Health inspection·November 13, 2023

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, staff interview, record review, and policy review, the facility failed to maintain infection control practices to prevent the potential spread of COVID-19. This had the potential to affect 16 (#89, #24, #51, #68, #41, #96, #99, #5, #57, #9, #93, #74, #66, #73, #75, and #30) of 16 residents residing on the affected hall. The facility census was 101. Residents Affected - Some Findings include: Review of the medical record for Resident #89 revealed an admission date of 09/12/22, with a current diagnosis of COVID-19. Review of the Annual Minimum Data Set (MDS) for Resident #89 dated 09/06/23, revealed Resident #89 was cognitively intact. Resident #89 required assistants, was not steady, and used a wheelchair for mobility. Review of the Care Plan for Resident #89 dated 11/07/23 revealed Resident #89 had an active COVID-19 diagnosis. Interventions included to maintain infection control per Centers of Disease Control (CDC) Prevention guidelines latest recommendations. Review of the physician orders for Resident #89 dated 11/07/23 revealed droplet precautions due to COVID-19 infection. Interview on 11/13/23 at 3:25 P.M., with Housekeeper #297 revealed Resident #89 was on isolation for COVID-19. Observation and interview beginning on 11/13/23 at 3:26 P.M., revealed Resident #89 had a sign on his door which revealed droplet precautions. Resident #89 had an isolation cart sitting next to the entrance of his doorway. Observation revealed Housekeeper #297 donned Personal Protective Equipment (PPE) to enter and clean Resident #89's room. Housekeeper #297 donned gloves, a gown, and an N95 mask. Housekeeper #297 did not put on goggles or a face shield. Housekeeper #297 entered Resident #89's room with cleaning supplies. Housekeeper #297 began wiping items down in Resident #89's room. Housekeeper #297 then exited the room with her same gown, gloves, and mask, went into the hall where the cleaning cart was located, (in the middle of the hall, outside of Resident #89's room), grabbed additional supplies off the housekeeping cleaning cart, (touching multiple items on the cart) then reentered Resident #89's room to continue cleaning. Within a few minutes, Housekeeper #297 again exited Resident #89's room with her same PPE on, went back to the housekeeping cart and gathered more supplies (after touching several items on the cart) then re-entered Resident #89's room with new supplies. Again, after a few minutes of cleaning in Resident #89's room, Housekeeper #297 again exited Resident #89's room, with the same PPE on (did not remove PPE or wash her hands), went back to the Page 1 of 2 365115 365115 11/13/2023 Rae-Ann Westlake 28303 Detroit Rd Westlake, OH 44145

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some housekeeping cart and grabbed the broom and mop then reentered Resident #89's room. The Administrator walked by and witnessed and verified Housekeeper #297 exited Resident #89's room without removing the PPE and reentering Resident #89's room with the cleaning supplies and no face shield or goggles. The Administrator verified there were no face shields or goggles on Resident #89's isolation cart located at the entrance of his room. The Administrator obtained a face shield and instructed Housekeeper #297 on the appropriate PPE to be donned before entering a room with COVID-19 and instructed her she should not be exiting the room without removing the PPE and washing her hands. Housekeeper #297 donned the face shield and completed cleaning Resident #89's room. Housekeeper #297 then removed the PPE, exited Resident #89's room, the put the used, uncleaned face shield back into the isolation cart. The Administrator was present during the observation. Interview at this time, with Housekeeper #297 and the Administrator verified the face shield was not cleaned prior to placing it in the isolation cart with other clean PPE supplies. Observation and interview on 11/13/23 at 3:50 P.M., with Housekeeper #297 who revealed Resident #89's room was the last room to be cleaned. Housekeeper #297 placed the used rags and the unused rags in a separate bag to be sent to laundry. Emptied the mop water in the housekeeping soiled utility room, emptied trash from the housekeeping cart, took the trash to the dumpster outside the facility and returned to the housekeeping cart. Housekeeper #297 then placed the housekeeping cart in the utility room to be stored with five other housekeeping carts. Housekeeper verified she used a clean mop head for each room and used the same broom and dustpan for each room. Housekeeper #297 then left the storage area and revealed she was done cleaning. Housekeeper #297 confirmed she did not clean the cart, broom, dustpan, or mop handles after she touched each of them while cleaning Resident #89's room. Housekeeper #297 revealed the housekeeping carts were cleaned every other day. Housekeeper #297 confirmed she did not use hand sanitizer or wash her hands after emptying the mop water, taking the trash out and removing the soiled rags from the housekeeping cart. Interview on 11/13/23 at 5:00 P.M., with Administrator revealed housekeeping carts were assigned to specific units. Administrator revealed Housekeeper #297's cart was used for cleaning 15 resident rooms, Resident #24, #51, #68, #41, #96, #99, #5, #57, #9, #93, #74, #66, #73, #75, and #30 that were not diagnosed with COVID-19, daily. Review of the policy titled PPE-Contingency and Crises Use of Eye Protection (COVID-19 Outbreak), revised September 2021, revealed to prevent transmission of infectious agents through the use of PPE included eye protection, gloves, masks, and gowns. Ensure appropriate cleaning and disinfection between users if goggles or reusable face shields are used. This deficiency represents non-compliance investigated under Complaint Number OH00148191 and the Focused Infection Control Survey. 365115 Page 2 of 2