Inspection·May 8, 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 medical record review, staff interview, observation, and facility policy review, this facility failed to ensure enhanced barrier protection including gloves were in place during wound care. This affected one (Resident #126) of the three residents reviewed for wound care. The facility census was 91. Residents Affected - Few Findings include: Review of the medical record for Resident #126 revealed and admission date of 10/22/24. Diagnoses included type two diabetes mellitus, foot ulcers, and peripheral vascular disease. Review of Resident #126's quarterly Minimum Data Set (MDS) 3.0 assessment dated [DATE] revealed a Brief Interview for Mental Status (BIMS) score of 12 out of 15 indicating a moderately impaired cognition for daily decision making abilities. Resident #126 was noted to have one venous and arterial ulcer, and a diabetic foot ulcer. Review of the care plan dated 03/20/24 and revised 04/13/24 revealed Resident #126 had impaired skin integrity, or was at risk for altered skin integrity due to right lateral foot ulcer, left skin skin tear, right knee skin tear, right top foot skin tear, left lateral foot arterial ulcer, left groin surgical, and left forearm skin tear. Interventions include to complete daily skin checks, and complete treatments as ordered. Review of treatment orders for Resident #126 revealed the following: -Cleanse with house wound cleanser, apply Calcium Alginate to areas on right lateral foot, cover with gauze and Kerlix. -Cleanse wound to dorsal right foot with normal saline solution, pat dry and apply Betadine to wound bed, and leave open to air daily. -Cleanse wound to left lateral foot with normal saline solution, pat dry apply Betadine to wound bed and leave open to air daily. -Cleanse wound to left lateral heel with normal saline solution or wound cleanser, apply Medihoney to wound bed and cover with gauze and wrap with Kerlix every day shift. -Cleanse wound to left shin with normal saline solution, pat dry apply skin prep to wound bed and (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 365313 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 365313 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bridgeport Health Care Center 2125 Royce Street Portsmouth, OH 45662 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)