Inspection·March 20, 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, interview, and review of facility policy, the facility failed to ensure staff implemented proper infection control practices related to hand hygiene. This affected two residents (Resident #14 and Resident #28) who were reviewed for incontinence care. The facility census was 84. Residents Affected - Few Findings include: 1. Review of the medical record for Resident #14 revealed an admission date of 07/08/21 with diagnoses including atherosclerotic heart disease, dementia, wheezing, benign prostatic hyperplasia with urinary tract symptoms, and contractures of bilateral hip, knees, and ankles. Review of the quarterly Minimum Data Set (MDS) assessment completed on 01/02/24 revealed Resident #14 had moderately impaired cognition. Further review revealed Resident #14 was always incontinent of bowel and bladder and was dependent on staff for toileting and bathing. Review of the current care plan revealed Resident #14 needed assistance with activities of daily living (ADLs). Interventions included assisting with ADLs as needed and reporting decline in ability to the physician and therapy department. Observation on 03/19/24 at 8:20 A.M. of Resident #14 revealed he was receiving personal care from State Tested Nurse Aide (STNA) #411. Further observation revealed STNA #411 was not wearing gloves while performing a bed bath and incontinence care. STNA #411 was observed removing an incontinence brief containing a small amount of smeared stool from under Resident #14 as she proceeded to wash his rectal area, then genitalia and groin area with ungloved hands. Continued observation revealed STNA #411 donned gloves and applied barrier cream without first performing hand hygiene. STNA #411 then removed her gloves and continued putting on a clean incontinence brief and dressing Resident #14's upper body with no hand hygiene after glove removal or before dressing the resident. Interview on 03/19/24 at 8:45 A.M. with STNA #411 confirmed she did not don gloves to provide the bed bath or incontinence care. Further interview confirmed STNA #411 did not perform hand hygiene before donning gloves prior to the application of barrier cream, dressing Resident #14, or between glove changes. Review of facility policy titled Perineal Care, dated 04/30/19, revealed gloves were to be worn when perineal care was performed. Gloves were to be removed after completing perineal care, and then staff were to perform hand hygiene prior to repositioning the resident and replacing the bed covers. Review of the policy titled Hand Washing/Hand Hygiene, dated 08/30/19, revealed hand hygiene was to (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: 366152 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 366152 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE West View Healthy Living 1715 Mechanicsburg Road Wooster, OH 44691 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)