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Based on observation, staff interview, and policy review, the facility failed to ensure that it provides a sanitary environment to avoid sources and transmissions of infections and communicable diseases.


Findings include:


Cross Refer to A-0749 for the facility's failure to ensure that infections and communicable diseases of patients and personnel were controlled.

Based on review of medical record and staff interview, the facility failed to provide nursing care to Patient #1 as needed.


Findings include:


Record review for Patient #1 revealed an order dated 01/17/13 at 1632 (4:32 p.m.) for the patient to receive wound care daily for a sacral wound and a left upper extremity (LUE) wound. Review of the wound care flow sheet note dated 01/21/13 at 4:30 p.m. revealed. "Unable to assess sacrum at this time due to severe diarrhea. Wound care to LUE comp per MD orders."

During an interview on 01/22/13 at 3:20 p.m. the Wound Care nurse was asked what the procedure was for documenting wound care. She stated, "I write a narrative after I do the wound care. Yesterday I was not able to perform wound care on both sites because the patient had real bad diarrhea. I did the wound care on the arm, but it was past my time to be off." No further documentation was presented for wound care.

Based on observation, staff interview and policy and procedure review, the facility failed to ensure that drugs and biologicals are prepared and administered in accordance with Federal and State laws and the orders of the practitioner or practitioners responsible for the patient's care.


Findings include:


During a tour of the facility on 01/22/13 at 2:10 p.m. observations in the medication room revealed a pill cutter with white residue. The Director of Nursing was present and stated, "They are supposed to wash that after each use."

Review of the facility's "Equipment cleaning" policy revealed, "POLICY: Cleaning of medical equipment after patient usage or in between patient usage will be done by LTAC of Greenwood employees."

Based on medical record review, policy and procedure review and staff interview, the facility failed to ensure properly executed consents for one (1) of 36 patient's records reviewed, Patient #2.


Findings include:


Record review for Patient #2 revealed that the "Consent For Tranfusion of Blood and Blood Components" had no documented time for the witness signature and "Consent To Withhold/Withdraw Life Sustaining Procedures" had no documented date or time for the witness's signature.


During an interview on 01/23/12 at 1:35 p.m. the Administrator stated, "All consents and entries in the record are to be dated and timed."


Review of facility's "Nursing Documentation Guidelines" policy revealed: "Procedure: ...8. Each entry must be dated and timed ....13. Documentation must be complete with no blank areas and include all required forms ... ".

Based on medical record review, medical staff rules and regulations review and staff interview, the facility failed to ensure four (4) of 16 medical records reviewed, Patients #1, #2, #3 and #6, contained a documented final diagnosis in the discharge summary.


Findings include:


Record review for Patients #1, #2, #3 and #6 revealed no documented evidence of a final diagnosis on the patient's "LTAC Unit Clinical Resume/LTAC Unit Discharge Summary."


On 01/23/13 at 2:15 p.m. an interview with the Administrator revealed, "The discharge diagnosis is supposed to be on the discharge summary."


Review of the facility's "...Medical Staff Rules and Regulations" revealed, "Medical Records...DIscharge Summary...5.4.3 THe discharge summary should contain the following...DIscharge DIagnosis."

Based on observation, staff interview, and policy review, the facility failed to ensure that infections and communicable diseases of patients and personnel was controlled.


Findings include:


On 01/22/13 at 2:00 p.m. observation in the facility hallway revealed medical personnel exit a room in which a code blue had been called. On the door was a sign for droplet precaution and an isolation box which held gowns, masks, and gloves. Eight (8) medical personnel were observed exiting the room without a mask and without washing their hands. The Director of Nursing was present and stated that she did not know why they did not wear their masks. "They know better than that. They (medical personnel) have been in serviced."


On 01/23/13 at 11:00 a.m. observation of Patient #1's wound care provided by the wound care nurse revealed that after she removed the dressing to the patient's left arm she cleaned the wounds. Observation of the wounds revealed one (1) on the patient's elbow, one (1) on the inner arm, and one (1) at the patient's wrist. The nurse cleaned all three (3) wounds using the same piece of gauze, and without changing gloves.

Review of the facility's "Infection Control" policy revealed, "(i) proper isolation instructions posted outside patient's room are followed. (ii) ...hospital personnel instructed on proper isolation technique."