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Based on medical records reviews, policies reviews and staff interviews, it was determined the facility failed to ensure that the nursing staff provided adequate supervision and evaluation of the nursing care afforded each patient. This was found in 2 of 11 medical records reviewed. This was found in patients #1 and #5. In addition, the nursing staff failed to ensure that all emergency equipment was available and functional.

Findings include:

1(a). Monitoring and observations of the patient were inadequate and the nursing staff did not provide a safe environment to ensure that patients did not fall in the facility.

A review of medical record #1 on December 9, 2014 revealed the patient was admitted to the hospital on June 19, 2014 from an acute care hospital for rehabilitation. The patient had multiple medical co-morbidities including Chronic Obstructive Pulmonary Disease, Coronary Artery Bypass Graft and End Stage Renal Disease which was being treated with hemodialysis. The patient was receiving oxygen for his breathing difficulties.

According to the medical record the patient was alert, but forgetful and required assistance with activities of daily living. The patient was noted to be at moderate risk for falls with a score of 25 (moderate range 25-50). The patient was found sitting at the floor at his bedside because the nursing staff failed to adequately monitor and supervise the care of this patient.

In addition, there was no evidence of documentation in the medical record that the patient's fall risk was reevaluated after the fall.

This finding was discussed with Staff #3, the Assistant Director of Nursing (ADN), during an interview conducted on December 9, 2014 at 2:00 PM, who stated fall risks interventions are specific for each patient. Staff #3 also stated the fall risk assessment is done on admission and may be done after the patients fall.

(b). A review of medical record #5 on December 10, 2014 revealed this seventy-seven year old patient was admitted to the hospital on December 12, 2013 with Advanced Dementia, Hemorrhagic Cerebrovascular Accident, Chronic Renal Failure and Congestive Heart. The psychiatrist evaluated the patient on December 18, 2013 and noted that the patient had significant memory impairment. The patient was found sitting on the floor next to her bed on January 5, 2014 at 7:45 PM. The patient was also found on the floor the next day in the day room on January 6, 2014 at 6:30 PM, less than 24 hours later. After the second fall the patient complained of neck and hip pain. There was no documented evidence that the fall risk assessment was completed on admission or after each fall.

This finding was discussed with Staff #3 on December 9, 2014 at 12:08 PM. Staff #3 stated the facility's fall risk policy is to prevent the incidents of fall. However, the facility does not have a written policy to prevent falls.

2(a) The nursing staff did not ensure that all emergency supplies were available and in good working condition. The hospital has 1 unit which is located on the 4th floor of the building and there is 1 code cart for emergencies on this unit. During a tour of the unit on December 8, 2014 at 11:45 AM, it was observed that all 4 bottles of Verapamil intravenous solutions had expired on December 1, 2014 and 1 box of 8.4% Sodium Bicarbonate solution expired on November 1, 2014. These drugs were stored on the code cart. Both of these drugs are required for treatment and stabilization of patients who have sustained a cardiac arrest or respiratory distress or arrest.

(b) During observation of the code cart on December 8, 2014 at 12:14 PM it was noted that there was only 1 Magill laryngoscope and it was not functional (the light was not working) and there was no size 6.0 or 6.5 endotracheal tubes on the code cart. These items are crucial supplies for resuscitative measures because they are vital and essential for intubation of patients to protect the patients airway when they are in distress.

Staff #3 witnessed and confirmed these findings when they were observed at the time stated above. Staff #3 also stated in an interview which was conducted on December 8, 2014 at approximately 11:40 AM, that the nursing staff is responsible for checking the code cart on each shift and also after the cart is used to resuscitate a patient. She also stated the pharmacist checks the contents and expiration of each medication every month. However, the pharmacist did not check the medications in November and the nursing staff did not identify these findings when they conducted their checks of the code cart.