventilator; and the other six nurses completed training and competency, in 2016. Nursing staff hired in 2017 and 2018 did not receive training on the Esprit ventilator.

The surveyor conducted a face to face interview on 09/06/18 at approximately 4:00 PM, with Employees #8, Chief Clinical Officer, #9, Chief Executive Officer, and 10, Quality Director. They acknowledged the above findings.

Based on record review and staff interview, nursing staff failed to adequately monitor the condition of a patient requiring mechanical ventilation in the presence of possible mechanical compromise in one of one medical record reviewed (Patient #1).

Findings included ...

Patient #1 was admitted on to the hospital on 8/16/18 for continuation of intravenous antibiotic use and respiratory failure. He had a history of chronic respiratory failure, a tracheal mass and acute on chronic renal failure. Patient #1 underwent a tracheostomy at an acute care hospital on 07/11/18, prior to admission to the long term acute care (LTAC) facility. The patient was made a Do Not Resuscitate (DNR) on 09/01/18. The patient was made a Do Not Resuscitate (DNR) on 09/01/18.

Review of the admission history and physical showed that Patient #1 was receiving oxygen via a tracheostomy mask at 40% fractured of inspired oxygen (FI02), to maintain his oxygen saturation. On 8/19/18 at 10:30 PM the physician wrote an order to place Patient #1 on mechanical ventilation related to hypoxia.

Review of the medical record showed a nursing note, written by Employee #1, Patient #1's Primary Nurse, dated 09/04/18 at 11:18 AM. The note revealed Employee #1 was walking down the hall and heard the ventilator alarming. She entered the room and observed Patient #1 awake, and the ventilator showed, "back-up battery low." Employee #1 notified respiratory therapy (RT), who verbalized she would be there immediately to check the ventilator. She then went to the medication room to pull medications, for another patient. According to the note, when she exited the medication room, she was told that a rapid response was called. The patient was pronounced dead at 12:04 PM.

The surveyor conducted a face to face interview on 09/05/18 at 2:47 PM, with Employee #3, RT, regarding her knowledge of the incident with Patient #1. Employee #3 stated that she was working with another patient with a tracheostomy, when Employee #1, Patient #1's Primary Registered Nurse, came in the room and said that the patient's ventilator was alarming and showing low battery. Employee #3 said that she finished doing what she was doing with the other patient and ran down to the room. She stated that as she approached Patient #1's room, she saw Employee #5, Respiratory Therapist, running into the room. When they got into the room, Patient #1 was unresponsive and they began to administer oxygen, via the ambu bag. At that time, Employee #5 yelled, "it's not plugged," indicating that the ventilator was not plugged into the wall socket. Employee #3 said that she did not know how the ventilator became unplugged.

The surveyor conducted a face to face interview on 09/06/18 at 9:17 AM, with Employee #1. She confirmed what she wrote in her nursing note. When asked how long she worked at the hospital, Employee #1 stated that she had been working at the hospital for three months, and had been a registered nurse for a little over a year. The surveyor asked what experience Employee #1 had with patients on a ventilator; she stated that her only experience prior to working at the facility was during clinical rotation in nursing school. The surveyor asked Employee #1 if she was trained on the use of the Esprit Respironics ventilator, she stated that she was not. She went on to say that her preceptor told her that if she had trouble with the ventilator to call the respiratory therapist, since the Esprit ventilators are older. The surveyor asked Employee #1 if she checked to see if the ventilator was unplugged, when she saw the message about the low backup battery. She stated that she checked and she couldn't see where the ventilator was unplugged. When asked if she knew the life of the back-up battery on the Esprit Respironics ventilator, she stated, "No".

The surveyor conducted a telephone interview on 09/06/18 at 11:10 AM with Employee #4, Registered Nurse and the former preceptor for Employee #1. Employee #4 stated that she had been working at the hospital for four years. The surveyor asked how long she had been a preceptor. Employee #4 stated that she started precepting this year and she did not take the preceptor class. The surveyor asked what she teaches the nurses that she is training about the Esprit Respironics ventilators, she stated that she teaches them what she knows about the old ventilators. If there is a problem with those ventilators, she calls the RT, immediately and places the patient on 100% FIO2. She stays with the patient until RT arrives. When asked if she was trained to use the Esprit Respironics ventilators, she stated that she didn't think she had been trained. When asked if she knew the life of the back-up battery on the Esprit Respironics ventilator, she stated, "No."

The nursing staff failed to continually assess the respiratory status of the patient requiring mechanical ventilation, in the presence of mechanical compromise.

The surveyor conducted a face to face interview on 09/06/18 at approximately 4:00 PM, with Employees #8, Chief Clinical Officer, #9, Chief Executive Officer, and 10, Quality Director. They acknowledged the above findings.

Based on record review, and staff interview, nursing staff failed to provide care and assessment, in accordance with the plan of care, in one of one patient record reviewed (Patient #1).

Findings included ...

Patient #1 was admitted on to the hospital on 08/16/18 for continuation of intravenous antibiotic use and Respiratory Failure. He had a history of Chronic Respiratory Failure, Tracheal Mass and Acute on Chronic Renal Failure. Patient #1 underwent a tracheostomy at an acute care hospital on 07/11/18, prior to admission to the long term acute care (LTAC) hospital. The patient was made DNR on 09/01/18.

Review of the admission history and physical showed that Patient #1 was receiving oxygen via a tracheostomy mask at 40% fractured of inspired oxygen (FI02), to maintain his oxygen saturation. On 08/19/18 at 10:30 PM, the physician wrote an order to place Patient #1 on mechanical ventilation, secondary to Hypoxia.

Review of the medical record showed a nursing note, written by Employee #1, Patient #1's Primary Nurse, dated 09/04/18 at 11:18 AM. The note revealed EMployee #1 was walking down the hall and heard the ventilator alarming. She entered the room and observed Patient #1 awake, and the ventilator showed, "back-up battery low." Employee #1 notified respiratory therapy (RT), who verbalized she would be there immediately to check the ventilator. She then went to the medication room to pull medications, for another patient. According to the note, when she exited the medication room, she was told that a rapid response was called. The patient was pronounced dead at 12:04 PM.

On 09/05/18 at approximately 10:00 AM, the surveyor conducted a tour of the Education office where the ventilator used for Patient #1 was housed, in the presence of Employee #10, Chief Executive Officer. Employee #10 explained that at the time of the incident, Patient #1 was using an Esprit Respironics ventilator. After the incident, the hospital pulled all of the Respironics ventilators out of service, and placed patients on the newer Hamilton C1 ventilators. There were a total of four Esprit Respironics ventilators in use, on 09/04/18.

The surveyor conducted a face to face interview on 09/05/18 at 2:47 PM, with Employee #3, RT, regarding her knowledge of the incident with Patient #1. Employee #3 stated that she was working with another patient with a tracheostomy, when Employee #1, Patient #1's Primary Registered Nurse, came in the room and said that the patient's ventilator was alarming and showing low battery. Employee #3 said that she finished doing what she was doing with the other patient and ran down to the room. She stated that as she approached Patient #1's room, she saw Employee #5, Respiratory Therapist, running into the room. When they got into the room, Patient #1 was unresponsive and they began to administer oxygen, via the ambu bag. At that time, Employee #5 yelled, "it's not plugged," indicating that the ventilator was not plugged into the wall socket. Employee #3 said that she did not know how the ventilator became unplugged.

The surveyor conducted a face to face interview on 09/06/18 at 9:17 AM, with Employee #1. She confirmed what she wrote in her nursing note. When asked how long she worked at the hospital, Employee #1 stated that she had been working at the hospital for three months, and had been a registered nurse for a little over a year. The surveyor asked what experience Employee #1 had with patients on a ventilator; she stated that her only experience prior to working at the facility was during clinical rotation in nursing school. The surveyor asked Employee #1 if she was trained on the use of the Esprit Respironics ventilator, she stated that she was not. She went on to say that her preceptor told her that if she had trouble with the ventilator to call the respiratory therapist, since the Esprit ventilators are older. The surveyor asked Employee #1 if she checked to see if the ventilator was unplugged, when she saw the message about the low backup battery. She stated that she checked and she couldn't see where the ventilator was unplugged. When asked if she knew the life of the back-up battery on the Esprit Respironics ventilator, she stated, "No".

The surveyor conducted a telephone interview on 09/06/18 at 11:10 AM with Employee #4, Registered Nurse and the former preceptor for Employee #1. Employee #4 stated that she had been working at the hospital for four years. The surveyor asked how long she had been a preceptor. Employee #4 stated that she started precepting this year and she did not take the preceptor class. The surveyor asked what she teaches the nurses that she is training about the Esprit Respironics ventilators, she stated that she teaches them what she knows about the old ventilators. If there is a problem with those ventilators, she calls the RT, immediately and places the patient on 100% FIO2. She stays with the patient until RT arrives. When asked if she was trained to use the Esprit Respironics ventilators, she stated that she didn't think she had been trained. When asked if she knew the life of the back-up battery on the Esprit Respironics ventilator, she stated, "No."

The surveyor conducted a telephone interview on 09/06/18 at 11:25 AM with Employee #5, RT, regarding the incident with Patient #1. She stated that she has been an RT for eight years. When she started working at the hospital, they was using the Esprit ventilator, then the Hamilton ventilators came. Regarding the incident with Patient #1, she stated that she was walking on the nursing unit, when a nurse came out of a room and said that the ventilator was not working. Employee #5 walked in the room, found Patient #1 was unresponsive, so she started to bag him. When she looked at the ventilator, it read the battery was depleted, and she saw that the ventilator was unplugged. When the educator entered the room, after the Rapid Response was called, he plugged the ventilator into the wall.

The surveyor conducted a face to face interview on 09/06/18 at 1:40 PM with Employee #6, Nurse Educator, regarding the incident with Patient #1. He stated that he went to Patient #1's room to respond to the Rapid Response. When he got there, he noticed that the ventilator was alarming and it was unplugged. He plugged the ventilator into the wall, and the alarming stopped.

Review of the Esprit Respironics Ventilator Service Manual, showed, "The 24 [volt] battery can power the ventilator for approximately 30 minutes at nominal settings, in case of AC [Alternating Current] power loss."

Review of the list of patients requiring mechanical ventilation on 09/05/18 showed a total of 14 patients. Three of the patients were using the Esprit Respironics ventilator, Patients #11, 2, and 3.

Review of nursing staffing from 08/29/18 to 09/05/18 showed a total of 11 nurses that cared for the patients on the Esprit Respironics ventilators. Of the 11 nurses, five did not complete training and competency for the use of the Esprit ventilator; and the other six nurses completed training and competency, in 2016.

The surveyor conducted a face to face interview on 09/06/18 at approximately 4:00 PM, with Employees #8, Chief Clinical Officer, #9, Chief Executive Officer, and 10, Quality Director. They acknowledged the above findings.

1. Based on record review, and staff interview, nursing leadership failed to ensure that nursing staff was qualified and assigned care, in accordance to the needs of the patient, requiring ventilator services, in four of four patient records reviewed (Patients #1, 2, 3, and 11).

Findings included ...

Patient #1 was admitted on to the hospital on 08/16/18 for continuation of intravenous antibiotic use and Respiratory Failure. He had a history of Chronic Respiratory Failure, Tracheal Mass and Acute on Chronic Renal Failure. Patient #1 underwent a tracheostomy at an acute care hospital on 07/11/18, prior to admission to the long term acute care (LTAC) hospital. The patient was made DNR on 09/01/18.

Review of the admission history and physical showed that Patient #1 was receiving oxygen via a tracheostomy mask at 40% fractured of inspired oxygen (FI02), to maintain his oxygen saturation. On 08/19/18 at 10:30 PM, the physician wrote an order to place Patient #1 on mechanical ventilation, secondary to Hypoxia.

Review of the medical record showed a nursing note, written by Employee #1, Patient #1's Primary Nurse, dated 09/04/18 at 11:18 AM. The note revealed Employee #1 was walking down the hall and heard the ventilator alarming. She entered the room and observed Patient #1 awake, and the ventilator showed, "back-up battery low." Employee #1 notified respiratory therapy (RT), who verbalized she would be there immediately to check the ventilator. She then went to the medication room to pull medications, for another patient. According to the note, when she exited the medication room, she was told that a rapid response was called. The patient was pronounced dead at 12:04 PM.

The surveyor conducted a face to face interview on 09/05/18 at 2:47 PM, with Employee #3, RT, regarding her knowledge of the incident with Patient #1. Employee #3 stated that she was working with another patient with a tracheostomy, when Employee #1, Patient #1's Primary Registered Nurse, came in the room and said that the patient's ventilator was alarming and showing low battery. Employee #3 said that she finished doing what she was doing with the other patient and ran down to the room. She stated that as she approached Patient #1's room, she saw Employee #5, Respiratory Therapist, running into the room. When they got into the room, Patient #1 was unresponsive and they began to administer oxygen, via the ambu bag. At that time, Employee #5 yelled, "it's not plugged," indicating that the ventilator was not plugged into the wall socket. Employee #3 said that she did not know how the ventilator became unplugged.

The surveyor conducted a face to face interview on 09/06/18 at 9:17 AM, with Employee #1. She confirmed what she wrote in her nursing note. When asked how long she worked at the hospital, Employee #1 stated that she had been working at the hospital for three months, and had been a registered nurse for a little over a year. The surveyor asked what experience Employee #1 had with patients on a ventilator; she stated that her only experience prior to working at the facility was during clinical rotation in nursing school. The surveyor asked Employee #1 if she was trained on the use of the Esprit Respironics ventilator, she stated that she was not. She went on to say that her preceptor told her that if she had trouble with the ventilator to call the respiratory therapist, since the Esprit ventilators are older. The surveyor asked Employee #1 if she checked to see if the ventilator was unplugged, when she saw the message about the low backup battery. She stated that she checked and she couldn't see where the ventilator was unplugged. When asked if she knew the life of the back-up battery on the Esprit Respironics ventilator, she stated, "No".

The surveyor conducted a telephone interview on 09/06/18 at 11:10 AM with Employee #4, Registered Nurse and the former preceptor for Employee #1. Employee #4 stated that she had been working at the hospital for four years. The surveyor asked how long she had been a preceptor. Employee #4 stated that she started precepting this year and she did not take the preceptor class. The surveyor asked what she teaches the nurses that she is training about the Esprit Respironics ventilators, she stated that she teaches them what she knows about the old ventilators. If there is a problem with those ventilators, she calls the RT, immediately and places the patient on 100% FIO2. She stays with the patient until RT arrives. When asked if she was trained to use the Esprit Respironics ventilators, she stated that she didn't think she had been trained. When asked if she knew the life of the back-up battery on the Esprit Respironics ventilator, she stated, "No."

Review of the list of patients requiring mechanical ventilation on 09/05/18 showed a total of 14 patients. Three of the patients were using the Esprit Respironics ventilator, Patients #11, 2, and 3. A review of the staffing from 08/29/18 to 09/05/18 showed a total of 11 nurse ' s care for the patients on the Esprit Respironics ventilators. Of the 11 nurses five did not complete training and competency for the use of the Esprit ventilator.

Review of nursing staffing from 08/29/18 to 09/05/18 showed a total of 11 nurses that cared for the patients on the Esprit Respironics ventilators. Of the 11 nurses, five did not complete training and competency for the use of the Esprit ventilator; and the other six nurses completed training and competency, in 2016. Nursing staff hired in 2017 and 2018 did not receive training on the Esprit ventilator.

The surveyor conducted a face to face interview on 09/06/18 at approximately 4:00 PM, with Employees #8, Chief Clinical Officer, #9, Chief Executive Officer, and 10, Quality Director. They acknowledged the above findings.

2. Based on record review, and staff interview, the hospital failed to develop a mechanism to ensure that nursing preceptors were trained and competent to provide clinical education to novice nursing staff.

Findings included ...

Patient #1 was admitted on to the hospital on 08/16/18 for continuation of intravenous antibiotic use and Respiratory Failure. He had a history of Chronic Respiratory Failure, Tracheal Mass and Acute on Chronic Renal Failure. Patient #1 underwent a tracheostomy at an acute care hospital on 07/11/18, prior to admission to the long term acute care (LTAC) hospital. The patient was made DNR on 09/01/18.

Review of the admission history and physical showed that Patient #1 was receiving oxygen via a tracheostomy mask at 40% fractured of inspired oxygen (FI02), to maintain his oxygen saturation. On 08/19/18 at 10:30 PM, the physician wrote an order to place Patient #1 on mechanical ventilation, secondary to Hypoxia.

Review of the medical record showed a nursing note, written by Employee #1, Patient #1's Primary Nurse, dated 09/04/18 at 11:18 AM. The note revealed that Employee #1 was walking down the hall and heard the ventilator alarming. She entered the room and observed Patient #1 awake, and the ventilator showed, "back-up battery low." Employee #1 notified respiratory therapy (RT), who verbalized she would be there immediately to check the ventilator. She then went to the medication room to pull medications, for another patient. According to the note, when she exited the medication room, she was told that a rapid response was called. The patient was pronounced dead at 12:04 PM.

The surveyor conducted a face to face interview on 09/06/18 at 9:17 AM, with Employee #1. She confirmed what she wrote in her nursing note. When asked how long she worked at the hospital, Employee #1 stated that she had been working at the hospital for three months, and had been a registered nurse for a little over a year. The surveyor asked what experience Employee #1 had with patients on a ventilator; she stated that her only experience prior to working at the facility was during clinical rotation in nursing school. The surveyor asked Employee #1 if she was trained on the use of the Esprit Respironics ventilator, she stated that she was not. She went on to say that her preceptor told her that if she had trouble with the ventilator to call the respiratory therapist, since the Esprit ventilators are older. The surveyor asked Employee #1 if she checked to see if the ventilator was unplugged, when she saw the message about the low backup battery. She stated that she checked and she couldn't see where the ventilator was unplugged. When asked if she knew the life of the back-up battery on the Esprit Respironics ventilator, she stated, "No".

The surveyor conducted a telephone interview on 09/06/18 at 11:10 AM with Employee #4, Registered Nurse and the former preceptor for Employee #1. Employee #4 stated that she had been working at the hospital for four years. The surveyor asked how long she had been a preceptor. Employee #4 stated that she started precepting this year and she did not take the preceptor class. The surveyor asked what she teaches the nurses that she is training about the Esprit Respironics ventilators, she stated that she teaches them what she knows about the old ventilators. If there is a problem with those ventilators, she calls the RT, immediately and places the patient on 100% FIO2. She stays with the patient until RT arrives. When asked if she was trained to use the Esprit Respironics ventilators, she stated that she didn't think she had been trained. When asked if she knew the life of the back-up battery on the Esprit Respironics ventilator, she stated, "No."

The surveyor conducted a face to face interview on 09/06/18 at 1:40 PM with Employee #6, Nurse Educator, regarding preceptor eligibility and education. He stated that potential preceptors are identified though their work performance and identification from the unit manager. He stated that preceptor training is done once a year and goes over how to teach individuals. He went on to say Employee #4, never went through preceptor training. When asked how clinical competency of a preceptor is established, Employee #6 could offer no further insight.

The surveyor conducted a face to face interview on 09/06/18 at approximately 4:00 PM, with Employees #8, Chief Clinical Officer, #9, Chief Executive Officer, and 10, Quality Director. They acknowledged the above findings.