**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on review of records and interviews on 3/9/2018, the facility failed to develop and keep current nursing care plans to address the patients' needs for 2 of 11 patients (Patient # 7 and 11) on the 6th floor. Findings: Record review on 3/9/2018 of patient (ID# 7) revealed the patient was admitted on [DATE] with the diagnoses of unstable angina. The patient did not have a plan of care initiated. Record review on 3/9/2018 of patient (ID# 11) revealed the patient was admitted on [DATE] with the diagnoses of pyelonephritis, sepsis and a history of diabetes. The plan of care was implemented on 3/7/2018 but did not address alteration in fluid and electrolyte imbalance or diabetes. Interview on 3/9/2018 at 1205, with staff (ID #60) RN, she stated the care plans should reflect the patient's current problems and completed at admission and updated every shift (every 12 hours). Record review of a Park Plaza policy entitled Admission Assessment and Re-Assessment, (revision date 7/15) revealed all patients shall be assessed by an RN on admission to the hospital and shall be reassessed by an RN at least daily. F. Problem Identification: 1. The RN assessment shall determine the initial problem list, which is documented on the Care Plan form. 2. Based on all aspects of the data collection during the initial assessment, the RN is responsible to evaluate and integrate the information collected, including the physician 's orders and the history and physical. 4. The policy also stated that each problem will have common interventions to be checked and measurable goals.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on record review and interview the facility failed to implement preventative measures when it was brought to their attention that a patient who required home oxygen was discharged from the facility without oxygen. This failed practice resulted in the patient becoming oxygen deprived and had to be treated with oxygen and hospitalized at another acute care hospital within two (2) hours of the discharge. Citing Patient (#1) named in a complaint. Findings: During a telephone interview on 6/21/2016 at 10:15 am with Complainant RJ , Social Worker, she stated Patient (# 1) was discharged on the morning of 12/11/2015 from the PP Hospital with orders that she needed home oxygen. The patient arrived at the HH Clinic on 12/11/2015 gasping for breath and could hardly speak. She did not have oxygen with her. According to RJ, the clinic nurse conducted a six (6) minute walk test with the patient to determine the patients ' oxygen saturation level. After the walk the patient ' s oxygen saturation was 50% on room air. The patient was evaluated by the Clinic's Physician and oxygen was started via nasal cannula. The patient was transferred to the HH Hospital emergency room for evaluation and treatment and was admitted as an inpatient. She spent four ( 4) days in the HH Hospital and was discharged home with oxygen therapy. Review of Patient #1's clinical record from the HH Clinic dated 12/11/2015 verified that the patient was seen in the clinic at 10:27 am and was sent to the ER at 2:26 pm. She was admitted at the HH Hospital 12/1/2015 at 3:00 pm for 4 days. During an interview on 6/24/2016 at 9:45 am with Staff G 57, Case Manager she stated she realized the patient should have been discharged to the clinic via ambulance with oxygen. She stated there was a breakdown in communication with the floor Nurse. Usually the staff on the Unit ordered the transportation. The staff stated on 12/11/2015 a Staff from HH Clinic contacted her with concerns that the patient was sent to the clinic without oxygen. Staff G 57 stated she did not report the occurrence but started to have a discussion with unit staff before patients are discharged . During an interview on 6/24/2016 at 11:41 am at the facility with Staff A 51, Director of Quality he stated the facility was not aware of this occurrence until the Surveyors came to the facility on [DATE]. He stated when Staff G 57 was informed of the problem with the patient's discharge she should have generated an occurrence report so that the facility could have investigated and implemented the correct interventions to ensure this situation never reoccur.
Based on interview and record review the facility failed to evaluate a patient ' s oxygen saturation status prior to discharge when her oxygen therapy was discontinued to ensure she could be safely discharged on room air. This failed practice resulted in the patient becoming severely oxygen deprived within an hour on room air. Citing Patient (#1) named in a complaint. Findings: During a telephone interview on 6/21/2016 at 10:15 am with Complainant RJ , Social Worker, she stated Patient (# 1) was discharged on the morning of 12/11/2015 from the PP Hospital with orders that she needed home oxygen. The patient arrived at the HH Clinic on 12/11/2015 gasping for breath and could hardly speak. She did not have oxygen with her. According to RJ, the clinic nurse conducted a six (6) minute walk test with the patient to determine the patients ' oxygen saturation level. After the walk the patient ' s oxygen saturation was 50% on room air. The patient was evaluated by the Clinic's Physician and oxygen was started via nasal cannula. The patient was transferred to the HH Hospital emergency room for evaluation and treatment and was admitted as an inpatient. She spent four ( 4) days in the HH Hospital and was discharged home with oxygen therapy. Review of Patient #1's clinical record from the HH Clinic dated 12/11/2015 verified that the patient was seen in the clinic at 10:27 am and was sent to the ER at 2:26 pm. She was admitted at the HH Hospital 12/1/2015 at 3:00 pm for 4 days. Review of the patient ' s medical record from Hospital PP revealed the Patient (#1) was treated in the hospital for seven days for Hypoxia and had been on continuous oxygen therapy. There was documentation the patient became hypoxic on room air. Review of Patient # 1's oxygen treatment notes revealed trhe patient was on oxygen via nasal cannula starting on 12/2/2015 date of admission until 12/11/2015 date of discharge. There was multiple documentation indicating the patient was tried on room air but became hypoxic Not enough oxygen). Review of nurses notes dated 12/11/2015 revealed at 5;47 am the patient was on 5 liters of oxygen with an oxygen saturation level of 98%. At 8:51 am the oxygen was decreased to 2 liters via nasal cannula at 100 % saturation. There was documentation the patient was discharged at 9:30 am in a private car with her daughter. There was no documentation when the oxygen was discontinued or indication that she was evaluated to determine her oxygen saturation level on room air prior to discharge. Review of Consultant discharge planning notes dated 12/9/2015 revealed documentation that the patient needed oxygen at home and should not be discharged without oxygen. During an interview on 6/24/2016 at 10:30 am with Dr.F56,Pulmonary Consultant ,she stated she requested home oxygen for the patient because the patient could not do without the oxygen. According to Consultant on the day the patient was discharged (12/11/2015) she went to see the patient was informed the patient was discharged home she stated she was very shocked to realize the patient ' s oxygen was yanked and she was not evaluated and sent to the clinic in an ambulance with oxygen. Dr. F 56 stated the patient should have been evaluated after the oxygen was discontinued and should never have left the hospital without oxygen.
Based on interview and record review the facility failed to develop and implement an acceptable discharge plan to ensure that a patient needing continuous oxygen therapy was safely discharged from the hospital with the needed oxygen. This failed practice resulted in the patient being admitted to an acute care hospital within five(5) hours of discharge due to oxygen depravation. Citing Patient (#1) named in a complaint. Findings: During a telephone interview on 6/21/2016 at 10:15 am with Complainant RJ , Social Worker, she stated Patient (# 1) was discharged on the morning of 12/11/2015 from the PP Hospital with orders that she needed home oxygen. The patient arrived at the HH Clinic on 12/11/2015 gasping for breath and could hardly speak. She did not have oxygen with her. According to RJ, the clinic nurse conducted a six (6) minute walk test with the patient to determine the patients ' oxygen saturation level. After the walk the patient ' s oxygen saturation was 50% on room air. The patient was evaluated by the Clinic's Physician and oxygen was started via nasal cannula. The patient was transferred to the HH Hospital emergency room for evaluation and treatment and was admitted as an inpatient. She spent four ( 4) days in the HH Hospital and was discharged home with oxygen therapy. Review of Patient #1's clinical record from the HH Clinic dated 12/11/2015 verified that the patient was seen in the clinic at 10:27 am and was sent to the ER at 2:26 pm. She was admitted at the HH Hospital 12/1/2015 at 3:00 pm for 4 days. Review of the patient ' s medical record from Hospital PP revealed the Patient (#1) was treated in the hospital for seven days for Hypoxia and had been on continuous oxygen therapy. There was documentation the patient became hypoxic on room air. Review of Consultant discharge planning notes dated 12/9/2015 revealed documentation that the patient needed oxygen at home and should not be discharged without oxygen. Review of Case Manager ' s notes dated 12/10/2015 revealed information they were aware the doctor wants the patient to go home with oxygen however the patient's insurance is with the HH System and the DME Company will only accept orders from a provider of that System. The discharge plan was to send the patient to HH Clinic where the oxygen would be ordered. There was documentation the patient would be discharged in a private car. There was no mention of oxygen therapy enroute to the HH clinic. Review of Nurses notes dated 12/11/2015 (date of discharge) revealed the patient was discharged with her daughter in a private car at 9:30 am. There was no documentation of the patient's oxygen saturation status upon discharge. During an interview on 6/24/2016 at 10:30 am with Dr. F56 ,Pulmonary Consultant ,she stated she requested home oxygen for the patient because the patient could not do without the oxygen. She was aware of the plan to send the patient to HH Clinic on discharge so she could get the oxygen .It was never her intention for staff to send the patient to the clinic in a private car without oxygen, she thought the patient would be safely sent to the clinic via ambulance with oxygen. During an interview on 6/24/2016 at 9:45 am with Ms. Arnold, Case Manager she stated she realized the patient should have been discharged to the clinic via ambulance with oxygen. She stated there was a breakdown in communication with the floor Nurse. Usually the staff on the Unit orders the transportation for patients.
Based on observation, record review, and interview the facility failed to ensure the infection control system controlled infections by ensuring staff performed hand hygiene, processed hinged instruments in a manner to ensure sterility and cleaned equipment storage cabinets. Findings include: ICU (Intensive Care Unit) Observation on 6/3/15 at 10:40 a.m. in ICU with Infection Control RN (Registered Nurse) #60 revealed RN #57 was providing care to Patient #4. RN #57 had on a pair of gloves and was flushing the patient's IV that was placed in her groin. RN #57 took off her gloves and without performing hand hygiene put on another pair of gloves to give medications through the patient's feeding tube. She removed those gloves and put on another pair of gloves without performing hand hygiene. She adjusted the flow rate on IV tubing and then opened a drawer to get an alcohol swab. She then injected medication into the patient's left upper thigh. RN #57 had RN #56 come into the room to help her pull the patient up in bed. RN #57 then changed gloves to perform oral hygiene without performing hand hygiene. Once she finished providing care and came out of the room, she used hand sanitizing gel. During an interview on 6/3/15 at 11:40 a.m. with IC (Infection Control) RN #60 she said the hospital protocol was for hand hygiene to be performed with each glove change. She went to RN #57 and talked to her about the observations. Record review of the facility's Policy and Procedure for Hand Hygiene dated 2/13 revealed the following: PURPOSE: Hand hygiene reduces the risk of infection transmission from patient to patient and from patient to healthcare provider. This policy outlines hand hygiene requirements... PROCEDURE: A. Indications for hand washing and hand antisepsis:... + Prior to donning gloves and after removing gloves... Sterile Processing Observation on 6/4/15 at 11:00 a.m. in Sterile Processing with Infection Control RN (Registered Nurse) #60 of individual sterilized packaged instruments revealed hinged hemostats and scissors were not in the open position. One of the hemostats was ratcheted (locked). Some of the hemostat tips were touching. There were no inserts or products used to ensure the instruments stayed in the open position to be processed. Interview at this time with Supervisor of Sterile Processing #62, he said the hemostats were left unratcheted, but he could see the tips were not in the open position. He said he could put tip protectors on the tips of the hemostats to keep them open. When he was asked about the scissors, he asked what could be used to keep them open. On 6/4/15 at 2:55 p.m. Quality Assurance (QA) Manager #51 was asked for a Policy and Procedure for sterilizing single wrapped instruments. At 3:00 p.m. QA Manager #51 said Director of Operating Room #61 said there was no Policy and Procedure because it was a Standard of Practice to sterilize hinged instruments in the open position. She told him that hinged instruments were put on stringers to keep them open in instrument sets. Record review of the AORN (Association of periOperative Registered Nurses) Perioperative Standards and Recommended Practices 2012 Edition on page 522 under Recommendation XII revealed the following: XII.c. Instruments with hinges should be opened ...Sterilization occurs only on surfaces that have direct contact with the sterilant... XII.c.1. Instruments should be kept in the open and unlocked position using instrument stringers, racks or instrument pegs designed to contain instruments.... Endoscopy Suite Observation on 6/4/15 at 11:15 a.m. in the Endoscopy Suite revealed there were two procedure rooms. A patient was in Procedure Room #1. The high level disinfection room had both the dirty and clean area in one room. Interview at this time with Endoscopy Manager #63, he said the endoscope processing machines were wiped off with sanitizing wipes after the dirty scopes were put inside to process. Once the process was completed, the scopes would be removed from the machines and placed in the storage cabinets as part of the clean process. Further observations of the endoscopy storage cabinet in the hallway revealed a scope was hanging in the cabinet. The white bottom of the cabinet had orange colored swirls. There was a thin, long, black string like item on the bottom of the cabinet. Further interview at this time with Endoscopy Manager #63, he said the orange swirls were stains that could not be removed. When he was asked how anyone could tell if the scopes were dripping discolored liquid from the present stains, he said he saw the point. He said the long black item was a hair. He said he did not have a cleaning schedule for the cabinets, but just cleaned them when it was needed. Observation at this time of Procedure Room #1's scope storage cabinet revealed brown colored substance on the top white multiple hanging receptacles. There was an accumulation of dust on the bottom of the cabinet. In Procedure Room #2 the bottom of the scope storage cabinet had a layer of debris that included a lump of black dust. On 6/4/15 at 2:55 p.m. Quality (QA) Manager #51 was asked for a Policy and Procedure for cleaning the endoscopy cabinets. At 3:00 p.m. QA Manager #51 said Director of Operating Room #61 said there was no Policy and Procedure for cleaning the endoscopy cabinets.
Based on observation, review of records, and interviews with staff, the governing body failed to be responsible for the organization, management, and operation of the dietary department, as unsanitary conditions were found throughout the kitchen where patient food is stored and prepared. This could potentially cause food-borne illness in patients of the hospital. Findings were: A tour of the kitchen and food preparation and storage areas was conducted at 2:45 pm on 10/28/13 in the company of staff #1, the Director of Dietary; staff #3, the Executive Chef; and staff #8, the Quality Manager. During the tour, unlabeled and undated open containers of food were found in the freezers, pantries and refrigerators. Also found during the tour were multiple areas that were potential infection control hazards. In the food preparation areas were trays and carts with dried-on food substances and were greasy to touch. Also noted in the food storage areas were food crumbs, and wet food juices dripping from defrosting meats. The handles of the freezer and refrigerator, and outer containers of food were covered in black, yellow, brownish and greenish substances and were sticky to touch. Floors contained build-ups of grease and unidentified particles. Pans were stored still dripping water, and the pans were greasy to touch. Air vents had visible dust and grime. Standing water was observed on the floors. A door to the outside was noted to have an opening between the floor and the door large enough for rodents and insects to enter the kitchen areas. For more information, cross refer to tag A0618.
Based on observation, review of records, and interviews with staff, the facility QAPI program failed to ensure that data collected was used to improve the condition of the kitchen and food preparation/storage areas. Cleanliness and food storage problems identified in December 2012 and May and June 2013 were not corrected as of the survey tour of the facility conducted 10/28/13, leaving a potential for food-borne illness in patients of the hospital. Findings were: The facility Performance Improvement Plan for 2013 states on page 3 under the section entitled THE PERFORMANCE IMPROVEMENT PROCESS, that monitoring of the hospital in order to improve processes includes gathering data obtained from observations of hospital activities. The Infection Preventionist, Staff #2, provided a document entitled Environment of Care, Food Service. Staff #2 explained that this form is utilized to identify problems in the kitchen area that need to be addressed and that walk-throughs are performed twice a year. The form provided by Staff #2 is dated 5/23/13, with a 2nd visit on 6/5/13. Additionally, the facility Quality Assurance Manager, Staff #8 provided the same form, which had been completed 12/15/12. According to the form dated 12/15/12, there were general descriptions of holes in the ceiling, dust throughout the kitchen, holes in the walls and debris on the floors. The form dated 5/23/13 with the 2nd visit on 6/5/13, also identified holes in the walls and ceilings, leaking water, and repairs that were needed to floors. These were issues that had not been addressed or repaired, and were identified during the survey tour of the facility, 10/28/13. A tour of the kitchen and food preparation and storage areas was conducted at 2:45 pm on 10/28/13 in the company of staff #1, the Director of Dietary; staff #3, the Executive Chef; and staff #8, the Quality Manager. During the tour, standing water was noted on the floors, and holes were noted in the ceilings and walls. Also, as identified in the Environment of Care forms dated 12/15/12 and 5/23/13, dust was found throughout the areas of the kitchen. An in-person interview was conducted with the Quality Manager, Staff #8, the afternoon of 10/30/2012. Staff #8 acknowledged that the findings of the Environment of Care forms filled out on 12/15/12 and 5/23/13 (2nd visit 6/5/13) should have been utilized as tools to improve the condition of the kitchen. Staff #8 acknowledged that the problems identified during the two walk-throughs had not been corrected as of the time of the tour on 10/28/13.
Based on observation, interviews with dietary staff, the facility failed to ensure that food and dietary organization requirements were met, as no polices were provided to the surveyor for work and food handling techniques and implementation of first-in first- out rotation system for all food supplies at all times; as there was unlabeled, undated, food in the freezers, prep refrigerators, storage closets in the dietary department and there was no evidence of stock rotation and unsanitary conditions. Findings: During a tour of the dietary department on the afternoon of 10/29/13, accompanied by facility staff # 1, 3, and 9 the following was observed. Prep refrigerators against the left wall upon entering the dietary department; three fish fillets were observed on one of the shelves with no indication of when the fish was put there. Raw turkey patties, red peppers, salad vegetables (bag was unsecured, with some of the vegetables spilling out) and baked chicken were observed with no date open, available for immediate use. Multiple containers of condiments mayo, mustard, salad dressings, olives, were observed open with no open date visible on the outside of the containers. Two dishes of pesto identified by staff # 3 were observed unlabeled, not dated, plastic wrap did not form a complete seal covering the dishes thus exposing the pesto to the refrigerator elements. Seven open unsealed, not dated bags of pasta, and rice, were in one container and the other two containers contained flour, and corn meal. The three containers were greasy to touch on the outside, with splatters and discolored particles appearing to be grease, food and dirt buildup on the outside of the containers. Containers of barbecue sauce, ketchup, vinegars, and various condiments were observed on a small metal table across from the prep fridges next to three containers. The containers were open; looking at the outside of the containers heavy dark brownish blackish thick material was visible clinging to the insides of the containers. There was no date identifying when the containers had been open. The three prep refrigerators contained two metal carts each inside the prep refrigerators, trays located in the carts inside the freezer carts contained greasy yellow brownish slimy substances in the corners and on the outside. The shelving in the carts was dirty, and greasy to touch. Raw chicken legs and thighs was observed in a pan in the freezer that was wet, contained food crumbs, and greasy to touch with plastic wrap that was not sealed over the pan. No labeling was observed indicating how long the chicken had been there. Two rolls of ground beef were observed in pans containing red watery substance dripping down into the shelves below on the cart located in the refrigerator. The surveyor asked the why these meats where there. Staff # 3 stated, The meats are defrosting for tomorrow meals. Three boxes of guacamole sauce, and a box of sausage, were open exposed to the freezer elements. Uncooked mixed vegetables were observed in open plastic bags lying in pans which contained greasy, brownish, yellowish, substances in and outside of the pans on shelves inside the freezer. The shelves had what appeared to be food particles, and irregular spots splashes of unknown substances. Trays located in the freezer carts contained greasy yellow brownish slimy substances in the corners and the outside. All of the carts shelves observed in the refrigerators and freezers were greasy to touch, food crumbs was observed on some of the shelves. The handles on the prep refrigerator doors were covered in black, yellow, brownish and greenish substance sticky to touch. The rubber casing on the inside of the prep fridges, freezers, beverage coolers doors and covers of the ice machine contained black grimy thick substance with the consistency of tar, apprearing thick, black and oozing. The doors on the outside of the ice machine left a white powdery substance on the surveyors' hands after touching. The floor corners inside the prep refrigerators and freezers contained a buildup of yellowish, brownish greasy, grimy substance that was sticky to touch, pieces of orange/green particles appearing to be vegetables and food crumbs was observed on the floors. A black cart used was observed next to the freezer covered with whitish, grayish, powdery substance. Staff # 3 stated, the cart is used to transport food received to the storage areas. The exit door next to the ice machine was covered with blackish, grimy, and sticky to touch substance. The surveyor observed a 2 inch opening between the floor and the door, causing a potential for rodents, insects to enter into the dietary department. There were several areas of the floor in the dietary department was wet and slippery. Water was observed dripping from the ice machine. A blue shovel was hanging on the wall opposite the freezer which was covered with black, grimy, and sticky residue. Staff # 3 stated, The shovel is used to scoop ice. Water was observed dripping from a pipe attached to the tilt skillet. The floors in the pots washing area were wet and slippery. Water was dripping from the garbage disposal. Celling and wall vents were observed to have dust hanging out of the vents. The vents were black, dark brown, greasy appearing. Celling light covers were yellow, greasy with black particles containing what appear to be insects. Gray color paint was observed peeling in several areas on the floor exposing the concrete. Areas on the walls behind the prep refrigerators, coolers, freezers, stoves, prep lines, and the dish washer contained dirty, grimy, and greasy to touch residue. All wall and counter surfaces were greasy and/or wet to touch. Pans and pots were observed on a metal cart which staff # 3 identified as clean, ready for immediate use. Seventeen prep trays and two stacks of baking pans were wet and sticky to touch. The inside of the pans and pots contained yellowish, brownish blackish substance. The substance on the outside of the baking pans appeared to be a buildup of burnt residue. Black bowls were on the top shelf left a sticky blackish residue on the surveyor's hand. The surveyors ask staff # 3 again if these items are clean. Staff # 3 stated, Yes they are supposed to be clean. All of the bake and cookware on the cart was greasy, grimy, containing dusty sticky residue. Cooking utensils were observed in metals square pans on the second shelf were watery and greasy to touch. A large dead cock roach was observed on the floor between the cart and the wall. Four stoves were observed against the wall across from the walk in prep refrigerator. The pilot lights were observed to be burning in the grill area. Opening the oven doors beneath the burners, card boxes, papers, rubbish were observed. The walls, doors, and the burners were covered with black hardened substance. The trays under the burners contain black, yellow, brownish greasy to touch, particles and pools of brown/black sticky liquid appearing to be grease. Staff # 3 stated, We do not use these ovens. The grill located next to the stoves was hot. The tray below the grill burner contained a large amount of black, yellow, brownish greasy to touch, particles and pools of brown/black sticky liquid appearing to be grease. Black, grimy substance was observed on the hand washing sink, and the back splash behind the sink. A green hose apparatus was attached to the wall near the sink, a sign was posted on the wall stating eye washing. The top of the hose for the water to exit was covered with a white powdery substance. The mixer was observed to have brownish sticky substance on the grate under the handle, when moving the handle dark flakes fell into the mixing bowl. Review of the policy manual did not contain polices for food handling or food rotation. No policy was offered or provided to the surveyors indicating food rotation, labeling, covering of food and supplies at all times. The findings were confirmed during the tour of the dietary department on the afternoon of 10/29/13 by staff # 1, 3 and 9.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on observation, interviews, and review of documentation, the facility Infection Prevention Officer failed to ensure implementation of infection control practices in that infection control practices were not adhered to in the dietary department causing a potential for food borne illnesses and transmissions of infections. Findings: During a tour of the dietary department on the Dietary Department at Park Plaza hospital on [DATE] at 2:45 pm with staff #3, #1, and #9 the following were observed. Prep refrigerators against the left wall upon entering the dietary department; three fish fillets were observed on one of the shelves with no indication of when the fish was put there. Raw turkey patties, red peppers, salad vegetables (bag was unsecured, with some of the vegetables spilling out) and baked chicken were observed with no date open, available for immediate use. Multiple containers of condiments mayo, mustard, salad dressings, olives were observed open with no open date visible on the outside of the containers. Two dishes of pesto identified by staff # 3 were observed unlabeled, not dated, plastic wrap did not form a complete seal covering the dishes thus exposing the pesto to the refrigerator elements. Seven open unsealed, not dated bags of pasta, and rice, were in one container and the other two containers contained flour, and corn meal. The three containers were greasy to touch on the outside, with splatters and discolor particles appearing to be grease, food and dirt buildup on the outside of the containers. Containers of barbecue sauce, ketchup, vinegars, and various condiments were observed on a small metal table across from the prep fridges next to three containers. The containers were open; looking at the outside of the containers heavy dark brownish blackish thick material was visible clinging to the insides of the containers. There was no date identifying when the containers had been open. The three prep refrigerators contained two metal carts each inside the prep refrigerators, trays located in the carts inside the freezer carts contained greasy yellow brownish slimy substances in the corners and on the outside. The shelving in the carts was dirty, and greasy to touch. Raw chicken legs and thighs was observed in a pan in the freezer that was wet, contained food crumbs, and greasy to touch with plastic wrap that was not sealed over the pan. No labeling was observed indicating how long the chicken had been there. Two rolls of ground beef was observed in pans containing red watery substance dripping down into the shelves below on the cart located in the refrigerator. The surveyor asked the why these meats here are. Staff # 3 stated, The meats are defrosting for tomorrow meals. Three boxes of guacamole sauce, and a box of sausage were open exposed to the freezer elements. Uncooked mixed vegetables were observed in open plastic bags lying in pans which contain greasy, brownish, yellowish, substances in and outside of the pans on shelves inside the freezer. The shelves had what appeared to be food particles, and irregular spots splashes of unknown substances. Trays located in the freezer carts contained greasy yellow brownish slimy substances in the corners and the outside. All of the carts shelves observed in the fridge, and freezers were greasy to touch, food crumbs was observed on some of the shelves. Three white containers containing seven open unsealed, not dated bags of pasta, rice, flour, and corn meal were greasy to touch on the outside, with splatters and discolor particles appearing to be grease, food and dirt buildup on the outside. The handles on the prep refrigerator doors were covered in black, yellow, brownish and greenish substance sticky to touch. The rubber casing on the inside of the prep refrigerator, freezers, beverage coolers doors and covers of the ice machine contained black grimy thick substance with the consistency of tar appearing thick, black and oozing. The doors on the outside of the ice machine left a white powdery substance on the surveyors' hands after touching. The floor corners inside the prep refrigerators and freezers contained a buildup of yellowish, brownish greasy, grimy substance that was sticky to touch, pieces of orange/green particles appearing to be vegetables and food crumbs was observed on the floors. A black cart used was observed next to the freezer covered with whitish, grayish, powdery substance. Staff # 3 stated, the cart is used to transport food received to the storage areas. The exit door next to the ice machine was covered with blackish, grimy, and sticky to touch substance. The surveyor observed a 2 inch opening between the floor and the door, causing a potential for rodents, insects to enter into the dietary department. There were several areas of the floor in the dietary department was wet and slippery. Water was observed dripping from the ice machine. A blue shovel was hanging on the wall which was covered with black, grimy, and sticky residue; opposite the freezer. Staff # 3 stated, The shovel is used to scoop ice. Water was observed dripping from a pipe attached to the tilt skillet. The floors in the pots washing area were wet and slippery. Water was dripping from the garbage disposal. Celling and wall vents were observed to have dust hanging out of the vents. The vents were black, dark brown, greasy appearing. Celling light covers were yellow, greasy with black particles containing what appear to be insects. Gray color paint was observed peeling in several areas on the floor exposing the concrete. Areas on the walls behind the prep fridges, coolers, freezers, stoves, prep lines, and the dish washer contained dirty, grimy, and greasy to touch residue. All wall and counter surfaces were greasy and/or wet to touch. Pans and pots were observed on a metal cart which staff # 3 identified as clean, ready for immediate use. Seventeen prep trays and two stacks of baking pans were wet and sticky to touch. The inside of the pans and pots contained yellowish, brownish blackish substance. The substance on the outside of the baking pans appeared to be a buildup of burnt residue. Black bowls were on the top shelf left a sticky blackish residue on the surveyor's hand. The surveyors asked staff # 3 again if these items are clean. Staff # 3 stated, Yes they are supposed to be clean. All of the bake and cookware on the cart was greasy, grimy, containing dusty sticky residue. Cooking utensils were observed in metals square pans on the second shelf were watery and greasy to touch. A large dead cock roach was observed on the floor between the cart and the wall. Four stoves were observed against the wall across from the walk in prep refrigerator. The pilot lights were observed to be burning in the grill area. Opening the oven doors beneath the burners, card boxes, papers, rubbish was observed. The walls, doors, and the burners were covered with black harden substance. The trays under the burners contain black, yellow, brownish greasy to touch, particles and pools of brown/black sticky liquid appearing to be grease. Staff # 3 stated, We do not use these ovens. The grill located next to the stoves was hot. The tray below the grill burner contained a large amount of black, yellow, brownish greasy to touch, particles and pools of brown/black sticky liquid appearing to be grease. Black, grimy substance was observed on the hand washing sink, and the back splash behind the sink. A green hose apparatus was attached to the wall near the sink, a sign was posted on the wall stating eye washing. The top of the hose for the water to exit was covered with a white powdery substance. The mixer was observed to have brownish sticky substance on the grate under the handle, when moving the handle dark flakes fell into the mixing bowl. Review of Food and Nutrition services IC. 4.10 effective date was blank, revision date 1/10/2013 stated, The food and nutrition services department maintains a sanitation program. Purpose: To maintain a clean, safe, and effective environment of care, and to prevent the transmission of disease carrying organisms. Procedure: The Executive chef with assistance from the supervisors and Sous chef monitors sanitizing scheduled and procedures. Equipment, walls, floors and storage areas are routinely cleansed with the appropriate sanitizing compounds. Reference local and state sanitation requirements to be in compliance. During the tour of the Dietary Department at Park Plaza hospital on [DATE] accompanied by staff #3, #1, and #9, the findings were confirmed.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on record review and interview, the facility failed to ensure that 3 of 10 sampled patients (Patient ID # 7, 9, 10) had been provided a complete and accurate informed consent prior to surgery. Findings include: TX # 402 Patient ID # 7 Record review on 02-27-13 with of Patient ID # 7 ' s clinical record revealed he was a [AGE] year old male who was admitted to the facility on on [DATE]. Review of the Operative Report, dated 07-11-12 revealed Patient ID # 7 underwent a left shoulder hemiarthroplasty, implant removal and open reduction internal fixation of humeral component (with readjustment of the fracture plate and screws). Review of the Disclosure and Consent form for Patient ID # 7, dated 07-11-12 listed the following under the space provided for the procedure: hemi long stem arthroplasty and removal of deep implant. The listed procedure did not specify right or left side of the patient ' s body. Further review of Patient # 7 ' s consent page 2 of 6 read: List A: procedure requiring full disclosure. ... (12) Arthroscopy of all joints with mechanical device ... (B) Mechanical internal; prosthetic device ... (B) Open reduction with internal fixation .... The risks associated with this surgery were not initialed by the patient as part of the consent. Patient ID # 9 Record review on 02-27-13 of Patient ID # 9 ' s clinical record revealed she was admitted to the facility on on [DATE] and underwent a right knee arthroscopy.. Further review of Patient # 9 ' s consent page 2 of 6 read: List A: procedure requiring full disclosure. ... (12) Arthroscopy of all joints with mechanical device ... The risks associated with this surgery were not initialed by the patient as part of the consent. Patient ID # 10 Record review on 02-27-13 of Patient ID #10 ' s clinical record revealed she was admitted to the facility on on [DATE] and underwent a right reverse shoulder total arthroscopy. Review of the Disclosure and Consent form for Patient ID # 10, dated 07-11-12 listed an inaccurate description of the procedure as follows: right total reversal total shoulder. Interview on 02-27-13 at 3:30 p.m. with the Director of Heath Information Management (HIM) Staff # 7 she acknowledged the risks of the procedures should have been initialed for Patient ' s 7, # 9 and that the sections listing the procedures were not complete /accurate for Patients 9, # 10. Review of facility policy titled Disclosure and Consent For Medical and Surgical Procedures, revised date 06/11, read: 1. Patients who are anticipating a non-emergency medical or surgical procedure(s) identified on List A (full disclosure required). Consents for List A procedures will be prepared to include the specific risks identified by the Texas Medical Disclosure Panel., and those risks shall be imprinted on the form in the space provided ...
Based on observation, interview, and record review, the facility failed to ensure that 14 of 14 patients (Patient ID#s: 1 ,2 ,3, 4, 5, 6, 11, 12, 13, 14, 15, 16, 17,18) received care in a safe setting. Supplemental oxygen cylinders were improperly stored in the Intensive Care Unit (ICU). Improper storage of oxygen cylinders placed 13 patients at greater risk of the spread of an existing fire. Findings include: TX # 402 Observation on 02-27-13 at 9:55 a.m. during initial tour of the ICU revealed six (6) improperly stored oxygen cylinders in the supply room. Three (3) oxygen cylinders were observed lying horizontally, unsecured on the bottom shelf of a cart. Three (3) additional cylinders were observed lying horizontally, unsecured, and stored directly on the floor. Further observation revealed an oxygen storage cart located in the room, with several unfilled spaces for cylinders. Interview on 02-27-13 at the time of observation with RN # 3, Charge Nurse, he stated the oxygen cylinders should be chained or stored in the oxygen storage rack. He stated he would have them removed immediately. Record review of the ICU daily census dated 02-27-13 revealed there were 14 current patients admitted to the unit. Review of facility policy titled Procurement, Handling, Storage of Therapeutic Gases, revised date 02/05, read: 3. Select departments retain a small number of E cylinders for use, no more than twelve...storage: a;; freestanding cylinders in the bulk storage area must be chained ...Caution should be taken when handling all therapeutic gas cylinders, Cylinders should never be left upright and unsecured ...Oxygen cylinders must be placed in their carts, with stands upright during transportation. National Fire Protection Association (NFPA) Standards 99 Health Care Facilities (2005 edition): a total of up to 300 ft.? of oxygen may be stored per smoke compartment in any room or alcove without special requirements for that room; Cylinders must be secured in racks or by chains.
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