Health inspection·February 22, 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 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 and infections for 1 (Resident #1) of 3 residents reviewed for infection. Residents Affected - Few The facility failed to ensure CNA A performed hand hygiene during incontinence care for Resident #1. This failure placed residents at risk for infection. Findings included: Review of Resident #1's Face Sheet dated 02/21/24, reflected he was an [AGE] year-old male admitted on [DATE]. His diagnosis included Alzheimer's disease. An observation and interview on 02/21/23 at 11:15 AM with CNA B and CNA A revealed they were preparing to provide Resident #1 with incontinence care. The resident was lying in bed, with his brief already removed. CNA A washed her hands and put on gloves. CNA A cleansed the resident's penis and scrotal area. Resident #1 was assisted to turn onto his right side by CNA B. CNA A cleaned the resident's buttocks. CNA A started to grab a clean brief. CNA B stopped her and prompted her to change her gloves. CNA A stopped, changed her gloves, and picked up the clean brief. CNA A was asked if she was going to perform hand hygiene since she changed her gloves. CNA A said, After I finish completely, I will wash my hands. An interview on 02/21/24 at 11:30 AM, with the DON revealed staff were supposed to perform hand hygiene when changing gloves. An interview on 02/21/24 at 1:30 PM, with CNA A revealed she said she forgot to perform hand hygiene when she changed gloves during incontinence care for Resident #1. She said hand hygiene was necessary to prevent infection . An interview on 02/21/24 at 2:55 PM, with the DON revealed hand hygiene was important to prevent transmission of infection . Record review of facility's policy, Infection Control Plan - Overview, dated 2019, reflected : Preventing Spread of Infection . (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: 675417 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 675417 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/22/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Fair Park Health & Rehabilitation Center 2815 Martin Luther King Jr Blvd Dallas, TX 75215 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)