OSHA Inspection: WILMINGTON NURSING & REHABILITATION CENTER, LLC

Issued

2013-09-25 00:00:00

Abate by

2014-02-03 00:00:00

Penalty

Initial $7000.00 · Current $7000.00

General-duty citation text

OSH ACT of 1970 Section (5)(a)(1): The employer did not furnish employment and a place of employment which were free from recognized hazards that were causing or likely to cause death or serious physical harm to employees, in that employees were required to perform tasks resulting in physical stressors that caused and are likely to cause musculosketal disorders (MSDs): At Wilmington Nursing & Rehabilitation Center, LLC, employees, including State Tested Nursing Assistants, manually lift, transfer, ambulate and reposition non-weight bearing and partial weight bearing residents, exposing them to tasks resulting in injuries.     Feasible Means of Abatement     Abatement will include:      Implement and enforce the comprehensive Resident Safe Handling Program which provides resident handling and movement policy and procedures to ensure that the lifting, transferring repositioning and assisted ambulation needs of all residents are assessed and that all responsible staff are aware and trained on the appropriate equipment and correct procedures to eliminate manual lifting, reduce the risk of staff injury and maintain a safe work environment.    The implemented policy and procedures will include:  1.       Staff Responsibilities:   a.       Leadership (Nursing Home Administrator (NHA), Director of Nursing (DON), Therapy Manager (PTM) will:    i.      Support the implementation of resident handling and movement policies,    ii.      Provide sufficient resources through the budget process to acquire and furnish              adequate lifting equipment/device aids for staff to accomplish safe resident handing movement, and   iii.      Incorporate resident handling equipment into new construction design or when remodeling physical space.    b.      Ensure employee participation throughout entire resident handling program.     c.       Department Managers (DON,PTM) will:     i.      Identify high risk tasks throughout the facility to ensure manual lifting more than 35 pounds  of the resident?s body weight is eliminated.  ii.      Ensure resident handling tasks are completed as per care plan protocol and using the mechanical lifting devices and other approved resident handling equipment and devices,    iii.      Ensure resident handling equipment and devices are maintained and conveniently stored,    iv.      Ensure training on resident handling policy and procedures, and equipment are provided,   v.      Maintain resident handling training records for a minimum of three years  vi.      Ensure the staff has the right to refuse to perform or be involved in resident handling task that will expose the employee to an unacceptable risk for injury.     d.      Maintenance Department will:    i.      Maintain all resident handling equipment and devices in proper working order as established by the manufacturer guidelines.  ii.      Maintain equipment and devices using a preventive maintenance schedule and repair work order  iii.      Ensure back up batteries are charged and available for all equipment and on all shifts    e.      Employees will:     i.      Complete education and training on use of resident handling equipment and devices,   ii.      Identify and recognize the risk of injury during manual resident lifting, transferring, repositioning or assisted ambulation.   iii.      Participate in the resident handling program and by using the appropriate devices and equipment when necessary to safely move residents at minimal risk to staff members.      2.       Resident Assessment:   The transferring needs of each resident will be assessed and the most appropriate lifting, transferring, repositioning and assistive ambulation devices will be based on the resident?s ability to bear weight, follow directions, assist with bed mobility, ability to ambulate, and the rehabilitation goals.  Resident assessment tools such as but not limited to Algorithms, Minimum Data Set Section G: Functional Status, Functional Independent Measure will be used to assess a resident?s transferring needs and identify the most appropriate method to lift and move the resident while eliminating manual lifting more than 35 pounds of the resident?s body weight by the staff. Convey the safe lifting and transferring methods to all staff responsible for the resident care through formal shift change meetings, care plan documentation and training.   The resident assessment tools will be used to determine:  a.       Transfer to and from: bed to chair, chair to toilet/commode, chair to chair, or car to chair  b.      Lateral transfers to and from bed to gurneys  c.       Transfer to and from chair to gurney  d.      Reposition in bed: side to side or up in bed   e.      Reposition in chair, wheelchair or dependency chair  f.        Transfer resident up from the floor   g.       Assisted ambulation for every resident with balance, strength or endurance limitations.      Identify all high risk tasks throughout the facility to ensure manual lifting more than 35 pounds of the resident?s body weight is eliminated.  Communicate resident assessment findings to all resident handling staff.      3.       Workplace Assessment:   The resident?s rooms, bathrooms, bathing areas and floor transitions should be assessed to identify risk factors that might contribute to resident handling incidents. This includes bedroom space constraints, furniture that might interfere with transfers or repositioning, the bathroom configuration, the shower room constraints, the distance from the resident?s room or dining room to the shower/toilet room, bed height adjustability, the battery storage area, the equipment storage locations and other physical barriers that might restrict movement of lifting equipment.  Ensure the slipping hazard in the shower room is eliminated.      4.       Training:    Training on all shifts responsible for safe resident lifting program will include administrators, nursing staff, physical and occupational therapy staff, maintenance staff and the direct care providers on the corporate ergonomics program.  Training will include: how to recognize MSDs and their early indications, advantages of addressing early indications of MSDs before serious injury has developed, be able to recognize the physical risks associated with  manual resident handling versus use of mechanical equipment, and demonstrate competence in the use of equipment and the  company safety program, policies and procedures to follow for resident lifting, transferring, repositioning, and assisted ambulating.       5.       Equipment:  A sufficient amount of appropriate equipment will be provided with the variety of appropriate slings for the tasks to enable mechanical lift, transfer, ambulation and repositioning for the residents and protect the staff.  The number of lifts to ensure safety of the direct care provider depends on the physical dependency, but one full dependency lift is needed for every 8 to 10 non-weight bearing residents.  One sit/stand lift should be provided for every 8 to 10 partial weight bearing residents to eliminate manually lifting more than 35 pounds of the resident?s body weight.  Ambulation aids are needed for every resident with balance, strength or endurance limitations.  Repositioning devices with friction?reducing aids or slip sheets should be available to assist with any repositioning needs to eliminate manually lifting more than 35 pounds of the resident?s body weight.  Weighing scales should be incorporated into some of the assistive devices.  All resident bed heights and full dependency lifts must be easily adjustable.  Batteries and slings will be readily available at all times for easy access.        6.       Medical Management Program:  All injuries should be reported promptly to the nurse manager on duty. Each injury should be investigated so that the root cause can be addressed and preventative measures can be implemented. Work restrictions should be closely monitored so that employees never work outside of their work restrictions. This should be a joint effort between NHA, DON, HR and the employee.  Provide recordkeeping training to record and monitor resident handling injury patterns and calculate resident handling incident rates.  Address resident handling Injuries through Safety/Resident Handling Committee to determine root cause of the injury and develop solutions.       7.       Corporate oversight:   Enforce and support implementation of company's resident handling and movement program to eliminate manual lifting during transfers, repositioning and assisted ambulation.  a.       Provide resident handling and movement program audits to include:     i.      Establish baseline resident handling injuries baseline data by tracking and trending of resident handling injuries and severity by year,      ii.      Determine root causes of resident handling injuries on all shifts by capturing description of the incident and the resident care activity performed during the occurrence of the injury, and where the incident occurred.

Issued

2013-09-25 00:00:00

Abate by

2013-11-13 00:00:00

Penalty

Initial $5000.00 · Current $5000.00

General-duty citation text

29 CFR 1910.1030(c)(1)(ii): The employer's Exposure Control Plan did not contain at least the elements in 29 CFR 1910.1030(c)(1)(ii)(A) through (c)(1)(ii)(C):    The employer did not ensure that the written bloodborne exposure control plan included the following information:    a) Exposure Determination-job classifications and evaluation of occupational exposure to blood;    b) Determination of annual consideration of safer needle devices;    c) Identification of the appropriate disinfectant to be used to clean-up blood;    d) The person responsible for initiating the Hepatitis B vaccination and titer;    e) The location of the Occupational Health Clinic or Emergency Department where employees could receive medical attention in the event of an exposure indicent;    f) Procedure for laundering personal clothing that becomes contaminated with blood or other infectious materials;    g) The identity or title of the person responsible for maintaining the medical records and recording activities following an exposure;    h) Documentation that the exposure control plan had been reviewed and updated annually.

Issued

2013-09-25 00:00:00

Abate by

2013-11-13 00:00:00

Penalty

Initial $0.00 · Current $0.00

General-duty citation text

29 CFR 1910.1030(c)(1)(v): An employer, who is required to establish an Exposure Control Plan shall solicit input from non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps in the identification, evaluation, and selection of effective engineering and work practice controls and shall document the solicitation in the Exposure Control Plan.  The employer did not ensure that employees who are potentially exposed to injuries from contaminated sharps were given the opportunity to evaluate and select safer needle devices.

Issued

2013-09-25 00:00:00

Abate by

2013-11-13 00:00:00

Penalty

Initial $5000.00 · Current $0.00 Reduced

General-duty citation text

29 CFR 1910.1030(g)(2)(i): The employer did not ensure that each employee with occupational exposure participated in a training program:    The employer did not ensure that employees with potential occupational exposure to blood or other infectious materials was provided initial training according to 1910.1030(g)(2)(vii)(A-N) in that employees such as but not limited to State Tested Nursing Assistants (STNAs) did not have initial training.

Issued

2013-09-25 00:00:00

Abate by

2013-11-13 00:00:00

Penalty

Initial $0.00 · Current $0.00

General-duty citation text

29 CFR 1910.1030(g)(2)(vii)(N): The bloodborne pathogens training program did not contain an opportunity for interactive questions or answers with the person conducting the training session:    The employer did not ensure employees had the opportunity for interactive questions and answers in that employees took annual bloodborne training via Silverchair computer based training while at home and no instruction as to whom to contact in the event of a question.

Issued

2013-09-25 00:00:00

Abate by

2013-11-13 00:00:00

Penalty

Initial $5000.00 · Current $5000.00

General-duty citation text

29 CFR 1910.1030(f)(1)(ii)(D): Provided according to recommendations of the U.S. Public Health Service current at the time these evaluations and procedures take place, except as specified by this paragraph (f).  The employer did not ensure that employees were tested for the Hepatitis B antibodies 1-2 months after receiving the 3 dose vaccine series according to current Center for Disease Control (CDC).

Issued

2013-09-25 00:00:00

Abate by

2013-10-15 00:00:00

Penalty

Initial $1000.00 · Current $1000.00

General-duty citation text

29 CFR 1904.8(a):  Work-related needlestick injuries or cuts from sharp objects contaminated with another person�s blood or potentially infectious material were not entered on the OSHA 300 Log as a privacy case.  The employer did not ensure that needlestick injuries were listed on the OSHA 300 Log as privacy cases in that the OSHA 300 Log for 2012 revealed employee's names on the log.

Issued

2013-09-25 00:00:00

Penalty

Initial $0.00 · Current $0.00

General-duty citation text

29 CFR 1910.1030(h)(5)(i): The employer did not establish and maintain a sharps injury log for the recording of percutaneous injuries from contaminated sharps:  The employer did not establish and maintain a sharps injury log.