Inspection·February 8, 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 maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections for one (Resident #1) of 2 residents reviewed for infection control practices in that: Residents Affected - Few RN A failed to perform hand hygiene, wash hands, change gloves and prevent cross contamination while providing wound care for Resident #1. These failures could affect the residents by placing them at risk for the spread of infection. Finding included: Review of Resident #1's Face Sheet dated 02/08/24, revealed a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of non-pressure ulcers, urinary tract infection, exposure to covid-19, and candidiasis. Review of Resident #1's Minimum Data Set (MDS) Assessment undated revealed Resident #1 required total assistance with most activities of daily living (ADLs) and was always incontinent of bowel and bladder. Review of Resident #1's care plan dated 08/03/22 revealed he was at risk pressure ulcers and skin breakdown related poor intake, abnormal labs, incontinence, and impaired mobility. Observation of wound care on Resident #1 on 02/08/24 at 11:30 a.m. revealed RN A did not wash hands but donned gloves before the start of care. She prepared a clean field on a paper spreader. RN A communicated and positioned Resident #1. She removed old dressing revealing a thin reddish clear dry wound on the left heel. RN A cleansed the wound with normal saline and patted dry. She did not wash hands, change gloves, or perform hand hygiene before retrieving the clean kerlix gauze bandage roll. As RN A was covering the wound with the kerlix gauze, it fell on the floor. She picked it up and continued to use it to cover the wound. RN A did not change or replace the dressing. In an interview on 02/08/24 at 11:46 a.m. with RN A, she said he had been employed in the facility for one year. She noted she received infection control training in November 2023. RN A stated she should have washed her hands, performed hand hygiene before retrieving the clean kerlix gauze. She said cross contamination was mixing clean with dirty and the resident could get sick if good infection practice was not followed. (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: 455965 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 455965 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/08/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Texhoma Christian Care Center Inc 300 Loop 11 Wichita Falls, TX 76306 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)