Inspection·May 25, 2023

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, staff interview, and policy review, the facility failed to maintain infection prevention measures intended to help prevent transmission of disease and infections for 1 of 1 residents on isolation precautions. (Resident #146) Residents Affected - Few The findings include: On 5/23/23 at 2:11 PM, an observation was made of Staff A, a Certified Nurse Assistant (CNA), inside Resident #146's room under contact/enhanced barrier precautions. CNA A was observed providing incontinence care donning only gloves as personal protective equipment (PPE). On 5/23/23 at 5:11 PM, an observation was made of Staff B, a Registered Nurse (RN), and Staff C, a Licensed Practical Nurse (LPN), entering Resident #146's room. Staff B, RN, and Staff C, LPN, were observed touching Resident #146's pump used for intravenous antibiotics. Staff B, RN, and Staff C, LPN, were not observed washing their hands or donning any PPE. On 5/23/23, a review of medical records for Resident #146 was conducted and revealed a physician order for contact isolation from 5/22/23 through 5/29/23. Further review of the record revealed a positive laboratory test result dated 5/14/23 for Pseudomonas Aeruginosa (a bacteria that can cause infection in the blood, lungs and other parts of the body, and can spread in healthcare settings from one person to another through contaminated hands, equipment, or surfaces). The lab result stated Pseudomonas Aeruginosa is a multi-drug resistant organism: contact precautions indicated. On 5/22/23 at 8:35 AM, a progress note written by Staff D, another RN, stated all staff and residents were notified of barrier precautions due to MDRO (Multidrug-resistant organisms). A notice of contact precautions and required PPE use was posted on Resident #146's entrance. On 5/23/23 at 2:39 PM, an interview was conducted with Staff A, CNA. The surveyor asked if she was aware that this was a contact isolation room and she replied that she was not aware. Staff A further stated she was not aware she needed to use a gown to provide incontinence care and stated she had provided bowel care 3 times that day because Resident #146 had diarrhea. On 5/23/23 at 5:20 PM, an interview was conducted with Staff C, LPN. During the interview, it was revealed Staff C, LPN, was not aware Resident #146 was under precautions and stated if she would have known she would have wore a gown and gloves and performed hand washing before and after donning PPE. A review was conducted of facility's Categories of Transmission-Based Precautions policy, last revised October 2018, stated, Staff and visitors will wear gloves gloves (clean, non-sterile) when (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: 106051 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 106051 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coral Bay at Pensacola, LLC 600 W Gregory St Pensacola, FL 32502 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)