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Based on review of documentation and interview it was determined that the facility failed to ensure that patient requests/needs were addressed.

Findings were:
Patient #1 did not have a bath for two consecutive days. No documentation was found by or provided to the surveyor for review to indicate that patient #1 had a bath on 12/01/2014 or 12/02/2014. A review of facility document entitled: "Other Tech Charting Documentation" for 12/02/2014 did not reveal any evidence of the patient having bathed for this date. In an interview with the Chief Nursing Officer on 9/01/2014 it was confirmed that there was no documentation on the 12/02/2014 "Other Tech Charting Documentation" form indicating that patient #1 had bathed on 12/02/2014. It was also confirmed in the same interview that there was no "Other Tech Charting Documentation" form available for review for the date of 12/01/2014.

A review of page 38 of the facility "Clinical Documentation Report"revealed that on 12/03/14 at approximately 17:00 hours, staff member # 1 documented: "pt c/o his linen has not been changed and he had no bath or shower since his admission beside today. (name of staff here), charge RN notified. She said she will not go see the pt because she knows he had a bath last Sunday." Review of additional facility document entitled: "Patient Care Notes" revealed entry dated: 12/03/2014 at 1700 hours which stated: "pt c/o his linen has not been changed and he had no bath or shower since his admission besides today. (name of staff here) said she will not go see the pt because she knows he had a bath last Sunday."

In an interview with the Chief Nursing Officer on 9/01/2014 she informed the surveyor that she had visited with patient #1 on 12/05/2015 after being notified that there had been no hot water in patient #1's hospital room.

Based on review of documentation and interview it was determined that the facility failed to ensure that a RN (Registered Nurse) evaluated the nursing care provided by an LVN (Licensed Vocational Nurse) for patient number #1.

Findings were:
There was no documentation found by or provided to the surveyor to indicate that a Registered Nurse had evaluated the care provided to patient #1 by LVN staff members.
Review of Clinical Documentation Report revealed on page 8 of 51 there was documentation that on 12/04/2015 at approximately 06: 44; staff member # 2, an LVN had " Esigned " a General Nursing Assessment on Mr. Huff. There was no documentation found indicating that an RN had evaluated the assessment.
Review of Clinical Documentation Report revealed on page 15 of 51 there was documentation that on 12/02/2014 at approximately 21:13 hours; staff member # 3, an LVN had " Esigned " a General Nursing Assessment on Mr. Huff. There was no documentation found indicating that an RN had evaluated the assessment.
Review of facility policy entitled: " Assignments, Written (R) " revision date: 1/12, stated under the Procedure section that: " 1. Nursing care of each patient is planned for, directed and evaluated each shift by the R. N. charge nurse/team leader. 1.1 RN initiates and oversees the Patient Plan of Care. 1.2 RN oversees Assessment/Reassessment and Patient Care Delivery. " In an interview with the Chief Nursing Officer on 9/01/2014 it was confirmed that there was no documentation in the facility "Clinical Documentation Report" to indicate that an RN had evaluated the care provided to patient #1 by staff members #2 and #3 who are LVNs.

Based on review of documentation and interview it was determined that the facility failed to ensure that nursing care plans were reviewed per hospital policies.

Findings were:
Nursing care plans for patient #1 were not evaluated every shift per hospital policies. Review of facility policy entitled: "Standards of Nursing Care for the Medical-Surgical Patient" revision date: 7/14, page 5 of 12 stated: "F. Care Plans are ongoing with shift-to-shift update(s)." "H. Care Plans are continuously evaluated every shift, reprioritized as necessary, and oversee by the RN." Review of facility policy entitled: "Documentation (L)" revision date: 8/14, page 5 of 7 stated: "8. The care plan will be reviewed by a nurse at least every 24 hours and documented accordingly." On the same page under item "#10 Collaborative Plan of Care / Patient Outcome:" the following statement was found: "Patient's individual plan(s) of care will be identified and prioritized by an RN during the admission process. Based on the patient's need, the plan will be individualized, prioritized and evaluated a minimum of once per shift. Subsequent revisions to the plan of care should be timed and documented. Reprioritization of the plan of care shall occur a minimum of once in a 24-hour period. Upon reassessment the, RN responsible for the care of the patient will evaluate all active plans of care selected for the patient."

A review of the facility "Clinical Documentation Report" for patient #1 revealed comment on page 35 which stated: "Care plan review (Care plan review -go to the care plan screen & select review) (Active)." On page 37 documentation was found indicating that care plans had been reviewed on 11/30/2014 at 22:22, 5:54, and 4:49. No other documentation was found by or provided to the surveyor to indicate that the nursing care plans had been evaluated per hospital policy. In an interview with the Chief Nursing Officer on 9/01/2015 and in telephonic interview on 9/03/2015 it was confirmed that the review of the care plans for patient #1 had not been documented per facility policy.