Inspection·May 22, 2025

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 record review, observation, interview, and facility policy review, the facility failed to use appropriate infection control precautions while providing wound care to Resident #50 who was in enhanced barrier precautions. This affected one Resident #50 but had the potential to affect all 29 residents who were ordered enhanced barrier precautions, Residents #5, #8, #9, #11, #12, #14, #15, #16, #17, #18, #19, #20, #21, #23, #24, #30, #31, #33, #36, #37, #40, #44, #46, #50, #58, #61, #63, and #64. The facility census was 64. Residents Affected - Few Findings include: Review of the medical record for Resident #50 revealed an admission date of 06/17/24. Diagnoses included chronic obstructive pulmonary disease, hypertension, and heart failure. Review of the care plan dated 06/17/24 revealed Resident #50 had impaired skin integrity on her left breast and left side of her neck. Interventions included providing wound care as ordered and enhanced barrier precautions. Review of the physician's order dated 09/16/24 revealed an order for enhanced barrier precautions. Review of the quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #50 had moderate cognitive impairment. Resident #50 required extensive assistance for all activities of daily living. Observation and interview on 05/22/25 at 11:15 A.M. of wound care for Resident #50 with Registered Nurse (RN) #502 revealed on the front of Resident #50's door signage that she was in enhanced barrier precautions. The sign stated for staff to wear a gown, gloves, and use hand hygiene when providing personal care including wound care. RN #502 entered the room, set up her area, washed her hands, and began performing the wound care. RN #502 maintained good hand hygiene during the wound care and changed her gloves often using hand sanitizer before applying new gloves. After the procedure was over RN #502 cleaned up her area, removed her gloves and washed her hands. Upon exiting the room, RN #502 confirmed Resident #50 was in enhanced barrier precautions and a gown was not worn during the procedure. RN #502 also confirmed that there was signage on Resident #50's door with personal protective equipment. Review of the facility policy infection prevention and control program policy, revised 02/19/24, revealed it is the policy to maintain an organized, effective facility-wide program designed to systemically prevent, identify, control, and reduce the risk of acquiring and transmitting infections among employees, volunteers, visitors, and contract healthcare workers; to conduct surveillance of (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: 365814 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 365814 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cortland Center 369 N High Street Cortland, OH 44410 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)