Health inspection·March 27, 2025

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 foods were properly labeled and stored. Residents Affected - Few Findings include: During an observation on 3/24/2025 at 9:20 AM while conducting the initial tour of the kitchen with the Certified Dietary Manager (CDM), there were thirteen bags of frozen variety of meats, without an identifying label, and one bag that was left open exposing chicken with ice particle buildup and the appearance of freezer burn in the reach-in freezer. During an interview on 3/24/2025 at 9:25 AM, the CDM confirmed that there were thirteen bags of a variety of meats without an identifying label and one bag of chicken that was completely open exposing the product to the elements and freezer burn. Review of the facility policy and procedure titled Date Marking for Food Safety dated 11/2020 and revised on 1/2025 showed it read, Policy Explanation and Compliance Guidelines for Staffing . 4. The marking system shall consist of a color-coded label, the day/date of opening, and the day/date the item must be consumed or discarded. Page 1 of 3 105825 105825 03/27/2025 Suwannee Valley Nursing Center 427 15th Avenue Northwest Jasper, FL 32052

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure staff performed hand hygiene and followed infection control standard of practice during medication administration for 1 of 4 residents observed for medication administration, Resident #7, to prevent the possible spread of infection and communicable diseases. Residents Affected - Few Findings include: During an observation on 3/26/2025 at approximately 9:10 AM, Staff A, Licensed Practical Nurse (LPN), prepared medications for administration to Resident #7, which included Baby Shampoo on a wet washcloth. Staff A donned a gown and gloves and proceeded to clean Resident #7's eyelids with the washcloth containing Baby Shampoo and placed the soiled washcloth on a piece of aluminum foil. Staff A did not remove her gloves or did not perform hand hygiene and proceeded to administer medications to Resident #7 through her gastrostomy tube (G-tube: a thin, flexible tube inserted through the abdominal wall and into the stomach. It is used to provide nutrition and medication to individuals who cannot eat or drink adequately by mouth.) While holding a medicine cup containing a crushed pill of Amlodipine (a medicine for treating high blood pressure) mixed with a small amount of water, Staff A used her gloved finger to stir the mixture before she administered it through Resident #7's G-tube. Review of Resident #7's physician order dated 3/18/2025 showed it read, Enhanced Barrier for tube feeding. During an interview on 3/26/2025 at approximately 9:30 AM, Staff A, LPN, stated, I should have washed my hands and changed my gloves after I washed her eyes, before I gave her meds. I shouldn't have mixed the medicine with my finger. During an interview on 3/26/2025 at 10:50 AM, the Director of Nursing (DON) stated, For a resident who was on Enhanced Barrier Precautions who had a procedure requiring cleaning on her eyes, the nurse should wash her hands and change her gloves before administering any medications through the gastric tube. The nurse should only use a spoon to mix the crushed medication suspended in water in a medication cup. Review of the facility's policy and procedures titled Medication Administration last reviewed on 1/19/2025 showed it read, Policy: Medications are administered by licensed nurses, or other staff who are legally authorized to do so in this state, as ordered by the physician and in accordance with professional standards of practice, in a manner to prevent contamination or infection. Review of the facility's policy and procedures titled Infection Prevention and Control Program last reviewed on 1/19/2025 showed it read, Policy: 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 infection as per accepted national standards and guidelines . Policy Explanation and Compliance Guidelines . 4. Standard Precautions . b. Hand hygiene shall be performed in accordance with our facility's established hand hygiene procedures. Review of the facility's policy and procedures titled Hand Hygiene last reviewed on 1/19/2025, showed it read, Policy: All staff will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. This applies to all staff working in all 105825 Page 2 of 3 105825 03/27/2025 Suwannee Valley Nursing Center 427 15th Avenue Northwest Jasper, FL 32052

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few locations within the facility . Policy Explanation and Compliance Guidelines: 1. Staff will perform hand hygiene when indicated, using proper technique consistent with accepted standards of practice. 2. Hand hygiene is indicated and will be performed under the conditions listed in, but not limited to, the attached hand hygiene table . Hand Hygiene Table - Condition . Before preparing or handling medications . After handling items potentially contaminated with blood, body fluids, secretions, or excretions . When, during resident care, moving from a contaminated body site to a clean body site. 105825 Page 3 of 3