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Based on record review and interview, the hospital failed to ensure that drugs were administered in accordance with physician orders as evidenced by failing to administer sliding scale insulin as ordered by the physician for 1 (Patient #5) of 5 (Patient #3, #5, #22, #26, and #28) patients reviewed for insulin administration in a total sample of 30 patients.
Findings:

Review of the Hospital's Policy and Procedure N3.001 revealed in part:
Policy - It is the policy of the hospital that all medications be administered safely and appropriately to aid patients to overcome illness, relieve and prevents symptoms and help diagnosis.

Purpose - To provide guidelines to ensure that all medications are administered and documented appropriately.

F. Medication Administration - 2. Check Physician Orders/Medication Administration Record (MAR). 9. Give patient the medication.

Review of Patient #5's physician's order dated 01/24/2019 revealed in part:
Blood Glucose checks before meals and at bedtime. Humalog Insulin SQ Sliding Scale - Blood Glucose 0-150 = 0 units; 151-175 = 4 units; 176-225 = 6 units; 226-250 = 8 units; 251-300 = 10 units; 301-325 = 12 units ...

Review of Patient #5's Medical Record revealed:
01/24/2019 at 8:00 p.m. blood glucose 300. No insulin given.
01/25/2019 at 8:00 p.m. blood glucose 200. No insulin given.
01/26/2019 at 8:00 p.m. blood glucose 200. No insulin given.

Review of Patient #5's Nurse's Notes failed to reveal why the insulin was not given as ordered and failed to reveal the physician was notified regarding the medication not being administered.

During an interview on 01/29/2019 at 1:05 p.m., S4LPN, after reviewing the medical record, acknowledged the medication was not given as ordered and the physician was not notified.

Based on observation and interview, the hospital failed to ensure outdated, mislabeled, or otherwise unusable drugs and biologicals were not available for patient use.
Findings:

Observation 01/28/2019 at 10:00 of the Therapy Department, the wound dressing cabinet revealed a bottle of Solo Site Wound Gel with an expiration date of 06/2013.

During an interview on 01/28/2019 at 10:20 a.m., S3Director of Therapy confirmed the expired product and acknowledged it should not have been available for patient use.

Based on interview, the hospital failed to ensure that radiology services were supervised by a qualified radiologist.
Findings:

On 01/28/19 at 11:15 a.m., an interview with S1Administrator revealed the hospital's Medical Director was appointed to be the Director of Radiology Services. Further interview with S1Administrator confirmed that the Medical Director is not a radiologist.

Based on record review, observation and interview, the hospital failed to have an effective system for controlling infections and communicable diseases as evidenced by failing to maintain a sanitary hospital environment.
Findings:

Review of the Hospital's Housekeeping Policy and Procedure HK 3.009 revealed in part:
Policy - It is the policy of the Housekeeping staff to provide a clean, safe and attractive environment for patients, visitors, and staff.
Purpose - To maintain the hospital in a clean, safe, sanitary, and attractive condition.
Part D. Equipment and Supplies: 2. Housekeeping is responsible for the routine cleaning of the hospital. 3. Refrigeration, microwaves, and miscellaneous items will be cleaned weekly or as needed.

On 01/28/19 at 10:00 a.m., a tour of the therapy department revealed the following:
- a stepstool under a therapy bed had a dried spill on the top step;
- a fan sitting on the floor had heavy dust on the blades and the cage, and was blowing in the direction of several patients receiving therapy treatments;
- the crash cart had heavy dust and debris on the shelves and drawers, and on several items sitting on the top of the cart, including a suction container and defibrillator;
- heavy dust was noted on the surfaces of the Nustep (patient therapy equipment);
- the plastic barrel containing dirty linen was overfilled and the lid did not cover the exposed linen.
- rips/tears to the vinyl covering of a pillow on the exam/treatment table.

During an interview on 01/28/19 at 10:15 a.m., S3Director of Therapy acknowledged the and revealed that housekeeping services were provided in the therapy department on a weekly basis. He stated he was unsure if the equipment was supposed to be cleaned by housekeeping or the therapy department staff.

Based on record review and interview, the Hospital failed to ensure exercises to test their emergency evacuation plan were conducted at least annually.
Findings:

Review of the Hospital's emergency preparedness training and testing records failed to reveal an evacuation drill was conducted for the previous year.

During an interview on 01/30/2019 at 10:40 a.m., S1Administrator acknowledged the facility did not conduct an annual evacuation drill.