Inspection·July 15, 2025

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews and record reviews, the facility failed to ensure the provision of a sanitary environment that would prevent the development and transmission of infections for one out of four residents (Resident 2) when:1. Resident 2's foley catheter (FC, a hollow tube inserted into the bladder to drain or collect urine also known as a urinary catheter) bag (a drainage bag connected to the FC) was touching the floor.2. Staff did not wear a gown, in accordance with enhanced barrier precautions (EBP, an infection control intervention, that involves the use of gowns and gloves during high-contact care activities to reduce the transmission of Multidrug-Resistant Organisms [MDRO, microorganisms (germs), that are resistant to one or more antibiotics]) while handling Resident 2's FC.These failures had the potential to cause and spread infections among residents and staff. Findings:1. During a concurrent observation and interview on 7/15/25 at 1:44 p.m. Unlicensed Staff A verified Resident 2's FC drainage bag was touching the floor. Unlicensed Staff A stated the FC drainage bag should not be touching the floor, for infection control purposes, as Resident 2 could get sick with an infection.During an interview on 7/15/25 at 1:58 p.m., Licensed Nurse (LN) B stated FC drainage bags should not touch the floor because the floor was dirty. LN B further explained, bacteria (germs) could contaminate the FC drainage bag and Resident 2 could end up with an infection.During an interview on 7/15/25 at 2:30 p.m., the Director of Nursing (DON) stated the FC drainage bag should not touch the floor, for infection control, as it increases the risk of a resident acquiring an infection.A review of the facility's policy and procedure (P&P) titled, Catheter Care, Urinary, revised 8/2022, the P&P indicated, . be sure the catheter tubing and drainage bag are kept off the floor.2. During a concurrent observation and interview on 7/15/25 at 1:53 p.m., outside Resident 2's door a poster indicated Resident 2 was on EBP. Unlicensed Staff A was observed handling Resident 2's FC drainage bag while not wearing a gown. Unlicensed Staff A verified Resident 2 was on EBP and that she had not followed the EBP when she had not worn a gown when she handled Resident 2's FC drainage bag. Unlicensed Staff A acknowledged EBP was expected to be followed to prevent spreading infections to other residents.During an interview on 7/15/25 at 1:58 p.m., LN B stated residents who had a FC were placed on EBP, and all staff were expected to follow the EBP when caring for these residents. LN B stated anytime a staff touched a residents' FC, staff must wear gloves and a gown to prevent cross contamination (transfer of germs from one place to another with harmful effect) and infection. During a concurrent interview and record review on 7/15/25 at 2:45 p.m., with the DON, the Centers for Disease Control (CDC, the national public health agency of the United States) EBP poster was reviewed, the DON verified Resident 2 had a foley catheter and was on EBP. The DON verified the facility followed the CDC's EBP guidelines which indicated when staff handled a resident's FC, they should wear gloves and gown. The DON stated it was important to follow EBP to prevent or reduce the spread of infections.A review of the CDC document titled Enhanced Barrier Precaution, undated, indicated, . everyone must: clean their hands, including before entering and when leaving the room. Providers and staff must also: wear gloves and Residents Affected - Few (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 3 Event ID: 056120 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 056120 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE North Bay Post Acute 300 Douglas Street Petaluma, CA 94952 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)