Inspection·February 13, 2024

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 observations, interviews, and record reviews, 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 for 1(Resident #1) of 2 residents reviewed for infection control practice, in that: Residents Affected - Some 1) CNA C and CNA D failed to perform hand hygiene and change their gloves while providing incontinence care for Resident #1. 2) LVN A failed to perform hand hygiene and change gloves while providing wound care. These failures placed residents at risk for the spread of infection. Findings included: Review of Resident #1's face sheet, dated 02/13/24, revealed the resident was an 82- year- old female admitted to the facility on [DATE] with diagnoses of personal history of Covid-19, acute candidiasis of vulva and vagina (Fungal infection), and Alzheimer's disease. Review of Resident #1's MDS assessment, dated 11/27/22, revealed Resident #1 required total assistance with most activity of daily living (ADLs) and two-person assist. Resident #1 was frequently incontinent of bowel and always of bladder. Review of Resident #1's care plan, dated 10/30/22, revealed the resident was care planned for being incontinent of bladder and bowel related to impaired cognition and mobility. Observation of incontinence care for Resident #1 on 02/12/24 at 10:32 a.m. revealed CNA C and CNA D was about to transfer the resident from wheelchair to bed when the surveyor entered the room. Both used proper transfer technique to move the resident. Both CNA C and CNA D did change gloves after transferring Resident #1. CNA C removed the resident's soiled brief. She wiped from front to back. Resident #1's brief was soiled with urine and fecal matter. Both repositioned Resident #1. CNA C continued to clean the resident bottom area. CNA C gloves were visibly soiled with urine. CNA C did not wash her hands, change gloves, or perform hand hygiene but proceeded to retrieve Resident #1's clean brief. CNA C applied skin protector on the resident perineal area with same soiled gloves. She placed the clean brief on the resident and fastened it. Meanwhile, CNA D was assisting CNA C to provide care to Resident #1. CNA D wore the same gloves for transferring and repositioning the resident including touching the perineal area and fastened the clean brief to the resident. CNA C and CNA D did not wash their hands before exiting Resident #1's room. (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: 455849 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 455849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehabilitation and Healthcare of Bowie 700 W Highway 287 S Bowie, TX 76230 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)