Health inspection·February 12, 2026

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 review of facility policies, Centers for Disease Control and Prevention (CDC) guidance, staff interviews, clinical record review, and direct observation, it was determined the facility failed to establish, maintain, and implement an effective infection prevention and control program to prevent the spread of infections regarding animal visitation and indwelling urinary catheter maintenance for 2 of 6 sampled residents. (Residents 1 and 2). Findings include: A review of the facility's policy titled Infection Control Policies and Practices, last reviewed February 12, 2025, revealed it is the policy of the facility to maintain an organized, effective facility-wide program designed to systematically prevent, identify, control and reduce the risk of acquiring and transmitting infections among employees, volunteers, visitors and contract healthcare workers. The policy indicated that employees support resident safety by adhering to all policies and procedures related to infection prevention. A review of a facility policy titled Animal Visitation Pet Policy reviewed March 31, 2025, revealed, the facility will allow residents to have pet visitation while attempting to provide a safe and infection free environment. Only dogs, cats, caged birds and small animals such as hamsters, gerbils, rabbits and fish are allowed as visitors to the facility. Prior arrangements must be made with the Life Enrichment (activity) department during the weekday prior to the pet visit. The policy required all medical vaccinations and check-ups must be up to date and a copy on file in the pet record binder maintained by the activity department. Pets shall not be permitted in the nurses' stations or in any areas where cleanliness and sanitary precautions are necessary to protect the health, comfort, safety and wellbeing of residents. Pets visiting the facility will be kept on a leash or in a safety cage throughout the visit. Small birds are required to have an annual exam, an annual fecal exam as well as wings clipped on a regular basis. An additional form entitled, Pet Protocol dated as reviewed March 31, 2025, revealed, all animals visiting the facility will have preventative care to ensure they do not pose a risk to the health, safety or rights of all residents. A review of Centers for Disease Control (CDC) documentation dated July 18, 2025, titled Healthy People, Healthy Pets: Backyard Poultry revealed that backyard poultry (including chickens, ducks, [NAME], [NAME] fowl, and turkeys) can carry germs that make people sick. The CDC identifies infections associated with poultry exposure to include:Avian influenza (bird flu), a viral infection that can infect humans.Campylobacter infection, a bacterial infection that can cause diarrhea and gastrointestinal illness.Escherichia coli (E. coli), bacteria found in the intestines of humans and animals that can cause serious foodborne illness.Histoplasmosis, a fungal infection that may cause flu-like respiratory symptoms.Salmonella infection, a bacterial infection that can cause diarrhea, fever, and abdominal cramps.Young children, older adults, and people with weakened immune systems are more likely to get sick from these germs. The CDC recommends that poultry and related equipment be kept outside and not permitted inside areas where people live, prepare food, or receive care. Don't eat or drink in areas where poultry live or roam. Stay outdoors when cleaning any Residents Affected - Few Page 1 of 3 395493 395493 02/12/2026 Julia Ribaudo Extended Care Center 1404 Golf Park Drive Lake Ariel, PA 18436

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few equipment or materials used to raise or care for poultry. This includes cages or food and water containers The CDC further recommends routine veterinary care (to remain healthy and prevent the spread of disease) and hand hygiene after handling poultry or items in their environment.During an interview on February 12, 2026, at 9:05 AM Employee 1 (Licensed Practical Nurse) stated that in late October 2025, during a 7:00 AM to 3:00 PM shift, she brought a sick chicken into the facility in a small pet carrier at approximately 6:45 AM. She indicated she has about 40 chickens at home and this was one of those chickens. She stated she did not notify facility administration in advance and did not obtain veterinary evaluation to ensure the animal was safe for contact with residents, staff, or visitors. She stated the chicken was kept at the nurses' station on the floor. She further stated she removed the chicken from the carrier at the nurse's station to clean the cage, and to feed and hydrate the animal. She stated she carried the chicken in her arms within the facility and allowed residents to pet the animal. She stated the chicken remained in the facility for a few hours until a family member picked it up.An interview February 12, 2026, at 10:00 AM, the Director of Nursing (DON) confirmed that on October 22, 2025, Employee 1 (LPN) brought a chicken into the facility with her at the start of the 7:00 AM to 3:00 PM shift. He stated that Employee 1 (LPN) indicated that she brought the chicken into the facility because it was sick and she had no one to care for the sick bird at home while she worked. He stated that he became aware of the chicken in the facility at approximately 8:30 AM that morning and the animal stayed in the facility for a few hours until the employee's family member could pick it up. He did confirm that he was aware that the animal was sick during the time it was in the facility and that he was aware that Employee 1 (LPN) removed the chicken from its cage and allowed residents to pet the animal. He confirmed that Employee 1 (LPN) did not follow the facility pet protocol and was not in compliance with infection control protocols.A review of an in-service training record dated October 23, 2025, titled Animal Visitation Policy, revealed the presenter reviewed the facility's animal visitation policy and explained that chickens out of a crate are not allowed as part of visitation at the facility. Employee 1 (LPN) attended and signed the form as completed.The facility failed to demonstrate adherence to its infection control and animal visitation policies, failed to prevent introduction of a sick poultry animal into the facility, and failed to restrict the animal from resident contact and from the nurses' station area, which is a clinical care environment requiring sanitary precautions. This practice had the potential to expose residents, including those with advanced age and cognitive impairment, to zoonotic diseases (diseases transmitted from animals, such as birds, to humans). In addition, the facility failed to maintain proper infection control practices related to indwelling urinary catheter (a flexible tube used for draining urine from the bladder and having an inflatable part at the bladder end that allows the tube to be kept in place for variable time periods) care.A review of the facility policy titled Indwelling Urinary Catheter Care Procedure, last reviewed July 15, 2025, revealed that urinary drainage bags must be positioned below the level of the bladder to allow gravity drainage, but not placed directly on the floor. Improper handling or contamination of the drainage system increases the risk of a urinary tract infection (UTI), an infection involving the urinary system that may cause fever, pain, confusion, and in severe cases bloodstream infection (sepsis).Clinical record review revealed Resident 1 was admitted [DATE], with diagnoses including dementia (a progressive decline in memory and cognitive function) and urinary retention (inability to empty the bladder). A quarterly Minimum Data Set (MDS, a federally required standardized assessment used to evaluate and plan resident care), dated December 5, 2025, revealed the resident was severely cognitively impaired, required assistance with activities of daily living, and had an indwelling urinary catheter.A review of a care plan last reviewed June 2, 395493 Page 2 of 3 395493 02/12/2026 Julia Ribaudo Extended Care Center 1404 Golf Park Drive Lake Ariel, PA 18436

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 2025, revealed Resident 1 utilized a suprapubic catheter (a tube inserted through a small incision in the lower abdomen to drain urine directly from the bladder when normal urination is not possible). The goals to include, the resident will have appropriately managed catheter care as evidenced by not exhibiting obstruction or signs of infection. Interventions to include, provide full assistance for catheter care, observe for signs/symptoms of infection, report complications and keep the catheter system a closed system (catheter tubing and drainage bag remain sealed and are not disconnected to prevent bacteria from entering the urinary tract and causing infection) as possible. During observation on February 12, 2026, at 11:30 A.M., Resident 1 was in bed, and his urinary collection bag was observed resting directly on the floor. The observation was confirmed at the time by Employee 1 (LPN).Clinical record review revealed Resident 2 was admitted [DATE], with diagnoses including obstructive and reflux uropathy (conditions involving blockage and backward flow of urine that can damage the urinary system) and morbid obesity (a condition characterized by excessive body weight that increases health risks). An admission MDS dated [DATE], revealed she was moderately cognitively impaired, required assistance with activities of daily living and had an indwelling urinary catheter.A review of a care plan last reviewed January 7, 2026, for altered elimination related to indwelling catheter, the resident will remain free from infection. Interventions to include, catheter care per routine, position catheter collection bag and tubing below the level of the bladder and provide a privacy cover (a fabric bag used to cover the urine collection bag). During observation on February 12, 2026, at 11:40 AM, Resident 2 was seated in her wheelchair at the nurses' station, and her urinary collection bag was observed resting directly on the floor. The observation was confirmed at the time by Employee 1 (LPN). During interview on February 12, 2026, at 12:00 PM, the DON confirmed that urinary collection bags should be maintained off the floor. 28 Pa. Code 211.10 (a)(d) Resident care policies.28 Pa. Code 211.12 (c)(d)(5) Nursing services. 28 Pa. Code 211.17 (2)(5.1)(6)(7) Pet therapy 395493 Page 3 of 3