Health inspection·October 3, 2019

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 observation, record review and interview the facility failed to maintain adequate infection control practices during wound care for Resident #49 to prevent the spread of infection. This affected one resident (#49) of one resident reviewed for pressure ulcer care. Residents Affected - Few Findings include: Record review revealed Resident #49 was admitted to the facility on [DATE] with diagnoses including unspecified convulsions, encephalopathy, altered mental status, cerebral infarction, dementia, and an unstageable pressure ulcer (a pressure ulcer with a wound bed that cannot be visualized or staged) which was present on admission. Review of the Minimum Data Set (MDS) 3.0 assessment, dated 08/07/19 revealed the resident had moderate cognitive impairment and required two or more staff to provide extensive physical assistance for mobility in bed. She had orders for daily and as-needed dressing changes. Her most recent assessment by the facility's wound-care nurse practitioner on 10/01/19 identified the resident's wound as being currently a Stage III pressure ulcer (a pressure ulcer that involves full-thickness tissue loss, but with no exposed bone, tendon, or muscle) on the coccyx which had improved since previous assessments and had no signs of infection. The surveyor observed a pressure ulcer dressing change on the coccyx for Resident #49 by Licensed Practical Nurse (LPN) #201 and LPN #202 on 10/03/19 at 9:31 A.M. While staff were exposing the wound, they revealed the resident had an incontinent diarrhea bowel movement which stained both the body and wound dressing. The staff then interrupted the dressing change procedure to provide incontinence care. During this process, Resident #49 was nonverbal and did not appear to understand verbal introductions or instructions. Resident #49 scratched herself at multiple times during the procedure, including areas potentially contaminated by stool (the back and buttocks). The resident did not receive hand-washing during the observation. Upon completion of the incontinence care, the staff began to perform the wound dressing change for Resident #49. LPN #201 removed the old dressing and washed out the wound (which appeared to be a Stage III pressure ulcer) with normal saline and gauze. At that time, the wound had no sign of infection or drainage. LPN #201 then moved to the bathroom to wash her hands before applying the new dressing, while LPN #202 held Resident #49 on her side. While LPN #201 was out of eyeshot, Resident #49 reached down and scratched inside of the uncovered wound with her fingernails, then removed her hand. Following this, scant bloody drainage began coming from the wound. LPN #201 returned to the bedside and began preparation of triad cream (a wound-care cream). LPN #202 did not say anything at this time, or otherwise indicate the wound was contaminated. The surveyor intervened in the procedure at this Page 1 of 2 366180 366180 10/03/2019 Riverview Pointe Care Center 9027 Columbia Road Olmsted Falls, OH 44138

F 0880 Level of Harm - Minimal harm or potential for actual harm time and asked staff what the current plan was. LPN #201 said that the wound was now cleaned, and she would apply the triad cream and continue with the dressing change. LPN #202 did not say anything. The surveyor informed LPN #201 the wound now had bloody drainage (being a change from when it was uncovered), and the resident had scratched inside it with a hand potentially contaminated with stool while LPN #201 was not present. Residents Affected - Few Following surveyor intervention, facility staff washed the wound and proceeded with the resident's dressing change. The procedure concluded on 10/03/19 at 10:59 A.M. The surveyor reviewed the above findings with LPN #201 on 10/03/19 at 11:00 A.M. Interview with LPN #202 on 10/03/19 at 11:55 A.M. revealed she stated she did not see the resident scratch the wound. Record review of the facility skin care policy, dated 12/02/15 revealed the facility was to provide needed treatment and services to promote healing and provide necessary treatments for wounds. 366180 Page 2 of 2