Health inspection·September 26, 2019

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 interview, review of the facility Legionella Environmental Assessment Form, review of Center for Disease Control (CDC) guidelines, and facility policy review, the facility failed handle linens in a sanitary manner, failed to complete water testing for Legionella Disease per facility policy, and failed to complete diagram which identified location of water entering the facility and of water heaters. This had the potential to affect all residents. The facility census was 79. Residents Affected - Many Findings Included: 1. Observation 09/25/19 at 3:10 P.M. of the basement laundry room revealed an isolation cart on the floor sitting in standing water. A storage cabinet filled with clean sheets and bath blankets used for residents was sitting next to a dirty linen bin. Five clean mechanical lift pads were observed hanging over a storage cabinet and touching the floor. Incontinence briefs were stored on an open shelf in the dirty area of the laundry room. Interview on 09/25/19 at 3:10 P.M., Laundry Assistant #402 and Licensed Practical Nurse (LPN) #602 verified the isolation cart was sitting in standing water and located on the dirty side of the laundry room. The incontinence briefs were stored on the dirty side of the laundry room and the five clean mechanical lift pads were touching the basement floor. 2. Review of the facility policy titled Legionnaire Disease, undated, revealed the facility was to use Legionella testing to confirm control measures are effective in preventing legionnaire contamination. Review of the Legionella Environmental Assessment Form, undated, revealed the facility failed to include water testing for detection of Legionella. No water testing results were found in the packet. Telephone interview with Corporate Maintenance Director #550 on 09/26/19 at 1:58 P.M. verified no water testing was completed. 3. Review of the Review of the Legionella Environmental Assessment Form, undated, revealed the facility water flow chart was available. There were no diagrams which indicated where the water supply entered the facility from the municipal supply and the locations of the water heaters. Interview on 09/26/19 at 2:33 P.M., Maintenance Director #500 and the Administrator revealed the facility failed to complete a diagram of the where the water supply entered the facility from the municipal supply and the locations of the water heaters. Page 1 of 3 366067 366067 09/26/2019 Vista Care Center of Milan 185 S Main St Milan, OH 44846

F 0880 Level of Harm - Minimal harm or potential for actual harm Review of the CDC Legionnaire Prevention Quick Reference Guide for Surveyors revealed elements of a water management program should include details like where the building connects to the municipal water supply and where water heaters are located. Residents Affected - Many 366067 Page 2 of 3 366067 09/26/2019 Vista Care Center of Milan 185 S Main St Milan, OH 44846

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to ensure the facility was maintained in a functional and sanitary manner. This affected two rooms (room [ROOM NUMBER] and room [ROOM NUMBER]) which had loose and missing wall tiles and the basement which contained standing water. This had the potential to affect all 79 residents of the facility as well as the employees. Findings include: Observation on 09/23/19 at 9:37 A.M., of the adjoining bathroom between room [ROOM NUMBER] and room [ROOM NUMBER] revealed loose and missing wall titles from behind and above the toilet. Observation on 09/25/19 at 3:32 P.M., of the basement floor revealed standing water on various areas of the floor from water seeping up from the cracks in the floor and water seeping from around the outer perimeter of the basement walls. The facility washer and dryer were located in this area and resident clothing was stored in this location. Interview on 09/26/19 at 1:23 P.M., Maintenance Director (MD) #500 reported he was not aware of the loose and missing bathroom wall tiles. He stated the basement floor had water seeping up from the cracks in the floor and from the outer perimeter of the walls due to the water table levels. MD #500 verified the missing and loose bathroom tiles and the water standing on the basement floor. 366067 Page 3 of 3