Kohala Hospital

“NURSING SERVICES CFR(s): Nursing services must meet the needs of patients. (1) A registered nurse must provide (or assign to other personnel) the nursing care of each patient, including patients at a SNF level of care in a swing-bed CAH. The care must be provided in accordance with the patient’s needs and the specialized qualifications and competence of the staff available. This Standard is not met as evidenced by: 39754 Based on record review, staff interview and review of policy, the facility failed to follow food/liquid preparation guidelines for one Patient (P)1 of three sampled. As a result of this deficient practice, P1 sustained skin burns from re-heated coffee. Findings include: Review of Electronic Health Record (EHR) showed P1 was admitted on 06/29/21 with diagnosis including Benign Prostatic Hyperplasia, Adjustment disorder, Hypothyroidism, Dementia, Primary Cancer of Skin. Facility Reported Incident (FRI), dated 03/27/24, read that P1 was sitting in the day room watching TV. P1 requested and was served hot coffee and accidently spilled it on abdomen sustaining 1st and 2nd degree burns. Staff interview on 12/04/24 at 09:40 AM, Staff Nurse 2 revealed during the incident previously mentioned, after P1 requested the coffee to be reheated, staff reheated the coffee in the microwave. Staff did not know that only the kitchen staff supposed to reheat food/liquids so they could monitor the temperature. Review of EHR showed Physician Note, dated 03/27/24, read patient seen for burns to chest and abdomen from spilled hot coffee ... Reporting increased pain ... Silvadene with Adaptic dressing and will follow closely ... Review of EHR showed Advanced Practice Registered Nurse Note, dated 04/08/24 read patient denies any pain or discomfort. Burns healing well ... Nursing reported no issues with pain during dressing changes ... Facility policy on Food Preparation read the following: Purpose, to provide guidelines to the Critical Access Hospital element of Kohala Hospital’s dietary staff on proper food preparation. Policy, standardize recipes are used for all food preparation. Food service manager and dietary department are responsible for the preparation and maintaining the quality and safety of patient and staff meals. Standardization of recipes, maintaining the recipe file, and supervising their use is overseen by the food service manager. Procedure, High standards of sanitation in followed for defrosting, preparing and cooking food products as well as in the serving of food products ... The cook II checks the temperature of food for safety using a stem thermometer ...”

“FREEDOM FROM ABUSE, NEGLECT & EXPLOITATION CFR(s): Freedom from abuse, neglect and exploitation (§483.12(a)(1), (a)(2), (a)(3)(i), (a)(3)(ii), (a)(4), (b)(1), (b)(2), (c)(1), (c)(2), (c)(3), and (c)(4) of this chapter). “ §483.12(a)(1) Freedom from abuse, neglect, and exploitation. The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart. This includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident’s medical symptoms.(a) The facility must-(1) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion; “ §483.12(a)(2) Ensure that the resident is free from physical or chemical restraints imposed for purposes of discipline or convenience and that are not required to treat the resident’s medical symptoms. When the use of restraints is indicated, the facility must use the least restrictive alternative for the least amount of time and document ongoing re-evaluation of the need for restraints. “ §483.12(a)(3) Not employ or otherwise engage individuals who- (i) Have been found guilty of abuse, neglect, exploitation, misappropriation of property, or mistreatment by a court of law; (ii) Have had a finding entered into the State nurse aide registry concerning abuse, neglect, exploitation, mistreatment of residents or misappropriation of their property. “ §483.12(a)(4) Report to the State nurse aide registry or licensing authorities any knowledge it has of actions by a court of law against an employee, which would indicate unfitness for service as a nurse aide or other facility staff. “ §483.12(b) The facility must develop and implement written policies and procedures that: (1) Prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property, (2) Establish policies and procedures to investigate any such allegations, “ §483.12(c) In response to allegations of abuse, neglect, exploitation, or mistreatment, the facility must: (1) Ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. (2) Have evidence that all alleged violations are thoroughly investigated. (3) Prevent further potential abuse, neglect, exploitation, or mistreatment while the investigation is in progress. (4) Report the results of all investigations to the administrator or his or her designated representative and to other officials in accordance with State law, including to the State Survey Agency, within 5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken. This Standard is not met as evidenced by: 39754 Based on record review, staff interview and review of policy, the facility failed to recognize and thoroughly investigate possible abuse for one Patient (P)1 of three sampled. As a result of this deficient practice, P1 was at increased risk for potential abuse or mistreatment. Findings include: Review of Electronic Health Record (EHR) showed P1 was admitted on 06/29/21 with diagnosis including Benign Prostatic Hyperplasia, Adjustment disorder, Hypothyroidism, Dementia, Primary Cancer of Skin. Facility Reported Incident (FRI) dated 10/15/24 read staff found multiple bruise to left forearm and big bruise to left upper arm measured 4x2cm prior to giving shower. Staff interview on 12/05/24 at 11:00 AM, Nurse Manager (Mgr)3 acknowledged that the facility did not further investigate possible abuse for P1. Review of EHR showed Nurse Note, dated 10/14/24, read alert charting, continue to monitor for multiple fading bruises on the left forearm, no changes noted ... Review of EHR showed Nurse Note, dated 10/17/24, read ... alert for bruise to left forearm ... Facility policy on Patient/Resident Abuse read the following: Purpose, to establish guidelines for the prevention, identification and protection of patients/residents right to be free from abuse and establish the standard for a “no tolerance” for patient and resident abuse ... To effect early identification and reporting of suspected dependent adult abuse and neglect cases to DHS-Adult Protective Services ... To conform to OBRA requirements requiring reporting of any bodily injury to any dependent adult eighteen (18) years of age or older. To conform to the Medicaid contract and Administrative Rules requiring reporting of any bodily injury. To conform to 42 CFR 483.13 and 483.15, there must be evidence that all alleged violations are thoroughly investigated, and that action(s) have been taken to prevent further potential abuse while the investigation is in progress ... Procedures; Identification, any instance of suspected abuse must be thoroughly investigated following hospital and legal policies and procedures, including reporting to local law enforcement agencies as required ... All threatened or alleged incidents of patient/resident abuse shall be thoroughly investigated and documented. Incidents of unwitnessed patient/resident injury will be considered possible patient abuse cases ... The CNE or designee will conduct the initial abuse investigation and local law enforcement will pursue their own investigation ...”