Inspection·June 22, 2023

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 06/20/2023, Staff D stated, I don't remember that. I don't use sanitizer because I'm allergic to the soap and the sanitizer, but I always wash my hands. Further interview with Staff C on 06/22/2023 at 11:25 AM, regarding the observation of her not washing her hands during dining, Staff C stated, Like I said earlier, when I pass the trays, I only wash my hands one time. I only wash my hands before I pass the trays. I wash my hands again before I assist a resident with anything including feeding. When transferring the residents from their room to the dining room, I wash my hands before I start assisting the resident. I don't wash my hands when I'm transferring the residents. Before the nurse gives the tray to me to put on the resident's table, I wash my hands. Before assisting the resident with feeding, I wash my hands again. I don't remember, but I always wash my hands. If it happened my bad. Interview with Staff E, (Registered Nurse, RN), on 06/22/2023 at 11:51 AM regarding handwashing procedures, Staff E stated, Before we (RN) check the trays, we use hand sanitizer. For each tray, we do hand sanitizer. When I come I wash my hands. Between each tray, I wash my hands. That goes for all staff. In the hallway, the (CNAs) have to do the same thing. Because when they go inside the patient room, they have to set up the tray for the patient. When they come out of the patient room, they have to wash their hands before handling the next tray. We only have a few residents who don't need help with setting up the trays. Almost every resident needs help to set up their trays. After each tray, they're supposed to wash their hands. If a nurse doesn't see the CNA wash their hands after entering the room, they should ask them if they washed their hands. At least I will ask if they wash their hands if I don't see them wash their hands. On 06/22/2023 at 12:32 PM, during an interview with Staff B, RN regarding handwashing procedures during dining, Staff B stated, When the trays arrive, we're supposed to wash our hands before handling the trays. The nurses check trays and passing the trays to the CNAs. They know they have to wash their hands, but if we don't see them washing their hands, we have to ask them. I was passing trays in the hallway last Monday. There is a sink in the hallway and in the residents' room. They're supposed to wash their hands before handling each tray. Like after they take a tray and give it to the resident. A couple of times I didn't see the CNA who was working with me wash her hands, I asked her. Her last name [Staff C]. I didn't see when she washed her hands, I asked her and she said, yes she washed her hands. We're all supposed to wash our hands between each resident. A review of the facility's policy and procedures of handwashing and hand hygiene which were reviewed in January 2022 and revised in January 2023 revealed: All personnel shall be trained and regularly in-serviced on the Importance of hand hygiene in preventing the transmission of healthcare-associated infections. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. Hand hygiene products and supplies (sink, soap, towels, alcohol-based hand rub, etc.) shall be readily accessible and convenient for staff use to encourage compliance with hand hygiene policies. Use an alcohol-based hand rub containing at least 62% alcohol; or alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: *Before and after direct contact with the residents; (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106034 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 106034 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Jackson Gardens Health and Rehabilitation Center 1861 NW 8th Avenue Miami, FL 33136 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 *before and after eating or handling food, Level of Harm - Minimal harm or potential for actual harm *before and after assisting a resident with meals. A review of the facility's handwashing procedure revealed: Residents Affected - Few Washing hands *Wet hands first with water, then apply and amount of product recommended by the manufacturer to hands; *Rub hands together vigorously for at least 20 seconds, covering all surfaces of the hands and fingers. Using alcohol-based hand rubs * Apply generous amount of product to palm of hand and rub hands together; *cover all surfaces of hands and fingers until hands are dry; *follow manufacturer's directions for volume of product to use. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 106034 If continuation sheet Page 3 of 3