Health inspection·February 27, 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 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 three residents reviewed for infection control practices. Residents Affected - Few CNA A and CNA B failed to perform hand hygiene and change gloves as appropriate while providing incontinence care to Resident #1 on 02/25/2025. This failure could place residents at risk for cross contamination and the spread of infection. Findings included: Review of Resident #1's face sheet dated 02/27/25, revealed he was a [AGE] year-old male admitted to the facility on [DATE] with diagnoses of Covid-19, gangrene (death of body tissue due to lack of blood flow or infection), acquired absence of right leg above knee (amputation), acquired absence of left leg above knee (amputation), and muscle weakness. Review of Resident #1's quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed Resident #1 required substantial/maximal with most activities of daily living (ADLs) and always incontinent of bowel and bladder. Review of Resident #1's Care Plan dated 03/15/24 revealed he has bowel and bladder incontinence. The goal was for the resident to remain free of skin breakdown due to incontinence and brief use through the review date. Observation on 02/25/25 at 3:30 p.m. of incontinence care on Resident #1 revealed CNA A and CNA B washed their hands before donning gloves. Resident #1's brief was completely soiled with fecal matter. CNA A and CNA B removed Resident #1's soiled brief. CNA A wiped the resident from front to back. The wipes were visibly soiled with fecal matter, but she continued to use it. She did not wash hands, change gloves, or perform any form of hand hygiene before then applying skin protector on Resident #1. CNA A then retrieved the clean brief with same soiled gloves and fastened it to Resident #1. CNA A used the same soiled gloves throughout the incontinent care process. Meanwhile, CNA B who was assisting CNA A wiped the Resident #1's back perineal side after repositioning. She did not change gloves before helping to fasten the clean brief. CNA A picked up the trash and walked out of the resident room without washing hands. CNA B completed incontinence care and washed her 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 2 Event ID: 675145 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 675145 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Buena Vida Nursing and Rehab Odessa 3800 Englewood LN Odessa, TX 79762 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)