Bridge View Nursing Home

Based on observations, record review and staff interviews, the facility did not ensure that a resident who displayed psychosocial adjustment difficulty received appropriate treatment and services to correct the assessed problem. Specifically, the staff did not ensure that a newly admitted resident with wandering behavior had interventions identified and implemented to address this behavior. This was evident for one (1) of twenty-nine (29) sampled residents. (Resident #18)

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

The finding is:

Resident #18 is an 85 year old male admitted on 1/15/10 with diagnoses which include: Parkinson"s Disease, Hypertension, Prostate Cancer, and Anemia.

The Minimum Data Set (MDS) 2.0 Assessment dated 1/28/10 documented that the resident has short and long term memory problems with moderate cognitive impairment.

On 2/5/10, at approximately 10:30-11:00 a.m., the resident was observed entering room 215A (the room of a female resident-Resident #14). The staff were observed coming in and out of the adjacent rooms, and were not observed re-directing the resident to his room.

On 2/8/10, at approximately 3:15-4:30 p.m., the resident was observed seated in a chair inside his room, and was asleep.

On 2/9/10, at approximately 9:30-10:45 a.m., the resident was observed sitting in a chair in his room with his arms folded over his chest, and asleep.

The Patient Transfer Form dated 1/15/10 documented:"Resident does not adjust well with changes...withdrawn and spends most of his time into his room..."

The Comprehensive Care Plan (CCP) dated 1/27/10 documented:
"Alteration in Mood State" as evidenced by: Unhappy with roommate; Anxiety; Social Isolation Related to: Institutionalization/relocation; Non-English speaking; Parkinson's Disease; Goals/Time Frame: Resident will verbalize/demonstrate effective coping strategies as evidenced by: Less wandering into other residents rooms; Time frame 90 days; Team intervention; Provide 1:1 visits; Provide calm environment, respect, individuality, and personal care; Provide reality orientation and reassurance; Encourage participation in rehabilitation, recreation, and ADL's..."

The Comprehensive Care Plan (CCP) dated 1/27/10 documented:
"Alteration in Behavior, Potential; Wandering; ADL (Activities of Daily Living) assistance...Team interventions: Encourage verbalization of feelings; Encouragefamily/significant other support; Maintain calm environment; Anticipate needs..."

Review of the Resident Care Accountability Record from January 15, 2010 through February 8, 2010 revealed no documented evidence that the resident required monitoring for Behavioral Problems ie: (for example Wandering).

The nurse's note dated 1/16/10 at 7:15 a.m. documented, "Awake all night pacing in his rm.(room) entering other residents room...resident stated I want to go home..."

The nurse's note dated 1/16/10 at 10:40 p.m. documented, "Ambulatory on unit most of the evening wandering into residents rooms..."

The nurse's note dated 1/17/10 at 9:50 p.m. documented, "Ambulatory on unit wandering into other residents rooms..."

The nurse's note dated 1/22/10 at 7:50 a.m. documented: "Resident alert and responsive removed from room for safety secondary to roommates behavior sitting accross from nsg (nursing) station for safety."

The nurse's note dated 1/22/10 at 1:35 p.m. documented: Room change recommended by SW (social worker). Awaiting decision at this time.

There was no documented evidence that interventions were identified and implemented to specifically address the resident's unhappiness with his roommate or the residents wandering behavior.

There was also no documented evidence that the unit SW and/or other members of the interdisciplinary team folluwed up with the possible room change for the resident.

The Certified Nurse Assistant (CNA) was interviewed on 2/9/10 at 11:00 a.m. and stated that she wasn't specifically told that the resident had been wandering into other residents rooms and that it had become a problem.

An interview was conducted with the unit Licensed Practical Nurse (LPN) on 2/9/10 at 12:15 p.m. The LPN stated that the CNA's are given verbal reports at the beginning of each shift related to changes in the condition of the residents assigned to them. The LPN further stated that she was unable to recall if the residents wandering and/or issues with the residents roomate had been discussed with the CNA's.

The unit Social Worker (SW) was interviewed on 2/9/10 at 11:30 a.m. The SW stated that he was not aware that the resident had "actually" been wandering in and out of other residents rooms, and had not read the "nurses notes." The SW also stated that he thought that the residents would be compatible as roomates "because they are both from Colombia and speak Spanish."

415.12(f)(1)

Based on observations, record review, and staff interviews, the facility did not ensure that infection control practices were maintained to prevent the development and transmission of infection during a medication pass observation. This was evident for one (1) of twenty-nine (29) sampled residents. (Residents #19)

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

The finding is:

Resident #19 is an 88 year old female with diagnoses which include unstable Angina, Left Lower Lobe Pneumonia, and Insulin Dependent Diabetes Mellitus.

The Minimum Data Set (MDS) 2.0 Assessment dated 11/10/09 documented that the resident has modified independence in decision making, transfer activity, and supervision for eating.

The physician's orders dated 1/20/10 documented: Calcium 500 mg (milligrams) + (plus) Vitamin D 125 IU (International Units) 1 (one) p.o.(per oral) bid (twice per day).

On 2/5/10, at 10:30 a.m., a Medication Pass observation was conducted with the unit Licensed Practical Nurse (LPN).

After the unit LPN poured the Calcium (tablet) into the medication cup, utilizing the stock bottle cap, she dropped the bottle cap onto the floor. The LPN then picked up the bottle cap from the floor with her bare hands, placed the cap onto the narcotic book (which was on the medication cart) and did not wash her hands. She then took a tissue and stated that she was going to "clean the top off " (the stock bottle cap) with the tissue. The LPN then touched the medication cup containing the other medications that had been previously poured.

The LPN was immediately interviewed and stated that she would not proceed further with the medication pass and would get another bottle of stock Calcium tablets from the medication room. The LPN further stated that she would discard the medication cup containing the poured medications that had become contaminated from her unwashed hand.

The LPN washed her hands and obtained an unopened stock bottle of Calcium tablets from the medication room. When the medication pass was resumed, the LPN was observed piercing the protective covering of the bottle top with her pen.

An interview was immediately conducted with the LPN. The nurse initially denied using her pen to pierce the top of the bottle, but did acknowledge the observation by the surveyor when she peeled the label back and ink was visible on the protective label.

The bottle was then given to the (Registered Nurse) Inservice Coordinator for disposal.

On 2/5/10 at 11:30 a.m., an interview was conducted with the Registered Nurse (RN) Inservice Coordinator. The RN stated that all the nurses are inserviced and observed performing a medication pass when they are hired, and again if problems are identified. The RN stated that the nurse would be re-inserviced on infection control practices, and to be observed on medication pass.

415.19(a)(1-3)

Based on observations, and interview conducted, it was determined that the facility did not ensure that housekeeping and maintenance services maintained an orderly interior. Reference is made to the torn wall paper on the second floor dining room and call bell mount not properly installed on the wall.

This resulted in no actual harm with the potential for minimal harm.

The findings are:

On February 4, 2010, at approximately 10:34 A.M., the resident dining room on the second unit was visited. Eleven (11) residents were congregated in the dining room.

Investigation of the physical environment revealed that the wall paper was torn apart in various places with pieces of the wall paper hanging from the wall. The locations of the missing wall paper (torn apart) included near the main door (1 foot), near television area ( 2 foot) section.

Furthermore, the call bell mount in the resident dining room on the second unit was not installed properly on the wall. Gap was observed around the wall mount (opening of the sheetrock). Also, the call bell box was not leveled with the wall,as it was pushed inside the wall.

This Finding was brought to the attention of the Administrator and Maintenance Director on 2/5/10 at approximately 3:00 p.m., they stated that this issue will be corrected.

NYCRR 415.5(h)(2)
415.29

Based on record review and staff interviews, the facility did not ensure that policies and procedures were implemented to protect residents from mistreatment. Specifically, that residents were not safeguarded from a resident (Resident #30) with documented behavioral outbursts directed towards his roommates. This was evident for 1 of 29 sampled residents (Resident #18) and 2 out of sample residents. (Residents #31, and #32)

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

The findings are:

1) Resident #30 is an 84 year old male admitted with diagnoses which include: Dementia, Depression with Psychosis, Diabetes Mellitus, and Cataracts.

The Minimum Data Set (MDS) 2.0 Assessment dated 10/02/09 documented that the resident has short and long term memory problems, and moderate cognitive impairment. The MDS further documented that the resident is independent in transfer, ambulation and toilet use.

The physician's orders dated 12/27/09 and 1/24/10 documented Risperdal 0.5 mg (milligrams) p.o.(per oral) twice per day.

The Comprehensive Care Plans (CCP) for Alteration in Behavior dated 10/1/09 documented "... Socially inappropriate ...roommate problems... Resident will not display behavior that may cause harm to himself/(herself) or others. Time frame: indefinite."

The CCP Social Work entry dated 10/1/09 documented "Has sporadic episodes of behavioral disturbances where he can be a danger to self and others...At (name of hospital) inpatient psych (psychiatric) attempting to light paper in his room with a lighter. Is controlling in his room shuts lights off, and roommate's television if he wants to go to sleep, is oblivious to roommates rights..says he pays $ 600 (six hundred dollars)..for the entire room..."

The CCP Social Work entry dated 12/29/09 documented "Has sporadic episodes of behavioral disturbances where he can be a danger to self and others...One occasion was hospitalized at (name of hospital) inpatient psychiatric noted trying to light paper in his room with a lighter...Complains of roommate...claims room belongs to him..."

A nurse's note dated 1/07/10 at 10 p.m. documented "... Resident kept pulling out the oxygen plug of his roommate (Resident #31). Supervisor and Social Worker notified. Resident was informed by nursing staff not to unplug the oxygen anymore..."

A nurse's note dated 1/22/10 at 7:05 a.m. documented "Resident angry and yelling at roommate and refuse to let him stay in the room. Stating "I pay for this rm (room), I don't want him here" in Spanish..."

A nurse's note dated 1/22/10 at 1:40 p.m. documented "Resident was spoken to this shift re: (regarding) behavior towards roommate on previous 11p-7a tour ... Resident maintains that he pays for the room, so it belongs to him. SW (Social Worker) recommended a room change for roommate. Awaiting decision."

2) Resident #18 is an 85 year old male admitted on 1/15/10 with diagnoses which include: Parkinson's Disease, Hypertension, Prostate Cancer, and Anemia.

The Minimum Data Set 2.0 Assessment dated 1/28/10 documented that the resident has short and long term memory problems with moderate cognitive impairment.

The Patient Transfer Form dated 1/15/10 documented, "Resident does not adjust well with changes...withdrawn and spends most of his time into his room..."

The nurse's note dated 1/22/10 at 7:50 a.m. documented: "Resident alert and responsive removed from room for safety secondary to roommates behavior sitting across from nsg (nursing) station for safety."

The nurse's notes dated 1/22/10 at 1:35 p.m. documented: Room change recommended by SW (social worker). Awaiting decision at this time."

There was no documented evidence that the unit SW and/or other members of the interdisciplinary team followed up with the possible room changes for the residents. (Resident #18 or Resident #30)

3) Resident #31 is a 57 year old male admitted to the facility from 9/18/09-1/25/09 (when resident left facility against medical advice) with diagnoses which include: Diabetes Mellitus, Hypertension, and Coronary Artery Disease.

Resident #31 shared a room with Resident #30 during his stay in the facility.

The Minimum Data Set (MDS) 2.0 Assessment dated 10/01/09 documented that the resident has no short and long term memory problems or cognitive impairment.

A "Social Service Department Assessment" dated 10/1/09 documented: "...Is controlling in room with lights, air conditioner, and use of television...Social Worker had to counsel ...about his behavior with his roommate... (name of Resident #31).

A review of the resident's Comprehensive Care Plan dated 9/18/09, revealed no documented evidence of interventions to address potential or actual issues with his roommate. (Resident #30)

There was no documented evidence that residents were protected from the documented behavioral outbursts of Resident #30.

An interview was conducted with the unit Social Worker (SW) on 2/9/10 at 6 p.m. The SW stated that he spoke to to the DNS (Director of Nursing) and the Administrator about the resident's issues with his roommate. The SW further stated that he spoke to the resident (Resident #30) via an interpreter, and informed the resident that if he continued to have problems with his roommate that he would be "subject to an involuntary room change since he is the aggressor."

The SW also stated "the only way to solve the problem is to do a room change, thought that the residents would be compatible as roommates because they speak Spanish."

An interview was conducted with the Director of Nursing on 2/09/10 at 7:20 p.m. The DNS stated that she was aware of the problem with the resident's current roommate (Resident #18), but was told by the SW that he would take care of it, and thought that he had.

An interview was conducted with the Administrator on 2/9/10 at 7:55 p.m. The Administrator stated that if there were any behavioral issues between the residents, the information is discussed in the morning meeting with the team. The Administrator also stated that if it is determined that a dangerous situation exists, then the recommendation is made for a room change.

The Administrator also stated that she usually writes her own notes from the morning meetings and did not recall the incident on 1/7/10 relating to the removal of another resident's oxygen.

415.4(b)

Based on record review and staff interview, the facility did not ensure that the resident received medication according to the physician's order. This was evident for one (1) of thirty (30) sampled residents. (Resident #14)

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

The finding is:

Resident #14 is a 72 year old with diagnoses which include Chronic Heart Failure, Hypertension, Diabetes Mellitus, Chronic Artery Disease, and Neuropathy.

The Minimum Data Set (MDS) 2.0 assessment dated 1/25/2010 documented the resident with modified independence in cognitive skills, with mild pain less than daily, receiving 14 medications in last 7 days."

On 2/5/2010 at 2:15 P.M., the resident's medical record and Medication Administration Sheet (MAR) were requested by the surveyor for a review.
The MAR dated 2/2/2010-2/5/2010, documented no medication nurse's signatures for medications that should have been administered at 10 AM and 2 PM.

On 2/5/2010 at 2:25 P.M., the resident was observed in her room during the individual interview, seated in a regular wheelchair. The Medication Licensed Practical Nurse walked in the resident's room and administered to the resident two of her medications scheduled for 2 PM: Isordil Titra and Neurontin. The Nurse signed the MAR after the administration of medication.

The Medication Administration Record dated 2/1/2010-2/5/2010 documented that the resident was supposed to receive at 10AM following medications: 1) Uti-stat Liq (liquid) 887ml, 30 ml orally, 2) Micronase 5mg tablet, 2 tabs (tablets)= (equals) 10 mg orally (twice a day), 3) Os-cal +D 500 mg tablet, 1 tab orally (twice a day), 4) Isordil Titra, 10 mg tablet, 1 tab orally (3 times a day), 5) Neurontin 600mg tablet, 1 tab orally (4 times a day), 6) Senokot 2 tabs PO (orally) & (at) am, 7) ASA/Aspirin (baby) 81mg, 1 tab orally daily, 8) Tenormin 50 mg tab, 1 tab orally every morning, 9) Lasix 40 mg tablet, 1 tab orally daily, 10) Prilosec 20 mg capsule, 1 cap orally daily, 11) Cymbalta 30mg capsule, 1 cap (capsule) orally daily.

On 2/5/2010 at 2:25 P.M., the Licensed Practical Nurse was interviewed and stated she administered to the resident her 10 AM medication at approximately 11:45 AM.

On 2/5/2010 at 2:15 P.M., the Registered Nurse (RN) covering for the Unit Manager was interviewed and stated she saw that the medications were administered to the resident before lunch. The RN further stated that "medications should be administered according to the physician's order and the MAR should have been signed when the meds were given. "

415.11(c)(3)(ii)

Based on observations, record reviews, and staff interviews, the facility did not ensure that professional standards of quality were maintained. Specifically:

-The licensed nurses did not pick-up a physician's order for rehabilitation services in a timely manner. (Resident #6);

-The licensed nurses did not assess a resident for the presence of a blister to the left hip, apply protective dressing and notify the physician in a timely manner. (Resident #9);

1) did not notify the Physician when a medication ordered to be given four times per day was administered late, 2)did not sign the MAR ( Medication Administration Record) at the time the medication was then administered, 3) did not notify the physician that a resident had developed a left hip blister or apply a protective dressing to the blister for a period of 6 (six) days, and did not ensure that a Physician's telephone orders for PT (Physical Therapy) referral and rehabilitation were signed by the Physician in a timely matter. This was evident for 3 of 30 sampled residents ( Residents #6, #9, and #14)

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

The findings are:

1) Resident #6 is a 84 year old with diagnoses which include Dementia, and Dysphagia.

On 2/8/10 at around 3:00 P.M., Resident #6 was observed in the dayroom sitting in her wheelchair.

The Minimum Data Set (MDS) 2.0 dated 1/19/10, documented that the resident requires total assistance for transfers, dressing, eating, and personal hygiene.

A physician's telephone order dated 1/29/10 at 12:30 p.m. documented, " PT (Physical Therapy) referral for transfer status, and possible FAP (Floor Ambulation Program)."

The physician's orders for Rehabilitation Services dated 2/2/10 documented: "Nursing Rehab Intervention As Needed: "Transfer max (maximum) (A) (assistance) x 2 (times two). D/C (discontinue) previous transfer status. Resident to be placed on FAP (Floor Ambulation Program) twice daily by the CNAs (Certified Nursing Assistants). Resident to ambulate with max (maximum) (A) assistance x 2(times two) with RW( rolling walker) with w/c (wheelchair) follow up to 20 to 25 ft (feet).

The physician's order dated 2/2/10 documented signatures by the 7-3, 3-11, and 11-7 shift nurses.

There was no documented evidence that the physicians order was signed in a timely manner. The physician's order was not signed until 2/9/10.

On 2/8/10 at 3:30 P.M., the Registered Nurse Manager was interviewed and stated, "Once we get the rehab order, the nurse will call the MD (physician) to see if the order is okay, and all three nurses will sign for it." The facility has a system where the nurse will flag the order and then would have the MD sign it. One nurse from each shift will sign off on the order.

The Policy and Procedure for "Telephone orders" effective 12/04, documented:" The nurse taking the telephone order:
"...Places the telephone order in the resident'chart in such a manner so as to indicate the date and time of the order, and the nurse responsible for taking the order.
All telephone orders are flagged in the Physician's section of the medical record. These orders are reviewed and signed by the attending Physician (or Medical Director) within 48 hours."
...All telephone orders must be countersigned by the Physician within 48 hours. Such countersignature shall bear the date of signing in the Physician's own handwriting."

2) Resident #9 is an 83 year old with diagnoses which include history of Left Hip Pressure Ulcer, Kyphoscoliosis, Rhabdomyolysis, Peripheral Vascular Disease, and Dementia.

The Minimum Data Set (MDS) 2.0 Assessment dated 10/9/2009 documented the resident with severe cognitive impairment, totally dependent on staff for all activities of daily living, without pressure ulcers.

The Pressure Ulcer risk assessment dated 10/9/2009 documented a score of 12, a total score of 8 or above represented high risk for skin break.

The Skin Impairment Care Plan (CP) dated 10/27/2009 included the following interventions: "treatment to affected site as per current MD (medical doctor's) order, toilet Q (every) 2-4 H (hours) & (and) PRN (as needed), protective/preventive skin care, surgical consultation, weekly decubiti charting/rounds, nutritional supplements as per MD order..."

The nurse's note dated 11/07/09 documented at 7:30 A.M., "L (left) hip blister noted (blood filled), protective dressing applied. There is no documented evidence that a skin assessment regarding the presence of a blister was conducted, or the physician was notified about the blister until 11/15/09.

The CP was updated on 11/7/09 and documented, "Blister was noted to L hip (bloodfilled). Protective dressing applied. Also noted to have a UTI (Urinary Tract Infection). Started on Ampicillin 500 mg (milligrams)...skin is kept well lubricated and will observe for deterioration. Good skin care continues to help prevent complication."

The first Weekly Pressure Ulcer, Stasis Ulcer & new Wound Flow Sheet dated 11/12/09 describes L Hip (blister) as stage II, oval in shape, 3 cm (centimeters) x 3 cm in size, treatment: protective dressing daily.

The Treatment Administration Record (TAR) dated 10/22/09-11/17/09 documented no protective dressing from 11/12/09 until 11/15/09.

The interim physician's telephone order dated 11/15/09 documented, "Protective dsg (dressing) to L (left) hip daily" and was transcribed to the TAR.

The nurse's note dated 11/16/09 documented, "Blister to L hip opened, pink in color, 0 (zero) drainage, noted new order for bacitracin oint. (ointment), cover & (with) DD (dry dressing) daily, (after) cleanse & (with) NS (normal saline)."

On 2/9/2010 at 11:15 A.M., the Registered Nurse (RN) Manager was interviewed and confirmed she wrote the nursing note dated 11/7/2009. She further stated that according to the facility's pressure ulcer protocol, when the resident is identified with redness or blister, an assessment should be done by the nurse, the physician notified, and an order for treatment would be obtained. The RN Manager stated that the physician's order should be transcribed to the TAR and implemented, while the nurse should document in the progress note that the physician was notified.

3) Resident #14 is a 72 year old with diagnoses which include Chronic Heart Failure, Hypertension, Diabetes Mellitus, Chronic Artery Disease, and Neuropathy.

The Minimum Data Set (MDS) 2.0 assessment dated 1/25/2010 documented the resident with modified independence in cognitive skills, with mild pain less than daily, and receiving 14 medications in last 7 days. "

On 2/5/2010 at 2:15 P.M., review of the Medication AR dated 2/2/2010-2/5/2010, documented no medication nurse's signatures for medications that should have been administered at 10 AM and 2 PM.

On 2/5/2010 at 2:25 PM the resident was observed in her room during the individual interview, seated in a regular wheelchair. The Medication Licensed Practical Nurse walked in the resident's room and administered to the resident two of her medications scheduled for 2 PM: Isordil Titra and Neurontin. The Nurse signed the MAR after the administration of medication.

The Medication Administration Record dated 2/1/2010-2/5/2010 documented that the resident was supposed to receive at 10AM following medications: 1) Uti-stat Liq (liquid) 887ml, 30 ml orally, 2) Micronase 5mg tablet, 2 tabs (tablets)= (equals) 10 mg orally (twice a day), 3) Os-cal +D 500 mg tablet, 1 tab orally (twice a day), 4) Isordil Titra, 10 mg tablet, 1 tab orally (3 times a day), 5) Neurontin 600 mg tablet, 1 tab orally (4 times a day), 6) Senokot 2 tabs PO (orally) & (at) am, 7) aSa/Aspirin (baby) 81 mg, 1 tab orally daily, 8) Tenormin 50 mg tab, 1 tab orally every morning, 9) Lasix 40 mg tablet, 1 tab orally daily, 10) Prilosec 20 mg capsule, 1 cap orally daily, 11) Cymbalta 30mg capsule, 1 cap (capsule) orally daily.

On 2/5/2010 at 2:25 PM the Licensed Practical Nurse was interviewed and stated she administered to the resident her 10 AM medication at approximately 11:45 AM, but did not sign the MAR because she got distracted.

There was no documented evidence in the nurse's notes for 2/5/2010 that the Medical Doctor was notified of late administration of 10 AM medication.

On 2/5/2010 at 2:15 PM the Registered Nurse (RN) covering for the Unit Manager was interviewed and stated that although the resident's MAR documented no signatures for 10 AM medication, she saw that the medications were administered to the resident before lunch. The RN further stated that the "MAR should have been signed when the meds were given."

415.11(c)(3)(i)

NYCRR 415.14(h) The facility shall store, prepare, distribute and serve food under sanitary conditions; and in accordance with the sanitary requirements of Part 14 (Service Food Establishments) of Chapter I (State Sanitary Code) of this Title.
STATE ONLY

Based on Observation and interview it was determined that the food items in the main freezer, walk in refrigerator and reach in refreigerator were not stored as to allow proper air circulation. Cardboard boxes were stored with other refrigerated foods. This can result in cross contamination of foods.

The findings are:

On Februry 4,2010, it was observed during the Annual Survey that the facility's three (3) refrigerators and main freezer was surveyed for proper food storage and temperature control.

In the main freezer, food items such as meats, pizza, fish, cold cut were stored too compacted as not to allow for proper air circulation during storage.

In addition to the main freezer, the walk in refrigerator was not accessible due to storage of carts with pudding, milk, grape juice that congested the refrigerator.

A cold storage unit was observed in the kitchen area which had shredded mozzarella cheese, soy milk, eggs etc...items were stored ( cheese) below the fan unit. Also, in this unit many cardboard boxes were observed stored with ready to eat foods.

In an interview with the Dietary supervisor on 2/4/10, she stated that these boxes come off the truck and storage is a problem especially for the foods as these cardboard boxes which come off the trucks are stored with other ready to eat foods.

415.14 (h)

Based on observation during a Life Safety Code survey, hazardous areas were not protected on three (Resident Units 6, 4, 3) of six resident units. Issues include doors protecting hazardous areas that did not self-close into their door frames.

This was a pattern with no actual harm with potential for more than minimal harm that is not immediate jeopardy.

REPEAT DEFICIENCY

The Findings are:

1. Observation on 2/4/10 at 11:00 AM, revealed the soiled linen room door on resident unit six (6) did not self-close into its door frame.

2. Observation on 2/4/10 at approximately 11:15 AM revealed the soiled linen room door on resident unit four(4)did not self-close into its door frame.

3. Observation on 2/5/10 at approximately 10:15 AM revealed the Soiled linen door on resident unit three (3) did not self-close into its door frame.

In an interview with the Maintenance Director on 2/5/10 he stated that the soiled linen door needed a hinge adjustment, and he stated that all doors will be adjusted to self-close in its frame.

10 NYCRR 415.29(a)(2), 711.2(a)(1)
1997 NFPA 101:13-3.2.1
2000 NFPA 101: 19.3.2.1

Based on observation and interview it was determined that the facility did not secure oxygen tanks properly in the basement. This was evidenced by two oxygen 'E' cylinders stored directly on the floor without a rack or chained to avoid tipping over.

The finding is:

On 2/04/10 and 2/05/10 between 9:00 A.M. and 3:00 P.M., the following was noted:
Two (2) full oxygen cylinders were noted to be stored in the Oxygen Storage room in the basement. The 'E' cylinders were stored standing directly on the floor without a rack or chained to avoid tipping over.

In an interview on 2/05/10 at 10:40 A.M., the Maintenance Director stated that the tanks should be stored in the two cylinder stands and that nursing was responsible for securing these oxygen tanks upon delivery.

NFPA 99,4.3.1.1.2, 19.3.2.1.

711.2(a)(1)