Inspection·September 3, 2024

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 interviews, record review, and policy review, the facility failed to implement their infection control policies ensuring staff wore the proper personal protective equipment (PPE) and have PPE readily available outside the residents' rooms. This affected one (#22) of two residents reviewed for contact precautions, This had the potential to affect all 52 residents residing in the facility. The facility census was 52. Residents Affected - Many Findings include: Review of the medical record for Resident #22 revealed and admission date of 08/15/24, with diagnoses including hypoxic ischemic encephalopathy, hemiplegia, and COVID-19 acute respiratory disease. Review of the medical record for Resident #22 revealed Resident #22 tested positive for COVID on 08/24/24. A progress note dated 08/25/24 revealed Resident #22 is droplet precautions/isolation due to testing positive for COVID. Review of the Care plan for Resident #22 revealed maintain droplet/contact isolation precautions and personal protective equipment as indicated on 08/24/24. Review of Resident #22's Minimum Data Set (MDS) admission assessment, dated 08/27/24, revealed the resident was cognitively intact. The resident required setup or clean-up assistance for eating, oral hygiene, and personal hygiene. The resident required substantial/maximal assistance for toileting hygiene, shower/bathe self, upper body dressing, and lower body dressing. Observation on 08/28/24 at 10:43 A.M., revealed Physical Therapist #4 and Rehab Services Manager #9 donning PPE to enter Resident #22's room. Physical Therapist #4 and Rehab Services Manager #9 donned a gown, a surgical mask and gloves prior to entering Resident #22's room. Observation on 08/28/24 at 10:43 A.M., of Resident #22's door revealed a pink sign that stated, Special Droplet/Contact Precautions. The sign further reads Everyone Must: including visitors, doctors, and staff, clean hands when entering and leaving room, wear face mask, wear eye protection (face shield or goggles), gown and glove at door, when doing aerosolizing procedures fit tested N-95 with eye protection or higher required, keep door closed, use patient dedicated or disposable equipment, and clean and disinfect share equipment. Interview on 08/28/24 at 10:43 A.M., with Physical Therapist #4 and Rehab Services Manager #9 confirmed they both do not have eye protection and did not wear N-95 face masks. Observation on 08/28/24 at 10:43 A.M., revealed Physical Therapist #4 and Rehab Services Manager #9 (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: 365351 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 365351 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/03/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Signature Healthcare of Galion 935 Rosewood Dr Galion, OH 44833 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)