Don't touch a dirty urinal and then open someone else's milk for them - not without washing your hands in between.
But that's what a certified nurse's aide was spotted doing at a District of Columbia nursing home last year.
The incident is just one of the numerous kinds of problems at local nursing homes you can learn about by researching nursing home inspection data.
And doing that kind of research on the Internet is easier now than ever before, thanks to a new application made available by Pro Publica, an independent investigative journalism outfit.
Pro Publica's news app allows users to search nursing home inspections in all 50 states. You can enter the name of your town, or the name of the facility where your loved one is staying, or research a certain type of infraction or problem.
That's how you can read about the aide who touched a dirty urinal with a gloved hand before opening a patient's milk and handing him a fork, without having washed hands or changed gloves.
An inspector reported the incident last August at Capitol Hill Nursing Center, a 140-bed facility on Constitution Avenue NE.
Capitol Hill was the only nursing facility in Pro Publica's records in the District, Virginia or Maryland that had an "L" deficiency -- one so severe it jeopardized the health and safety of the residents. (The deficiencies are rated by letters, starting at A.)
The urinal-milk connection may have been the yuckiest finding on the inspection report, but it wasn't the most dangerous. That was when the fire alarm failed to sound throughout the building after being pulled on each of five floors. A repairman was summoned and had the alarm working again in a couple of hours, the report said.
Risk of fire is a major threat to nursing home residents because many of them have limited mobility and may have other physical or mental conditions that make it difficult for them to flee without assistance if a fire breaks out. Thirty people died when major fires broke out at nursing home facilities in Nashville, Tenn., and Hartford, Conn., in 2003.
The CMS has had the database available online for several years with a function enables users to perform searches -- that search function used to be pretty clunky, but it has been improved over the years, and now allows for searches by a town, state, ZIP Code or nursing home name.
But Pro Publica's Nursing Home Inspect app is more powerful because it allows for searches of any word in all the reports at once. For instance, searching on "milk" produces 3,340 hits.
But just because Capitol Hill was the only facility to get an "L" rating doesn't mean every other nursing home in the area is perfect.
Seventeen nursing home facilities the District and its primary suburban counties in Virginia and DC rated just one star out of a possible five by CMS, according to an Examiner analysis of the federal data. (See the ratings of all the DC-area nursing homes in the embedded spreadsheet below this story.)
And two of those 17 facilities, both in Maryland, have recently been in the federal government's "Special Focus Facility" program, which targets nursing homes with "a history of serious quality issues."
One, Kensington Nursing and Rehabilitation Center in Montgomery County, just recently got off the Special Focus Facility list, while the other, St. Thomas More in Prince George's County, is still on the list but is marked as having shown improvement, according to a version of the list that was updated just a few days ago.
Nursing home photo by flickr user robinsan, used under a Creative Commons license.
Contact Jennifer Peebles at firstname.lastname@example.org.