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Based on observation, interview and record review, facility failed to ensure patients received care in a safe setting in that the infection control policies werenot implemented to maintain a sanitary environment in the facility. The facility staff and contracted environmental staff failed to follow the facility's policy in that the facility patient care corridors and equipment was not properly cleaned. Facility had a census of 34 patients.

Findings:

Policy Review:

Review on 04/30/2019 of the facility's current policy and procedure titled "Cleaning and Disinfection of Equipment, Devices and Supplies", Policy # ICP.08.02, Review Date 4/13 reads in part, Purpose: To ensure that medical equipment is appropriately cleaned and disinfected prior to use to prevent the spread of infection or disease. Policy: A. This policy applies to medical equipment that requires disinfection. E. Medical equipment shall be cleaned when visible dirty, ... Patient care equipment shall be damp dusted with germicidal cleaner daily. F. Medical equipment shall be taken to the Soiled Utility area when the equipment needs to be cleaned and disinfected, and/or after the patient is discharge ......to reduce the risk of cross contamination between patients. Environmental services personnel shall be responsible for such cleaning and disinfection of equipment.

Review on 04/30/2019 of the facility's current policy and procedure titled "Crash Carts/Defibrillators", Policy # CL1.11, Revised Date 5/2016 reads in part .... Policy: Crash arts will be located in designated areas throughout the hospital for quick access. 1. Procedures: A. Daily Crash Cart Inspections 1. Each crash cart will be inspected and tested at least daily to ensure the integrity of its contents and validate that the defibrillator is in working order. B. Crash Cart Restock 1) The house Supervisor is responsible for seeing that the crash cart is restocked. 2 .... the crash cart is to be wiped down with Sani-wipes.

Review on 04/30/2019 of the facility's current policy and procedure titled "Housekeeping" Policy # ICP0.6.03, Reviewed Date 1/19 reads in part .... Purpose: To keep the hospital clean, organized and clutter free. Cleaning of Patient Care Areas: 3. All equipment taken into the room must be disinfected after the room cleaning has completed. 4. All ledges and surfaces in the room should be checked daily for need of dusting. Perform necessary dusting of ledges .... Environmental Cleaning 1. Thorough scrubbing/disinfecting shall be done for all environmental surfaces that are being cleaned in-patient areas. 6. In patient care areas, cleaning of non-carpeted floors and other horizontal surfaces shall be done daily. 18. Cleaning schedules and procedures for all patient rooms, bathrooms, corridors, nursing stations, outpatient campus-based clinics and other areas shall be maintained in the Department of Environmental Services.

Observations:

Observation on 04/29/2019 at 3:00 p.m. along with the Chief Nursing Office, Employee ID #1 and Employee ID #55 of the patient care area the following was observed:

Crash Cart #1 located in the Intensive Care Unit was observed to have a visual buildup of dust on the lateral surfaces of the cart.

Crash Cart #2 located in the Special Procedure room was observed to have a visual buildup of dust on the lateral surfaces of the cart.

Crash Cart #3 located on the 3rd floor medical surgical unit was observed to have a visual buildup of dust on the lateral surfaces of the cart.

Portable X-ray machine was observed in the hallway of the Intensive Care Unit with dark droplets observed on the bottom legs of the machine along with visual buildup of dust. The top portion of the X-ray machine was observed to have multiple clear plastic strips of tape adhered to it. Also observed was a sticky substance that had a dark substance attached that appeared to be tape debris and dust.

Observation of the patient area corridor of the 3rd floor medical surgical unit a visible collection of dust was observed on the lateral surface of the wall mounted hand sanitizer dispensing units and drop down mounted desk located outside of 319, 320 and 321

Interview with Chief Nursing Officer, Employee ID #1 confirmed the buildup of dust on the three observed crash carts, portable X-ray machine and wall mounted hand sanitizer dispensing units and stated that it should have been cleaned when they do the daily crash cart checks and staff should be disinfecting the portable X-ray machine after use. Employee ID #1 stated the housekeeping department which is contracted is responsible for cleaning the patient corridors and they should be cleaned and monitored more closely. Employee ID #1 stated they would start doing audits for cleanness of the hallway.

Employee ID # 55 also confirmed the buildup of dust on the mounted hand sanitizer units and the drop down mounted desk located in the 300s patient care hallway and said it should be cleaned by housekeeping.

Interview with Director of Maintenance, Employee ID #56 confirmed that housekeeping was responsible for cleaning the corridors. Employee ID #56 stated the corridor cleaning were on a schedule and should have been cleaned more often if dust was accumulating.

Based on interview and record review a Registered Nurse (RN) failed to supervise and evaluate the care of sampled patients. RN failed to ensure implementation of phsycain order related to prevention of skin breakdown for 2 of 10 sampled patients. Facility has a current census of 34 patients.

Findings:

Policy:

Review of the facility's current policy title "Skin Integrity Check", Policy # WC-3.1. Revised Date 10/2016. Policy: Skin Integrity checks will be completed each shift (2 times daily) and PARN to ensure skin/wound problems are assessed and treated in a timely manner. Procedure: A. Licensed Nurse Responsibilities: 3. The nurse must confirm that a wound exists and that documentation and treatments have been established and current ordered treatments are implemented. Documentation: Document all procedures and treatments in the Nurses Assessment Notes

Review of the clinical record of Patient ID #1 revealed:

History and physical:
83-year-old male patient with past medical history significant for advanced dementia of Alzheimer type, severe protein-calorie malnutrition, toxic metabolic encephalopathy, status post G-tube placement, stage IV pressure ulcer of sacrum with active bleeding. Patient underwent surgical debridement of pressure ulcer.

Physician Order:

Dated: 03/29/2019 reads "turn every two hours" by Dr. Kaveh Samani.

Review of daily nursing notes for Patient ID # 1 revealed:

04/25/2019 no documentation of reposition of patient from 1700 to 2000
04/19/2019 no documentation of reposition of patient 0200 to 0700
04/18/2019 no documentation of reposition of patient 1700 to 2000
04/15/2019 no documentation of reposition of patient 0200 to 0600
04/14/2019 no documentation of reposition of patient from 1000 to 1900
04/13/2019 no documentation of reposition of patient from 0800 to 2100
04/11/2019 no documentation of reposition of patient from 1900 to 2200
04/10/2019 no documentation of reposition of patient from 0000 to 0800
04/09/2019 no documentation of reposition of patient from 1800 to 0000
04/07/2019 no documentation of reposition of patient from 2300 to 0200
04/05/2019 no documentation of reposition of patient from 1700 to 2000
04/01/2019 no documentation of reposition of patient from 0300 to 0600
03/31/2019 no documentation of reposition of patient from 0800 to 2000
03/29/2019 no documentation of reposition of patient from 1800 to 0800

Review of the clinical record of Patient ID #8 revealed:

History and physical:

91-year-old female morbidly obese, with past medical history of end stage renal disease on hemodialysis, diabetic mellitus, hypertension, cardiomyopathy, respiratory failure, tracheostomy, currently on a ventilator.

Physician Order:
Dated: 04/26/2019 reads "turn every two hours" by Dr. Rajesh Rethnam.

Review of daily nursing notes for Patient ID # 8 revealed:

04/29/2019 no documentation of reposition of patient from 0800 to1900.

Interview on 04/30/2019 at 3:00 p.m. with Chief Nursing Office Employee ID #1 confirmed the missing documentation on the daily nurses notes for every 2-hour repositioning documentation for Patient ID #s 1 & 8 daily. Employee ID #1 stated the physician's order was for every 2 hours and it should have been documented on the patient's record.