Health inspection·December 28, 2023

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide a sanitary environment when one out of three sampled residents, (Resident 1), had oxygen tubing, suctioning tubing and yankhauer (hard tube-like plastic tool which is placed into a person ' s mouth to suction secretions) laying on Resident 1 ' s bedroom floor. Residents Affected - Few This failure had the potential to transmit communicable diseases and infections to Resident 1. Findings: During a review of Resident 1 ' s record titled, admission Record, dated 11/28/2023 indicated Resident 1 was admitted on [DATE]. Resident 1 was admitted with cancer of the major salivary glands (glands located in and around the mouth area), trouble swallowing, muscle weakness and a gastrostomy tube, (tube inserted directly into the stomach used for nutrition when a person cannot eat using their mouth). During a review of Resident 1 ' s record titled, Order Summary Report, indicated Resident 1 had an order for: 1. Oxygen 2 liters via nasal cannula (tube that is connected to oxygen on one end and the other end is placed in a person ' s nose to deliver the oxygen) as needed. 2. Change the nasal canula every night shift on Sundays and as needed. 3. Speech therapy to work with Resident 1 with trial diets to assess if Resident 1 could tolerate food and fluid via the mouth. During a review of Resident 1 ' s record titled, Care Plans, dated 12/1/2023 indicated Resident 1 had mouth care daily, and to ,cue Resident 1 to cough and clear secretions as able and suction as needed. During an interview on 12/6/2023 at 9:20 am, with Resident 1, Resident 1 appeared confused. Resident 1 attempted to respond but was only able to make sounds. During an observation on 12/6/2023 at 9:20 am, in Resident 1 ' s room, observed Resident 1 ' s bed against the wall with a portable oxygen tank next to his bed with oxygen tubing connected to it. The oxygen tubing did not have a date on it and it was laying on the floor under the portable oxygen tank. Resident 1 had a suction machine on a small dresser next to his bed with tubing and a yankhauer. Page 1 of 2 055512 055512 12/28/2023 Wolf Creek Care Center 107 Catherine Lane Grass Valley, CA 95945

F 0880 The tubing and yankhauer were laying on the floor under his bedside table. Level of Harm - Minimal harm or potential for actual harm During an interview with Licensed Vocational Nurse (LVN) 1, on 12/6/2023 at 9:25 am, stated she did not know when the oxygen tubing or suction tubing had been placed in Resident 1 ' s room. LVN 1 stated the oxygen tubing, should be changed weekly, dated, and stored in a black bag (an antimicrobial bag to decrease bacteria), hanging on Resident 1 ' s bed. LVN 1 was unsure how to store the suction tubing and yankhauer in Resident 1 ' s room. LVN 1 confirmed Resident 1 ' s oxygen tubing should have been dated. LVN 1 confirmed Resident 1 ' s oxygen tubing, suction tubing and yankhauer should not have been on the floor. Residents Affected - Few During an interview on 12/6/2023 at 10:25 am, with Director of Nursing (DON), confirmed the oxygen tubing should have been dated. DON confirmed Resident 1 ' s oxygen tubing, suction tubing and yankhauer should not have been left on the floor. During an interview on 12/6/2023 at 11:00 am, with Assistant Director of Nursing (ADON), confirmed Resident 1 ' s oxygen tubing should be changed weekly, dated, and stored in an antimicrobial black bag at the resident ' s bedside and not on the floor. 055512 Page 2 of 2