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Based on interview and record review Hospital Administration failed to fully review a complaint regarding the possibility of an impaired nursing staff member. (Nurse ID# 53)

Findings include:

Record review of a complaint document dated 8/31/10 from a family member of patient ID# 1 stated "The nurse who admitted patient ID# 1 seemed Impaired, slow speech, dry mouth."

Record review of the personnel file for admitting nurse ID# 53 for patient ID# 1 revealed she was hired in December 2009. The file stated she had a "Narcotic Restriction." The hospital had agreed to employee nurse ID# 53 under the Texas Peer Assistance Program for Nurses (TPAPN). The "Employer Guide" for the TPAPN program stated "Request a drug screen for reasonable cause if any signs of impairment or inappropriate behavior occur and immediately notify the TPAPN Case Manager."

The Director of Nursing acknowledged 9/27/10 at 1 p.m. that she investigated the family complaint regarding nurse ID# 53 possibly being impaired but she did not drug test the employee.

Based on observation, interview and record review the Food Service Supervisor (ID# 55) failed to ensure prepared food was labeled and dated and expired milk was discarded in the nourishment rooms on Hall A, B and C and in the Dietary department.

Findings include:

Observation 9/27/10 at 9:30 a.m. revealed the following:

Unit / Hall A nourishment room / Inside the refrigerator were the following prepared foods without dates:
-Four 1/2 pimento cheese sandwiches
-Four 1/2 peanut butter and jelly sandwiches
Also the refrigerator contained milk that was beyond the expiration dates:
-One cartoon of Fat Free Milk (1/2 pint) with an expiration date of 9/20/10
-Three cartoons of Fat Free Milk (1/2 pint) with an expiration date of 9/25/10
-Two cartoons of Regular Milk (1/2 pint) with an expiration date of 9/24/10

Unit / Hall B nourishment room / Inside the refrigerator were the following prepared foods without dates:
-Two 1/2 turkey sandwiches
-Five 1/2 pimento cheese sandwiches
-Two salads
-Three plates of food (pork chops, mixed vegetables, and potatoes)
-Three plates of food (sandwiches and fruit)
Also, the refrigerator contained food items that were labeled one week old:
-Two 1/2 ham and cheese sandwiches dated 9/23/10
-One 1/2 ham and cheese sandwich dated 9/22/10

Unit / Hall C nourishment room / Inside the refrigerator were containers of milk beyond the expiration date:
-Two cartoons of Fat Free milk (1/2 pint) with an expiration date of 9/25/10
-One cartoon of Regular milk (1/2 pint) with an expiration date of 9/24/10

Inside the walk-in cooler in the cafeteria the following prepared foods were not dated:
-Three turkeys had been previously sliced
-One ham had been previously sliced
-Three cold plates of sandwiches and fruit
-One Pot of stew
-One Tray of meat-loaf
-One container of sausage
-Large container of pimento cheese
-Large container of potatoes salad
-Multiple desserts (cake and puddings)
Also, the refrigerator contained milk that was beyond the expiration dates:
-One cartoon of milk (1/2 pint) with an expiration date of 9/19/10
-Three cartoons of milk (1/2 pint) with an expiration date of 9/24/10

The Director of Nursing acknowledged 9/27/10 at 10:00 a.m. that the Food Service Supervisor is responsible to date pre-prepared foods and to check the nourishment rooms for expired items.

Record review of a policy titled "Nourishment Refrigerator" dated 10/2009 stated "All refrigerated food items for patient use must be labeled or have the expiration date clearly marked on the container by the manufacturer. There shall be no opened containers stored in the nourishment refrigerator without being properly sealed, labeled, and dated. All opened food items will be discarded after 24 hours by the dietary aid or the supervisor."

Based on observation and interview the Hospital failed to maintain the air-conditioning cooling system. Thermostat covers were missing in patient rooms on Halls A, B and C.

Findings include:

The Maintenance Manager (ID# 52) acknowledged 9/27/10 at 11 a.m. the hospital has been experiencing problems with the air-conditioning cooling system for the past six months. The Manager stated the hospital has leased a portable air-conditioning unit to place in the hallway to help cool and patients are provided fans if they complain about the temperature being too hot.

The Manager further stated the hospital wants to exchange the individual thermostats in each patient room so that they can be computer controlled and he is working with corporate office for funding approval. The Manager admitted that at least 80% of the thermostat covers in patients rooms are missing.

Observation 9/27/10 at 9:30 a.m. revealed the following rooms had missing thermostat covers with exposed wiring:

Hall A: Rooms 2000, 2001, 2004, 2007, 2008, 2009 and the Dialysis room / Tub room

Hall B: Rooms 2031, 2035, 2036, 2041, 2042, and 2044.

Hall C: Rooms 2051 and 2053.