| 99 |
MAPLE LEAF HEALTH CARE CENTER |
305030 |
198 PEARL STREET |
MANCHESTER |
NH |
3104 |
2019-05-03 |
880 |
E |
0 |
1 |
2O0511 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was determined that the facility failed establish and follow written policies and procedures for standard and transmission-based precautions and when and how isolations should be used for a resident for 4 of 4 residents observed on precautions. (Resident identifiers are #18, #53, #99, #205.) Findings include: Resident #18 Observation on 4/30/19 at 9:40 a.m. revealed a precaution sign outside of room [ROOM NUMBER]. Interview on 4/30/19 at approximately 9:45 a.m. with Staff B (Unit Manager) revealed that Resident #18 in room [ROOM NUMBER] was on precautions for [MEDICAL CONDITION]. Observation on 4/30/19 at 10:20 a.m. revealed a staff changing Resident #18's bed with gown hanging off of the staff's shoulders. Observation on 4/30/19 at 10:50 a.m. revealed housekeeping cleaning room and mopping floor around Resident #18's bed not wearing a gown or gloves. Observation on 4/30/19 at 1:50 p.m. revealed two Licensed Nursing Assistants (LNA) in Resident #18's room not wearing a gown or gloves. Staff C (LNA) removed the garbage bag from the trash container that contained used gowns and took it down the hallway to the soiled utility room. Observation on 5/1/19 at 8:30 a.m. revealed staff went to deliver food to Resident #18. Staff put food on top of the precaution cart in the hallway and put on a mask and brought the tray into Resident #18 who was in bed. Review on 5/3/19 of Resident #18's care plan dated 4/29/19 revealed that the resident is on contact precautions. Review on 5/3/19 of Resident #18's physician orders [REDACTED]. Interview 5/3/19 at 12:50 p.m. with Staff D (Infection Preventionist) revealed that for some residents on contact precautions, staff only need wear gloves and gowns during direct care, that residents can attend activities and dining and some residents would need to stay in their room and require staff to wear gloves and gowns whenever they enter the resident's room. Staff D revealed the differences in procedure is not reflected in facility policy, on signs, or in the resident's care plan. Staff D revealed that a mask is not a recommendation for contact precautions but is available for use if staff want to wear one. Resident #99 Interview on 4/30/19 at approximately 8:55 a.m. with Staff B (Registered Nurse) revealed that there is a question of bed bugs in Resident #99's room, and the room has been treated for [REDACTED]. Observation on 4/30/19 at 10:22 a.m. of this room revealed there is a precaution cabinet outside the room with PPE (personal protective equipment), but there is no precautions signage or Stop/see Nurse signage at the room entrance. Interview on 4/30/19 at approximately 9:15 a.m. with Staff I (clinical) revealed that instruction was to wear gown and gloves to go into the room. Observation on 4/30/19 at 10:50 a.m. revealed a visitor, without donning any personal protective equipment (PPE), walked into the room and spoke with Resident #99, then carried 2 framed pictures, one at a time, out of the room into the hallway, showing them to people in the hall, then returning the pictures to the room. Interview on 4/30/19 at approximately noon with Staff B revealed gown and gloves indicated when contacting linens/residents, the room was treated for [REDACTED]. Interview on 5/3/19 in the afternoon with Staff G (Director of Nursing) revealed the bed bugs were for Resident #99, they found a couple live bed bugs that Staff G thinks may have come in with Resident #99, he has one treatment to go. Interview on 5/3/19 at 2:04 p.m. with Staff J (clinical) confirmed Resident #99 has one treatment to go. Observation on 5/3/19 at approximately 12:43 p.m. revealed there was a Stop signage at the doorway to Resident #99''s room, there was still a PPE cabinet outside the room but no precaution sign on the PPE cabinet. Resident #205 Interview on 4/30/19 at approximately 8:55 a.m. with Staff B (Registered Nurse) revealed that Resident #205 is on precautions for [MEDICAL CONDITION]. Observation on 4/30/19 at 11:12 a.m. revealed a precaution cabinet outside of Resident #205's room with Contact Precautions signage and a Stop sign at the doorway. Staff K (clinical) was observed at this time in the room near the doorway without PPE on. Staff K exited the room and interview at that time with Staff K revealed Staff K had a mask on as they were only talking to the resident, and they had just removed it, Staff K related gloves are only needed if touching/doing care, if entering the room and only talking just need a mask. Observation on 4/30/19 until 11:24 a.m. revealed, after Staff K exited the room, a visitor was observed in the room with Resident #205, the resident was not visualized as they were behind a pulled curtain. The visitor came into view, and was observed wearing a mask and gloves but no gown. The visitor was touching things in the room including a grasping tool. Interview on 4/30/19 at approximately noon with Staff B revealed that for Resident #205, one should wear gown and gloves when contacting linens, the resident; and a mask is not needed in the room. Interview on 5/1/19 at approximately 1:54 p.m. with the resident's daughter revealed Resident #205 is presently on precautions for [DIAGNOSES REDACTED] ([MEDICAL CONDITION]); after staff finish care the staff discard their gown/gloves in the trash then remove the liner and replace it; after the resident uses the bedside commode the staff puts the contents in a bag and removes it. Observation of the room at time of this interview revealed the bathroom in the room is located on the roommate's side of the room, by the room entrance. There is only one sink in the room which is not in the bathroom but is in the room itself, again on the roommate's side. Resident #205's bed is at the far side of the room, by the window, separated from the roommate by a pulled curtain. There is a portable commode located between Resident #205's bed and the window wall, and the waste basket, which has a plastic liner, is also adjacent to the window wall. Record review on 5/2/19 at 9:22 a.m. of Resident #205's Discharge Summary for Date of Service 4/15/19 reveals Metabolic [MEDICAL CONDITION] due to [DIAGNOSES REDACTED] and secondary active [DIAGNOSES REDACTED]. Record review on 5/2/19 at 12:27 p.m. of the Admission Minimum Data Set assessment dated [DATE] revealed that that Resident #205 has frequent incontinence of urine and bowel, and Section I codes [DIAGNOSES REDACTED]. Interview on 5/3/19 at 9:37 a.m. with Staff B revealed Staff usually have bags with them that they put their PPE into when they are done, and then take the bag out of the room; similarly after commode use, the liner with waste is taken out of the room to the dirty utility. Record review on 5/3/19 at 12:24 p.m. of Resident #205's physician's orders [REDACTED]. Record review of the facility's [DIAGNOSES REDACTED]icile-Contact Precautions sheet, provided on survey, and dated 5/1/18, reveals, in part, that gloves are to be used When giving direct care. Also, The use of gowns when giving direct care will depend on site of infection and residents sign & symptoms. Resident #53 Observation on 4/30/19 at approximately 9:30 a.m. of Resident #53 revealed Resident #53 was sitting in a common area of the 3rd floor wing. There was a precautions cart and a sign identifying that the purpose for the cart was Droplet Precautions. The cart was located outside of a room that had four resident occupants. Staff was queried as to whom the precautions were for, the staff identified Resident #53 who was sitting in the common area. At the same time that the observation was taking place, a member of the Laundry staff delivered laundry items to the room in question. Laundry staff did not don Personal Protection Equipment prior to entering the room. Interview on 4/30/19 at 10:15 with Staff H (3rd floor Unit Manager) revealed that Resident #53 had Upper Respiratory Infection (URI) symptoms. Resident #53 was given an influenza test that resulted negative. Observations that occured at 9:30 a.m. were revealed to Staff H. Staff H responded that the concerns would be addressed. Interview on 5/3/19 at 12:10 PM with Staff D (Infection Preventionist) and Staff G, Registered Nurse, revealed that facility staff is empowered to initiate precautions if it is suspected by staff that infection prevention is needed. Staff D revealed that Resident #53 was suspected of requiring droplet precautions and that unit staff were finding it difficult to keep a mask on her or monitoring Resident #53's movements in the hallway. |
2020-09-01 |