| 83 |
HALE MAKUA - KAHULUI |
125007 |
472 KAULANA STREET |
KAHULUI |
HI |
96732 |
2018-11-30 |
880 |
E |
0 |
1 |
6SFF11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, observation, record and policy review, the facility failed to post a warning sign of contact precautions at the entrance of two resident rooms, Resident (R) 192 and R8's room. The deficient practice put the staff and visitors at risk of contracting R192's known illness of [MEDICAL CONDITION]-resistant Staphylococcus aureus (MRSA) and R8's active infestation of lice. The facility also failed to ensure direct contact staff demonstrated proper use of gloves with hand hygiene and proper technique for wound care/dressing change. The deficient practice increased R204's risk of illness/ complications of infection. Findings Include: During a record review for R192, revealed the resident had a [DIAGNOSES REDACTED].>During an observation of R192's room, on 11/27/18 at 12:24 PM, several carts were noted to be parked outside the room. One of the carts was yellow, and the other cart was blue and gray. The carts were not marked with a warning sign that would indicate that R192 was on contact precautions. Anyone could have entered the room not knowing that contact precautions were needed. During an interview with Charge Nurse (CN) 41 on 11/27/18 at 12:28 PM, CN41 acknowledged that a warning Sign should have been posted at the entrance of R192's room. Facility policy titled Hale Makua Infection Control Manual for LTC, Contact Precautions was reviewed, it stated At the time a resident is place on Contact Precautions, the Unit Clerk will notify all pertinent departments. Before entering the room of a resident on Contact Precautions, staff and visitors should consult with a licensed nurse for instructions on specific precautions to be taken and Personal Protective Equipment to be used. 2. During an observation on 11/27/2018 at 12:30 PM observed a conspicuous sign outside R8's room that said isolation. The sign did not have any other information (i.e. type of isolation or instructions to report to the nursing station prior to entry) on it. Two residents, R8 and R44 were observed in the room sitting in wheel chairs approximately 5 feet apart. Neither R8 or R44 had any personal protective equipment (PPE) on to prevent transmission of a condition requiring isolation by direct or indirect contact. During an interview on 11/27/2018 at 01:15 PM Licensed Practical Nurse (LPN)130 stated, R8 has head lice, and is on contact precautions. On 11/28/2018 at 10:00 AM, observed the isolation sign on R8's room was gone. During an interview with LPN130 at 10:15 AM who stated that we took it down because someone thought it was a dignity issue. During further interview with LPN130, she pointed out a very small magnet sign located on the door frame. It was difficult to see. On 11/30/2018 Maintenance worker (MW) 115 went to R8's room to check the temperature and was advised R8 was in isolation. Prior to entering the room, MW115 approached surveyor and stated, I didn't see an isolation sign. After the small signage was pointed out to MW115 he put on the appropriate PPE and entered the room. During an interview with RN126 on 11/28/2018 at 2:00PM about the presence of R44 observed in the isolation room [ROOM NUMBER] on 11/27/2018. RN126 stated, That is her regular room. She has been sleeping in another room while R8 is on isolation. R44 didn't want to go to another room and is able to wheel herself around in her wheelchair. She keeps going back into her old room. The facility did not have a process in place to ensure R44 did not enter the isolation room putting her at risk. 3. On 11/29/2018 at 11:16 AM, observed LPN107 preparing for and providing wound care/dressing change on R204's left heel. LPN197 did not clear and clean a space for supplies and did not prepare the supplies in advance. LPN107 did not perform proper hand hygiene and wash hands prior to beginning removing the old dressing. After LPN107 put non-sterile gloves on, she removed the old dressing and disposed of it. With the same gloves LPN107 opened two different drawers on the dressing cart and removed clean supplies from each of the drawers. Some of these supplies were placed on R204's bed. The remainder of the dressing change was completed after washing hands and putting on new gloves. Professional standards of care state when changing a dressing, standard of care is to use aseptic technique to avoid introducing infections into the wound. Position the resident, wash your hands, clear and clean available space for dressing supplies (usually a bedside table), prepare the supplies for the dressing, and wash hands. To remove dressing, after washing hands, put on non-sterile gloves, and remove the old dressing. A wound assessment and visual check should be done. The gloves should be removed, hands washed, and new gloves put on to clean the wound, and again to put on the new dressing. |
2020-09-01 |