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Based on observation, interview and record review the facility failed to follow their policy and procedure for infection control based on the facility staff failed to remove unused supplies and medications found in patient care rooms that had been identified as being clean and sanitized and available for the next patient in 7 of 12 rooms observed. (Room # ICU-101, ICU-107, 228, 233, 234, 325)

Findings:

Current Policy and Procedure Reviewed:

Review on 10/28/2019 at 2:00 p.m. along wiwth Chief Clinical Office, Employee ID #51 of the current policy and procedure titler, "CORE: Terminal Cleaning of a Patient Room", H-IC-02-011; Orginal Date: 06/2011, Release Date: 06/2019 reads: Purpose: This procedure established uidelines for terminal cleaning. patient rooms are thoroughly cleaned and disinfected following termination of occupancy by transfer or discharge. Policy: The policy of Kindred Hospitalis to ensure terminal cleaning is completed before another patient is admitted or transferred to a room. Procedure: 3. Remove any patient's personal items from nightstands drawers bedside table drawer and closet and turn into Charge nurse. 7. a. Thoroughly clean the inside and outside of each drawer with disinfectant solution. b. Wipe the inside of cabinet. 10. General patient Room Areas/Appliances f. Using disiinfeted wipe clean walls,, windows, window ledges, inside/outside of closets, bedside table...

Observation:

Room ICU 101:

Observation on 10/28/2019at 9:45 a.m. along with Chief Clinical Officer, Employee ID #51 of ICU room #101 medication box was observed to contain:
1- unopened vial hydralazine Hydrochloride 20 mg/ml
3 - packaged 3 ml BD syringes
6- BD Blunt needles18 ga 1 1/2 inch.
Sign posted outside of door read "The Room is Clean and Sanatized for our next Patient"

Room ICU 107:

Observation on 10/28/2019at 9:45 a.m. along with Chief Clinical Officer, Employee ID #51 of ICU room #107 medication box was observed to contain:
3 - packaged 10 ml .9 NaCl (Saline) flushes
5 - packets of Prevantics

Room 234:

Observation on 10/28/2019 at 10:30 a.m. along with Chief Clinical Officer, Employee ID #51 of room #234 medication box was observed to contain:
3 - packages of Orange Daily Fiber
8 tablets - Individual Packaged Creon DR Capsules
Lactulose Solution 20grams/30 ml
5 tablets - Cyclobenzaprim 5 mg
1 - Movantik 25 mg
2 vials - Pantoprazole 40 mg per vial
2 -noxaparin Sodium 40mg/0.4ml
3 - IV pumpsets
1 - Blood collection tubing set
Sign posted outside of door read "The Room is Clean and Sanatized for our next Patient"

Room 233:

Observation on 10/28/2019 at 10:40 a.m. along with Chief Clinical Officer, Employee ID #51 of room #233 medication box was observed to contain:
2- BD Safety Glide 1 ml syringes
2 - 1 1/2 inch blunt needles
1 - Blood collection tubing set
3 - IV connections
Sign posted outside of door read "The Room is Clean and Sanatized for our next Patient"

Room 228:

Observation on 10/28/2019 at 10:50 a.m. along with Chief Clinical Officer, Employee ID #51 of room #228 medication box was observed to contain:
5 - packaged BD Safety Glide Insulin 1 ml 29 ga syringes
1 - packaged BD Safety Glide 27 ga 1/2 inch 1 ml syringes
10 - packaged BD-Blund Needles 18 ga, 1/12 inch
Sign posted outside of door read "The Room is Clean and Sanatized for our next Patient"

Room 325:
Observation on 10/28/2019 at 10:55 a.m. along with Chief Clinical Officer, Employee ID #51 of room 325 medication box was observed to contain:
1- packaged 10 ml .9NaCL (Saline) flush syringe
1- packaged 3ml BD syringe
Sign posted outside of door read "The Room is Clean and Sanatized for our next Patient"

Interview with the Chief Clinical Officer, Employe ID #51 at 11:00 a.m. confired that the rooms had been not been clean and sanatized properly for the next patient. Employee ID #51 stated that the medication drawers should of been opened and cleaned and no medication or supples should have been left in the room.

Interview on 10/28/2019 at 10:30 a.m. with Medical Surgical Charge Nurse, Employee ID #54 stated the medication boxes should of been opened by the nurse and supplies disposed of and medication should of been sent back to pharmacy for them to dispose of.

Based on interview and record review the facility failed to follow their policy and procedure in that the required patients assessments by a registered nurse was not completed every 24 hours as required. This failure of documentation of information affects proper care and treatment of the patient's condition in 3 of 9 records reviewed (Patient ID #s 2, 3, & 5). Current census 54 patients.

Findings included:

Policy and Procedure Reviewed:

Reviewed on 10/29/2019 at 3:00 p.m. along with Chief Nursing Officer policy Title: CORE: "Interdisciplinary Assessment and Re-Assessment" H-PC 02-OO1; Original Date: 08/2013; Release Date 10/2019. Procedure: Licensed, qualified staff assess each patient's care needs throughout the patient's hospital stay and provide patient specific care at the time based on assessment data. The assessment framework is structured around two components: Initial screening and assessment/reassessment of each patient as appropriate to the clinical discipline and individual patient condition charges ... ...3. f. Patients are re-evaluated by a licensed nurse (RN, LPN/LVN- according to state specific practice acts) at a minimum every 12-hour shift-based on level of care and patient care needs. (i) An RN directs the nursing care of every patient through delegation and supervision to the other nurses and non-nurse's personnel. The extent of that delegation is defined by individual state nurse practice acts. (ii) An RN reassessment of the patient shall occur, at a minimum of once every other 12-hour shift.

Records Reviewed:

Patient ID #2

Review on 10/29/2019 at 3:00 p.m. along with Chief Clinical Officer, Employee ID #51 of current patient's ID #2's medical records document no registered nurse (RN) assessment of the patient on 10/26/2019 and 10/27/2019. Records document assessment on 10/26/2019 and 10/27/2019 were completed by a licensed vocational nurse for both 12-hour shift for those days.

Patient ID #3

Review on 10/29/2019 at 3:00 p.m. along with Chief Clinical Officer, Employee ID #51 of current patient's ID #3's medical records document no registered nurse (RN) assessment of the patient on 10/23/2019 and 10/24/2019. Records document assessment on 10/23/2019 and 10/24/2019 were completed by a licensed vocational nurse for both 12 hour shift for those days.


Patient ID #5

Review on 10/29/2019 along with Chief Clinical Officer, Employee ID #51 of current patient's ID #5's medical records document no registered nurse (RN) assessment of the patient on 10/23/2019, 10/24/2019 and 10/25/2019. Records document assessment on 10/23/2019, 10/24/2019 and 10/25/2019 were completed by a licensed vocational nurse for both 12-hour shift for those days.

Interview on 10/29/2019 at 3:30 p.m. with Chief Clinical Officer, Employee ID #51 confirmed there should have been a registered nurse assessment done on each patient every 24 hours.