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Based on record reviews and interview, the hospital failed to implement its grievance procedure as evidenced by failure to have documented evidence of a grievance form being initiated and investigation begun when Patient #3's family reported concerns regarding Patient #3's care being provided.
Findings:

Review of the policy titled "Complaint/Grievance Process", presented as a current policy by S2DON, revealed that a patient grievance is a written or verbal complaint by a patient or the patient's representative regarding the patient's care, abuse, or neglect by the staff present. All complaints that cannot be resolved immediately at the time of the complaint by staff will be addressed as a grievance.

Review of the grievances presented by S1ADM and S2DON revealed no documented evidence that a grievance had been documented related to Patient #3.

Review of a physician progress note documented by S10MD on 05/25/17 at 7:48 a.m. revealed a notation that he had a family meeting with Patient #3's granddaughter on 05/24/17 that included Patient #3's daughter by telephone to discuss goals of care with S12MD and S13CM present. There was no documented evidence of the content that was discussed during the meeting.

Review of a physician progress note documented by S12MD on 05/29/17 at 11:10 a.m. revealed an addendum at 3:30 p.m. as a late entry for 1:00 p.m. that included the following information: family had several concerns regarding the patient's care. They were present for the wound care session today and were very upset about the extent of the wound (Stage IV status post debridement). Per the daughter and son, they were told the ulcer had healed prior to her transfer to this hospital, but they had not visualized the wound themselves. The family was concerned that Patient #3 was not being repositioned every 2 hours. Further documentation revealed that "will d/w (discuss with) nursing staff regarding this.

In an interview on 06/06/17 at 9:40 a.m., S2DON confirmed the hospital did not implement the grievance process relative to Patient #3.

In an interview on 06/06/17 at 10:20 a.m., S1ADM confirmed the hospital did not implement the grievance process relative to Patient #3.

In an interview on 06/07/17 at 10:45 a.m., S13CM indicated he was present for two meetings with Patient #3's family. He further indicated he met with Patient #3's granddaughter and S10MD on 05/24/17, and Patient #3's daughter joined the meeting by telephone. He indicated the daughter got aggressive and was yelling with complaints that baths were not given on the night shift, her mother wasn't being turned, and the staff wasn't getting her out of bed. S13CM confirmed he didn't complete a grievance form or report the grievance that was reported by Patient #3's family to S1ADM to be investigated.

Based on record reviews and interviews, the hospital failed to ensure the RN supervised and evaluated the nursing care for each patient as evidenced by:
1) failing to ensure each patient was assessed prior to delegating patient care to the LPN in accordance with the LSBN's administrative rule for 3 (#2, #3, #4) of 4 (#1, #2, #3, #4) patient records reviewed for RN assessment prior to delegation to the LPN from a total sample of 5 patients.
2) failing to ensure there was documented evidence that patients were turned every 2 hours in accordance with physician orders for 3 (#2, #3, #4) of 4 (#1, #2, #3, #4) patient records reviewed for implementation of physician orders related to turning from a total sample of 5 patients.
3) failing to ensure there was documented evidence that each patient had a bath daily for 3 (#1, #3, #4) of 4 (#1, #2, #3, #4) patient records reviewed for documentation of a bath being given from a total sample of 5 patients.
4) failing to ensure wound care was performed and documented as ordered by the physician for 5 (#1, #2, #3, #4, #5) of 5 patient records reviewed for wound care from a total sample of 5 patients.
5) failing to ensure patients' CBGs were assessed as ordered by the physician for 2 (#1, #3) of 2 patient records reviewed for CBG monitoring from a total sample of 5 patients.
Findings:

1) The RN failing to ensure each patient was assessed prior to delegating patient care to the LPN in accordance with the LSBN's administrative rule:
Review of the Louisiana State Board of Nursing's "Administrative Rules Defining RN Practice LAC46:XLVII" revealed, in part, "3703. Definition of Terms Applying to Nursing Practice Delegating Nursing Interventions revealed the RN retains the accountability for the total nursing care of the individual. The registered nurse shall assess the patient care situation which encompasses the stability of the clinical environment and the clinical acuity of the patient, including the overall complexity of the patient's health care problems. The assessment shall be utilized to assist in determining which tasks may be delegated and the amount of supervision which will be required. Any situation where tasks are delegated should meet the following criteria: a) the person has been adequately trained for the task; b) the person has demonstrated that the task has been learned; c) the person can perform the task safely in the given nursing situation; d) the patient's status is safe for the person to carry out the task; e) appropriate supervision is available during the task implementation; f) the task is in an established policy of the nursing practice setting and the policy is written, recorded and available to all. The RN may delegate to LPNs the major part of the nursing care needed by individuals in stable nursing situations, that is, when the following three conditions prevail at the same time in a given situation: a) nursing care ordered and directed by the RN or MD requires abilities based on a relatively fixed and limited body of scientific fact and can be performed by following a defined nursing procedure with minimal alteration, and responses of the individual to the nursing care are predictable; b) change in the patient's clinical conditions is predictable; and c) medical and nursing orders are not subject to continuous change or complex modification.

Review of the hospital policy titled "Patient Assessment/Reassessment", presented as a current policy by S2DON, revealed that each patient is assessed by a RN upon admission to the hospital and at least once during every 24 hour period (defined as midnight to midnight). The RN will document the patient's assessment in the medical record. Further review revealed any significant change in the patient's condition should elicit a reassessment of the patient (documented in the narrative notes) within one hour.

Review of page 3 of the "Nurses Daily Flow Sheet" revealed a section with the heading of "RN Assessment (complete only if RN did not perform AM or PM shift assessment)". Further review revealed this section included an assessment of the level of consciousness, skin, pain, and the respiratory, cardiovascular, gastrointestinal, and genitourinary systems.

Patient #2
Review of Patient #2's "Nurses Daily Flow Sheet" for 06/01/17, 06/02/17, 06/03/17, 06/05/17 and 06/06/17 revealed care was provided on both shifts by LPNs with no documented evidence that a RN had assessed Patient #2 to determine if he met criteria to be delegated by the RN to a LPN.

Patient #3
Review of Patient #3's "Nurses Daily Flow Sheet" for 05/05/17, 05/06/17, 05/11/17, 05/12/17, 05/13/17, 05/14/17, 05/15/17, 05/16/17, 05/17/17, 05/18/17, 05/19/17, 05/22/17, 05/23/17, 05/24/17, 05/25/17, 05/26/17, 05/29/17, 05/30/17, 05/31/17, 06/02/17, 06/03/17 and 06/05/17 revealed no documented evidence of an RN assessment prior to delegating the care to an LPN.

Patient #4
Review of Patient #4's "Nurses Daily Flow Sheet" for 05/30/17, 05/31/17, 06/01/17, 06/02/17, 06/03/17 and 06/05/17 revealed no documented evidence of an RN assessment prior to delegating the care to an LPN.

In an interview on 06/07/17 at 5:30 p.m., S2DON confirmed the RN should assess each patient at least once every 24 hours and indicated she wasn't aware the RNs weren't assessing and documenting the patients every 24 hours.

2) The RN failing to ensure there was documented evidence that patients were turned every 2 hours in accordance with physician orders:
Review of the physician orders for Patients #2, #3 and #4 revealed orders to turn bedbound patients every 2 hours.

Patient #2
Review of Patient #2's medical record revealed he was bedbound, and there was no documented evidence that he was turned every 2 hours on 05/27/17, 05/28/17, 06/01/17, 06/03/17, 06/04/17 and 06/05/17.

Patient #3
Review of Patient #3's medical record revealed she was bedbound. Further review revealed no documented evidence that she was turned every 2 hours as ordered on 05/06/17, 05/07/17, 05/09/17, 05/11/17, 05/12/17, 05/16/17, 05/18/17 and 06/05/17.

Patient #4
Review of Patient #4's medical record revealed he was bedbound, and there was no documented evidence that he was turned every 2 hours as ordered on 05/27/17, 05/30/17, 05/31/17, 06/01/17, 06/03/17 and 06/07/17.

In an interview on 06/07/17 at 5:30 p.m., S2DON reviewed a "Nurses Daily Flow Sheet" and indicated the box in front of the words "turn q 2 (every) hours while in bed" should be checked to indicate that a patient is turned every 2 hours during the shift. She confirmed the above patient records did not have documentation of being turned every 2 hours.

3) The RN failing to ensure there was documented evidence that each patient had a bath daily:
Review of the "Nurses Daily Flow Sheet" revealed page 2 had a box to be checked if the patient had a bath or shower.

Patient #1
Review of Patient #1's "Nurses Daily Flow Sheet" for 05/31/17 revealed no documented evidence whether she had a bath or shower.

Patient #3
Review of Patient #3's "Nurses Daily Flow Sheet" revealed no documented evidence whether she had a bath or shower on 05/09/17, 05/12/17, 05/17/17, 05/18/17, 05/22/17, 05/23/17, 05/28/17, 05/29/17, 05/30/17, 06/01/17, 06/02/17 and 06/05/17.

Patient #4
Review of Patient #4's "Nurses Daily Flow Sheet" revealed no documented evidence whether he had a bath or shower on 05/29/17.

In an interview on 06/07/17 at 9:00 a.m., Patient #2 indicated getting a bath varies as needed and when needed. He further indicated staff do not come every day to give him a bath.

In an interview on 06/07/17 at 5:30 p.m., S2DON indicated she wasn't aware that patients were not receiving a bath each day.

4) The RN failing to ensure wound care was performed and documented as ordered by the physician:

Patient #1
Review of Patient #1's physician orders revealed an order at admit to clean the left heel wound with Normal Saline then Dakin's solution 0.25%, apply Mepilex AG dressing, cover with 2 cast paddings, and a flex net and boot and to change the dressing every Monday, Wednesday, and Friday. Further review revealed the order for the sacral decubitus was to clean with Normal Saline, apply gauze soaked with 0.25% Dakin's solution to the sacral wound, apply Santyl to yellow tissue in wound, adaptic over bone, blade foam to wound bed, and cover with drape and change every Monday, Wednesday and Friday.

Review of the "Wound Care Treatment Flow Sheet" dated 05/18/17 and documented by S3WC revealed the left heel orders were to paint the heel with Betadine and apply heel protectors to bilateral heels. Further documentation revealed the incorrect wound care (painting with Betadine) was performed to the left heel on 05/18/17, 05/19/17, 05/22/17, 05/23/17, 05/25/17, 05/26/17, 05/28/17, 05/29/17, 05/30/17, 05/31/17, 06/01/17, 06/02/17,06/05/17, and 06/06/17.

Review of the "Wound Care Treatment Flow Sheet" dated 05/18/17 and documented by S3WC revealed the sacral wound orders were to clean with Dakin's Solution, apply adaptic, then wound vac dressing set at 120 millimeters and change every Monday, Wednesday, and Friday. Wound care was not provided as ordered on 05/18/17, 05/19/17, 05/22/17, 05/23/17, 05/24/17, 05/25/17, 05/26/17, 05/29/17, 05/30/17, 05/31/17, 06/02/17, 06/05/17 and 06/06/17.

Review of Patient #1's medical record revealed her sacral decubitus was debrided on 05/25/17 with no documented evidence of physician orders for treatment after the debridement.

In an interview on 06/07/17 at 4:25 p.m., S3WC confirmed there were no physician orders related to wound care after Patient #1's sacral wound was debrided on 05/25/17. She confirmed the received physician orders were not transcribed as given on the treatment flow sheet. S3WC indicated the orders for the heel wound care were changed by the physician, but she failed to document the verbal order.

Patient #2
Review of Patient #2's physician orders revealed an order on 05/26/17 at 9:00 p.m. to clean the coccyx and left and right ischium wounds with wound cleanser, apply Santyl, Xeroform, and cover with a dry, clean dressing daily and as needed. Further review revealed an order on 05/29/17 at 4:35 p.m. to paint the right heel with Betadine daily.

Review of the "Wound Care Treatment Flow Sheet" revealed no documentation to indicate the wound care to the left and right ischiums and the coccyx was performed on 05/27/17 and 05/28/17. Further review revealed no documentation to indicate wound care to the right heel was performed on 06/03/17 and 06/04/17.

In an interview on 06/07/17 at 4:35 p.m., S3WC confirmed the above wound care was not documented as done.

Patient #3
Review of Patient #3's physician orders revealed an order on 05/05/17 at 5:00 p.m. to cleanse the sacral wound with Normal Saline, apply Xeroform, and Mepiflex soft border daily. Further review revealed an order on 05/12/17 at 9:30 a.m. to apply Santyl and Xeroform to the sacral wound. Further review revealed an order on 05/26/17 at 9:25 a.m. to pack the sacral wound with Iodoform packing, cover with Santyl and Xeroform, and apply dry, clean dressing daily and as needed.

Review of Patient #3's "Wound care Treatment Flow Sheet" revealed no documentation to indicate the wound care was performed on 05/06/17, 05/07/17, 05/13/17, 05/19/17, 05/20/17, 05/21/17, 05/31/17, 06/01/17, 06/02/17, and 06/03/17.

In an interview on 06/07/17 at 3:55 p.m., S3WC confirmed there was no documented evidence that wound care was done on the above-listed days. She indicated the staff nurse assigned to the patient on the weekend is supposed to do wound care. She further indicated when she sees that wound care wasn't done on the weekend, she reports it to S2DON. After reviewing Patient #3's medical record, she indicated there was no documented evidence that the nurse performed site care to the PEG (percutaneous esophagogastrostomy tube) site on 06/02/17, 06/03/17, 06/04/17, 06/05/17 and 06/06/17. S3WC further indicated PEG site care isn't a wound care issue. It should be a routine nursing task done daily.

Patient #4
Review of Patient #4's physician orders revealed an order at admit to apply Santyl to the right heel wound, apply cast padding, and secure with stockinette or tape. Further review revealed an order on 05/26/17 at 4:00 p.m. for Aquacell Ag and Xeroform to the sacral wound with no documented evidence of the frequency at which the treatment was to be provided. Further review revealed an order on 05/27/17 at 4:00 p.m. for Santyl and Xeroform to buttocks, Xeroform to sacrum, Santyl and Xeroform to left heel, and wrap with 2 layers of cast padding and secure with flexinet.

Review of Patient #4's "Wound Care Treatment Flow Sheet" for the sacrum revealed orders were dated 05/25/17 to clean with Normal Saline, apply Xeroform, and cover with dry, clean dressing daily and as needed (no order was received on 05/25/17). Further review revealed on 05/26/17 the order was to clean with wound cleanser, apply Aquacell Ag, Xeroform, and cover with a dry, clean dressing daily and as needed (order didn't include what was to be used to clean the wound and the frequency of treatment). There was no documented evidence that the "Wound Care Treatment Flow Sheet" was updated with the order received on 05/27/17. There was no documented evidence wound care was performed on 06/03/17 and 06/04/17.

Review of Patient #4's "Wound Care Treatment Flow Sheet" for the right buttock revealed orders were written on 05/25/17 (order not received until 05/27/17). There was no documented evidence that wound care was provided to the right buttocks on 05/27/17, 06/03/17 and 06/04/17.

Review of Patient #4's "Wound Care Treatment Flow Sheet" for the left heel revealed no documented evidence the wound care was provided on 05/26/17, 05/27/17 and 06/04/17.

In an interview on 06/07/17 at 4:40 p.m., S3WC confirmed wound care was not documented as listed above.

Patient #5
Review of Patient #5's physician orders revealed an order at admit to apply Aquacel Ag rope dressing times 2 packed gently to scrotal wound as the primary dressing, covered with gauze and an ABD pad as the secondary dressing. Change daily and as needed (secondary dressing). Change primary dressing every other day after cleaning wound with Normal Saline. Paint right heel with Betadine daily. An order was received on 06/02/17 at 4:00 p.m. to clean the scrotum with wound cleanser, apply Santyl and Iodoform packing, and cover with Mepilex soft border daily. An order was received on 06/05/17 at 5:00 p.m. to clean the left and right ischium with wound cleanser and apply Santyl and Xeroform. There was no documented evidence that the order contained the frequency at which the treatment was to be provided.

Review of Patient #5's "Wound Care Treatment Flow Sheet" revealed a flow sheet for a right buttock wound dated 06/02/17 that included to keep clean and dry and apply barrier cream daily and as needed. There was no documentation to indicate the wound care was done on 06/03/17 and 06/04/17.

Review of Patient #5's "Wound Care Treatment Flow Sheet" for the scrotum revealed it was dated 06/02/17 and had no documented evidence that the care was provided on 06/03/17 and 06/04/17.

Review of Patient #5's "Wound Care Treatment Flow Sheet" for the right and left ischium revealed the order was dated 06/02/17, but the physician's order isn't documented until 06/05/17. Wound care was performed on 06/02/17 with no documented physician order present.

In an interview on 06/07/17 at 4:50 p.m., S3WC confirmed wound care was not documented as done to the scrotum on 06/03/17 and 06/04/17. She confirmed the above findings related to the right and left ischium.

5) The RN failing to ensure patients' CBGs were assessed as ordered by the physician:

Patient #1
Review of Patient #1's physician order dated 05/17/17 at 6:00 p.m. revealed an order to check CBG before meals and at bedtime. Further review revealed no sliding scale insulin was ordered for CBG below 200 mg/dl (milligrams per deciliter).

Review of Patient #1's "Diabetic Flow Chart" and the MAR (medication administration record) revealed no documented evidence that the CBG was assessed by the nurse on 05/31/17 at 4:00 p.m. Further review revealed she was administered Apidra 1 unit (not ordered) on 05/23/17 at 9:00 p.m. for a CBG of 168 mg/dl.

Patient #3
Review of Patient #3's physician order revealed an order on 05/04/17 at 5:00 p.m. to check her CBG every 6 hours (9:00 a.m., 3:00 p.m., 9:00 p.m., 3:00 a.m.) and to administer Apidra 2 units for a CBG of 151 to 200 mg/dl.

Review of Patient #3's "Diabetic Flow Chart" and MARs revealed her CBG was above 151 mg/dl or above but below 201 mg/dl on 05/09/17 at 9:00 p.m., 05/18/17 at 3:00 a.m. and 9:00 p.m., 05/19/17 at 3:00 a.m. and 9:00 p.m., 05/20/17 at 3:00 a.m. and 9:00 a.m., and 05/30/17 at 9:00 a.m. with no documented evidence that Apidra 2 units was administered as ordered.

In an interview on 06/07/17 at 5:30 p.m., S2DON indicated she didn't include a check of accuracy with assessing CBGs in the chart audits that did.

Based on record reviews and interview, the hospital failed to ensure the nursing staff developed a nursing care plan for each patient as evidenced by having the plan not specific to the patient's condition and that included appropriate nursing interventions to meet identified patient needs and an expected achievement date for 2 (#1, #2) of 3 patient records reviewed for care plans from a total sample of 5 patients.
Findings:

Review of the policy titled "The Nursing Process - Care Planning", presented as a current policy by S2DON, revealed the nursing care plan communicates pertinent patient problems/needs, delineates appropriate medical and nursing interventions to meet these needs, and documents the effectiveness of those interventions in the medical record. Expected outcomes are specific and provide goals for addressing patient problem/needs.

Patient #1
Review of Patient #1's "Nursing Care Plan" initiated on 05/17/17 revealed problems identified of impaired skin integrity and sleep pattern disturbance with no documented evidence of goals and interventions related to each. In addition, there was no documented evidence of the expected achievement date of goals to determine if the plan needed revision.

Patient #2
Review of Patient #2's "Nursing Care Plan" initiated on 05/26/17 revealed no documented evidence of the expected achievement date of goals to determine if the plan needed revision.

In an interview on 06/07/17 at 5:30 p.m., S2DON confirmed the nursing care plans did not have expected achievement or target dates and designated the person responsible for the interventions.

Based on record reviews and interview, the hospital failed to ensure a RN assigned the nursing care of each patient to nursing personnel in accordance with the specialized qualifications and competence of the nursing staff as evidenced by failing to have documented evidence of a competency evaluation in accordance with hospital policy for 2 (S3WC, S9LPN) of 5 (S2DON, S3WC, S6LPN, S9LPN, S11LPN) nurses' personnel files and 1 (S7LPN) of 1 contract nurse's personnel file reviewed for competency.
Findings:

Review of the policy titled "Orientation And Staff Competency", presented as a current policy by S2DON, revealed that an evaluation of each staff member's competence will include an objective assessment of the individual's performance in delivering patient care services. Competence is assessed through daily observations, performance evaluations, discipline specific in-services, direct observation, age-specific testing, and unit orientation.

Review of the policy titled "Agency Personnel Requirements", presented as a current policy by S2DON, revealed clinical competencies of agency staff will include a Core Competency Checklist completed at the completion of the shift by the preceptor validating clinical competency of the contract employee. The checklist will be reviewed and signed by the DON or supervisor and placed in the contract employee's personnel file.

Review of S3WC's personnel file revealed she was the wound care nurse. Further review revealed no documented evidence of an evaluation of competency in staging wounds.

Review of S9LPN's personnel file revealed her competency evaluation was conducted on 06/20/16, and all skills were evaluated verbally with no documented evidence of observations as required by hospital policy.

Review of S7LPN's personnel file revealed she was a contracted agency LPN. Further review revealed no documented evidence of a Core Competency Checklist completed at the completion of the shift by a preceptor employed by the hospital.

Based on observations, record reviews, and interviews, the hospital failed to ensure its infection control officer implemented the infection control plan as evidenced by:
1) Failing to maintain a sanitary environment by having bags of biohazard waste carts and soiled linen carts overflowing with bags of biohazard waste and soiled linen stacked on the floor in the respective rooms.
2) Failing to mitigate risks associated with patient infections as evidenced by observation of breaches in infection control related to personal protective attire, cleaning of the glucometer machine, and performance of wound care.
Findings:

1) Failing to maintain a sanitary environment:
Observation on 06/06/17 at 9:30 a.m., with S2DON in attendance, revealed the Biohazard Room had 2 carts overflowing with sealed red bags of biohazard waste. Further observation revealed there were 6 sealed red bags of biohazard waste stacked on the floor next to the carts. Observation in the Soiled Utility Room revealed the soiled linen cart was overflowing with bags of soiled linen. There were 8 sealed bags of soiled linen stacked on the floor next to the cart.

In an interview on 06/06/17 at 9:30 a.m., S2DON indicated the bags were from the night shift, and staff had not come yet to empty the carts. She further indicated "staff should probably call" to have the carts emptied. S2DON indicated "bags are never supposed to touch the floor."

2) Failing to mitigate risks associated with patient infections:
Observation on 06/06/17 at 4:05 p.m. revealed S4LPN in Patient #3's room (who was on contact precautions) with her protective gown not tied to protect the back of her personal clothing. Further observation revealed she removed her gown and gloves, exited the room, and touched items on the cart located outside the patient's room in the hall before she used hand sanitizer.

Observation on 06/0717 at 9:15 a.m. revealed S3WC performing wound care while S5CNA assisted holding Patient #3 on her side. S3WC took a culture of the wound and indicated she had new orders for wound care. She applied Santyl to the wound, applied a Saline-moistened Hydrofera blue dressing, Xeroform,and a dry 4x4 with Metiplex borders. She removed her gloves, performed hand hygiene, regloved, and applied wound barrier. With contaminated gloves from the wound barrier, S3WC took the container of wipes off the bed and placed it on the linen saver on the overbed table. With the same contaminated gloves, she assisted in turning the patient. With the same contaminated gloves, she used the bed control to lift the patient's bed. S3WC and S5CNA then removed their gown and gloves. S3WC picked up the contaminated container of wipes and placed it on the bedside table. S3WC and S5CNA then performed hand hygiene.

Observation on 06/07/17 at 11:10 a.m. revealed S8LPN performing an Accucheck on Patient R1. After leaving the room S8LPN placed the contaminated container of strips and the glucometer machine on the nursing station desk. She gloved and used a Sani-Cloth to clean the glucometer and wiped the desk where the glucometer had been placed. She removed her gloves and washed her hands. Continuous observation revealed S8LPN did not clean the contaminated container of strips before placing it in the storage container or the desk where it had been placed.

In an interview on 06/07/17 at 11:15 a.m., S8LPN confirmed she didn't clean the container of strips or the desk where she had placed the container. After waiting several minutes after the interview, observation revealed S8LPN did not clean the contaminated container of strips or wipe the desk after having been informed of the breach in infection control.

Observation on 06/07/17 at 3:25 p.m. revealed an unidentified staff member at Patient #3's bedside performing care with her protective gown not tied which left the back of her clothing exposed.

Review of the policy titled "Isolation Precautions", presented as a current policy by S2DON, revealed washing hands as promptly and thoroughly as possible after contact with blood, body fluids, secretions, excretions, and equipment contaminated by them is an important component of infection control and isolation precautions. When gowns are worn as protective apparel, they are removed before leaving the patient's environment and hands are washed. There was no documented evidence that policy addressed that gowns were to be tied when worn to protect and reduce opportunities for transmission of microorganisms.

In an interview on 06/07/17 at 5:30 p.m., S2DON was informed of the observed breaches in infection control listed above. She confirmed the observations were actual breaches in infection control.