Health inspection·November 21, 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** Residents Affected - Some Based on record review, observation, staff interview, review of nursing standards and policy review, the facility failed to follow appropriate infection control while providing peritoneal dialysis, tube feed administration and blood glucose checks. This affected one (Resident #102) of one resident reviewed for peritoneal dialysis, one (Resident #9) of three residents reviewed for tube feeding, and had the potential to affect three residents (#39, #67 and #89) identified by the facility receiving blood glucose checks. The facility identified four residents receiving dialysis services. The facility census was 120. Findings include: 1. Record review for Resident #102 revealed the resident was admitted to the facility on [DATE]. Diagnoses included bacteremia, Methicillin resistant staphylococcus aureus, end stage renal disease and renal dialysis. Review of the admission Minimum Data Set (MDS) assessment, dated 11/07/19, revealed the resident had no cognitive deficits, requires extensive assistance from staff with activities of daily living, and was continent of bowel and bladder. Review of the care plan, dated 11/04/19, revealed Resident #102 required peritoneal dialysis and has the potential for complications/infection related to end stage renal disease and renal failure. Interventions included to follow cyclic procedure. Observation on 11/20/19 from 8:55 A.M. to 9:02 A.M. with Registered Nurse (RN) #12 disconnecting Resident #102 from his peritoneal dialysis treatment without a face mask on. The RN disinfected, removed, and placed a new mini-cap with no face mask on the nurse or the resident. Interview on 11/20/19 at 9:03 A.M. with RN #12 verified she forgot to put on a face mask on the resident and herself while disconnecting Resident #102 from his peritoneal dialysis. Review of the facility's Peritoneal Dialysis Policy, dated 11/2017, revealed to wash your hands, clean the work surface, gather supplies and put on a face mask and apply gloves. 2. Observation on 11/20/19 at 8:13 A.M. revealed RN #3 took Resident #39's blood glucose and then set the glucometer on the 2200 hall medication cart without cleaning it. RN #3 then gave Resident #39 his medications. Page 1 of 2 366320 366320 11/21/2019 Shawneespring Health Care Center 10111 Simonson Road Harrison, OH 45030

F 0880 Level of Harm - Minimal harm or potential for actual harm Interview on 11/20/19 at 8:39 A.M. with RN #3 stated she was finished and started to walk away from the medication cart and the soiled glucometer was still sitting on the medication cart. RN #3 verified that she had forgotten to clean the glucometer. The facility identified Resident #39, #67 and #89 received blood glucose checks by the facility. Residents Affected - Some Review of the Nursing Standards of Practice for Bedside Glucose Testing with the Evencare G3 Blood Glucose Monitor revealed the glucose monitor will be disinfected after a test is performed and before testing another resident. 3. Medical record for Resident # 9 revealed an admission date of 05/03/18. Diagnoses included hemiplegia and hemiparesis following cerebral infarction and dysphagia following cerebral infarction Review of the quarterly Minimum Data Set (MDS) assessment, dated 08/28/19, revealed Resident #9 was cognitively intact and had a gastrostomy tube for feeding. Review of the care plan, dated 08/21/19, revealed the resident was to have nothing by mouth (NPO) and stated he required tube feeding for dysphagia. Review of the physician order, dated 05/03/18, revealed Resident #9 was to have tube feeding at 75 milliliters (ml.) per hour for 24 hours via pump per a percutaneous endoscopic gastrostomy tube (PEG) (a flexible feeding tube placed through the abdominal wall into the stomach allowing nutrition, medication and fluids placed directly into the stomach bypassing the mouth and esophagus). Observations on 11/19/19 at 9:42 A.M. and at 3:19 P.M. and on 11/20/19 at 10:02 A.M. and 10:40 A.M. revealed the gastrostomy feeding tube pump had tan colored dry spots on top of the pump, on the side of the pump, on the face of the pump and on the bottom of the pump. Interview on 11/20/19 at 10:40 A.M. with Registered Nurse (RN) #53 confirmed the tan colored dry spots on the gastrostomy feeding pump. 366320 Page 2 of 2