Health inspection·March 25, 2024

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 03/25/24 at 11:55 A.M. with PT #357 confirmed she was sitting on Resident #13's bed with no gown while assisting with therapeutic exercises. Further interview revealed PT #357 did not realize Resident #13 was still on EBP, since there was no PPE outside the door. At this time, PT #357 confirmed the sign indicating Resident #13 was in EBP was still posted beside her door. Interview on 03/25/24 at 11:58 A.M. with Registered Nurse (RN) #350 confirmed Resident #13 was on EBP due to her wound status and further confirmed there was no PPE outside the door to Resident #13's room. During the interview, RN #350 confirmed PPE was supposed to be outside the resident rooms when they were on any type of precautions. Interview on 03/25/24 at 5:1 P.M. with RN #319 confirmed PPE should be available outside the resident's rooms when on enhanced barrier precautions and should be checked and restocked at the end of every shift and as needed. Review of the undated facility policy titled Enhanced Barrier Precautions revealed wounds and indwelling medical devices were indications for being placed on EBP and the facility was to ensure PPE was maintained outside the resident's room. Further review of the policy revealed staff were to wear gowns for high touch resident care activities. 2. Review of the medical record for Resident #45 revealed an admission date of 05/31/23 with diagnoses including infection and inflammatory reaction due to an indwelling urethral catheter, neuromuscular dysfunction of the bladder, atrial fibrillation, bipolar disorder, dysphagia, kidney failure, and dementia. Review of the Minimum Data Set (MDS) assessment completed on 03/04/24 revealed Resident #45 had severely impaired cognition, had an indwelling catheter, was always incontinent of bowel, and was dependent on staff for bathing, toileting, and personal hygiene. Review of the care plan revealed Resident #45 was placed in enhanced barrier precautions (EBP) on 06/01/23 secondary to a suprapubic catheter, wounds, and a percutaneous endoscopic gastrostomy (PEG) tube (a tube through the resident's stomach for nutrition and/or medications). Interventions included staff were to wear a gown and gloves during care per recommendations for EBP. Observation on 03/25/24 at 2:45 P.M. of catheter care revealed State Tested Nurse Aide (STNA) #340 did not bag the soiled linen, then used soiled gloved hands to open and close Resident #45's bedroom door and the soiled linen cart in the hallway. During the observation, STNA #340's soiled gloved hands touched both the inside and the outside doorknobs, as well as the soiled linen cart other staff were observed pushing through the hallway throughout the day of the survey. This process occurred twice during the observation of catheter care. Interview on 03/25/24 at 2:50 P.M. with STNA #340 confirmed she opened and closed Resident #45's door and handled the linen cart in the hallway with soiled gloves both times she removed soiled linen from Resident #45's room. During the interview, STNA also confirmed staff were supposed to place soiled linen into plastic bags as they were used during care and close the bags filled with soiled linen prior to removing them from residents' rooms. Interview on 03/2/24 at 3:10 P.M. with the Administrator confirmed Resident #45's doorknobs should not have been handled with soiled gloves. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366306 If continuation sheet Page 2 of 3 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 366306 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Valley Oaks Care Center 500 Selfridge Street East Liverpool, OH 43920 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Interview on 03/25/24 at 5:20 P.M. with the Director of Nursing (DON) confirmed exposed linen was not supposed to leave the resident's room and that the linen should first be bagged. Interview with the DON further confirmed soiled gloves should not be used to manipulate high touch surfaces like doorknobs. Review of the policy titled Laundry and Bedding, Soiled, dated September 2022 revealed contaminated linen and laundry bags should not be held close to the body, should be handled with minimal agitation, and staff should use appropriate standard precautions. Review of CDC Updates as of July 12, 2022 revealed the following. 1. Multidrug-resistant organism (MDRO) transmission is common in skilled nursing facilities, contributing to substantial resident morbidity and mortality and increased healthcare costs. 2. Enhanced Barrier Precautions (EBP) are an infection control intervention designed to reduce transmission of resistant organisms that employs targeted gown and glove use during high contact resident care activities. 3. EBP may be indicated (when Contact Precautions do not otherwise apply) for residents with any of the following: o Wounds or indwelling medical devices, regardless of MDRO colonization status o Infection or colonization with an MDRO. 4. Effective implementation of EBP requires staff training on the proper use of personal protective equipment (PPE) and the availability of PPE and hand hygiene supplies at the point of care. 5. Standard Precautions, which are a group of infection prevention practices, continue to apply to the care of all residents, regardless of suspected or confirmed infection or colonization status. Review of the resident census provided by the facility dated 03/24/25 revealed Residents #29, #30, #31, #32, #33, #34, #35, #36, #37, #38, #39, #40, #31, #42, #43, #44, #46, #47, #48, #49, #50, #52, #52, #53 and #54 resided on the 200 hall. This deficiency represents non-compliance investigated under Complaint Number OH00151588. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 366306 If continuation sheet Page 3 of 3