Health inspection·September 7, 2023

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 and interview the facility failed to ensure staff washed/sanitized their hands appropriately during medication administration for Resident #20 and failed to don appropriate personal protective equipment and handle laundry appropriately during wound care for Resident #68. This affected one out of three residents observed for medication administration and one out of two residents observed for wound care (#20 and #68). The facility census was 105. Residents Affected - Few Findings include: 1. Record review revealed Resident #20 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus, polyneuropathy, hypertensive heart disease, osteoarthritis, lymphedema, bipolar disorder, anxiety, diverticulosis, urinary tract infection, heart arrhythmias, irritable bowel syndrome and hyperlipidemia. A review of Resident #20's physician orders dated 08/01/23 to 08/31/23 indicated to administer acetaminophen 500 milligrams (mg) orally three times a day, vitamin D 100 micrograms (mcg) orally in the morning, Culterelle probiotic one tablet orally two times a day, magnesium oxide 400 mg orally two times a day, multivitamin with minerals one tablet orally once a day, docusate sodium tablet 100 mg orally two times a day, omega 3 1000 mg orally, lasix 40 mg orally once a day, losartan potassium chloride 50 mg orally once a day, potassium chloride extended release 10 milliequivalents (mEq) orally once a day, sennosides 8.6 mg (two tablets) orally twice a day, and Salonpas patch (lidocaine 4 percent) apply topically to the left arm one time a day and remove at bedtime. An observation of Licensed Practical Nurse (LPN) #735 administer medications to Resident #20 on 08/31/23 at 7:33 A.M. revealed a failure to wash or sanitize her hands to prevent a possible cross contamination of germs to Resident #20. LPN #735 prepared the above listed medications and administered the medications to Resident #20 orally mixed in applesauce. LPN #735 exited Resident #20's room to obtain the lidocaine 4 percent patch from the storage area in the facility and did not wash her hands prior to exiting the room. LPN #735 proceeded to walk to the elevator pushed the button and traveled to the medication storage area in the basement of the facility. LPN #735 opened the medication storage door and searched the shelves for the lidocaine patch. LPN #735 obtained the lidocaine patch from the manufacturer's packaging and documented the removal on the medication storage log and exited the medication storage room. LPN #735 traveled back to the first floor using the elevator and stopped at the nursing station to obtain a pair of scissors from her personal belongings. LPN #735 proceeded to enter Resident #20's room, cut the lidocaine patch packaging, removed the lidocaine patch and wrote the date and her initials on the patch and applied the patch to Resident #20's left upper arm. LPN #735 exited Resident #20's room and proceeded to administer medications to another resident. LPN #735 did not wash or sanitize her hands upon exiting Resident #20's room or prior to administering the lidocaine patch to Resident #20. Page 1 of 5 365048 365048 09/07/2023 Life Care Center of Westlake 26520 Center Ridge Rd Westlake, OH 44145

F 0880 An interview with LPN #735 on 08/31/23 at 7:55 A.M. verified the above findings. Level of Harm - Minimal harm or potential for actual harm The facility policy and procedure titled Hand Hygiene revised 06/13/23 indicated the facility adopted the Center for Disease Control (CDC) infection control prevention and control practices for safe healthcare delivery in all settings for hand hygiene. The facility policy indicated associates perform hand hygiene {even if gloves are used) in the following situations: Residents Affected - Few -Before and after contact with the resident: -After contact with blood, body fluids, or visibly contaminated surfaces; -After contact with objects and surfaces in the resident's environment: -After removing personal protective equipment (e.g. gloves. gown. eye protection. facemask); and -Before performing a procedure such as an aseptic task (e.g., insertion of an invasive device such as a urinary catheter, manipulation of a central venous catheter. and/or dressing care). 2. Record review revealed Resident #68 was admitted to the facility on [DATE] with diagnoses including osteomyelitis (bone infection) of the left ankle and foot, urinary tract infection, dementia, diabetes mellitus, heart arrhythmias and heart malnutrition, valve disease, anemia, stage 3 pressure ulcer to the sacral region, polyosteoarthritis, depression, osteoporosis, peripheral venous insufficiency, lymphedema, high blood pressure, hyperlipidemia and fibromyalgia. A review of Resident #68's physician orders dated 08/01/23 to 08/31/23 indicated to clean Resident #68's left buttock wound, left heel and coccyx with normal saline, apply aquacel silver and cover the wound with a foam dressing three times a week and as needed. Clean the left toes with saline, apply skin preparation and leave the wounds open to air daily and as needed. Resident #68's wound assessment dated [DATE] indicated the presence of a stage 3 pressure ulcer of the coccyx, left heel, and left buttock, and a stage 2 pressure ulcer of the left big toe, plantar metatarsophalan (the joints between the metatarsal bones of the foot and the proximal bones of the toes), and the left third toe. An observation of LPN #846 and Registered Nurse (RN) #830 perform Resident #68's wound treatment on 08/31/23 at 1:00 P.M. revealed a concern with maintaining infection control standards. Upon entering Resident #68's room there was a sign on the door for staff to don a mask, gloves and gown for enhanced isolation precautions. LPN #846 and RN #830 washed their hands and donned a pair of gloves and mask and proceeded to apply the Resident #68's physician ordered wound treatments. RN #830 and LPN #846 did not don a gown prior to providing the wound treatments. Upon completion of the wound treatments LPN #846 gathered the soiled linen used during the wound treatment task and placed the linens directly on the floor. LPN #846 proceeded to obtain a plastic bag and placed the soiled linens in the plastic bag and placed the plastic bag with the soiled linens in the appropriate linen receptacle. An interview with LPN #846 and RN #830 on 08/31/23 at 1:30 P.M. verified the above findings and indicated Resident #68 was on enhanced barrier protection due to her multiple pressure ulcer wounds and should have worn a gown during the wound treatment task. LPN #846 verified she should have obtained a plastic bag to place the soiled linens and should not have placed the linens on the floor. The facility policy and procedure titled Infection Prevention and Control Program (IPCP) and Plan revised 01/25/23 indicated the facility has an ongoing infection prevention and control program (I PCP) lo prevent, 365048 Page 2 of 5 365048 09/07/2023 Life Care Center of Westlake 26520 Center Ridge Rd Westlake, OH 44145

F 0880 recognize, and control the onset and spread of infection to the extent possible and reviews and Level of Harm - Minimal harm or potential for actual harm updates the IPCP annually and as necessary. This would include revision of the IPCP as national standards change; Residents Affected - Few The definition of contact precautions indicated the intention was to prevent transmission of pathogens that were spread by direct (e.g., person-to-person) or indirect contact with the resident or environment (e.g., C. difficile, norovirus, scabies), and requires the use of appropriate PPE, including a gown and gloves before or upon entering (i.e., before contact with the resident or resident's environment) the room or cubicle. Prior to leaving the resident's room or cubicle, the PPE is removed, and hand hygiene is performed. When Contact Precautions are indicated, efforts must be made to counteract possible adverse effects on patients (i.e., anxiety, depression and other mood disturbances, perceptions of stigma, reduced contact with clinical staff), and increases in preventable adverse events in order to improve acceptance by the residents and adherence by staff. When implementing contact precautions, consideration should be given to the following: l. The identification of resident risk factors that increase the likelihood of transmission, (such as uncontained secretions or excretions, non- compliance, cognition deficits, incontinence, etc.); 2. The provision of a private room as available/appropriate. 3. Co-horting residents with the same pathogen; and 4. Sharing a room with a roommate with limited risk factors (e.g., without indwelling or invasive devices, without open wounds, and not immunocompromised) as appropriate. 5. Determine if outbreak protocol should be implemented. (Refer to policy entitled Outbreak Control and/or Pandemic Control and Management) 6. When a resident is placed on contact precautions, the staff should implement the following: a. 365048 Page 3 of 5 365048 09/07/2023 Life Care Center of Westlake 26520 Center Ridge Rd Westlake, OH 44145

F 0880 Level of Harm - Minimal harm or potential for actual harm Place Contact precaution signage (may be more than one type), on the outside of the resident room in a conspicuous place such as the door or on the wall next to the doorway identifying the resident is on contact precautions. The sign should include the instructions for use of specific PPE, and/or instructions to see the nurse before entering. Residents Affected - Few b. Ensure that signage also complies with residents' rights to confidentiality and privacy; c. Ensure that healthcare personnel are educated, trained, and have practiced the appropriate use of PPE prior to caring for a patient/resident. Refer to policy entitled Personal Protective Equipment (PPE). d. Make PPE (e.g., gowns and gloves) readily available near the entrance to the resident's room; e. Any anticipated supply shortages of PPE should be reported to the local and state public health agency. f. Don appropriate PPE before or upon entry into the environment (e.g., room or cubicle) of resident on transmission -based precautions (e.g., contact precautions). The CDC guidelines for handling soiled linens dated 05/04/23 indicated the best practices for linen (and laundry) handling: -Always wear reusable rubber gloves before handling soiled linen (e.g., bed sheets, towels, curtains). -Never carry soiled linen against the body. Always place it in the designated container. -Carefully roll up soiled linen to prevent contamination of the air, surfaces, and cleaning staff. Do not shake linen. -If there is any solid excrement on the linen, such as feces or vomit, scrape it off carefully with a flat, firm object and put it in the commode or designated toilet/latrine before putting linen in the designated container. -Place soiled linen into a clearly labeled, leak-proof container (e.g., bag, bucket) in the patient care area. Do not transport soiled linen by hand outside the specific patient care area from where it was removed. -Reprocess (i.e., clean and disinfect) the designated container for soiled linen after each use. 365048 Page 4 of 5 365048 09/07/2023 Life Care Center of Westlake 26520 Center Ridge Rd Westlake, OH 44145

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few -If reusable linen bags are used inside the designated container, do not overfill them, tie them securely, and launder after each use. -Soiled linen bags can be laundered with the soiled linen they contained. This deficiency represents non-compliance investigated under Master Complaint Number OH00145263 and Complaint Number OH00145031. 365048 Page 5 of 5