Health inspection·June 30, 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 record review, observation, staff interview, review of online resources from the Centers for Disease Control (CDC), and policy review, the facility failed to ensure staff utilized proper handwashing technique while completing wound care. This affected one (#15) of the three Residents (#13, #14, and #15) reviewed for wound care. The facility census was 65. Residents Affected - Few Findings include: Review of the medical record for Resident #15 revealed the resident was admitted on [DATE]. Diagnoses included, but not limited to, Stage IV (full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed) sacral decubitus ulcer, depression, pulmonary embolism, and osteomyelitis. Review of the Minimum Data Set (MDS) assessment dated [DATE], revealed Resident #15 had mild cognitive deficits and required extensive assistance with activities of daily living (ADLs). Review of the care plan dated 04/23/24, revealed Resident #15 had skin breakdown/open area to bilateral gluteal folds and the left fifth toe that was present upon admission. Review of physician orders dated 06/20/24 for Resident #15 revealed resident was ordered to have left buttock cleaned with normal saline or wound cleanser then pat dry. Apply moistened gauze with Dakin's one quarter strength every shift. Observation of wound care /dressing change on 06/30/24 from 10:00 A.M. to 10:19 A.M. for Resident #15 and being completed by Registered Nurse (RN) #31 and Licensed Practical Nurse (LPN) #30, revealed RN #31 removed the resident's incontinence brief and soiled dressings. RN #31 removed her soiled gloves and put on new gloves without sanitizing or washing her hands. RN #31 then cleansed the left buttock area with normal saline, applied Dakin's moistened gauze and covered it with a protective dressing. RN #31 then cleansed the right gluteal fold skin area with normal saline and applied a protective dressing. RN #31 did not wash or sanitize her hands when going from a work area of a soiled body part to a clean body site. Interview on 06/30/24 at 10:31 A.M. with LPN #55 verified that RN #31 did not wash or sanitize her hands when going from a soiled work area to a clean body site. Review of the undated New Hire Orientation on Handwashing guidelines revealed staff were to change gloves between tasks and procedures on the same resident. (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: 365946 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 365946 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St. Theresa Care Center 7010 Rowan Hill Drive Cincinnati, OH 45227 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)