Health inspection·August 19, 2021

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, record review, facility policy and procedure review, review of Centers for Disease Control (CDC) guidance and interview the facility failed to maintain acceptable infection control practices including following contact isolation precautions (wearing a gown and gloves) and using proper hand washing for Resident #30 and utilizing proper infection control practices during a dressing change for Resident #310 to prevent the spread of infection. This affected two residents (#30 and #310) and had the potential to affect all 58 residents residing in the facility. Residents Affected - Many Findings include: 1. Record review for Resident #30 revealed an admission date of 06/15/21 with diagnoses including Clostridium difficile (infection of the large intestine causing diarrhea), urinary tract infection, hypertension (high blood pressure) and congestive heart failure. Review of the physician's order dated 08/10/21 revealed Resident #30 had an order for Vancomycin 125 milligrams, one capsule by mouth one time a day for Clostridium difficile with a stop date of 09/24/21. On 08/16/21 at 8:35 A.M. State Tested Nursing Assistant (STNA) #141 was observed to enter Resident #30's room to deliver his meal tray. Resident #30 had an over the door yellow pocketed divider with personal protective equipment (PPE) including gowns, gloves and masks. There was a bright pink sign on the door stating to report to the nurse before entering, contact precautions, PPE required, gown and gloves. STNA #141 went into the room, did not put on PPE, went to Resident #30's tray table, placed the tray on the table, moved the tray closer to the resident and then opened the items on the resident's tray. STNA #141 then left the room without washing her hands. On 08/16/21 at 8:36 A.M. interview with Licensed Practical Nurse (LPN) #122 verified Resident #30 was on contact isolation for Clostridium difficile and staff should be wearing gowns and gloves in the room as resident was on contact isolation. On 08/16/21 at 8:37 A.M. interview with STNA #141 verified she did not wear PPE in the resident's room. STNA #141 was asked if she washed her hands when she exited and she stated she used hand sanitizer frequently. On 08/17/21 at 1:28 P.M. interview with Physician #140 verified staff should wear PPE while performing personal care for the resident. Physician #140 revealed if you did not touch anything in the room or provide personal care to the resident, staff did not need PPE but had to wash their hands prior to leaving the room. Physician #140 did verify if a staff member touched any item in the room, the staff member should be wearing PPE and washing hands. Review of the facility policy titled Handwashing, revised December 2020 revealed the objective of Page 1 of 2 365793 365793 08/19/2021 Crown Center at Laurel Lake 200 Laurel Lake Dr Hudson, OH 44236

F 0880 handwashing was to prevent the spread of infection and disease to residents, staff and visitors. Level of Harm - Minimal harm or potential for actual harm Guidance from The Centers for Disease Control, updated on 07/15/21 titled Information for Healthcare Professionals about C. Diff revealed important interventions included contact isolation precautions with wearing gloves and gown and following hand hygiene practices before seeing a patient and after removal of gloves. This information is located at https://www.cdc.gov/cdiff/clinicians/index.html. Residents Affected - Many 2. Record review for Resident #310 revealed an admission date of 07/28/21 with diagnoses including heart failure and Stage I pressure ulcer (reddened skin over boney prominences that is non-blanchable). Review of the physician's order, dated 08/11/21 revealed a treatment order for the right buttock wound, cleanse with wound cleanser, apply barrier cream and cover with bordered foam dressing, change three times per week and as needed. On 08/18/21 at 9:47 A.M. Registered Nurse (RN) #104 was observed completing wound care for Resident #310's right buttock Stage I pressure area. RN #104 washed her hands, applied (donned) clean gloves, removed the dressing, placed a new dressing on the wound and then removed her gloves. RN #104 did not remove her gloves after removing the soiled dressing or perform hand hygiene and place new gloves prior to placing a clean dressing. On 08/18/21 at 9:51 A.M. interview with RN #104 verified she did not remove her gloves after removing the soiled dressing or perform hand hygiene and donned new gloves prior to placing a clean dressing. Review of the facility policy titled Clean Dressing Change, revised December 2020 revealed after removing soiled dressing to wash hands and don gloves. Review of the policy titled Handwashing, revised December 2020 revealed the objective handwashing was to prevent the spread of infection and disease to residents, staff and visitors. 365793 Page 2 of 2