Inspection·November 27, 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 and to help prevent the development and transmission of communicable diseases and infections for 2 (CNA B and CNA C) of 4 staff and 1 of 1 resident (Resident #1) observed for resident care. Residents Affected - Few CNA B and CNA C did not wear the proper PPE when performing catheter care on Resident #1 per Enhanced Barrier Precautions increasing risk of MDRO contamination. This deficient practice has the potential to affect residents in the facility receiving incontinent care by exposing them to care that could lead to the spread of infections, tissue breakdown, and feelings of isolation related to poor hygiene. Findings include: Record review of Resident #1's face sheet printed 11-27-2024 revealed he was a [AGE] year-old male admitted to the facility originally on 1-18-2024 and readmitted on [DATE] with diagnoses to include hemiplegia (partial paralysis), seizures (sudden, uncontrolled body movements and changes in behavior that occur because of abnormal electrical activity in the brain), intracranial abscess (a puss fill pocket of infection in the brain), neuromuscular dysfunction of the bladder(the nerves and muscles of the bladder do not work well resulting in the bladder not filling or emptying well), malnutrition (lack of proper nutrition), and encounter for attention to gastrostomy (an opening into the stomach from the abdominal wall). Record review of Resident #1's clinical record revealed his last MDS was a quarterly completed 9-26-2024 which indicated he had a BIMS was 5 indicating he was severely cognitively impaired, and he had a functionality of being dependent on staff for all his activities of daily living. Section H - Bladder and Bowel Resident #1 was marked for having an indwelling catheter and Section K - Swallowing/Nutritional Status Resident #1 was marked for having a feeding tube. Record review of Resident #1's Order Summary Report with Active Orders as of 11-27-2024 revealed Resident #1 had the following: - Enteral Feed Order every 4 hours Enteral feed bolus Glucerna 1.2, 240mls via PEG Tube q4hours with 50mls water flush before and after Phone Active 02/08/2024. PEG Tube (a feeding tube that is inserted through the abdomen and into the stomach). - Foley catheter to be placed d/t NEUROMUSCULAR DYSFUNCTION OF BLADDER, UNSPECIFIED Phone Active (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: 675336 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 675336 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kirkland Court Health and Rehabilitation Center 1601 Kirkland Dr Amarillo, TX 79106 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)