Health inspection·November 15, 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, interview, and record review the facility failed to ensure appropriate hand washing was implemented during dining service and failed to appropriately handle food. This affected two residents (Residents #2 and #5) observed in the first floor dining room and had the potential to affect one of two residents (Residents #8 and #28) observed in the second floor dining room. The facility census was 44. Residents Affected - Few Findings include: 1. Record review of Resident #2 revealed an admission date of 05/28/18 and diagnoses included muscle weakness, osteoporosis and dysphagia (swallowing difficulties). The quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #2 had impaired cognition and required extensive assistance of one staff with eating. The November 2019 physician orders revealed an active order with a start date of 02/21/19 for staff to assist/feed at all meals. Resident #2's care plan initiated on 05/09/19 for Activities of Daily Living (ADL) intervention included this order. Record review of Resident #5 revealed an admission date of 08/06/19 and diagnoses included muscle weakness, cerebral infarction (stroke), and dysphagia following cerebral infarction. The quarterly MDS assessment dated [DATE] revealed Resident #5 was alert and oriented and had intact cognition. Resident #5 required extensive assistance of one staff with eating. The care plan initiated on 08/06/19 for Activities of Daily Living (ADL) intervention included an intervention for staff to assist with meals and encourage Resident #5 to self feed as much as possible. On 11/13/19 at 12:12 P.M., Resident #2 was seated at the table with Resident #5 and State Tested Nurse Aide (STNA) #240 was seated between them. Resident #2 was observed to sneeze into his hand. STNA #240 grabbed a tissue from a box on the table and assisted Resident #2 by cleaning his hand and shirt with the tissue. STNA #240 stayed seated and held the dirty tissue in her hand. Then STNA #240 was observed to pick up Resident #5's cup and plate with her contaminated hand and move it closer to the resident. Interview on 11/13/19 at 12:14 P.M. with STNA #240 verified the above observations and stated she should have thrown away the tissue and washed her hands. Review of the facility policy titled, Hand washing/Hand Hygiene, revised 09/2017, revealed use of an alcohol-based hand rub containing at least 62% alcohol or alternatively, soap and water for the following situations, which included after contact with blood or bodily fluids and before and after assisting a resident with meals. 2. Observation on 11/13/19 at 12:10 P.M. in the second-floor dining hall revealed, Dietary Aide, Page 1 of 2 366373 366373 11/15/2019 Brookdale Westlake Village 28450 Westlake Village Drive Westlake, OH 44145

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (DA) #277 was preparing an egg salad sandwich on a high divide adaptive plate. While cutting the sandwich in sections, DA #277 held the sandwich with her non-gloved left hand, while cutting the sandwich with her gloved right hand. This had the potential to affect Resident #8 or #28, both of which would have been served an egg salad sandwich using a high side adaptive divided plate. Interview with (DA) #277 on 11/13/19 at 2:10 P.M. confirmed that she was not wearing a glove on her left hand when holding the sandwich to cut in sections. (DA) #277 stated she was knowledgeable of infection control procedures during the interview. 366373 Page 2 of 2