OSHA Inspection: SBH-NORTH DENVER, LLC

Issued

2019-07-24 00:00:00

Abate by

2019-10-28 00:00:00

Penalty

Initial $9661.00 · Current $9661.00

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970: 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 exposed to physical threats and assaults by patients:  (a)  SBH-North Denver, LLC, dba Clear View Behavioral Health, at 4770 Larimer Parkway, Johnstown, CO: On and preceding 1/28/19, 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 exposed to physical threats and assaults by patients.  Employees, including nurses and mental health technicians, were exposed to incidents of violent behavior by patients, including punches, kicks, forceful grabs, pushes, head butting, biting, and tripping, that resulted in serious injuries including bites, sprains, lacerations, bruising, scratches, concussion, and injuries to the head, torso, and legs.  Employees were exposed to the hazard of physical threats and assaults when attempting to restrain patients, and during routine interactions with patients who had known histories of violent behavior.  Such interactions included, but were not limited to, intake and daily communications with patients. The employer had not established or implemented effective measures to protect employees from assaults or other physical violence in the workplace.  Abatement Note:  Among other methods, feasible and acceptable means to abate the WPV hazards at Clear View Behavioral Health include implementation of a comprehensive and effective WPV prevention program which includes engineering and administrative controls, as well as training to materially reduce WPV hazards.  These controls include:     Engineering Controls:    1.   Provide a reliable and readily available communication device (e.g., personal panic alarm or walkie-talkie) to all employees who may work in close proximity to patients, including but not limited to nurses, MHTs, housekeeping staff, and case workers.  Provide training on this equipment and ensure that the equipment is maintained in working order at all times.  2.  Ensure that nurses? stations that are located outside units have unobstructed views into the units.    Administrative Controls:     3.  Designate staff on each shift to monitor and respond to any incident of violence.  Designated staff (e.g., Code Purple team, security staff, or crisis intervention specialists) must not be given other assignments that would prevent them from immediately responding to an incident.  Staff must have the physical capability and training to effectively respond to aggressive patients.  4.  Ensure that appropriately trained and experienced personnel staff units whose patients pose potential or actual aggressive threats.  Maintain staffing that is adequate for census and patient acuity, taking into consideration patient aggression and history of violence.  5.  Update and implement the WPV policies identified in the written comprehensive WPV prevention program (WVPP) ?Security Management Program.? The plan should include (1) A worksite-specific hazard assessment of the worksite for risks of workplace violence to employees, including but not limited to, potential weapons, potential for victims to be cut off from communication, delays in activating emergency alert systems, potential for physical entrapment of victim.  The assessment should also include a records review and employee surveys to further assess potential risks; (2) Tracking, trending and investigation of prior incidents to identify root causes and implement controls to prevent future occurrences.  (3) Hazard prevention and control measures that address patient-on-employee violence, providing clear written procedures for how employees should respond to patients making threats, showing aggression, and assaults; (4) Mechanisms for the participation of direct care staff such as MHTs and RNs, e.g., through the committees that discuss WPV incidents.  Ensure the WVPP continues to be effective by (1) providing copies of the WVPP and making it readily available to all staff; (2) Annually reviewing the WVPP annually and updating as necessary; (3) Soliciting employee feedback at all staffing levels during the review process; and (4) Providing bi-annual training on the WVPP to all staff.    6.  Establish a system to communicate to all affected staff members any incidents of WPV and/or escalating behavior to ensure that the on-coming staff members are notified and aware of a patient?s previous acts of violence or aggression.  Information sharing should occur during shift change as well as with other staff (such as food service employees) who may come in contact with aggressive patients.  Assure that affected staff have dedicated time to review all intake information on a patient before working with them.     Training:    7.  Ensure all staff members who may come into contact with patients in the course of their work are trained in all elements of a comprehensive WVPP, including opportunities for them to be involved in evaluating and improving the program.  Training should specifically include: (1) When and how to call for assistance, including how to use emergency communication systems such as walkie-talkies and/or panic buttons to initiate a response and use of the PA system (or other means) to summon additional help; (2) Uniform and effective methods for responding to a ?Code Purple? or other type of WPV incident; (3) Hands-on exercises for de-escalation and restraints that include practice drills and assault scenario drills to improve staff skills and confidence in responding to Codes, emphasizing and providing training on the importance of team restraint.  Include training tactics that teach self-extrication and escape; (4) How to contribute to a post-incident debriefing and/or root cause analysis; and (5) Properly wearing and storing badges/communication devices so they cannot be taken or grabbed at by patients.  The hands-on exercises, practice drills and assault scenario drills should occur at least bi-annually and more frequently based upon employees? abilities.  A staff member is not considered available to assist with incidents of WPV if they are not able to complete the training and/or they are not comfortable implementing the appropriate actions while working with aggressive patients.     Post Incident:    8.   Conduct an investigation and debriefing after each act of WPV, including near misses, with the attacked and/or injured employee and other involved employees, including root cause or similar analysis, lessons learned, and corrective actions to prevent re-occurrence.  Maintain accurate records of patient assault upon staff.  Provide the attacked and/or injured employee and other involved employees an opportunity to provide feedback about specific measures that could prevent such future incidents.  Review and evaluate each WPV related incident, both on a case-by-case basis and to monitor for trends in areas with high rates of incidents such as the 400 and 500 units.  Make available reports of root cause analysis and corrective measures to all personnel.  Ensure that all personnel have an opportunity to be informed of WPV incidents in the workplace and employer intended corrective actions.

Issued

2019-07-24 00:00:00

Abate by

2019-08-28 00:00:00

Penalty

Initial $6440.00 · Current $3445.00 Reduced

General-duty citation text

29 CFR 1910.1030(c)(1)(iv)(B): The annual review and update of the Exposure Control Plan did not include annual consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize occupational exposure:    (a)  SBH-North Denver, LLC, dba Clear View Behavioral Health, at 4770 Larimer Parkway, Johnstown, CO: On and preceding 1/28/19, the employer did not ensure that the annual review and update of the Exposure Control Plan included annual consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize occupational exposure.  Employees performed nursing and other healthcare duties at Clear View Behavioral Health, including but not limited to injection of medications using syringes with needles or blood sugar checks using lancets.  The employer determined that employees were occupationally exposed to blood or other potentially infectious materials (OPIM).  The employer's annual review of the Exposure Control Plan did not include consideration of commercially available and effective safer medical devices.  This condition exposed employees to bloodborne pathogens hazards.

Issued

2019-07-24 00:00:00

Abate by

2019-08-28 00:00:00

Penalty

Initial $6440.00 · Current $3447.00 Reduced

General-duty citation text

29 CFR 1910.1030(d)(2)(vii)(A): Contaminated needles and other contaminated sharps were bent, recapped, or removed:    (a)  SBH-North Denver, LLC, dba Clear View Behavioral Health, at 4770 Larimer Parkway, Johnstown, CO: On and preceding 1/28/19, the employer did not ensure that contaminated needles and other contaminated sharps were not bent, recapped, or removed.  Employees performed nursing and other healthcare duties at Clear View Behavioral Health, including but not limited to assisting patients with shaving.  After being used by patients, Mental Heath Technicians recapped the used disposable razors prior to disposal.  The used disposable razors were contaminated sharps.  This condition exposed employees to bloodborne pathogens hazards.

Issued

2019-07-24 00:00:00

Abate by

2019-08-28 00:00:00

Penalty

Initial $0.00 · Current $0.00

General-duty citation text

29 CFR 1910.1030(d)(4)(iii)(A)(2)(i): During use, containers for contaminated sharps were not easily accessible to personnel or located as close as was feasible to the immediate area where sharps were used or could be reasonably anticipated to be found:  (a)  SBH-North Denver, LLC, dba Clear View Behavioral Health, at 4770 Larimer Parkway, Johnstown, CO: On and preceding 1/28/19, the employer did not ensure that containers for contaminated sharps were easily accessible to personnel or located as close as was feasible to the immediate area where sharps were used or could be reasonably anticipated to be found.  Employees performed nursing and other healthcare duties at Clear View Behavioral Health, including but not limited to injection of medications using syringes with needles or blood sugar checks using lancets.  Nurses administered medications using multiple syringes with Medline safety needles to patients in Quiet Rooms or other areas on units.  Following injections, the nurses transported the multiple contaminated sharps to sharps containers located within Med Rooms, behind locked doors, for disposal.  The employer did not ensure that sharps containers were easily accessible or located as close as feasible.  This condition exposed employees to bloodborne pathogens hazards.  (b)  SBH-North Denver, LLC, dba Clear View Behavioral Health, at 4770 Larimer Parkway, Johnstown, CO: On and preceding 1/28/19, the employer did not ensure that containers for contaminated sharps were easily accessible to personnel or located as close as was feasible to the immediate area where sharps were used or could be reasonably anticipated to be found.   Employees performed nursing and other healthcare duties at Clear View Behavioral Health, including but not limited to injection of medications using syringes with needles or blood sugar checks using lancets.  Nurses administered insulin using Kendall Monoject syringes with needles to patients in their rooms.  Following injections, the nurses transported the contaminated sharps to sharps containers located within Med Rooms, behind locked doors, for disposal.  The employer did not ensure that sharps containers were easily accessible or located as close as feasible.  This condition exposed employees to bloodborne pathogens hazards.

Issued

2019-07-24 00:00:00

Abate by

2019-08-28 00:00:00

Penalty

Initial $6440.00 · Current $3447.00 Reduced

General-duty citation text

29 CFR 1910.1030(g)(2)(vii)(F): The bloodborne pathogens training program did not contain an explanation of the use or limitations of methods that would prevent or reduce exposure including appropriate engineering controls, work practices or personal protective equipment:    (a)  SBH-North Denver, LLC, dba Clear View Behavioral Health, at 4770 Larimer Parkway, Johnstown, CO: On and preceding 1/28/19, the employer did not ensure that the bloodborne pathogens training program contained an explanation of the use or limitations of methods that would prevent or reduce exposure including appropriate engineering controls, work practices or personal protective equipment.  Employees performed nursing and other healthcare duties at Clear View Behavioral Health, including but not limited to injection of medications using syringes with needles or blood sugar checks using lancets.  The employer determined that employees were occupationally exposed to blood or other potentially infectious materials (OPIM).  The employer's new employee initial bloodborne pathogen training did not include training with regards to the medical devices, including but not limited to, syringes, lancets, and needles used by nursing staff.  This condition exposed employees to bloodborne pathogens hazards.    (b)  SBH-North Denver, LLC, dba Clear View Behavioral Health, at 4770 Larimer Parkway, Johnstown, CO: On and preceding 1/28/19, the employer did not ensure that the bloodborne pathogens training program contained an explanation of the use or limitations of methods that would prevent or reduce exposure including appropriate engineering controls, work practices or personal protective equipment.  Employees performed nursing and other healthcare duties at Clear View Behavioral Health, including but not limited to injection of medications using syringes with needles or blood sugar checks using lancets.  The employer determined that employees were occupationally exposed to blood or other potentially infectious materials (OPIM).  The employer's annual bloodborne pathogen training did not include training with regards to the medical devices, including but not limited to, syringes, lancets, and needles used by nursing staff.  This condition exposed employees to bloodborne pathogens hazards.

Issued

2019-07-24 00:00:00

Abate by

2019-08-28 00:00:00

Penalty

Initial $0.00 · Current $0.00

General-duty citation text

29 CFR 1910.1030(f)(1)(ii)(D): The employer did not ensure that all medical evaluations or procedures including the hepatitis B vaccine, vaccination series, post-exposure evaluation, or follow-up, including prophylaxis, were provided according to recommendations of the U.S. Public Health Service current at the time the evaluations or procedures took place:  (a)  SBH-North Denver, LLC, dba Clear View Behavioral Health, at 4770 Larimer Parkway, Johnstown, CO: On and preceding 1/28/19, the employer did not ensure that all medical evaluations or procedures including the hepatitis B vaccine, vaccination series, post-exposure evaluation, or follow-up, including prophylaxis, were provided according to recommendations of the U.S. Public Health Service current at the time the evaluations or procedures took place.  Employees performed nursing and other healthcare duties at Clear View Behavioral Health, including but not limited to injection of medications using syringes with needles or blood sugar checks using lancets.  The employer determined that employees were occupationally exposed to blood or other potentially infectious materials (OPIM).  The employer did not ensure that all employees who accepted the hepatitis B vaccination series were provided the vaccination series.  This condition potentially exposed employees to a bloodborne pathogen hazard.

Issued

2019-07-24 00:00:00

Abate by

2019-08-28 00:00:00

Penalty

Initial $0.00 · Current $0.00

General-duty citation text

29 CFR 1910.1030(f)(2)(iv): The employer did not assure that employees who declined to accept the hepatitis B vaccination offered by the employer signed the statement in Appendix A:  (a)  SBH-North Denver, LLC, dba Clear View Behavioral Health, at 4770 Larimer Parkway, Johnstown, CO: On and preceding 1/28/19, the employer did not assure that employees who declined to accept the hepatitis B vaccination offered by the employer signed the statement in Appendix A.  Employees performed nursing and other healthcare duties at Clear View Behavioral Health, including but not limited to injection of medications using syringes with needles or blood sugar checks using lancets.  The employer determined that employees were occupationally exposed to blood or other potentially infectious materials (OPIM).  The employer did not obtain signed declination forms from all employees who declined the hepatitis B vaccination.