Health inspection·May 11, 2024

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation on 5/11/24 at 10:34a.m., revealed LVN A provided Resident #1 with wound care. LVN A was assisted by ADON. LVN A gathered the supplies at the treatment cart in the hallway before bringing them into Resident's room. Supplies included 1 wound cleanser bottle, 1 package of skin prep, 1 package of T drainage sponge, 1 package of boarder dressing and an opened package of Calcium Alginate. Prior to initiation of the treatment ADON asked LVN A to wash her hands. LVN A applied double gloves, closed curtain for privacy and assisted resident on to her right side. LVN A unfasten the resident's brief and removed one pair of gloves. LVN A removed the resident's soiled sacral area wound dressing and placed in the clear bag taped on the bedside table. There was no date visible on the dressing. Continued observation revealed an open area of approximately 1.0 centimeters in diameter. LVN A removed the 2nds pair of soiled gloves and without sanitizing/washing her hands LVN A applied clean gloves. LVN A sprayed the wound with the wound cleanser, opened the T drainage sponge packet and pat dried the wound with the T drainage sponge. LVN A then opened the skin prep package and applied the skin prep on to the wound. LVN A took small piece of calcium alginate from the opened calcium alginate package and applied that to the wound and covered it with dry boarder dressing. LVN A said, I have to hold the dressing for 10 seconds for it to adhere. LVN A pressed and held on to the dressing and counted for 10 seconds out loud. LVN A completed wound care and with the same soiled gloves on, touched the Resident's clean shirt, brief, sheet, and blanket. Observation on 5/11/24 at 10:45a.m., revealed ADON came out of Resident#1's room and used the hand sanitizer sitting on top of the treatment cart placed outside of Resident#1's room. Observation and interview on 5/11/24 at 10:47a.m., revealed LVN A came out of Resident#1's room opened the treatment cart placed outside of Resident#1's room. Unlocked the cart, took out sanitizing wipe out of the individual packaging and rubbed it over all areas of the hands for about 5 seconds. LVN A said she performed wound care on the weekends. She said she recalled doing competency check off for wound care about 3 months ago with the Corporate Nurse but could not recall the exact date. When asked LVN A if she double gloved when performing wound care. LVN A said, I don't like touching [NAME] she came back from the hospital last night and to protect myself I have cancer I double glove. At this time Surveyor asked if LVN A had the hand sanitizer in the room. LVN A said she did not like taking the hand sanitizer bottle in the room and preferred to use the sanitizing wipes. Surveyor shared the wound care observation from earlier explaining that no hand hygiene was observed during the wound care. LVN A said her actions in not performing hand hygiene while changing gloves could result in cross contamination. She said she had completed in-service on infection control 3 month ago but could not recall the exact date. In an interview on 5/11/24 at 11:09a.m., with the ADON, she said LVN A should not have double gloved it's not the policy. LVN A should not have double gloves for patients protection. LVN A needed to get new set of gloves the discharge from the wound treatment can get on the other gloves and cross contaminate. In an interview on 5/11/24 at 1:29p.m., with the DON and the ADON. The DON said the expectation was to maintain infection control throughout the process. She said staff received in-service on infection control once or twice a month. She said wound care Nurse were provided training and competency check offs annually and as needed if noted concerns. DON said LVN A should not have double gloved she needed to use standard precautions. DON said LVN A preformed wound care on weekends. DON said LVN A was spot check by the wound care nurse that worked Monday through Friday. DON said she would do another competency check off and in-service LVN A. The DON said as per LVN A she opened the skin prep and the hand sanitizing wipes at the same time. At this time the Surveyor explained to the DON and the ADON that the Surveyor did not see the sanitizing wipes in the resident's room and did not observe (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675739 If continuation sheet Page 2 of 3 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 675739 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgewood at the Woodlands 10450 Gosling Rd The Woodlands, TX 77381 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few LVN A using the wipe to rub it over all areas of the hands. The Surveyor further explained that LVN A should have performed hand hygiene prior to donning clean gloves. LVN A contaminated the wound. LVN A cleaned the wound with T drainage sponge and with the same soiled gloves, applied skin prep and Calcium Alginate. Record review of facility's Skills Check list for Wound Care dated 2/16/24 for LVN A revealed read in part: .9. Put on clean gloves 10. Remove soiled dressing and discard in red bag 11. Wash hands or use alcohol gel 12. Put on clean gloves 13. Clean wound following physician's orders 14. Wash hands or use alcohol gel 15. Apply ordered treatment to wound 16. Apply dressing and secure with tape, Date and initial dressing 17. Remove gloves and dispose into red bag, along with any unused supplies 18. Wash hands . Record review of facility's Policies and Practices - Infection Control dated (Revised July 2014) read in part: .Policy Statement: This facility's infection control policies and practices are intended to facilitate maintaining a safe, sanitary and comfortable environment and to help prevent and manage transmission of diseases and infections . Record review of facility's Handwashing/Hand Hygiene policy dated (August July 2015) read in part: .Policy Statement: This facility considers hand hygiene the primary means to prevent the spread of infections.2. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. 7. Use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations: b. Before and after direct contact with residents; g. Before handling clean or soiled dressings, gauze pads, etc.; h. Before moving from a contaminated body site to a clean body site during resident care; 9. The use of gloves does not replace hand washing/hand hygiene. Integration of glove use along with routine hand hygiene is recognized as the best practice for preventing healthcare-associated infections. Applying and Removing Gloves: 1. Perform hand hygiene before applying non-sterile gloves . Record review of facility's Wound Care policy dated (Revised January 2022) read in part: .Steps in the procedure: 4. Put on exam glove. Loosen tape and remove dressing. 5. Pull glove over dressing and discard into appropriate receptacle. Wash and dry your hands thoroughly. 6. Put on gloves . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675739 If continuation sheet Page 3 of 3