Inspection·March 30, 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 ensure staff follow appropriate isolation precautions during the provision of resident care for 1 of 3 sampled residents on transmission-based precautions. (Resident #13) Residents Affected - Few The findings include: An observation of resident #13 was conducted on 3/27/23 at 3:29 PM. The resident was sitting in her wheelchair in her room and employee A, Certified Nursing Assistant (CNA) was observed taking the resident's blood pressure using a rolling vital sign machine. Employee A, CNA was not wearing a gown or gloves while taking resident #13's blood pressure. Contact precautions signage was observed on resident #13's door stating everyone must: clean their hands, including before entering and when leaving the room. Providers and staff must also: put on gloves before room entry, discard gloves before room exit, put on gown before room entry, discard gown before room exit, do not wear the same gown and gloves for the care of more than one person, use dedicated or disposable equipment. Clean and disinfect reusable equipment before use on another person. (Photographic evidence obtained.) When Employee A finished taking resident #13's blood pressure, she exited the resident's room and then entered resident #53's room. She donned a pair of gloves and then began taking resident #53's blood pressure with the same rolling vital sign machine. Employee A did not wash her hands before leaving resident #53's room and did not disinfect the rolling vital sign equipment between uses on resident #13 and #53. Review of resident #13's electronic record revealed a current physician order dated 3/23/23 for contact isolation every shift for C-diff (clostridium difficile). An interview was conducted with the Director of Nurses (DON) on 3/3/23 at 9:07 AM. She stated staff should sanitize the vital sign machine between each resident regardless of if they are on isolation or not. Staff are to sanitize their hands upon entering a C-diff isolation room and if they are providing care they should also wear appropriate personal protective equipment (PPE) to include gown and gloves. Review of the facility policy for Clostridium Difficile (revised 6/7/22) revealed C. difficile is a spore-forming gram-positive anaerobic bacillus that was first isolated from stools of neonates in 1935 and identified as the most commonly identified causative agent of antibiotic associated diarrhea and pseudomembranous colitis in 1977. This pathogen is a major cause of healthcare associated diarrhea and has been responsible for many large outbreaks in healthcare settings that were extremely difficult to control. Alcohol-based hand rubs do not kill spore-forming organisms therefore hand washing must be done with soap and water. Mitigation of Spread: Place patient on Standard plus contact precautions if they have symptoms consistent with C-diff. Clean and disinfect equipment after use and before use by another resident. Review of the policy for Transmission-based Precautions and Isolation Procedures (reviewed 6/6/22) revealed the facility will implement and utilize transmission based (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: 106073 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 106073 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Life Care Center of Pensacola 3291 East Olive Rd Pensacola, FL 32514 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)