Health inspection·July 18, 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 record review, the facility failed to follow their infection control policy and procedure for 1 of 3 residents (R18) who was on contact isolation precautions for Clostridium difficile (C-diff). Residents Affected - Few Findings include: R18's Face Sheet, with a print date of 07/17/24, documented R18 has a diagnosis of but not limited to enterocolitis due to clostridium difficile. R18's Minimum Data Set (MDS), dated [DATE], documented R18 is cognitively intact with a Brief Interview for Mental Status (BIMS) of 14 out of 15, and requires assistance with his activities of daily living (ADL). R18's Progress Notes, dated 7/2/2024 at 5:41 PM, documented R18 was admitted to the local hospital with pneumonia and C-diff. On 07/17/24 at 11:02 AM, V21, Certified Occupational Therapy Assistant (COTA) was in R18's room on the north end of the 100-hall doing therapy with him using exercise bands. V21 was observed not wearing a gown or gloves. She also was observed to have an over the bed table with her computer, stackable objects, a blue tote with different items in it, and a gripper on the table. On 07/17/24 at 11:10 AM V21, COTA came out of R18's room with the table and the bag. She left the table in the hallway against the wall while she went up to the nurse's station to wash her hands. After she was done doing hand hygiene, she got the table and pushed it down past the nurse's station to the very end of the south 100 hallway without any kind of sanitation/cleaning being done to the table or the content on the table. On 07/16/24 at 12:39 PM, V6, Licensed Practical Nurse (LPN) stated when someone comes back positive for C-diff they will put that person on isolation, and staff will use gloves and gowns when going into the resident's room. On 07/16/24 at 12:56 PM, V7, Certified Nurse's Assistant (CNA) said when someone is on isolation for C-diff they are put in a room by themselves and when the staff go into the room, they are to wear a gown and gloves to be on the safe side. On 07/17/2024 at 9:30 AM, V2, Director of Nursing (DON) stated R18 is the only resident in the facility at this time who has C-diff. She said he just finished up his antibiotic and his stools are Page 1 of 2 145410 145410 07/18/2024 Evercare of Breese 1155 North First Street Breese, IL 62230

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few starting to be more formed. V2 said when someone is confirmed to have C-diff they will immediately move the resident to another room especially if they both don't have C-diff and she would expect treatment to be started immediately. V2 said she would expect staff to be wearing a gown and gloves when going into a room with someone who has C-diff. On 07/17/24 at 12:46 PM, V2, Director of Nursing stated she would absolutely expect for staff to wear the proper personal protective equipment (PPE) when caring for a resident who is on isolation for C-diff. On 07/18/24 at 2:35 PM, V11, Infection Control Preventionist (ICP) stated if someone was positive for C-diff they would be placed on contact isolation. She would expect any staff who went into the room to give any kind of care to wear a gown and gloves and that includes occupational therapy, she would expect them to do proper hand washing after they were done with the resident's care. She stated staff should not be bringing anything into a room of a resident who has C-diff. If it's bed linens or something like that, they should be disposing of the dirty ones in the dirty linen bin in the resident's room. If they are bringing in any kind of therapy equipment, they should be wiping it down with the appropriate disinfectant wipe before bringing it out of the room. The facility's policy Infection Control Practices Clostridium Difficile, revised date of 03/2004, documented Purpose: The purposes of this procedure are to provide guidelines for the care of persons with Clostridium Difficile, verified by culture or by evidence of positive cytotoxin assay, and to prevent transmission of Clostridium Difficile to others. It further documented Infection Control Protocol and Safety 4. Wear appropriate personal protective equipment (e.g. gloves, gown, mask, eyewear, etc. as necessary) to prevent exposure to spills, splashes of blood or other potentially infectious materials. 5. Maintain clean technique and isolation precautions as indicated. 6. After completion of the procedure, clean, store and/or dispose of equipment and supplies in the appropriate manner as identified per facility infection control policy. 145410 Page 2 of 2