Inspection visit
Inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
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
observations, interviews, and policy review, the facility failed to ensure isolation protocols were followed
related to PPE (personal protection equipment) use and notifying visitors of infections, in two rooms (231
and 230) out of 15 rooms in hall 200.Findings included: On 02/02/2026 at 03:33 PM, room [ROOM
NUMBER] was observed with a contact isolation sign on it, requiring gloves and a gown prior to room entry.
There was no indication of whether the sign was for the resident in Bed A or the resident in Bed B. Staff A,
Certified Nursing Assistant (CNA) and Staff B, CNA, were observed leaving room [ROOM NUMBER] B,
without gloves and gowns after assisting a resident on Bed B's side, as the resident was in a wheelchair.
Staff A and Staff B did not use hand hygiene after leaving room [ROOM NUMBER] B.On 02/02/2026 at
03:37 PM Staff A, CNA and Staff B, CNA, were observed re-entering room [ROOM NUMBER] B, without
donning gloves and gowns, prior to entering the room. Staff A and Staff B made contact with a curtain
divider in room [ROOM NUMBER], and the resident in room [ROOM NUMBER] B's wheelchair, shoulder,
right hand, and wrist. Staff A and Staff B were observed leaving room [ROOM NUMBER] and made contact
with a table in the hall that had multiple items on it.On 02/02/2026 at 03:40 PM, room [ROOM NUMBER]
was observed with a contact isolation sign on the door. Staff A, CNA and Staff B, CNA, were observed
entering room [ROOM NUMBER] without donning gloves or gowns. The contact precaution sign on the
door did not reveal which resident it applied to. Staff A and Staff B exited room [ROOM NUMBER] and did
not use hand hygiene between rooms.On 02/02/2026 at 03:36 PM, an interview was conducted with a
family member of the resident in room [ROOM NUMBER] B. The family member explained not having been
told anything about the contact isolation sign. The family member of the resident in room [ROOM NUMBER]
B stated not knowing gloves and gown were required prior to entering room [ROOM NUMBER]. The family
member stated after seeing the contact isolation sign on the door they may need to stop visitation. The
family member confirmed they had not been notified or educated on appropriate PPE use prior to entering
the room.On 02/02/2026 at 03:42 PM, an interview was conducted with Staff A, CNA and Staff B, CNA,
after they were observed leaving room [ROOM NUMBER]. Staff A explained the contact sign on the door of
room [ROOM NUMBER] was for Bed B. Staff A stated they assisted the resident in Bed B. Staff A pointed
at the contact isolation sign on the door of room [ROOM NUMBER] and stated, I know everything about
that. Staff A stated gown and gloves were not needed because only the hands of the resident in Bed B
were touched without gloves. Staff A stated if the resident was being picked up during a transfer, then
gloves should have been worn. Staff A stated she would have washed her hands afterwards. Staff A stated
hand sanitizer had not been used between care contact in rooms [ROOM NUMBERS]. After reading a
contact isolation sign on room [ROOM NUMBER]'s door, Staff A stated PPE should have been put on if
contact had been made with a resident, not before entering the room.On 02/02/2026 at 03:59 PM, an
interview was conducted with Staff C, Registered Nurse (RN), who stated for contact isolation signs, gloves
and gown were required to be donned before entering the room. Staff C, RN stated after leaving a
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:
105385
Printed: 05/28/2026
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
105385
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/02/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Royal Oak Nursing Center
37300 Royal Oak Lane
Dade City, FL 33525
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
contact isolation room, hand hygiene should be used. Staff C stated all her aides knew how to use PPE and
when to use it. Staff C stated, that's nursing 101 right there, or at least it should be.On 02/02/2026 at 04:55
PM, an interview was conducted with the Nursing Home Administrator (NHA), Director of Nursing (DON),
and the Infection Preventionist (IP). The DON stated prior to entering a room with a contact isolation sign on
it, staff should have put on gloves and gowns. The DON stated when the aides left the room, the gown and
gloves should have been disposed of, and their hands should have been washed. The DON stated before
the aides went to another room, the process should have been restarted. The DON stated if aides were
going near residents, PPE would have been required. The DON stated if a curtain, or a resident's
wheelchair was touched, gown and gloves would have been required. The DON stated if a resident's hands
were touched, definitely, PPE was required. The DON stated every resident room and bathroom had hand
hygiene. The DON stated a new procedure was required from space to space.Review of an undated facility
policy titled, Infection Prevention and Control Program, revealed: This facility has established and maintains
an infection prevention and control program designed to provide a safe, sanitary, and comfortable
environment and to help prevent the development and transmission of communicable diseases and
infections as per accepted national standards and guidelines. Definitions: Staff includes all facility staff
(direct and indirect care functions), contracted staff, consultants, volunteers, others who provide care and
services to residents on behalf of the facility, and students in the facility's nurse aide training programs or
from affiliated academic institutions. Policy Explanation and Compliance Guidelines:1. The designated
Infection Preventionist is responsible for oversight of the program and serves as a consultant to our staff on
infectious diseases, resident room placement, implementing isolation precautions, staff and resident
exposures, surveillance, and epidemiological investigations of exposures of infectious diseases. 2. All staff
are responsible for following all policies and procedures related to the program. 3. Surveillance:a. A system
of surveillance is utilized for prevention, identifying, reporting, investigating, and controlling infections and
communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services
under a contractual arrangement based upon a facility assessment and accepted national standards.b. The
Infection Preventionist serves as the leader in surveillance activities, maintains documentation of incidents,
findings, and any corrective actions made by the facility and reports surveillance findings to the facility's
Quality Assessment and Assurance Committee.c. The RNs and LNs participate in surveillance through
assessment of residents and reporting changes in condition to the residents' physicians and management
staff, per protocol for notification of changes and in-house reporting of communicable diseases and
infections. 4. Standard Precautions:a. All staff shall assume that all residents are potentially infected or
colonized with an organism that could be transmitted during the course of providing resident care
services.b. Hand hygiene shall be performed in accordance with our facility's established hand hygiene
procedures.c. All staff shall use personal protective equipment (PPE) according to established facility policy
governing the use of PPE.d. Licensed staff shall adhere to safe injection and medication administration
practices, as described in relevant facility policies.5. Isolation Protocol (Transmission-Based Precautions):a.
A resident with an infection or communicable disease shall be placed on transmission-based precautions
as recommended by current CDC guidelines.b. Residents on transmission-based precautions should be
placed into a private/single room if available/appropriate, or are cohorted with residents with the same
pathogen, or share a room with a roommate with limited risk factors, in accordance with national
standards.c. Residents will be placed on the least restrictive transmission-based precaution for the shortest
duration possible under the circumstances.d. When a resident on transmission-based
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
105385
If continuation sheet
Page 2 of 3
Printed: 05/28/2026
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
105385
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/02/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Royal Oak Nursing Center
37300 Royal Oak Lane
Dade City, FL 33525
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
FORM CMS-2567 (02/99)
Previous Versions Obsolete
precautions must leave the resident care unit/area, the charge nurse on that unit/area shall communicate to
all involved departments the nature of the isolation and shall prepare the resident for transport in
accordance with current transmission-based precaution guidelines.g. Visitors coming to visit a resident who
is on transmission-based precautions or quarantine, will be informed by the facility of the potential risk of
visiting and precautions necessary when visiting the resident.13. Resident/Family/Visitor Education and
Screening:a. Residents, family members, and visitors are provided information relative to the rationale for
the isolation, behaviors required of them in observing these precautions, and conditions for which to notify
the nursing staff. d. Passive screening, such as signs, are posted in the facility to alert family members and
visitors to adhere to handwashing, respiratory etiquette, and other infection control principles to limit spread
of infection from family members and visitors. Photographic Evidence Obtained.
Event ID:
Facility ID:
105385
If continuation sheet
Page 3 of 3
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Back to topCitations
1 citation recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F880 - Infection Control
Provide and implement an infection prevention and control program.
FAQ · About this visit
Common questions about this visit
What happened during the February 2, 2026 survey of ROYAL OAK NURSING CENTER?
This was a inspection survey of ROYAL OAK NURSING CENTER on February 2, 2026. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ROYAL OAK NURSING CENTER on February 2, 2026?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Provide and implement an infection prevention and control program."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.