Catskill Regional Medical Center

Based on observation and interview, the facility did not ensure that staff maintained each residents' dignity and respect. Specifically, (1) During the initial tour, at least 6 rooms were noted with signs indicating the presence of an infection requiring the need for isolation practices; and (2) During mealtime observation, disposable plates and cups were being used on resident trays. This was evident in 6 of 6 resident rooms in the 64 bed facility, in 3 of 3 facility dining rooms, and for 1 non-sampled resident.

This resulted in no actual harm with the potential for more than minimal harm that is not immediate jeopardy.

Findings are:

1. During the initial tour of the facility on 6/2/10 at 9:00AM, at least 6 rooms were observed with signs on the door that notified anyone entering the that there was an infection present for one or both of the residents in the room.

During an interview with the Director of Nursing and the Administrator on 6/2/10 at 1:30PM they stated, they were trying to be consistent with hospital practice. Following surveyor intervention, the signs were changed such that anyone entering the room was instructed to see the nurse before entering. The indication of the presence of an infection was removed.

2. During mealtime observations on 6/2/10 for lunch and on 6/3/10 for breakfast and lunch in all three dining rooms, it was observed that disposable/styrofoam cups, small round dessert/fruit dishes and flat salad/dessert plates were all used in the place of china.

During an interview with the Registered Dietitian on 6/2/10 at 12:50PM, she stated that residents should not be served sandwiches, salads or desserts on disposable plates. Regular dishes should be used, but they ran out of dishes in the kitchen.

During an interview with a non-sampled resident during the lunch meal on 6/2/10 at 1:15PM, she stated that she preferred regular dishes and not the styrofoam/disposable type.

415.5(a)

Based on observation, interview and record review, the facility did not ensure prompt efforts to resolve resident grievances. Specifically, the facility has not resolved ongoing grievances with regard to meals. This concern was expressed by 9 of 10 residents during the group meeting.

This resulted in no actual harm with the potential for more than minimal harm that is not immediate jeopardy.

Findings are:

During the group meeting of June 2, 2010, residents expressed ongoing dissatisfaction with several aspects of meal service. The issues raised included menu items not being served as ordered, quality of preparation of specific foods (i.e. hard string beans and soggy sliced bread), and delays in the distribution of trays resulting in food being served that is not sufficiently warm. During this meeting, 9 of 10 residents expressed the above concerns. Residents stated that these concerns had repeatedly been brought to the attention of facility staff.

A review of the resident council minutes for the months of March, 2010 and April, 2010 reflect "ongoing discussions" or that discussions "continue" with food service, without satisfactory resolution of stated concerns.

The noon meal on June 2, 2010 was observed. During this observation, residents complained that the sliced bread was soggy. Observation confirmed residents' complaint as the sliced bread was held under the plate covers causing it to become soggy.

The menu for the June 3 lunch included a hot open turkey sandwich. The noon meal of June 3, 2010 was observed. This meal was not served in accordance with the menu as residents received turkey, but did not receive bread.

In an interview with the food service director on June 3, 2010, he could not explain the absence of bread for the hot open turkey sandwich.

415.1(c)(1)(ii)

Based on observation and interview, the facility did not ensure that staff followed acceptable clean technique and procedures to prevent the spread or development of infection. Specifically, (1) During a dressing change, the Registered Nurse (RN) was observed a)using community scissors to cut dressings and b)not using acceptable practice when washing hands; and (2) During medication pass, a Licensed Practical Nurse (LPN) was observed using antiseptic gel to cleanse hands without following manufacturer's recommendations. These observations were evident for 1 of 2 dressing changes and one medication pass on the 3rd floor unit.

This resulted in no actual harm with the potential for more than minimal harm that is not immediate jeopardy.

Findings are:

Acceptable practices include (a) hand hygiene/washing guidelines published by the Centers for Disease Control (CDC) recommend washing hands with soap and water for a minimum of 15 seconds. In addition, (b) dressing change standards are described in the Association for Professionals in Infection Control and Epidemiology (APIC) Policy and Procedure Manual. These standards include several areas describing cleansing wound surfaces, discarding materials used in the dressing change, the use of disposable scissors and the method for sanitizing non-disposable scissors by soaking in alcohol for at least 30 seconds after each use.

1. Resident #6 has diagnoses including Insulin Dependent Diabetes Mellitus and Cerebrovascular Accident (CVA/Stroke) with left-sided weakness. On 6/3/10 at 7:45AM, during a dressing change for a Stage II Pressure Ulcer (3X4centimeters) on the left (calf area) leg, the RN was observed to use community scissors to cut off the soiled dressing. After completing the dressing change, the RN placed the contaminated scissors into the pocket of her uniform without sanitizing them. In addition, handwashing did not follow CDC recommendations. This RN was observed to wash hands at least three times during this observation for only 4 to 5 seconds.

During an interview on 6/3/10 at 8:00AM, the RN was unable to explain her actions.

2. During a medication pass on 6/3/10 at 9:15AM, the LPN used antiseptic gel to cleanse hands between administering medications. However, this LPN was observed to wipe the gel off her hands with a tissue instead of rubbing the gel into the hands until absorbed, per manufacturer's directions.

During an interview on 6/3/10 at 9:30AM, the LPN was unable to explain this action.

415.19(a)(1-3)

Based on interview and record review, the facility did not ensure that it adhered to professional standards of nursing practice in that an injury of unknown origin was not reported and investigated to rule out abuse and/or neglect. This was evident for 1 of 15 sampled residents (Resident #1).

This resulted in no actual harm with the potential for more than minimal harm that is not immediate jeopardy.

Findings are:

Resident #1 was admitted to the facility with diagnoses including Rheumatoid Arthritis and Peripheral Vascular Disease. Review of the Nursing Progress Notes dated 4/17/10 revealed the following note:

"Resident noted to have 3 skin tears on right forearm. Wounds were cleansed with saline and a dry sterile dressing was applied."

Review of the Accident/Incident reports revealed no evidence that Resident #1's skin tears had been investigated to determine a probable cause of the injuries and to rule out abuse and/or neglect.

In an interview with the Director of Nursing on 6/3/10 at 1:30PM, she stated that an incident report for the skin tears had not been completed.

415.11(c)(3)(i)

Based on observation and interview, the facility did not ensure that the survey results were available to residents and/or visitors without having to verbally request them. This was evident for all residents and visitors to the facility.

This resulted in no actual harm with the potential for more than minimal harm that is not immediate jeopardy.

Findings are:

During the annual survey review on 6/3/10 at 2:00PM, it was observed that the latest survey results were not readily available. The Director of Nursing was interviewed at this time as to where these results were located. She then retrieved the binder containing the survey results, located behind a large bouquet of flowers, which blocked the view of these survey results.

415.3(1)(c)(1)(v)