Inspection·October 2, 2024

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and policy review, the facility failed to ensure measures to prevent the spread of infection were followed for 1 of 3 residents observed on contact isolation precautions. (Resident #1) Residents Affected - Few The findings include: During an initial facility tour between 10:37 am and 11:40am on 10/01/2024, an observation was made of Staff G, a Housekeeper, through the open door of room [ROOM NUMBER] mopping the floor. Housekeeping Staff G was wearing gloves while mopping, but no other personal protective equipment (PPE) was observed. A sign outside the door of room [ROOM NUMBER] indicated contact isolation precautions were in place and indicated that all staff were to wear a gown and gloves upon entering room and another sign on the door indicated staff are to wash hands with soap and water after completing care in this room. A plastic bin containing gowns was observed outside the door. The door for room [ROOM NUMBER], which was adjacent to room [ROOM NUMBER], also had a contact isolation precautions sign and handwashing with soap and water sign present. Additional observations revealed similar signage for contact precautions a little way down the hall for room [ROOM NUMBER]. Upon exiting the room, Staff G was interviewed and asked about the contact isolation sign, which was visible and pointed out during the interview. Staff G stated as long as the door of the room is open, he does not need to wear a gown. He repeated this statement when asked for clarification. During the interview, it was noted housekeeping staff G spoke with an accent and may not be a native English speaker. The signs on the doors were observed to be printed only in English. In an interview with the Infection Preventionist on 10/01/2024 at 10:47 am, she indicated that the resident in room [ROOM NUMBER] was diagnosed with Clostridioides Difficile (C. diff) in August and the residents in rooms [ROOM NUMBERS] were diagnosed in the past week and received confirmative positive results on 09/30/2024 and 10/01/2024 and placed on contact isolation precautions. During an interview on 10/02/2023 at 10:47AM with the Director of Environmental Services and the Infection Preventionist, they discussed the training of housekeeping staff and acknowledged that Staff G is not a native English speaker but does speak English. Both acknowledged that signs are provided in English and they try to provide training that is color-coded for transmission-based precautions because there are staff who are native speakers of languages other than English and may have difficulty reading English. A review of the facility policy for transmission-based precautions included a policy titled Transmission-based Precautions and Isolation Procedures from chapter 4: Standard Precautions, transmission-based precautions: A guide to infection prevention and control. Issued 01/30/2019; reviewed (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 10/02/2024 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)