Hospital Name: Geneva General

PFI # 0671

Complaints:

Complaint Information: 2002
Complaint Investigations Completed 4
Complaints with Statements of Deficiencies (SOD) Issued 2
% of Complaints with SODs Issued 50%
Regional % of Complaints with SODs Issued 28.6%

Areas Cited:

SOD Date Regulatory Citation Areas Cited Date Plan of Correction Accepted
6/19/2002 405.5 NURSING SERVICES- DELIVERY OF SERVICES 7/17/02
6/19/2002 405.2 GOVERNING BODY- CARE OF PATIENTS NO POC REQUIRED

Areas Cited as a Result of Surveys:

DATE OF SURVEY TYPE Areas Cited: Date Plan of Correction Accepted
5/14/2002 - 5/20/2002 TITLE 18 V344 - FILLING WITH GERMICIDE, CAP CLEANING 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V264 - AAMI-CHEMICAL CONTAM 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V300 - CONDITION OF PARTICIPATION REUSE 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V303 - DIALYZER REPROCESSING MANUAL 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V309 - PERSONNEL QUALIFICATIONS 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V311 - TRAINING DOCUMENTED 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V314 - REUSE EQUIPMENT 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V315 - WATER SYSTEM 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V316 - WATER SYSTEM DISINFECTION 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V320 - MAINTENANCE OF EQUIPMENT 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V322 - REPROCESSING AREA VENTILATION 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V325 - PERSONNEL PROTECTION 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V327 - REUSE SUPPLIES SPECS AND TESTS 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V332 - LABEL INFORMATION 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V262 - AAMI-H20 BACTERIOLOGY 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V159 - PATIENT CARE POLICIES DEVELOPMENT AND REVIEW 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V259 - PHYSICAL ENVIRONMENT FREE OF HAZARDS 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V258 - PHYSICAL ENVIRONMENT EQUIPMENT PM 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V256 - PHYSICAL ENVIRONMENT CONSTRUCTION & MAINTAIN FOR SAFETY 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V232 - MEDICAL RECORD PATIENT ASSESSMENTS 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V189 - LONG TERM PLAN REVIEWED BY TEAM 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V333 - REPROCESSING 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V166 - PATIENT CARE POLICIES RX SERVICES 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V334 - TRANSPORTATION AND HANDLING 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V124 - GOVERNING BODY RESPONSIBILITY FOR REUSE 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V112 - GOVERNING BODY HEALTH AND SAFETY 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V110 - GOVERNING BODY & MANAGEMENT 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V376 - QUALITY ASSURANCE PROCESS REVIEW; OUTCOMES 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V347 - EXTERIOR CLEANING 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V261 - PHYSICAL ENVIRONMENT WATER TREATMENT 8/19/02
5/14/2002 - 5/20/2002 TITLE 18 V187 - WRITTEN LONG TERM PLAN 8/19/02