Inspection·March 30, 2023

N 000 INITIAL COMMENTS

N 000 An unannounced licensure survey was conducted on through at Life Care Center of Pensacola, Florida. Deficient practice was identified at the time of the survey.

N 201 400.022(1)(f), FS Right to Adequate and Appropriate Health Care SS=D

N 201 (I) The right to receive adequate and appropriate health care and protective and support services, including social services; mental health services, if available; planned recreational activities; and therapeutic and rehabilitative services consistent with the resident care plan, with established and recognized practice standards within the community, and with rules as adopted by the agency. This Statute or Rule is not met as evidenced by: 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) The findings include: An observation of resident #13 was conducted on 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 using a rolling vital sign machine. Employee A, CNA was not wearing a gown or gloves while taking resident #13's. Contact precautions signage was observed on resident #13's door stating everyone must: clean their must, including before entering and when Preparation and/or execution of this plan of correction does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth in the statement of deficiencies. The plan of correction is prepared and/or executed solely because it is required by the provisions of federal and state law. * Resident #13 and Resident #53 will be monitored for any signs or symptoms for the next 14 days. The Residents number 13 and 53 will have the physician notified of the risk the residents were place in and the responsible person of the residents will be notified. * Residents that reside in the facility are /23 STATE FORM 6809 B57511 35961009 03/30/2023 LIFE CARE CENTER OF PENSACOLA 3291 EAST OLIVE RD PENSACOLA, FL 32514 PREFIX TAG ID PREFIX TAG PROVIDERS PLAN OF CORRECTION DEFICIENCY) COMPLETE DATE

N 201 Continued From page 1 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 . . . . . . reusable equipment before use on another person. (Photographic evidence obtained.) When Employee A finished taking resident #13's . . . . . . ., 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 . . . . . . with the same rolling vital sign machine. Employee A did not wash her . . . . . . . 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 for contact isolation every shift for . . . ( . . . . . . . - . . . ). An interview was conducted with the Director of Nurses (DON) on 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 . . . . . . . upon entering a 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 . . . . . (revised ) revealed C. is a spore-forming gram-positive anaerobic . . . . . that was first from stools of . in 1935 and identified as the most commonly identified causative agent of associated . . . and , . . . . in 1977. This , is a major cause of healthcare

N 201 at risk for this deficient practice. " The Staff Development Coordinator/ will conduct an in-service training on the proper use of PPE, cleaning of equipment, and removal of PPE after use. The Staff Development coordinator/ will conduct a second in-service on proper care of the residents when is present, which will include proper PPE, control process, transmission based precautions and isolation procedures. The Staff Development Nurse/ will conduct a third in-service training for Proper Handwashing Techniques. The Certified Nursing Assistant who gave care to residents #13 and # 53 without using proper isolation precautions and procedures will have a one on one training and content will be placed in the associate 's educational file. This associate will have a skills checklist for PPE, Handwashing, Equipment cleaning, and Isolation techniques performed and placed in the associate 's educational file. These in-services will include, but not limited, to proper use of , protection, mask as required, glove use, gowns use, cleaning of equipment before use and after, handwashing, and disposal of isolation PPE. The in-services will be presented on hire of new associates during orientation. The Director of Nursing/Designee will conduct weekly audits of observations of handwashing, cleaning of equipment, isolation room entry, room entry, and disposal of PPE properly. The Director of Nursing/Designee will initiate a process, so when the equipment is sanitized it will STATE FORM 6599 B57511 35961009 03/30/2023 LIFE CARE CENTER OF PENSACOLA 3291 EAST OLIVE RD PENSACOLA, FL 32514 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE

N 201 Continued From page 2 associated . . . and has been responsible for many large outbreaks in healthcare settings that were extremely difficult to control. . . -based rubs do not kill spore-forming organisms therefore . . . washing must be done with soap and water. Mitigation of Spread: Place patient on Standard plus contact precautions if they have symptoms consistent with . . . Clean and . . . equipment after use and before use by another resident. Review of the policy for Transmission-based Precautions and Isolation Procedures (reviewed ) revealed the facility will implement and utilize transmission based precautions to ensure the mitigation of spread and to ensure standards of prevention and control are followed. Contact Precautions are intended to prevent transmission of that are spread by direct or indirect contact with the resident or environment, and require the use of appropriate PPE, including a gown and gloves upon entering the room or cubicle. Prior to leaving the resident's room or cubicle, the PPE is removed, and . . . hygiene is performed. Class III

N 201 be labeled for the next associate who needs to use the equipment. This process will be audited weekly for proper identification and cleaning. * The Staff Development Coordinator/ Control Preventist/Designee will bring the in-servicesto the monthly QAPI meeting for review and compliance of attendees for the next 90 days. The weekly audits will be brought to the monthly QAPI meeting for review and compliance for the next 90 days. STATE FORM notes B57511 LIFE CARE CENTER OF PENSACOLA 3291 EAST OLIVE RD PENSACOLA, FL 32514 |---|---|---|---|---| | F 000 | INITIAL COMMENTS An unannounced recertification survey was conducted on through at Life Care Center of Pensacola. At the time of the survey, the facility was not in compliance with 42 CFR 483, requirements for Long Term Care Facilities. | F 000 | | | | F 880 SS=D | Infection Prevention & Control CFR(s): 483.80(a)(1)(2)(4)(e)(f) §483.80 Control The facility must establish and maintain an prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable and . §483.80(a) prevention and control program. The facility must establish an prevention and control program (IPCP) that must include, at a minimum, the following elements: §483.80(a)(1) A system for preventing, identifying, reporting, investigating, and controlling and communicable for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to §483.70(e) and following accepted national standards; §483.80(a)(2) Written standards, policies, and procedures for the program, which must include, but are not limited to: (i) A system of surveillance designed to identify possible communicable or | F 880 | | | COMPLETED 03/30/2023 LIFE CARE CENTER OF PENSACOLA 3291 EAST OLIVE RD PENSACOLA, FL 32514 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETION DATE

F 880 Continued From page 1

F 880 ... before they can spread to other persons in the facility; (ii) When and to whom possible incidents of communicable or should be reported; (iii) Standard and transmission-based precautions to be followed to prevent spread of ; ( ) When and how isolation should be used for a resident; including but not limited to: (A) The type and duration of the isolation, depending upon the . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |---|---|---|---| **LIFE CARE CENTER OF PENSACOLA** **3291 EAST OLIVE RD** **PENSACOLA, FL 32514** |---|---|---|---| **F 880** Continued From page 2 ensure staff follow appropriate isolation precautions during the provision of resident care for 1 of 3 sampled residents on transmission-based precautions. (Resident #13) The findings include: An observation of resident #13 was conducted on [date] 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 [vital signs] using a rolling vital sign machine. Employee A, CNA was not wearing a gown or gloves while taking resident #13's [vital signs]. 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 [vital signs], 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 [vital signs] 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 [date] for contact isolation every shift for [vital signs]. **F 880** " Resident #13 and Resident # 53 will be monitored for any signs or symptoms of [infection] for the next 14 days. The Residents number 13 and 53 will have the physician notified of the risk the residents were place in and the responsible person of the residents will be notified. " Residents that reside in the facility are at risk for this deficient practice. " The Staff Development Coordinator/ will conduct an in-service training on the proper use of PPE, cleaning of equipment, and removal of PPE after use. The Staff Development coordinator/ will conduct a second in-service on proper care of the residents when [infection] is present, which will include proper PPE, control process, transmission based precautions and isolation procedures. The Staff Development Nurse/ will conduct a third in-service training for Proper Handwashing Techniques. The Certified Nursing Assistant who gave care to residents #13 and # 53 without using proper isolation precautions and procedures will have a one on one training and content will be placed in the associate's educational file. This associate will have a skills checklist for 106073 03/30/2023 LIFE CARE CENTER OF PENSACOLA 3291 EAST OLIVE RD PENSACOLA, FL 32514 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETION DATE

F 880 Continued From page 3

F 880 An interview was conducted with the Director of Nurses (DON) on . . . at 9:07 AM. She stated staff should sanitize the vital sign machine between each resident regardless if they are on isolation or not. Staff are to sanitize their . . . upon entering a . . . 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 (revised . . . ) revealed C. . . is a spore-forming gram-positive anaerobic that was first . . . from stools of . . . in 1935 and identified as the most commonly identified causative agent of . . . associated and . . . in 1977. This . . . is a major cause of healthcare associated and has been responsible for many large outbreaks in healthcare settings that were extremely difficult to control. . . -based . . . rubs do not kill spore-forming organisms therefore . . . washing must be done with soap and water. Mitigation of Spread: Place patient on Standard plus contact precautions if they have symptoms consistent with . . . Clean and equipment after use and before use by another resident. Review of the policy for Transmission-based Precautions and Isolation Procedures (reviewed . . . ) revealed the facility will implement and utilize transmission based precautions to ensure the mitigation of spread and to ensure standards of prevention and control are followed. Contact Precautions are intended to prevent transmission of . . . that are spread by direct or indirect contact with the resident or environment, and require the use of appropriate PPE, including a . . . PPE, Handwashing, Equipment cleaning, and Isolation techniques performed and placed in the associate's educational file. These in-services will include, but not limited, to proper use of . . . protection, mask as required, glove use, gowns use, cleaning of equipment before use and after, handwashing, and disposal of isolation PPE. The in-services will be presented on hire of new associates during orientation. The Director of Nursing/Designee will conduct weekly audits of observations of handwashing, cleaning of equipment, isolation room entry, room entry, and disposal of PPE properly. The Director of Nursing/Designee will initiate a process, so when the equipment is sanitized it will be labeled for the next associate who needs to use the equipment. This process will be audited weekly for proper identification and cleaning. * The Staff Development Coordinator/ Control Preventist/Designee will bring the in-services to the monthly QAPI meeting for review and compliance of attendees for the next 90 days. The weekly audits will be brought to the monthly QAPI meeting for review and compliance for the next 90 days. 106073 03/30/2023 3291 EAST OLIVE RD PENSACOLA, FL 32514 PREFIX PREFIX COMPLETION DATE

F 880 Continued From page 4 gown and gloves upon entering the room or cubicle. Prior to leaving the resident's room or cubicle, the PPE is removed, and hygiene is performed. F 880