A COVID-19 Focused Emergency Preparedness Survey was conducted by the Centers for
Medicare & Medicaid Services (CMS) on December 9-10, 2020 at Creswell Health and Rehabilitation. The facility was found to be in compliance with 42 with 42 CFR §483.73 related to E-0024 (b)(6).
Total residents: 41
US Department of Health and Human Services
Centers for Medicare and Medicaid Services
Region 10
701 Fifth Avenue, Suite 1600
MailStop RX-400
Seattle, Washington 98104
206-615-2313
A COVID-19 Focused Infection Control Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) with onsite review completed on December 9-10, 2020 and offsite review conducted on 12/14/2020.
Total residents: 41
US Department of Health and Human Services
Centers for Medicare and Medicaid Services
Region 10
701 Fifth Avenue, Suite 1600
MailStop RX-400
Seattle, Washington 98104
206-615-2313
A COVID-19 Focused Infection Control Revisit Survey was conducted by the Oregon State Survey Agency on 3/19/21.
The facility was found to be in compliance with 42 CFR §483.80.
Total residents: 45
Based on interview and record review, the facility failed to consult with the resident's physician when the facility was unable to weigh the resident daily as the physician had ordered for 1 of 3 residents (Resident (R)3) reviewed for care on the COVID-19 unit. This failure had the potential to place the resident at risk for complications associated with increase weight/edema.
Findings included:
R3 had diagnoses that included congestive heart failure (a progressive condition that affects the pumping power of the heart symptoms include swelling in feet, ankles, and legs; weight gain, cough, shortness of breath which could indicate pulmonary edema (excess fluid in the lungs), COVID-19, respiratory failure, and pneumonia.
Physician Order's for R3 included an order dated 10/30/2020 for "Daily weights. Report gain of more than 2 lbs (pounds) between weights or more than or equal to 5 lbs in one week."
On 11/25/2020, R3 tested positive for COVID-19 and was moved to the facility's COVID unit. The nursing documentation in the Progress Notes reviewed the following:
*11/26/2020 10:41 AM - No scale available at this time"
*11/28/2020 10:59 AM - Scale not available"
*11/29/2020 1:54 PM - No weights at this time"
*11/30/2020 10:33 AM - Not able to weigh at this time"
*12/1/2020 1:10 PM - Not able to weigh, hoyer (a mechanical lift) is not calibrated at this time."
*12/3/2020 10:28 AM - Scale not available at this time."
*12/4/2020 12:08 PM - On COVID unit no scale, no signs of weight gain."
*12/6/2020 12:57 PM - Resident in bed D/T (due to) COVID, no weight done."
*12/7/2020 7:54 AM - eight "Unable to obtain"
*12/8/2020 7:13 AM - eight "Unable to obtain"
On 12/14/2020 at approximately 10:30 AM, a telephone interview was conducted with the Director of Nursing (DON). The DON was asked about the ability to weigh R3 when he was on the COVID unit. The DON stated that there was not a scale on the COVID unit. During the discussion regarding R3's weights, the DON stated that staff should have call R3's physician to get the order changed or discontinued.
Resident 3 discharged from the facility on 12/14/2020 related to covid -19 symptoms. MD was notified of daily weights not completed per MD order.Residents on the covid unit with orders related to weights are at risk related to this citation. Resident orders were reviewed, and MD notified of any missed weights. Order updated were received if resident unable to be weighed. Staff were re-educated regarding policies for completion of MD orders, process when orders are not completed, including MD and DNS notification,To ensure on-going compliance the Director of Nursing/designee will complete audits to ensure MD orders were followed, and if unable to be followed- proper MD notification and follow up was completed. These audits will be daily (Monday thru Friday) for two weeks, then weekly for four weeks and will occur monthly until substantial compliance is maintained. Audit outcomes will be reported to monthly quality assurance meeting.Director of Nursing is responsible for compliance, and out date of compliance is 01/05/2021
Based on observation, interview, and record review, the facility failed to maintain an infection prevention and control program that ensured a safe and sanitary environment to help prevent transmission of communicable diseases, including COVID-19 (an infectious disease that spreads person to person and can cause respiratory illness. Symptoms include cough, congestion, sore throat, fever, chills, headache, nausea, vomiting, loss of taste and/or smell, and in severe cases difficulty breathing that could result in severe impairment or death) when staff were unaware of the contact time for the disinfectant wipes being used in the facility. The facility had a total census of 41 residents (28 residents in the COVID-19 unit and 13 residents in the non-COVID-19 unit).
Findings include:
The Centers for Disease Control and Prevention (CDC) recommendations include the following:
"Disinfect with a household disinfectant on List N: Disinfectants for use against SARS-CoV-2, the virus that causes COVID 19. Follow the instructions on the label to ensure safe and effective use of the product. Many products recommend: Keeping the surface wet for a period of time ..." https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html
The information on the Environmental Protection Agency (EPA) List N Tool defined contact time (wet time) as "the amount of time the treated surface should remain wet to be effective against SARS-CoV-2 (COVID-19). The surface should be visibly wet for the full duration of the contact time." https://cfpub.epa.gov/giwiz/disinfectants/index.cfm
Observations in the Non-COVID Unit:
On 12/9/2020 at approximately 9:25 AM, a vital sign monitor was observed to have a container of disinfectant wipes in the attached basket. The container indicated that the wipes were Mycolio Disinfectant Wipes. The label indicated a 3-minute contact time for Mycobacterium bovis BCG, Pseudomonas aeruginosa, Staphylococcus aureus, Poliovirus Type 1, and Trichophyton mentagrophytes; a 2-minute contact time for Vancomycin Resistant Enterococcus faecalis (VRE), Methicillin Resistant Staphylococcus aureus (MRSA), Duck Hepatitis B Virus, Bovine Viral Diarrhea Virus, Avian Influenza A, and Salmonella enterico; and 1-minute contact time for Human Immunodeficiency virus (HIV). The label did not indicate the contact time for COVID-19. The EPA List N Tool for disinfectants used against SARS-CoV-2 (COVID-19) indicated that Mycolio Disinfectant Wipes were effective in killing the COVID-19 virus using a contact time of 3-minutes. Also observed on the non-COVID unit were zip-lock plastic bags with wipes in them. These bags were on each of the Personal Protection Equipment (PPE) carts in the hallways.
At approximately 10:15 AM, a staff person was observed taking the vital signs monitor into a resident's room. After exiting the room, the staff person was observed using the wipes from the Mycolio Wipes container to use on the monitor. The staff person used multiple wipes to wipe all the surfaces on the vital signs monitor. At 10:20 AM, the staff person was asked about the contact time for the Mycolio wipes. The staff person did not seem to understand the term "wet time." It was explained and the staff person (a Physical Therapy Aide) stated she did not know but would find out. At approximately 10:44 AM, the staff person returned and indicated that the label on the Mycolio wipes label indicated that the contact time was 1-3 minutes but that the label did not indicate it was effective for COVID but it was what they were told to use.
At 10:55 AM, a housekeeping staff person was observed using the Mycolio wipes in the hallways. The housekeeper was wiping high-touch areas (hand rails and door knobs). The housekeeper was asked about the Mycolio wipes and how long the surfaces needed to stay wet. The Housekeeper stated, "Oh, I do not know."
At 11:05 AM, a Certified Nursing Assistant (CNA) was observed picking up one of the plastic bags with wipes in it and placing it in her pocket. The CNA was asked about the contact time for the wipes. The CNA stated that she could not remember then said "maybe one minute."
At 11:35 AM, a Licensed Nurse (LN) was observed coming out of a resident's room with a glucometer. The LN wrapped the glucometer in a Mycolio wipe and placed the glucometer on the top of the medication cart. The LN was asked about the wet time for the Mycolio wipes. The LN stated she did not remember but maybe it was 1 minute. The glucometer was wrapped in the Mycolio wipe for longer than 3-minutes.
On 12/9/2020 at approximately 1:30 PM, a dietary worker was asked about cleaning procedures during the COVID-19 pandemic. The dietary worker explained how the staff were cleaning the carts and that additional cleaning was taking place such as wiping high touch areas in the kitchen. The dietary worker was asked what the staff were using to clean the high touch areas. The dietary worker went and got a container of Mycolio Wipes and indicated that the wipes were the product staff was using for the high touch areas. The dietary worker was asked how long the surfaces needed to stay wet when using the Mycolio wipes. The dietary worker indicated that they just learned that but she could not remember for sure. The dietary worker then stated 10 minutes.
On 12/10/2020 at 8:15 AM an interview was conducted with the Director of Nursing (DON). The observations from 12/9/2020 were discussed. The DON acknowledged that the staff needed to know the contact time when using the Mycolio wipes. The DON indicated that the facility would start writing the contact times on the containers and the plastic bags.
Packaging will be labeled with product name and dwell time instructions per manufacture recommendations. No individual residents were identified in this citation. All staff and residents are at risk related to this citation.All staff were re-educated regarding high touch cleaning, disinfection products and dwell (wet) time.To ensure on-going compliance the Administrator/designee will complete audits for proper product labeling of dwell time and observation of dwell time via observation and staff interview. These audits will be daily for two weeks, then weekly for four weeks and will occur monthly until substantial compliance is maintained. Audit outcomes will be reported to monthly quality assurance meeting.Administrator is responsible for compliance and date of compliance is 01/05/2021
