Failure to Ensure Timely TB Screening for Staff
Penalty
Summary
Facility staff failed to fully implement their infection prevention and control program by not ensuring that two LPNs received the required two-step tuberculosis (TB) screening test prior to working on the floor, as mandated by facility policy. The policy required all new employees to receive a two-step PPD skin test upon hire and an annual one-step TB test thereafter, with documentation kept in employee files. However, the facility was unable to provide personnel files or TB test documentation for the two LPNs in question. One LPN confirmed during interview that they had worked on the floor without a TB test, and the Business Office Manager stated that neither LPN was an employee of the corporation or a staffing agency, and no TB test records were available for them. Multiple staff interviews, including with the facility physician and Medical Director, confirmed that staff should have a negative TB test prior to working with residents. The Administrator acknowledged that staff should have their first TB skin test read before working on the floor but was unaware of who authorized the LPNs to work or their employment status. Both LPNs worked as charge nurses without the required TB screening, and the facility census at the time was 44.