Health inspection·August 22, 2023

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. Residents Affected - Some The facility failed to ensure that facility staff performed hand hygiene appropriately during the delivery of food trays to nine of forty-two residents in the three hundred hall of the facility. This failure could place the residents at an increased risk of exposure to viral infections, secondary infections, communicable diseases, and feelings of isolation related to poor hygiene. Findings Included: Observation on 8/22/23 at 11:43 AM, revealed CNA A obtained a food tray from the mobile food cart and delivered it to room [ROOM NUMBER]. CNA A exited room [ROOM NUMBER], did not practice hand hygiene, obtained another tray from the cart, and delivered it to room [ROOM NUMBER]. Upon exiting, CNA A did not practice hand hygiene and obtained another tray from the cart. CNA A delivered the tray to 312. Upon exiting, CNA A obtained another tray and delivered a second tray to 312. CNA A exited the room, returned to the cart, obtained a tray, and delivered it to 319. CNA A left room [ROOM NUMBER] with no hand hygiene practiced after exiting. CNA A obtained an additional tray from the cart and delivered it to room [ROOM NUMBER]. No hand hygiene was practiced upon exiting. CNA A obtained another tray from the cart and delivered a second tray to room [ROOM NUMBER]. In an interview on 8/22/23 at 11:51 AM, CNA B stated that hand hygiene needs to be practiced between every tray or every other tray. In an interview on 8/22/23 at 1:22 PM, ADON A stated that the policy for hand hygiene is included when hand hygiene is to be performed. ADON A Statedstated that staff should use hand sanitizer between patients, between trays, the policy is more detailed than just those two instances. ADON A indicated that hand hygiene should be practiced after everything, and hands should especially be washed if visibly soiled. ADON A revealed that hand hygiene competency is every month and spot checks are completed. ADON A stated a negative outcome of not practicing proper hand hygiene would be cross contamination to the residents. In an interview on 8/22/23 at 1:43 PM with CNA C indicated hand hygiene is practiced when leaving the room and hands need to be washed after every third room. CNA C stated that policy used is infection control. CNA C Statedstated that a negative outcome is germs and residents contracting anything else. (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: 675498 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 675498 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Hillside Heights Rehabilitation Suites 6650 South Soncy Road Amarillo, TX 79119 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)