Failure to Implement Covid-19 Precautions, Testing, and Staff Screening
Penalty
Summary
The facility failed to follow public health nurse (PHN) guidance and its own policies for infection prevention and control during a Covid-19 outbreak. Specifically, the facility did not ensure that proper signage for novel respiratory precautions was displayed outside the rooms of residents presumed to be infected with Covid-19. Observations revealed that only one resident's room had the correct signage, while others had signage for enhanced barrier precautions (EBP), which require less stringent use of personal protective equipment (PPE). Interviews with the Infection Preventionist Nurse (IPN) and review of facility policy confirmed that novel respiratory precautions, including full PPE, were required for these residents, but were not implemented until after the surveyor's inquiry. Additionally, the facility did not adhere to the PHN's instructions to test all newly admitted and re-admitted residents for Covid-19 on days 0, 3, and 5. Instead, residents were tested only twice weekly, regardless of their admission or readmission status. This was confirmed through interviews with the Assistant Director of Nursing (ADON) and review of the facility's Covid-19 Mitigation Plan, which also specified the need for serial testing on the specified days. The PHN stated that the facility was expected to follow these serial testing instructions, but this was not done for the sampled residents. The facility also failed to ensure that staff completed Covid-19 rapid antigen tests (RAT) and confirmed negative results before entering patient care areas. An observation showed that a Licensed Vocational Nurse (LVN) began their shift and entered patient care areas before their RAT result was fully developed and confirmed negative. The LVN acknowledged that the test result was unclear and that they should have waited for a definitive result before starting work. Facility policy and PHN instructions required staff to test before each shift and restrict work until a negative result was confirmed.