Health inspection·September 26, 2023

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observations, record review, staff interviews, review of the Centers for Disease Control and Prevention (CDC) COVID-19 guidance, and policy review, the facility failed to ensure wore the proper Personal Protective Equipment (PPE) in resident rooms who were in isolation for COVID-19. This had the potential to affect 10 residents (#35, #60, #115, #120, #130, #135, #145, #150, #170, and #180) residents on the 100 B hall who had not tested positive for SARS-CoV-2 (COVID-19) in the facility outbreak dated 09/07/23. The facility census was 60. Residents Affected - Some Findings include: Review of the facility's COVID-19 outbreak documentation dated 09/07/23 revealed the facility initiated COVID-19 outbreak status on 09/07/23. There were two residents (#100 and #100) currently in isolation for COVID-19 and resided on the 100 B-Hall unit. There were eight residents (#05, #40, #50, #55, #105, #124, #140 and #190) who had been infected with COVID-19 but had completed their isolation period, and 10 residents (#35, #60, #115, #120, #130, #135, #145, #150, #170 and #180) who had not been infected during the current outbreak and lived on the 100 B-Hall unit. Observation of Resident #100 and #110's room on 09/25/23 at 1:45 P.M. revealed resident's room door was observed to have signage up that revealed staff were not to enter without wearing a N-95 mask, gown, gloves, and goggles. The signage also stated the items must be removed prior to leaving the room. There was observed by a three drawer chest in the hallway next to the room which contained the required PPE. Housekeeper #320 was in the room in her scrubs and a surgical mask using a broom to sweep the floor in the room. Housekeeper #320 was observed talking to the residents as she worked. Housekeeper #320 was not wearing a N-95 mask, gown, gloves, and eye protection. Interview with Registered Nurse (RN) #325 on 09/25/23 at 1:47 P.M. confirmed Housekeeper #320 should have on a N-95 mask, gown, gloves, and eye protection. RN #325 was observed to tell Housekeeper #320 to come to the doorway and instruct Housekeeper #320 to put on the required PPE. Interview with Housekeeper #320 on 09/25/23 at 1:55 P.M. confirmed she forgot to put on the required PPE prior to starting to Resident #100 and #110's room which was a isolation room. Subsequent observation of Resident #100 and #110's room on 09/26/23 at 5:47 A.M. revealed State Tested Nursing Assistant (STNA) #300 and #305 were in the room assisting the residents. STNA #300 was on the left side of of Resident #100's bed by the head of the bed and STNA #305 was standing by the bathroom door. STNA #300 and #305 were observed to have surgical mask in place but no PPE. The signage remained on the resident's room door for staff not to enter without wearing a N-95 mask, gown, gloves, and goggles. The signage also stated the items must be removed prior to leaving the room. Page 1 of 2 366194 366194 09/26/2023 Bennington Glen Nursing & Rehabilitation Center 825 State Route 61 Marengo, OH 43334

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Observation and interview with RN #390 on 09/26/23 at 5:48 A.M. confirmed STNAs #300 and #305 did not have on the required PPE. RN #390 stated she forgot to tell them. Interview and observation with STNA #300 on 09/26/23 at 5:49 A.M. revealed she was starting to exit Resident #100 and #110's room wearing her surgical mask. STNA #300 did not dispose of her surgical mask or complete hand hygiene after exiting Resident #100 and #110's room. STNA #300 started to walk down the hallway towards other resident rooms and another staff member asked her to change her surgical mask and complete hand hygiene. STNA explained she rushed into Resident #100 and #110's room and didn't think about putting on the proper PPE. Review of the CDC Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic (updated 05/08/23) revealed the recommendations in this guidance continue to apply after the expiration of the federal COVID-19 Public Health Emergency. The recommended infection prevention and control practices when caring for a patient with a suspected or confirmed SARS-CoV-2 infection revealed healthcare professionals who enter a room of a patient with suspected or confirmed SARS-Co-V-2 infection should adhere to standards precautions and use a National Institute for Occupational Safety and Health (NIOSH) Approved particulate respirator with N-95 filters or higher, gown, gloves, and eye protection. Review of the facility policy titled COVID 19 Positive+ Testing Schedule Policy, revised 09/23/22 revealed a resident with confirmed COVID-19 will be isolated and remain on transmission based precautions (TBP) (Isolation) in a private room. Staff who enter the room should use a NIOSH-approved respirator (N95), gown, gloves, and eye protection. A NIOSH-approved respirator with N95 filter or higher should be removed and discarded after each COVID-19 patient care encounter and a new one should be put on. Only residents who have tested positive for COVID-19 could be housed in the same room. This was an incidental finding during the complaint investigation. 366194 Page 2 of 2