Inspection·November 3, 2023

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 maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of infections for 1 of 2 staff (LVN B) reviewed for infection control, in that: Residents Affected - Some LVN B took a stack of PPE gowns enclosed with a plastic wrap on the outside and handed them to another person on the outside the door of Unit 6 ([NAME]) without following infection control procedures when removing items from a isolation/quarantine area. These failure could place residents at risk for cross contamination. The findings included: Observation on 11/02/2023 at 7:38 a.m. revealed LVN B in a green gown come from behind the nurses station carrying a stack of PPE Gowns enclosed in plastic wrap and open the entrance door and handed from the quarantine area to the outside door to another staff member on the outside door who then took the PPE gowns and placed them on the clean PPE cart. Interview on 11/02/2023 at 7:42 a.m. with LVN A-Unit Charge Nurse, confirmed a person (LVN B- Staff Development Nurse) indeed took a stack of PPE gowns out of the quarantine area and handed them to another staff person on the outside of Unit 6 ([NAME]). LVN A, stated she saw her but, could not stop her in time. Further interview on 11/02/2023 at 8:20 a.m. with LVN A, she stated CNA E from Central Supply and Nursing Administration were responsible for making sure the clean PPE cart was full of PPE items. She stated taking the PPE gowns out of the quarantine area could cause exposure to other people. Interview on 11/09/2023 8:30 a.m. with LVN B confirmed she had taken gowns from inside Unit 6 ([NAME]) which was under quarantine and handed them to another person to place on the clean PPE cart. When asked her if there was a problem taking items out of the quarantine are and handing them to someone else, she stated, it could be I guess cross contamination then everyone is exposed. She stated it was everybody's responsibility to make sure there is no exposure. Interview on 11/02/2023 at 9:22 a.m. with the DON concerning removing PPE items from inside the quarantine area she stated she was told about the issue with infection control gowns. Everyone was responsible to prevent cross-contamination. She stated it looks like it is time for another in-service. Interview on 11/02/23 at 10:30 a.m. with the Administrator revealed she had talked to the DON a (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 455618 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 455618 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Eden Home 631 Lakeview Blvd New Braunfels, TX 78130 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)