Health inspection·September 23, 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, record review, and interview, 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 one resident (Resident -R# 1) of five residents that were reviewed for infection control and transmission-based precautions policies and practices, in that: Residents Affected - Few The facility failed to ensure LVN A performed hand hygiene and removed her contaminated gloves prior to the commencement of perineal care after she touched multiple surfaces. This failure could place residents at risk for infection through cross contamination of pathogens. The findings included: Record review of R #1's Face Sheet dated 09/23/2023, admitted on [DATE] revealed a [AGE] year-old female with the following diagnoses of: acute kidney failure, Parkinson's disease, epilepsy, congestive heart failure, and morbid (severe)obesity. Record review of R #1's MDS assessment dated [DATE] documented a BIMS score of 14 - cognitively intact. The assessment indicated R #1 required extensive dependency of staff to assist in bed mobility, transfers, toilet usage, and personal hygiene with two-person physical assist. Record review of R #1's Comprehensive Care Plan date initiated 09/08/2023 revealed, the focus that the resident had functional, bladder incontinence. Goal, the resident will decrease frequency of urinary incontinence through the next review date. Interventions, establish voiding patterns, monitor/document for s/sx UTI; pain, burning, blood-tinged urine, cloudiness, no output, deepening of urine color, increased pulse, increased temp, urinary frequency, foul smelling urine, fever, chills, altered mental status, change in behavior, change eating patterns. Provide peri-care and/or assistance after each incontinent episode. During an observation on 09/22/2023 at 3:35PM LVN A washed her hands for 24 seconds, applied gloves, retrieved a clean brief and a package of wipes, then proceeded to pull the light string to turn light on, followed by retrieving the bed remote to lower the head of bed and elevated the bed to LVN A's waist level. LVN A then removed R #1's blanket and detached R #1's brief. LVN A retrieved perineal wipes and commenced perineal cleaning, using the same initial gloves, that touched multiple surfaces. LVN A continued peri care without performing hand hygiene or glove changes. During an interview on 09/22/2023 at 3:45PM LVN A stated she should have performed hand hygiene and (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: 675773 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 675773 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/23/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brookdale Trinity Towers 317 N Carancahua Corpus Christi, TX 78401 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)