Health inspection·March 5, 2025

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 establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for one of three residents (Resident #1) reviewed for infection control. Residents Affected - Few 1. RT A failed to wash her hands or use hand sanitizer between gloves changes while providing Tracheostomy (Trach) care for Resident #1. 2. RT A failed to ensure she did not double glove in placed of hand hygiene while providing Tracheostomy Care. These failures could place residents at risk for spread of infection. Findings include: Record review Resident #1's face sheet, dated 03/05/25, reflected a [AGE] year-old female who was admitted to the facility on [DATE]. Resident #1 had diagnoses which included acute respiratory failure with hypoxia (a condition where the lungs are unable to exchange oxygen and carbon dioxide properly, resulting in low oxygen levels in the blood), dependence of respirator (ventilator) status, hypertension (a condition in which the force of blood against the walls of the arteries is consistently too high), diabetes (a chronic condition where the body either doesn't produce enough insulin or doesn't use insulin effectively, leading to high blood sugar levels), Chronic Obstructive Pulmonary Disease (a condition caused by damage to the airways or other parts of the lung), and Tracheostomy status (a procedure to help air and oxygen reach the lungs by creating an opening into the trachea (windpipe) from outside the neck). Record review of Resident #1's care plan, dated 12/31/24, reflected a focus area that Resident #1 had a tracheostomy and was at risk for changes in secretions, infection, and respiratory distress. Record review of Resident 1's quarterly MDS assessment, dated 01/04/25, reflected a BIMS score of 15, which indicated cognition was cognitively intact. Section O- Respiratory Treatment- E1. Tracheostomy Care. During an observation on 03/05/25 at 10:59 AM revealed Trach Care was provided by RT A. RT A entered Resident #1's room and placed Trach supplies on the bedside table. RT A donned mask, gown, and gloves. RT A was observed donning another pair of gloves on top of the initial pair of gloves she already had on (RT A had 2 pair of gloves on). After suctioning Resident #1, RT A was observed removing (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 4 Event ID: 455714 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 455714 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Paradigm Northwest 17600 Cali Dr Houston, TX 77090 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)