Health inspection·August 23, 2019

F 0684 A review of the physicians order for Resident 50, dated July 3, 2019, indicated Accucheck AC and HS . Level of Harm - Minimal harm or potential for actual harm During an interview with LVN 3, on August 21, 2019, at 11:29 AM, LVN 3 stated she was supposed to wipe the first drop of blood and test the second drop of blood according to the facility policy and procedure. LVN 3 further stated she did not know why she had not been doing that. Residents Affected - Few During an interview with the Director of Nursing (DON), on August 23, 2019, at 8:40 AM, the DON stated the facility policy and procedure indicated staff should be discarding the first drop of blood and testing the second drop of blood if alcohol is used because alcohol may alter the blood sugar result. The facility policy and procedure titled Obtaining a Fingerstick Glucose Level revised December 2011, indicated Steps in the Procedure: .7. Obtain a blood sample by using a sterile lancet (a spring-loaded lancet or manual lancet). Discard the first drop of blood if alcohol is used to clean the fingertips because alcohol may alter the results. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055872 If continuation sheet Page 2 of 11 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 055872 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Nursing Center 9440 Citrus Ave Fontana, CA 92335 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. During an observation on August 19, 2019, at 9:10 AM, an oxygen concentrator (A device that provides concentrated oxygen by taking in air, purifying it, then delivering the oxygen) and oxygen tubing in a dated plastic bag was noted at Resident 87's bedside. During review of the clinical record for Resident 87, the admitting physician orders dated July 15, 2019, is written for Oxygen at 2 liters (liter-a unit of measurement) per minute via nasal cannula PRN (as needed) for SOB (shortness of breath). During an observation on August 19, 2019, at 9:32 AM, a Certified Nursing Assistant (CNA 4) observed placing a Oxygen in use/No smoking sign out outside of Resident 87's room (35 days after the oxygen use was initiated). During review of the clinical record for Resident 87, the admission assessment dated [DATE], indicated Resident 87's current room and bed assignment was unchanged since admission. During an interview with CNA 4 on August 20, 2019, at 10:10 AM, he stated that he was told that the Resident 87's room needed an oxygen in use sign. During interview with CNA 4 on August 21, 2019, at 8:10 AM, he stated he does rounds every Monday to inventory and inspect oxygen concentrators. He stated that he noticed that Resident 87's room did not have an oxygen in use sign on the door and he put up an oxygen in use sign after discovering that oxygen was being used in the room. The facility policy and procedure titled Oxygen Therapy revised July 2018 states under the section Equipment and Supplies, The following equipment and supplies will be necessary when performing this procedure .Oxygen in use sign. Based on observation, interview, and record review, the facility failed to ensure a safe environment when: 1. For one of three residents (Resident 13), the resident was found in possession of smoking materials without being provided a locked drawer to keep them in, as per the facility policy and procedure titled, Smoking. 2. For one of one residents (Resident 87), there was no Oxygen in Use/No smoking sign posted outside Resident 87's room while there was oxygen in her room. This failure had the potential cause harm and placed residents at risk for harm due to the potential for fire. Findings: 1. During a concurrent observation and interview with Resident 13, on August 20, 2019, at 11:00 AM, the resident was observed with cigarettes which were seen in her open purse lying on her bed. Resident 13 stated that she does smoke and she signed a paper at the time of admission so she could (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055872 If continuation sheet Page 3 of 11 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 055872 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Nursing Center 9440 Citrus Ave Fontana, CA 92335 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 0689 smoke. Resident 13 further stated that she always keeps her cigarettes and lighter in her purse. Level of Harm - Minimal harm or potential for actual harm During review of the facility provided list of Current Residents Who Smoke on August 19. 2019, at 10:00 AM, Resident 13 was not included on the list. Residents Affected - Few During a follow up interview with Resident 13, on August 20, 2019, at 3:30 PM, in the smoking area, when asked where she keeps her cigarettes and lighter, Resident 13 pulled the cigarettes and lighter from her purse and stated, I always carry everything in my purse. During an interview with the maintenance staff (MS 1) on August 22. 2019, at 1:145 PM, he stated that he placed a lock on Resident 13's drawer this week to keep her smoking materials safe. During a review of the clinical record for Resident 13, the Smoking Assessment dated August 6, 2019, indicated Resident 13 was assessed for smoking and determined to be safe. The facility policy and procedure titled, Smoking revised August 2017, indicated Policy and Interpretation and Implementation: if smoking materials are kept in the resident's possession, they must be stored in a locked box or drawer. If the resident cannot safely manage their own smoking materials, they will be maintained by the facility staff and distributed to residents at their request. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055872 If continuation sheet Page 4 of 11 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 055872 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Nursing Center 9440 Citrus Ave Fontana, CA 92335 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to safely store medications for one of one sampled residents (Resident 445) when two medications were stored beyond the expiration date. This failure had the potential to result in decreased efficacy of the medications for Resident 445. Findings: During observation of medication storage on August 21, 2019, at 7:10 AM, the south station medication cart was noted to contain the following prescriptions for Resident 445: a. Sertraline (an antidepressant) 25 mg (milligram a unit of measurement) with an expiration date of February 12, 2019 b. Atorvastatin (cholesterol lowering medication) (40 mg) with an expiration date of April 22, 2019 During an interview with a Licensed Vocational Nurse (LVN 6) on August 21, 2109, at 7:15 AM, she stated that the medications for Resident 445 were expired. She stated that the nurses are supposed to look at dates every day and that she was going to discard the medications. During a review of the facility's policy and procedure titled Storage of Medications revised June 2016, under the section titled Expiration Dating the policy indicated The nurse will check the expiration date of each medication before administering it. No expired medication will be administered to a resident .All expired medications will be removed from the active supply FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055872 If continuation sheet Page 5 of 11 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 055872 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Nursing Center 9440 Citrus Ave Fontana, CA 92335 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to ensure safe and sanitary food preparation and storage practices for dietary services when: Residents Affected - Many 1. Plastic tray bins were found stacked and stored wet. 2. Ice machine Cooling Compartment (where the ice is made) had a build-up of yellowish orange residue, that was removable with a white paper towel. These failures had the potential to lead to harmful bacteria and cross contamination that could lead to foodborne illness for a medically compromised population of 91 residents who receive food and water from dietary services. Findings: 1. During an observation and interview on August 19, 2019, at 9:00 AM, with Dietary Supervisor (DS). Nine out of Nine plastic tray bins were found clean and stacked wet for use. The DS stated these plastic bins are used for the residents drinks to be kept on ice on the tray line and verified they were found stacked clean and wet. The DS stated stacking them wet had the potential for bacterial growth. During a record review and interview on August 19, 2019, at 2:56 PM, of the Policy and Procedure for Manual Warewashing, revised on September, 2017, under Procedures . 3. All serviceware and cookware will be air dried prior to storage. The DS validated by stating this was the correct procedure and it had not been followed. During an interview on August 21, 2019, at 9:29 AM, with the Registered Dietician (RD), the RD stated clean trays stacked wet and ready for use, should not be considered ready for use because they need to be air dried. The RD stated this needs to be done in order to prevent bacterial growth and cross contamination to the residents. During an interview on August 23, 2019, at 2:08 PM, with the Infection Preventionist (IP) the IP stated stacking washed, clean trays wet and ready for residents use in the kitchen has the potential for bacterial growth and cross contamination to the residents. 2. During an observation of the ice machine and interview on August 21, 2019, at 8:58 AM, with the Maintenance Supervisor (MS). The ice making/cooling compartment was found to have a yellow to orange colored residue on the side wall of the compartment which was easily wiped off with a white paper towel. The MS validated seeing the residue and stated this is a potential for contamination of the ice, which could make residents ill from the ice being dirty. During an interview on August 21, 2019, at 9:29 AM, the RD stated an ice machine found dirty has the potential for bacterial growth and cross contamination to the residents. During an interview on August 21, 2019, at 10:45 AM, with the DS, the DS stated all ice obtained for resident use including for the water pitchers at the bedside comes from the only ice machine in this facility, which is outside of the kitchen. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055872 If continuation sheet Page 6 of 11 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 055872 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Nursing Center 9440 Citrus Ave Fontana, CA 92335 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During an interview on August 23, 2019, at 10:20 AM, with a Certified Nursing Assistant (CNA 1), CNA 1 stated all ice including the ice for the water pitchers at residents' bedside is obtained from the only ice machine in the facility which is located outside in the hallway by the kitchen. During an interview on August 23, 2019, at 2:08 PM, with the Infection Preventionist (IP), the IP stated the Ice Machine found with yellowish/orange residue on the ice making/cooling compartment has the potential for bacterial growth and cross contamination to the residents. During a review of the facility's policy and procedure, titled Ice, revised on September, 2017, indicated .2. The Dining Service Director will coordinate with the Maintenance Director to ensure that the ice machine will be disconnected, cleaned and sanitized quarterly and as needed, or according to manufacturer guidelines. The Manufacturer Guideline under section III. Maintenance A. Maintenance Schedule. The maintenance schedule below is a guideline. More frequent maintenance may be required depending on water quality, the appliance's environment and local sanitation regulations. Under Maintenance Schedule, it reveals maintenance is to clean on a monthly frequency for the underside of Icemaker and Top Kits; Bin Door and Snout. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055872 If continuation sheet Page 7 of 11 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 055872 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Nursing Center 9440 Citrus Ave Fontana, CA 92335 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a Licensed Vocational Nurse (LVN 1) followed the facility policy and procedure for medication administration when the LVN did not document the administration of one medication in the Medication Administration Record (MAR-a record used to document the administration of medications) for one of 16 Residents sampled for medication pass (Resident 340). This failure lead to the facility not having complete nor accurate medication administration records for Resident 340 which may put the residents' health and safety at risk. Findings: During a review of Resident 340's clinical record, the Record of admission (contains demographic and medical information), indicated Resident 340 was admitted to the facility on [DATE]. A review of the Physicians admission Orders/Medication Record, dated August 17, 2019, indicated the resident had diagnoses which included acute ischemic stroke (the sudden loss of blood circulation to an area of the brain), lung cancer, and hypotension (low blood pressure). During further review of Resident 340's clinical record, a physician's order dated August 17, 2019, indicated Midodrine [a medication used to increase blood pressure] 10 mg [mg/milligram-unit of measure] 1 tab [tablet] PO [PO-taken by the mouth] Q8h [every 8 hours] hold if SBP [systolic blood pressure] > [greater than] 120. During a medication pass observation on August 21, 2019, at 5:34 AM, the Licensed Vocational Nurse 1 (LVN 1), took Resident 340's blood pressure and received a result of 100/68 (100 systolic and 68 diastolic). During continued medication pass observation on August 21, 2019, at 5:45 AM, LVN 1 administered midodrine 10 mg 1 tablet PO to Resident 340. After administering the medication, LVN 1 did not document the administration of the medication midodrine in Resident 340's Medication Administration Record (MAR). The medication was scheduled to be administered at 6:00 AM. During an interview and concurrent record review with LVN 2, on August 21, 2019, at 11:54 AM, LVN 2 reviewed the MAR, dated August 2019, for Resident 340, and confirmed there was no documentation regarding the administration of the medication midodrine for the 6:00 AM scheduled medication pass on August 21, 2019. LVN 2 stated the medication should have been documented if it was administered. During an interview and concurrent record review with the Director of Nursing (DON), on August 21, 2019, at 11:58 AM, the DON reviewed the MAR, dated August 2019, for Resident 340, and confirmed there was no documentation regarding the administration of the medication midodrine for the 6:00 AM scheduled medication pass on August 21, 2019. The DON stated she expects nurses to document the administration of medications in the residents' MAR. During an interview and concurrent record review with LVN 1, on August 22, 2019, at 9:15 AM, LVN 1 reviewed the MAR, dated August 2019, for Resident 340, and confirmed the medication midodrine was (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055872 If continuation sheet Page 8 of 11 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 055872 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Nursing Center 9440 Citrus Ave Fontana, CA 92335 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete not documented as administered for the 6:00 AM scheduled medication pass on August 21, 2019. LVN 1 stated she forgot to document the medication in Resident 340's MAR because she got distracted when another resident asked for assistance. The facility policy and procedure titled Medication Administration revised February 2013, indicated Documentation: 1. The individual who administers the medication dose, records the administration on the resident's MAR following the medication being given. In no case should the individual who administered the medications report off-duty without first recording the administration of any medications. Event ID: Facility ID: 055872 If continuation sheet Page 9 of 11 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 055872 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Nursing Center 9440 Citrus Ave Fontana, CA 92335 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 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based observation, interview, and record review, the facility failed to ensure infection control prevention was implemented when: Residents Affected - Few 1. For one of one residents (Resident 18) a urinary catheter (a hollow, flexible tube that collects urine from the bladder and leads to a drainage bag) tubing was dragging on the floor while the resident self-propelled in the wheelchair across the hallway. 2. For Resident 15 a Certified Nursing Assistant (CNA 4) was observed touching the sitting stool he sat on and then touching the straw multiple times of a resident's beverage. These failures had the potential for cross contamination and the spread of infection. FINDINGS: 1. During an observation on August 20, 2019, at 11:30 AM, in the hallway on the north side of the facility, Resident 18 was sitting in a wheelchair. He was observed wheeling himself down the hallway with tubing from a urinary catheter dragging on the floor. During an interview with Licensed Vocational Nurse (LVN 4), on August 20, 2019, at 11:30 AM, she was asked if the resident's catheter was positioned correctly. LVN stated What? The tubing? LVN 4 donned gloves and bent down to put the excess tubing in the black urinary bag holder to keep it off the ground. During an interview with CNA 2, on August 22, 2019, at 11:40 AM, she stated that when she cares for Resident 18, she places the catheter tubing down Resident 18's pant leg and into the black urinary bag holder or to the side of his bed. She further stated that the urinary catheter tubing is not to touch the ground. During an interview with CNA 3, on August 22, 2019, at 11:45 AM, she stated the urinary catheter tubing is not to touch the floor, for infection control. The facility policy and procedure titled Catheter Care, Urinary, revised December 2004, indicated The purpose of this procedure is to prevent infection of the resident's urinary tract 11. Be sure the catheter tubing and drainage bag are kept off the floor. 2. During dining observation on August 19, 2019, at 12:10 PM, CNA 4 was observed touching with bare hands, the base of the sitting stool he sat on prior to touching Resident 15's drinking straw multiple times. He did not sanitize his bare hands while providing feeding assistance to Resident 15. During an interview with CNA 4 on August 19, 2019, at 12:28 PM, CNA 4 stated hands should be cleaned between residents. When CNA 4 was asked if he opens the resident's straws with bare hands, he responded Yes. When asked if the sitting stool was considered clean, CNA 4 answered, No. During an interview with LVN 5 on August 19, 2019, at 12:40 PM, she was asked if she would perform hand hygiene after touching a sitting stool. LVN 5 states she would clean her hands after touching the sitting stool prior to feeding a resident. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055872 If continuation sheet Page 10 of 11 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 055872 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/23/2019 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Nursing Center 9440 Citrus Ave Fontana, CA 92335 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 - Few During an interview with CNA 5 on August 19, 2019, at 12:40 PM, she was asked if she would perform hand hygiene after touching a sitting stool. She answered yes. During an interview with the Director of Nurses (DON) on August 22, 2019, at 11:21 AM, she was asked what should staff do if they touch a sitting stool with bare hands while assisting a resident with eating. The DON stated she would expect the staff and herself to at the least sanitize their hands. The facility's policy and procedure titled Handwashing/Hand Hygiene revised February 28, 2017 states When to use alcohol-based hand rub . 6. In most situations, the preferred method of hand hygiene is with an alcohol-based hand rub. If hands are not visibly soiled, use an alcohol-based hand rub containing 60-95% ethanol or isopropanol for all the following situations: .i. After contact with objects (e.g. medical equipment) in the immediate vicinity of the resident. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055872 If continuation sheet Page 11 of 11