Health inspection·July 17, 2023

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, interviews, and review of facility policy, the facility failed to perform appropriate infection control techniques during wound care. This affected one resident (#03) out of three residents reviewed for infection control. The facility census was 55. Residents Affected - Few Findings Include: Review of medical record for Resident #03 revealed an admission date 03/14/23. Diagnoses included tracheostomy, chronic pulmonary disease, and type two diabetes. Review of Minimum Data Set (MDS) assessment dated [DATE] for Resident #03, revealed the resident was severely cognitively impaired. Resident #03 required total dependence for activities of daily living (ADLs). Review of plan of care dated 06/19/23 for Resident #03, revealed the resident was at risk for skin impairment and had Pressure ulcers to left and right buttocks. Interventions included administer medications and treatments as ordered, assess and document per protocol, skin checks, Braden scale, and resident would be followed by wound physician. Review of the current physician orders dated 06/08/23 for Resident #03, revealed the resident was ordered to have left gluteal cleansed, a barrier cream with zinc applied every shift and as needed and no briefs until healed. Orders also revealed Resident #03 was ordered to have the right buttocks cleansed with normal saline, dried, calcium alginate (wound cream) applied and covered with abdominal, or foam dressing daily and as needed. Observation of wound care for Resident #03 on 07/11/23 from 1:24 P.M. with Registered Nurse (RN) #110 and State Tested Nursing Assistant (STNA) #120, revealed RN #110 washed her hands and applied gloves before starting wound care. RN #110 sprayed wound cleaner on a four-by-four (4x4) gauze and cleaned the residents right buttocks. RN #110 changed her gloves, then completed the same procedure for the resident's left buttocks. RN #110 changed her gloves and applied calcium alginate in right buttocks and barrier cream with zinc to the left buttocks and applied an overlap dressing to cover the areas. RN #100 did not complete any hand hygiene while going from a dirty to a clean procedure. Interview on 07/11/23 at 1:55 P.M. with RN #110 verified she did not complete any hand hygiene before going from a dirty to clean procedure. Interview on 07/11/23 at 2:40 P.M. with Director of Nursing (DON), revealed her expectations were for staff to complete the appropriate hand hygiene when going between a dirty and clean wound care (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: 366157 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 366157 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dunbar Health & Rehab Center 320 Albany Street Dayton, OH 45417 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)