Inspection·January 30, 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 observation, interview, and record review, the facility failed to ensure the facility established and maintained 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 (Resident #1) of two residents reviewed for infection control practices. Residents Affected - Few CNA C and CNA D failed to perform hand hygiene and change their gloves at the appropriate times while providing incontinence care for Resident #1. These failures placed residents at risk for the spread of infection. Findings included: Review of Resident #1's face sheet, dated 01/30/24, revealed the resident was a 90- year- old male admitted to the facility on [DATE] with diagnoses of urinary tract infections, constipation, and benign prostatic hyperplasia (enlarged prostate). Review of Resident #1's MDS assessment, dated 01/17/24, revealed Resident #1 required extensive assistance with most ADLs and one person assist. Resident #1 was always incontinent of bowel and bladder. Review of Resident #1's care plan, dated 12/27/23, revealed the resident was care planned for bowel but not bladder incontinence. Observation of incontinence care for Resident #1 on 01/29/24 at 2:38 p.m. revealed CNA C and CNA D did not wash their hands or perform hand hygiene before the start of care. Both CNAs donned gloves. CNA C wiped Resident #1 from front to back making 5 strokes of clean with same soiled wipe. Resident #1's brief was soiled with urine and fecal matter. CNA C picked up the clean brief and placed it on the trash bag where the dirty wipes were kept. Her gloves were visibly soiled but she continued to clean the resident with it. CNA C did not wash her hands, change gloves, or perform hand hygiene but proceeded to retrieve Resident #1's clean brief. 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 while repositioning and putting back the resident clean sheets and pillows. She also walked out of the room without washing hands and returned without performing hand hygiene and assisted in putting Resident #1 clothes on. CNA C and CNA D doffed their gloves, picked up the trash and left the room without washing their hands or performing hand hygiene. In an interview on 01/29/24 at 2:54p.m. with CNA C she stated she had been employed at the facility (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: 455916 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 455916 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE University Park Nursing and Rehabilitation 4511 Coronado Ave Wichita Falls, TX 76310 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)