Health inspection·August 29, 2023

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of policies and clinical records, as well as observations and staff interviews, it was determined that the facility failed to ensure that proper infection control practices were performed while obtaining a blood glucose for two of 19 residents reviewed (Residents 2, 18), and failed to ensure the blood sugar monitoring device (glucometer) was appropriately cleaned between residents. Residents Affected - Few Findings include: The facility's policy for disinfection of the glucose monitoring machine, dated February 1, 2023, indicated that the machine should be wiped with Clorox wipes before and after each resident care. Once in the resident's room the machine was to be placed on a clean paper towel on a flat, dry, clean surface. After obtaining the blood glucose level, remove gloves and wash hands, and clean the blood glucose device with Clorox wipes. The diagnosis record for Resident 18, dated December 16, 2021, included the diagnosis of diabetes. Physician's order for Resident 18, dated June 28, 2023, indicated that she was to have Novolog insulin (rapid acting insulin) provided twice a day depending on the blood glucose result and the coverage scale as ordered. Observations on August 29, 2023, at 4:20 p.m. revealed that Licensed Practical Nurse 1 was obtaining Resident 18's blood glucose levels. The nurse, with gloved hands, entered the resident's room and placed the blood glucose device directly on her bedside stand. After obtaining a blood sample she proceeded out of the room to the medication cart. She placed the glucose device on the medication cart, removed her gloves, and cleaned the device with alcohol swabs. She placed the device back onto the medication cart and without performing any hand hygiene, she obtained equipment to obtain Resident 2's blood glucose. Licensed Practical Nurse 1 donned gloves and obtained a blood glucose for Resident 2. She proceeded to the medication cart, placed the device on the cart, cleaned the device with alcohol swabs then removed her gloves. Without performing hand hygeine she proceed to remove medications from the medication cart for another resident. Interview with Licensed Practical Nurse 1 on August 29, 2023, at 4:30 p.m. indicated that she should not have placed the used glucose device on the medication cart before cleaning it, she should have used the hand sanitizer after her glove removal, and that she was to use alcohol for cleaning the device. Interview with the Director of Nursing and the clinical compliance Certified Registered Nurse Practioner on August 29, 2023, at 5:14 p.m. confirmed that hand hygeine should have been done after Page 1 of 2 395435 395435 08/29/2023 Westmoreland Manor 2480 South Grand Blvd Greensburg, PA 15601

F 0880 Level of Harm - Minimal harm or potential for actual harm Licensed Practical Nurse 1's glove removal, there should have been a barrier placed on the resident's over-the-bed stand/medication cart. and that the glucose machine should have been cleaned with Clorox wipes as per the policy. 28 Pa. Code 211.12(d)(1)(5) Nursing services. Residents Affected - Few 395435 Page 2 of 2