Health inspection·May 7, 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 maintain an infection control program designed to prevent the development and transmission of infection for 1 of 4 residents (Resident #117) observed for infection control. Residents Affected - Few The facility failed to ensure CNA B followed appropriate infection control and hand hygiene procedure during incontinent care for Resident #117 on 05/05/2025. These failures could place the residents at risk for infection. Findings included: Record review of Resident #117's face sheet dated 04/24/25 revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnosis of Septic Arthritis to the left knee (bacterial infection in the knee joint) Record review of Resident #117's MDS admission Assessment, dated 04/16/25, revealed that the resident had a BIMS summary score of 15, which indicated that the resident was cognitively intact. Further review revealed that Resident #117 required supervision and touch assistance with toileting. Record review of Resident #117's comprehensive care plan revealed that the resident had an infection related to a compromised immune system and the presence of pathogenic microorganisms. Interventions included proper hand washing using antibacterial soap before and after each care activity and maintaining sterile technique when changing dressings, suctioning, and providing site care, such as an invasive line or a urinary catheter. During an observation on 05/05/25 at 10:21 AM, CNA B walked into Resident #117's room accompanied by CNA J. Both CNA B and CNA J washed their hands and donned (put on) their gown and gloves. CNA B performed catheter care on Resident #117, turned the resident to his right side, and wiped his buttocks three times. She removed the old brief, discarded it in the trash, and applied a new brief. CNA B used the same gloves and did not perform hand hygiene throughout the entire incontinent care process. They doffed (removed)their PPE and washed their hands. CNA B and CNA J thanked the resident and left the room. During an interview on 05/05/25 at 10:21 AM, CNA J said she was unsure why CNA B did not wash her hands or change her gloves while performing catheter care. She said the staff wereare in-serviced on washing their hands and changing gloves when going from dirty to clean. She said the risk of not washing hands and changing gloves during incontinent care could lead to cross contamination. She was (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 3 Event ID: 455770 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 455770 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Bend Medical Center 1705 Jackson St Richmond, TX 77469 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)