Summary of Remedial Measures. To remedy the deficiencies identified above, Piedmont should promptly implement the minimum remedial measures set forth below. Specifically, the Facility should: Review the 2008 NCCHC Jail Standards and use those standards to create and adopt facility-specific policies, focusing from the outset on the standards deemed “essential” by the NCCHC. Revise medical policies to include policies on chronic care, infection control, and quality assurance. Increase medical staffing by hiring additional staff with higher credentials (e.g. RNs, LPNs, and a psychiatrist) and increasing the hours that current staff—most especially the doctor—are onsite. Specifically, hire at least two RNs; add 6 LPNs, which will allow for a reduction in the number of CNAs; increase the physician’s onsite hours to at least 23 hours per week, and, in conjunction with hiring a psychiatrist, increase the mental health counselor’s hours or hire a nurse practitioner to cover additional hours. Limit the tasks that CNAs undertake to those that they are credentialed to perform, and ensure that proper physician supervision is provided. Specifically, among other things, CNAs should not be performing intake screenings or clinical evaluations, and should not take medication orders. Ensure that security officers are not rendering medical decisions regarding prisoners’ care, and make sure that there are clear guidelines in place for any security officers providing clinical support, with physician oversight. Ensure that all initial screenings are performed by trained staff and documented electronically, including documentation of any referrals to the physician. Implement a policy that provides guidance to nurses about when to refer prisoners to the physician following screening, sick call, or emergency visits. Conduct comprehensive health assessments of all prisoners within fourteen days of their arrival, with a physician either conducting the screening or overseeing RNs who conduct the screening. Provide for physician oversight, including periodic review, of sick call, with nursing protocols and clinical assessment forms that guide the nurses performing sick call. Develop a detox procedure that includes the Clinical Institute Withdrawal Assessment tool for prisoners at risk of alcohol withdrawal and requires physician input before nurses can treat prisoners withdrawing from abused substances. Implement a chronic care program that identifies prisoners for enrollment; defines illness...
