Inspection·October 2, 2024

AHCAForm3020-0001 X6DATE 124 STATE FORM 续表 KZX811 of 1 AHCAForm3020-0001 X6DATE 124 STATE FORM 续表 KZX811 of 1 X5 DATE /2024 a 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan often includes a requirement to continued program participation. 1 of 5 <table><tr><td colspan="2">STATEMENT OF DEFICIENCIESAND PLAN OF CORRECTION</td><td>(X1) PROVIDER/SUPPLIER/CIAIDENITIFICATION NUMBER106073</td><td colspan="2">(X2) MULTIPLE CONSTRUCTIONA. BUILDINGB. WING</td><td colspan="2">(X3) DATE SURVEYCOMPLETEDC10/02/2024</td></tr><tr><td colspan="4">NAME OF PROVIDER OR SUPPLIER</td><td rowspan="2" colspan="3">STREET ADDRESS, CITY, STATE, ZIP CODE3291 EAST OLIVE RD PENSACOLA, FL 32514</td></tr><tr><td colspan="4">LIFE CARE CENTER OF PENSACOLA</td></tr><tr><td>(X4)IDPREFIXTAG</td><td>SUMMARY STATEMENT OF DEFICIENCIES(EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION)</td><td>IDPREFIXTAG</td><td colspan="2">PROVIDER&#x27;S PLAN OF CORRECTION(EACH CORRECTIVE ACTION SHOULD BE CROSSED-REFERENCED TO THE APPROPRIATE DEFICIENCY)</td><td colspan="2">(X5)COMPLETIONDATE</td></tr><tr><td>F 880</td><td colspan="2">Continued From page 2Based on observation, interview, and policy review, the facility failed to ensure measures to prevent the spread of were followed for 1 of 3 residents observed on contact isolation precautions. (Resident #1)The findings include:During an initial facility tour between 10:37 am and 11:40am on , an observation was made of Staff G, a Housekeeper, through the open door of 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 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 with soap and water after completing care in this room. A plastic bin containing gowns was observed outside the door. The door for , which was adjacent to , 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 forUpon 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</td><td>F 880</td><td colspan="3">On , prior to resuming assigned duties, staff member &quot;G&quot; was immediately provided in-servicing with re-education reviewing facility policies and procedures for prevention and control practices, including hygiene and contact isolation procedures.On , the DON/ Designee conducted an initial audit/ observation for other residents requiring contact isolation procedures. prevention and control practices observed, including hygiene and donning and doffing PPE for isolation rooms. No additional concerns were identified.On , the DON/ Designee initiated in-servicing with re-education for all associates, reviewing facility policy and procedures for prevention and control practices, including hygiene and contact isolation procedures.The DON/ Designee will conduct ongoing routine audits/ observations twice weekly reviewing PPE procedures for residents requiring isolation precautions. Associates will be observed donning/ doffing PPE to ensure ongoing compliance with facility policy and procedures. Audits will be reviewed monthly at the Quality Assurance Performance Improvement Meeting X 3 months, or until substantial compliance is achieved.</td></tr></table> 4of5 5 of 5