HospitalInspections.org

Based on observations during facility tour with hospital staff by the Fire Safety Compliance Officer and staff interviews, it was determined that the facility was not constructed, arranged and maintained to ensure patient safety.

Findings include:

Refer to Life Safety Code violations.

Based on observations and interviews the facility failed to ensure the patient care areas were clean. This had the potential to affect all patients admitted to the facility.

The findings include:

During a tour of the patient rooms on 5/20/14 at 1:27 PM the over bed tables in rooms 149, 150, 159 and 160 had several drip areas and dust accumulation on the base and arm that held the table.

In room 151 there was a coffee cup size Styrofoam cup taped over the commode. The cup contained what looked like unused coffee granules. The bathtub in the room had a big blue stain.

Room 149 was vacant and in the closet was an opened package of 15 large underpads with one of the underpads missing. The chair in the room had several places that the foam under the plastic covering was exposed.

During an interview on 5/22/14 at 8:15 AM Employee Identifier EI # 10, Risk Manager; and EI # 11, Director of Nursing both verified the above findings.

Based on observation, review of policy and procedures, and interview with administrative staff, it was determined the facility failed to follow the policy for Hand washing/hand hygiene. This had the potential to negatively affect every patient in the facility.

Findings include:

Title: Hand Washing / Hand Hygiene
Reviewed or Revised: 08/2008
Policy:
All staff is to utilize appropriate handwashing and hand antiseptics at all times to help prevent Healthcare-Acquired Infections...Handwashing/Hand Antisepsis include the following:
1. When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with either a non-antimicrobial soap and water or an antimicrobial soap and water. Hands are also to be washed with soap and water prior to donning gloves and after removal of gloves.
2. If hands are not visibly soiled use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations described below...
A. Decontaminate hands before having direct contact with patients...
G. Decontaminate hands after contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient.

1. Upon entering a patient room on 5/21/14 at 9:30 AM, to observe Employee Identifier (EI) # 13, LPN, dispense medications, the LPN washed his/her hands and donned gloves. The patient then asked the LPN for a jacket. The LPN picked up the jacket and gave it to the patient, then reviewed the patient's identification (ID) bracelet and scanned the patient's bracelet for charting in the POCW (Point of Care Workstation) system. The LPN then changed gloves and proceeded to scan each medication, open the packets and place the medications into a medicine cup. He/she then removed a bottle from the POCW drawer, scanned it, removed the tablet from the bottle, placed the tablet in the medicine cup with the other medications, and returned the bottle to the drawer. The LPN failed to perform hand hygiene between glove changes.

An interview conducted on 5/22/14 at 12:15 with EI # 10, Risk Manager, and EI # 11, Director of Nursing, verified that hand hygiene is to be performed after removing gloves and before donning clean gloves.

2. The next medication pass was observed on 5/21/14 at 9:40 AM. The LPN washed hands and donned gloves, then assisted the patient to lie down in bed, lifting the patient's legs for him/her. After making the patient comfortable in bed, the LPN removed gloves, donned a clean pair of gloves, and proceeded to dispense the patient's medications without performing hand hygiene between glove changes.

An interview conducted on 5/22/14 at 12:15 with EI #10 and EI # 11, verified that hand hygiene is to be performed after removing gloves and before donning clean gloves.



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3. An observation of a medication pass was conducted on 5/20/14 at 12:30 PM with EI # 13. He/she did not perform hand hygiene after administering insulin injection to patient.

An interview was held on 5/22/14 at 9:15 AM with EI # 11 who verified hand hygiene should be performed after removing gloves.

Based on review of policy and procedures, observation of preparing patient medications, medication passes, medical record documentation, and interview with administrative staff, it was determined that the facility failed to:

1. Ensure that expired medications were not available for use.
2. Ensure that medications in the Point of Care Workstation (POCW) were inaccessible to others.
3. Ensure medication dosage requiring half of a tablet was disposed of in a proper manner and per policy.
4. Ensure patients requiring tube feeding received adequate nutrition.

This had the potential to affect all patients in the facility.

Findings Include:

Facility Policy and Procedure:
Title: Open Vial
Revised 05.21
A Multi-dose vial is a vial of liquid medication intended for parenteral administration (injection or infusion) that contains more than one dose of medication. Multi-dose vials are labeled as such by the manufacture and typically contain an antimicrobial preservative to help prevent the growth of bacteria. the preservative has no effect on viruses and does not protect against contamination when healthcare personnel fail to follow safe injections practices.
Policy:
1. Medication vials should always be discarded whenever sterility is compromised or questionable.
2. In addition, the United States Pharmacopoeia (USP) General Chapter 797 [16] recommends the following for multi-dose vials of sterile pharmaceuticals:
a. If a multi-dose vial has been opened or accessed (e.g. needle- punctured) the vial should be dated and discarded within 28 days unless the manufactured specifies a different (shorter or longer) date for that opened vial.
b. If a multi-dose vial has not been opened or accessed (e.g. needle- punctured), it should be discarded according to the manufacturer's expiration date.

Title: MED-05 Multi-dose Containers
Revised 1/2011
Policy:
The use of multi-dose medications and diluents in vials is discouraged.
Procedure: ... when multi-dose vials are used, they should be used on a single patient and labeled with the dare they were opened and the initials of the person who first accessed the container. They should be stored in a refrigerator unless otherwise stated on the vial. Opened vials are discarded after a maximum of 30 days or less if indicated on the vial.

Title: Medication Destruction
Revised 1/2007
Policy:
Controlled and non-controlled drugs shall be disposed of in conformance with professional legal guidelines. Controlled drugs shall be disposed of and a record kept of the disposal in such a way that a readily available record of the handling of controlled substances will be in existence.

Procedure:
1. Controlled drugs shall be listed on separate list - they shall not be listed with non-controlled drugs that are to be destroyed...
2. This destruction will be done by a qualified pharmaceutical returns management company.
3. The mode of destruction shall be described.
4. A copy of the destruction record will be kept in the pharmacy at all times.

Title: Unit Inspection
Revised: 1/11
Policy:
All drug storage units within this Hospital will be inspected at least monthly by pharmacy personnel. The purpose is to ensure proper storage of medications for expiration dates.

Pharmacy services will inspect all drug storage units in the hospital.

Inspections shall address at least the following:
1. All drug labels shall be legible and in compliance with state and federal requirements.
3. Drugs shall not be kept in stock after the expiration date on the label and no contaminated or deteriorated drugs shall be available for use.

Facility Policy and Procedure: Tube Feeding Administration
Revised date 2/2013
Policy: RN/LPNs may administer tube feeding as ordered by the physician.

Procedure:
6. Irrigate feeding tube with 25-50 milliliter (ml) of water:
A. After each bolus.
B. After each medication administration.
C. When a continuous tube feeding has been interrupted, irrigate tube prior to restarting tube feeding.

Documentation
1. Record intake and output every 8 hours.
3. Feeding amount given, method used, rate at which administered and amount of water given.

1. During observation of the Outpatient Physical Therapy area on 5/21/14 at 10:00 AM the surveyor asked if any drugs were kept in the Outpatient Department. Employee Identifier (EI) # 9, the Rehabilitation Services Director, stated only one was kept in the department. There were multiple open and closed vials of Dexamethasone 10 mg (milligrams) per ml, and one opened vial that did not have a date when opened or initials of staff who opened the vial. This vial was expired with a date of 6/2013. Five vials were open without date when opened and no initials of staff who opened the vial.

EI # 9 verified the above during an interview with on 5/21/14 at 11:00 AM.



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2. Observation of medication preparation by EI # 13, Licensed Practical Nurse (LPN), was conducted on 5/21/14 at 8:40 AM. During this observation, EI # 13 was noted to split two medications to provide the proper dosage for the patients. The first medication was ordered Lipitor 10 mg. The medication was stocked in the Pyxis Medication Management System (Pyxis) in 20 mg strength, requiring the tablet to be split. EI # 13 removed the tablet from the Pyxis, split the tablet and then discarded the unused half tablet in the garbage can. The next patient's medication was ordered Coreg 12.5 mg. The medication stocked in the Pyxis was 25 mg strength. EI # 13 removed the tablet from the Pyxis, split the tablet, and then discarded the unused half in the garbage can.

While on medication pass, one of the patients requested pain medication. After assessing the patient's pain and reviewing the orders, EI # 13 obtained a Dilaudid 2 mg tablet from the Pyxis (2 mg strength is stocked in the Pyxis.) The patient's order was for Dilaudid 1 mg. EI # 13 split the 2 mg Dilaudid tablet in half and the RN witnessed EI # 13 place the unused half of the tablet in the sharps container at the nurse's station.

During an interview conducted on 5/22/14 at 8:15 AM EI # 10, Risk Manager and EI # 11, Director of Nursing, both verified when a tablet is cut in half the unused portion is not to be disposed of in the regular garbage can.

3. On 5/21/14, at 9:25 AM, after observing the RN administer an intravenous (IV) medication, the surveyor exited the room and went into the hallway to locate EI # 13, to observe medication passes to other patients. Upon entering the hallway, the POCW was observed to be outside the room of a patient in isolation, unattended, and with the medication drawer open. This drawer contained medications for two other patients.

An interview conducted on 5/22/14 at 12:15 with EI # 10, Risk Manager, and EI # 11, Director of Nursing, verified that the drawer to the POCW should be closed and locked when unattended.



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4. Tour of the pharmacy department on 5/21/14 at 1:30 P.M. with EI # 14, Director of Pharmacy, revealed the pharmacy had failed to follow agency policy for removing expired medications from stock.

The following list of expired medications were found in the pharmacy.
1. One (1) 500 ml bag of Normal Saline (NS) IV fluid with the added medication of Morphine Sulfate 2 mg per 10 ml at the rate of 10 ml per hour. This medication was not labeled per policy with the date medication was prepared or initials of who prepared. The pharmacist revealed the patient this had been prepared for had expired more than a month ago.
2. Fifteen (15) tablets of Bumex 0.5 mg with an expiration date of 3/2013.
3. One hundred (100) tablets of Bumetamide 0.5 mg with an expiration date of 1/2014.
4. One (1) tablet of Bystolic 10 mg with an expiration date of 10/2013.
5. Seventy two (72) Oxycodone tablets 15 mg with an expiration date of 2/2014.

EI # 14 verified the above findings during an interview on 5/21/14 at 1:50 PM.

5. Observation of a medication pass on 5/20/14 at 1:35 PM with EI # 13 surveyor noted in patient's bedside table an open bottle of NS 250 ml with no documentation of the date opened or the initials of who opened the container. The patient's tube feeding was not connected to the patient for their continuous tube feeding administration of 50 ml/per hour. He/she stated it had not been connected since 10:15 AM. He/she had a difficult time flushing the feeding tube and had to use force to unstop the feeding tube.

Review of the medical record revealed this patient did not receive the physician ordered tube feeding of Jevity 1.5 50 ml per hour for a total of 1200 ml per day or the required water for flushing the tube after each medication since admission of 4/2/14.

A dietary consult was faxed to the Registered Dietitian (RD) on 4/2/14 with no response from the RD received to agency until surveyor questioned this finding on 5/21/14.

The patient's Intake and Output Record revealed documentation of Oxygen at 2-3 liters per nasal cannula was administered intermittently since admission. There was no physicians order found for this medication.

An interview was held on 5/22/14 at 9:15 AM with EI # 11 who verified the aforementioned findings.

Based on review of job description for Certified Nursing Assistant (CNA), review of employee files, and interview, it was determined that the hospital failed to ensure the employees had current cardiopulmonary resuscitation (CPR) in 1 of 1 Certified Nursing Assistant (CNA) employee files reviewed. This had the potential to affect all patients served by the facility.

Findings include:

Washington County Hospital & Nursing Home
Medical Surgical Nursing Assistant Job Description/Performance Evaluation Form

...Part B
Professional Requirements:
...Maintains current CPR certification...

1. Review of employee file for Employee Identifier (EI) # 12, CNA, it was discovered that employee's CPR had expired 05/31/2013.

An interview conducted on 5/22/14 at 11:55 AM with EI # 5, Human Resources, verified there was no current CPR card for this employee.

Based on observation, review of policy and procedures, and interview with administrative staff, it was determined the facility failed to follow the policy for:

1. Hand washing/hand hygiene.
2. Contact precautions.
3. Medication administration.

This had the potential to negatively affect every patient in the facility.

Findings include:

Title: Hand Washing / Hand Hygiene
Reviewed or Revised: 08/2008
Policy:
All staff is to utilize appropriate handwashing and hand antiseptics at all times to help prevent Healthcare-Acquired Infections...Handwashing/Hand Antisepsis include the following:
1. When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with either a non-antimicrobial soap and water or an antimicrobial soap and water. Hands are also to be washed with soap and water prior to donning gloves and after removal of gloves.
2. If hands are not visibly soiled use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations described below...
A. Decontaminate hands before having direct contact with patients...
G. Decontaminate hands after contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient.

Policy: Medication Administration
Date revised: 2/2011
Policy:
Orders: Medications may be ordered by a physician who is a member of the medical staff of Washington County Hospital. Each order for medication should include:
1. Name of drug.
2. Dosage.
3. Route of administration.
4. Frequency of administration.

Self Administration of medications by patients may be permitted on a specific written order by the physician.
1. When the physician orders medication for "self" administration, the medication should be identified by the physician or Pharmacy. The medication should be appropriately labeled and in a child-proof container.
2. After identification the medication may be left at the patient's bedside.
3. RN/LPN (Registered Nurse/Licensed Practical Nurse) should document "SA" (self administration) on the Medication Administration Record (MAR) to indicate patient's report of "self" administration of medication.

Policy: Contact Precautions
Date revised: 2/2008
C. Contact Precautions:
In addition to Standard Precautions, use of Contact Precautions for specified patients known or suspected to be infected or colonized with epidemiologically important microorganisms that can be transmitted by direct contact with the patient (hand or skin-to-skin contact that occurs with performing patient-care activities that require touching the patient's dry skin) or indirect contact (touching) with environmental surfaces or patient-care items in the patient's environment.

Gown
In addition to wearing a gown as outlined under Standard Precautions, wear a gown (a clean, nonsterile gown is adequate) when entering the room if you anticipate your clothing will have substantial contact with the patient, environmental surfaces or items in the patient's room, or if the patient is incontinent...

1. Upon entering a patient room on 5/21/14 at 9:30 AM, to observe Employee Identifier (EI) # 13, LPN, dispense medications, the LPN washed his/her hands and donned gloves. The patient then asked the LPN for a jacket. The LPN picked up the jacket and gave it to the patient, then reviewed the patient's identification (ID) bracelet and scanned the patient's bracelet for charting in the POCW (Point of Care Workstation) system. The LPN then changed gloves and proceeded to scan each medication, open the packets and place the medications into a medicine cup. He/she then removed a bottle from the POCW drawer, scanned it, removed the tablet from the bottle, placed the tablet in the medicine cup with the other medications, and returned the bottle to the drawer. The LPN failed to perform hand hygiene between glove changes.

An interview conducted on 5/22/14 at 12:15 with EI # 10, Risk Manager, and EI # 11, Director of Nursing, verified that hand hygiene is to be performed after removing gloves and before donning clean gloves.

2. The next medication pass was observed on 5/21/14 at 9:40 AM. The LPN washed hands and donned gloves, then assisted the patient to lie down in bed, lifting the patient's legs for him/her. After making the patient comfortable in bed, the LPN removed gloves, donned a clean pair of gloves, and proceeded to dispense the patient's medications without performing hand hygiene between glove changes.

An interview conducted on 5/22/14 at 12:15 with EI #10, Risk Manager, and EI # 11, Director of Nursing, verified that hand hygiene is to be performed after removing gloves and before donning clean gloves.

3. On 5/21/14 at 2:10 PM, the surveyor observed EI # 15, Registered Nurse (RN) administer an intravenous (IV) medication. The order was for Lasix 40 mg (milligrams) IV which was stocked in 20 mg vials. The RN performed hand hygiene and donned gloves, prepared the syringe and needle, then opened one vial of medication. The vial top was cleaned with an alcohol wipe. The alcohol wipe was then placed on the POCW while the nurse withdrew the medication into the syringe. The RN then removed the top from the second vial. The same alcohol wipe was then used to clean the top of the second vial and the placed back on the POCW while the RN withdrew the medication into the syringe. The needle was then removed from the syringe and the syringe taken to the patient's bedside where the same alcohol wipe was used to clean the cap of the patient's IV line. The alcohol wipe was laid on the patient's bed, the medication was administered and the line flushed. The RN then used the same alcohol wipe to clean the cap after the flush.

An interview conducted on 5/22/14 at 12:15 with EI #10, Risk Manager, and EI # 11, Director of Nursing, verified a clean alcohol wipe should be used for each step of the procedure.


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4. An observation of a medication pass was conducted on 5/20/14 at 12:30 PM with EI # 13. He/she did not perform hand hygiene after administering insulin injection to patient.

Upon entry into a room of patient on contact isolation precautions, a RN was observed providing care to the patient. The RN was not wearing an isolation gown.

A respiratory inhaler was noted in the patient's beside table and EI # 13 explained to the surveyor that the medication was to be self administered by patient as needed.

Review of the medical record revealed documentation that the staff administers this medication to the patient, and no documentation was found in the record that the patient self administers this medication as evidenced by the notation of "SA".

An interview was held on 5/22/14 at 9:15 AM with EI # 11 who verified the aforementioned findings.

Based on medical record reviews, interview, review of facility policies and procedures, and review of Position Descriptions the facility failed to:

1. Ensure an activity assessment was completed by the Activity Specialist.

2. Ensure documentation of the activities completed by the patients was documented in the medical record.

3. Document a psychosocial assessment, psychosocial concerns, and a social service plan with interventions was documented in the medical record. The facility failed to document sufficient and appropriate social services to meet the residents' needs.

This had the potential to affect all swing bed patients.

Findings include:

Refer to C 0385 and C 0386 for findings.

Based on medical record (MR) review, review of Position Description, review of the Activities / Social Service Policy and Procedure, and interview, the facility failed to ensure an activity assessment was completed by the Activity Specialist. The facility also failed to ensure documentation of the activities completed by the patients was documented in the medical record. This affected MR # 1, and # 3 ( 2 of 3 swing bed patients reviewed). This potentially could affect all Swing Bed patients admitted to this facility.

The findings include:

Activities / Social Service Policy and Procedure
Revised: 001/2011

Policy: It is the policy of Washington County Hospital Swing Bed Program that each Swing Bed admission will be provided an activities and social program appropriate to the needs and interest of each patient.

Procedure:
1. The Initial Activity Assessment will be completed within 3 days of admission and placed on the Medical Record ...
3. Nursing Service and the Swing bed Coordinator will document on the activities participation form any activities that patient precipitate (participate) in.
4. The Swing Bed patients that are unwilling or unable to attend any activities in the Nursing Home will have one on one activities.
5. Each Swing Bed patient will have the activities patient participation form on his chart.

Position Description: Activities Coordinator
Page 1 of 6
Job summary: Provides one on one, small, and/or large group activities depending on the needs and interest of the patients which include social activities, indoor and outdoor activities, religious programs, creative activities, educational activities and exercise activities...
Demonstrate Competency in the following Areas:
Assess patients on admission within 24 hours; except weekends and holidays then next business day... Chooses a specific activity plan for each patient... Maintains programs designed to make life more meaningful, to stimulate and support physical and mental capabilities to the fullest extent and to enable the patient to maintain the highest attainable social, physical and emotional functioning... Assists with activities. Makes room visits, holds conversations with patient and reassures them and gives moral support where necessary... Keeps current list of all swing bed patients.

1. MR # 1 was admitted on 5/2/14 with diagnoses to include Status Post Right Hip Fracture with Open Reduction and Internal Fixation (ORIF.)

Review of the MR revealed there was no documentation of the Activity Director assessing the individual Swing Bed patients for activities or the daily documentation of activities in the MR as directed in the facility policy and procedure.

During an interview conducted on 5/22/14 at 10:50 AM, with Employee Identifier (EI) # 10, Risk Manger and EI # 11, Director of Nursing, the above findings were verified.



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2. MR # 3 was admitted on 4/2/14 with diagnoses to include CVA (Cerebral Vascular Accident) with Right Sided Weakness.

Review of the MR revealed there was no documentation of the Activity Director assessing the individual Swing Bed patients for activities or the daily documentation of activities in the MR as directed in the facility policy and procedure.

During an interview with EI # 10, and EI # 11, on 5/22/14 at 10:50 AM, they verified the above findings.

Based on medical record (MR) review, review of the Policy and Procedures, review of Position Description, and interview the facility failed to ensure a psychosocial assessment was completed by the Social Worker for each Swing Bed patient. The facility also failed to ensure documentation of the patient psychosocial concerns and plan with interventions was documented in the medical record. The facility failed to document sufficient and appropriate social services to meet the residents' needs. This affected MR # 1 and # 3 ( 2 of 3 swing bed patients reviewed). This potentially could affect all Swing Bed patients admitted to this facility.

The findings include:

Activities / Social Service Policy and Procedure
Revised: 001/2011

"Policy: It is the policy of Washington County Hospital Swing Bed Program that each Swing Bed admission will be provided an activities and social program appropriate to the needs and interest of each patient.

Procedure: ...
6. The Swing Bed Coordinator or Supervisor of Nursing will complete the Social History on each Swing Bed patient."

Activities/ Social Services/ Discharge Planner
Revised 02/2013

"Policy: ... the Swing Bed Coordinator will serve as the coordinator for activity, discharge planning and social service functions.

Procedure: ... B. the Swing Bed Coordinator will address social issues which contribute meaningfully to the treatment of a patient's condition. Such services include, but not limited to: i. Assessment of the social and emotional factors related to the patient's illness, his or her need for care, response to treatment and adjustment to care in the facility; ... iii. Assessment of the relationship of the patient's medical and nursing requirements to his or her home situation, financial resources, and the community resources available to him or her in making the decision regarding their discharge."

Position Description: Assistant Med (medical)/ Surg (Surgery) Director of Nursing (DON)
"Page 1 of 6
Job summary: ... Assesses, plans, implements and evaluates the needs of patients for discharge planning and utilization review...
Page 2 of 6
Demonstrates Competency in the Following Areas:
Maintains current knowledge of resources available within the community, maintains supply of resources available within the community, and maintains supply of resource materials to be distributed to patients when needed. Is able to obtain other resources as needed...
Initiates ongoing communication with the patient and patient's family to assess discharge needs...
Communicates with family members and caretakers regarding the needs of the patient and anticipated plans.
Interacts professionally with patient/family and involves patient/family in the formation of the plan of care.
Documents discharge planning in an ongoing manner.
Coordinates admissions to swing bed program including obtaining social history and developing a plan of activities."

1. MR # 1 was admitted on 5/14/14 with diagnoses to include Status Post Right Hip Fracture with Open Reduction and Internal Fixation. There was no documentation in the medical record of a social services assessment or identification of psychosocial concerns.

There was no documentation in the medical records of items such as:
1. Making referral and obtaining services from outside entities,
2. Assisting residents with financial and legal matters,
3. Providing or arranging provision of needed counseling services,
4. Finding options that meet the physical and emotional needs of each resident,
5. Meeting the needs of the residents who are grieving, and
6. Assisting residents with dental / denture care, podiatry care, eye care, hearing services and obtaining equipment for mobility or assistive eating devices.

There was no system in place to ensure the psychosocial needs of the patient were identified and addressed.

During an interview conducted on 5/22/14 at 8:15 AM, EI # 10, Risk Manger, and EI # 11, Director of Nursing, were asked who does the social work for the swing bed unit and they stated EI # 14, Assistant DON. EI # 10 and # 11 were asked if EI # 14 had social work experience and they confirmed EI # 14 did not have a social work background.

During an interview conducted with EI # 10 and EI # 11 on 5/22/14 at 10:50 AM, the above findings were verified.




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2. MR # 3 was admitted on 4/2/14 with diagnoses to include CVA (Cerebraebral Vascular Accident) with Right Sided Weakness. There was no documentation of a social services assessment or identification of psychosocial concerns.

There was no documentation of the Activity Director assessing the individual Swing Bed patients for activities or the daily documentation of activities in the MR as directed in the facility policy and procedure.

There was no documentation in the medical records of items such as:
1. Making referral and obtaining services from outside entities,
2. Assisting residents with financial and legal matters,
3. Providing or arranging provision of needed counseling services,
4. Finding options that meet the physical and emotional needs of each resident,
5. Meeting the needs of the residents who are grieving, and
6. Assisting residents with dental / denture care, podiatry care, eye care, hearing services and obtaining equipment for mobility or assistive eating devices.

There was no system in place to ensure the psychosocial needs of the patient were identified and addressed.

During an interview conducted on 5/22/14 at 8:15 AM, EI # 10, Risk Manger, and EI # 11, Director of Nursing, were asked who does the social work for the swing bed unit and they stated EI # 14, Assistant DON. EI # 10 and # 11 were asked if EI # 14 had social work experience and they confirmed EI # 14 did not have a social work background.

During an interview with Employee Identifier # 10 and EI # 11, on 5/22/14 at 10:50 AM, they verified the above findings.