Inspection·June 29, 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 maintain an infection control program designed to prevent the development and transmission of infection for one of one resident (Resident #1) observed for infection control. Residents Affected - Few The facility failed to ensure CNA A and CNA B performed hand hygiene while providing incontinence care to Resident #1. This failure could place the residents at risk for infection. Findings include: A record review of Resident #1's Comprehensive MDS assessment, dated 04/28/2023, reflected Resident #1 was a [AGE] year-old female admitted to the facility on [DATE] with Diabetes Mellitus, Major Depressive Disorder, and Anemia. Resident #1 had a BIMS of 08 which indicated Resident #1's cognition was moderately impaired. Resident#1 required extensive assistance of two-person physical assistance with toilet use and personal hygiene. Observation on 06/29/23 at 09:36 AM revealed CNA A provided incontinent care to Resident #1. CNA A had gloves on, brief opened, and was wiping the bedside table down with clean with wipes. CNA A proceeded to clean Resident #1's genital area with wipes. CNA A wiped front to back once and threw each wipe away. CNA A removed his gloves and used hand sanitizer. CNA A put on new gloves. Resident #1 helped CNA A to roll to the side. CNA A tucked the soiled brief into itself and pulled it out. CNA A tucked the old sheet under the resident. CNA A removed his gloves and used hand sanitizer. CNA A put on new gloves. CNA A used wipes to clean stool off Resident #1's buttocks. With the same gloves on, CNA A tucked a clean brief under Resident #1 and rolled the resident to get the brief fully under. CNA A then clasped the clean brief while wearing the same gloves. CNA A touched the air conditioner unit with while wearing the same gloves. CNA A then removed his gloves and performed hand hygiene in the restroom. Observation on 06/29/2023 at 09:45 AM revealed CNA B to remove three pillowcases from Resident #1's pillows . One pillowcase appeared to have a yellow and brownish stain on it, which appeared to be same color as Resident #1's stool. CNA B placed the dirty pillowcases into a trash bag. CNA B removed his gloves. CNA B did not perform hand hygiene and touched Resident #1's drawer and removed mouth wash and took the lid off. CNA B then poured mouth wash into a cup. Resident #1 took the cup and used mouth wash. CNA B performed hand hygiene after Resident #1 was done with mouth wash. In an interview on 06/29/23 at 09:45 AM with CNA A, he stated he was to wash his hands when (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: 675503 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 675503 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beacon Hill 3515 S Park Ave Denison, TX 75020 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)