Inspection·January 10, 2020

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm 5. On 1/08/20 at 12:30 p.m. during an interview with Resident #61, Staff G, RN entered the bedroom holding an insulin syringe in her right hand along with an alcohol wipe. She walked over to the resident's bedside table where her lunch tray sat and removed the cover off the meal tray. She spoke with the resident, as they both agreed half of the lunch meal had been consumed. Staff G, still holding the insulin syringe in her right hand, picked up the lunch tray and walked outside of the bedroom. The meal cart sat in the hallway and was in close proximity of the resident's bedroom, as Staff G was observed placing tray inside of the meal cart. Staff G reentered the bedroom with the syringe still in her right hand. She said that the resident was due for her insulin and indicated that it was 10 units. Staff G, RN opened the alcohol wipe and cleaned the resident's left upper arm. Then inserted the needle into the arm and administered the insulin. This process was performed without hand hygiene prior to the administration of the injection nor were gloves utilized during the invasive procedure. Residents Affected - Some On 1/9/2020 at 10:50 a.m. Staff G, RN was observed as she performed a blood glucose check for Resident #61. After the procedure was performed Staff G, RN removed a bleach wipe and cleansed the glucose meter for approximate 30 seconds. Staff G, RN was asked about the thirty second cleaning process to the glucose meter. She stated, I have always done it that way. On 1/9/20 at 10:56 a.m. an interview was conducted with the Unit Manager (unit one) on the facility's procedure for cleaning and disinfecting the glucose meter. As multiple observations were performed differently. The UM said that it had been brought to her attention yesterday (1/8/20), and the staff were reeducated on the process of cleaning of the meters. At that time, she provided a bleach wipe container and pointed to the area on the container's label that identified the directions written at number 5. The directions were reviewed and written under hospital disinfection as, .5. A 30 second contact time is required to kill all of the bacteria and viruses ** . Further review of the bleach packaging stated 3-minute c-diff (clostridium difficile) spore kill time. The UM was asked about the 3-minute time that the front of the package had directed. She said that is the advertisement indicating it cleans c-diff. She stated, We don't have any one here with c-diff. At 11:05 a.m. the facility's Nursing Consultant confirmed that the meters are only being cleaned for thirty seconds. She said that if anyone has c-diff they will have their own meter. Based on observation, interview record and policy review, the facility failed to maintain an effective infection prevention and control program by 1. not cleaning a glucose meter after use for four residents (#34, #95, #408, #407) and 2. not ensuring appropriate hand hygiene practice during one glucose check for one resident (#61) of three observations of medication administration of a sample of 10 residents that received glucose monitoring. (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: 105436 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 105436 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2020 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meadowpark Health and Rehabilitation Center 870 Patricia Ave Dunedin, FL 34698 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)