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 and interview, the facility failed to protect two of two sampled Residents (Resident 1 and
Resident 2) while performing wound care when the cleaning and sanitizing of the surgical scissors was not
done between each use.This failure had the potential to cause widespread infection among the
residents.Findings:A review of the facility policy titled, Cleaning and Disinfection of Resident-Care
Equipment dated 1/1/2026, indicated, Staff Shall follow established infection control principles for cleaning
and disinfecting reusable; non-critical equipment general guidelines include.d. Multiple resident use
equipment shall be cleaned and after each use.A review of Resident 1's admission Record, indicated
Resident 1 was admitted to the facility on [DATE] with diagnoses that included difficulty walking, need for
assistance with personal care, diabetes and pressure ulcer of the left heel. A review of Resident 2's
admission Record indicated Resident 2 was admitted to the facility on [DATE] with diagnoses that included,
need for assistance with personal care, diabetes and chronic ulcer (open sore or wound that fails to heal),
of other part of right foot.During interview on 1/22/26 at 10:30 am, in Resident 1 & 2's room (Resident 1 and
2 were roommate), Resident 1 stated he came to the facility with right and left heel wounds. Resident 1
stated the right heel healed and the left is receiving treatment and dressing changes. Resident 1 described
his morning routine as being woken up between 5-6 am. Resident 1 stated he is not offered a cloth to wash
his face and hands. He stated he does not receive showers, only sponge baths twice a week, Resident 1 is
unable to stand in a shower due to his heel wound.During an interview on 1/22/26 at 10:28 am, in Resident
1 & 2's room, Resident 2 stated he came to the facility with a diabetic ulcer on his right foot. Resident 2
stated he is supposed to get a shower twice a week. Resident 2 stated he must ask for his care, including
wash clothes to clean his face and hands.During observation on 1/22/26 at 11:20 am, in Resident 1 & 2's
room, observed Licensed Vocational Nurse (LVN A) performing wound treatment to Resident 1's left heel.
LVN A gathered needed supplies to complete task. LVN A reviewed Physician order for treatment. LVN A
began with soaking gauze with saline due to gauze being stuck to the left heel. After saturated by saline,
removed the wet gauze and dabbed the heal dry. LVN A removed scissors from her pocket to cut special
dressing Calcium Alendronate. LVN A applied the dressing to the heel, covered with 4 centimeter by 4
centimeter (cm) gauze then wrapped with gauze dressing and taped. Observed the tape indicated date and
initials. LVN A then placed the uncleaned scissors in her pant pocket.During Observation on 1/22/26 at
11:40 am, in Resident 1 & 2's room, observed LVN A performing wound treatment to Resident 2's right
heel. LVN A gathered needed supplies, reviewed Physician orders. LVN A began removing gauze dressing
with minimal use of saline. After dressing and gauze were removed, dabbed the heel dry. LVN A then
removed the scissors that was previous used on Resident 1 from her pant pocket, cut the special dressing
Calcium Alendronate then applied 4 cm by 4 cm gauze to cover special dressing. Wrapped the heel with
gauze dressing and taped. Observed tape indicated date and initials. LVN A disposed of trash and soiled
towel. Observed
Residents Affected - Some
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 2
Event ID:
055612
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055612
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/29/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Feather River Care Center
1 Gilmore Lane
Oroville, CA 95966
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0880
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
LVN A place the scissors in pant pocket. Observed LVN A did not clean the scissors after resident.During
interview with LVN A on 1/22/26 at 1:52 pm, when asked about the process of wound change and using
personal scissors when working with multiple patients. LVN A stated she forgot to sterilize the scissors in
between each resident. LVN A stated standard is to sterilize equipment between residents.During interview
with Infection Control (IP) at 1:54 pm, when asked the expectation of nurses working with multiple patients
using personal scissors IP stated, the expectation is to disinfect instruments between residents.
Event ID:
Facility ID:
055612
If continuation sheet
Page 2 of 2