Health inspection·September 29, 2023

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Record review of Resident #7's quarterly MDS dated [DATE] documented a BIMS score of 02 out of 15 indicating that Resident #7 was severely cognitively impaired. Resident #7 required extensive assistance of 2 plus people for bed mobility and transfers. Resident #7 required extensive assistance with eating, dressing and toilet use. Record review of Resident #7's care plan dated 9/18/23 documented the following: Focus: I am at risk for falls related to balance problems and require total assistance with transfers. I have had a decline in ROM to upper and lower extremities due to pain. I require a wheelchair for mobility and am totally dependent on staff for mobility. Goal: I will be free of falls and will not sustain serious injury through next review date. Interventions/Tasks: Ensure call light is within reach and encourage use for assistance, as needed. Focus: I have an ADL self-care performance deficit, pain related to arthritis, physical limitations of weakness, limited ROM and require wheelchair for mobility. I have increased risk for contractures due to pain/weakness. Goal: I will maintain or improve current level of function in ADL status by review date. Interventions/Tasks: Encourage resident to use bell to call for assistance. Observation on 9/27/23 at 1:11PM Resident #1 was observed sleeping in her bed. One side, and the head of the bed were touching adjoining walls. Resident #1 was clean, dressed and had water on her bedside table. Her call light, which was a red string connected to a light switch, was seen hanging against the wall, near the end of her bed. Record review of Resident #1's face sheet, dated 9/27/23 , revealed a [AGE] year-old female admitted to the facility on [DATE] with the following diagnoses : generalized idiopathic epilepsy (primary generalized epilepsy) and epileptic syndromes, not intractable, without status epilepticus (a seizure lasting 5-minutes or more), long-term use of opiate analgesic, candidiasis (yeast infection), non-pressure chronic ulcer of left foot, unspecified chronic conjunctivitis (Pink Eye), muscle wasting and atrophy, unspecified abnormalities of gait and mobility, unspecified dementia without behavioral disturbance, psychotic disturbance, mood disturbance and anxiety, bilateral primary osteoarthritis of knee (both knees), other hemoglobinopathies (a group of blood disorders passed down through families), immune thrombocytopenic purpura (an abnormal decrease in the number of platelets in the blood), other specified rheumatoid arthritis, multiple sites, iron deficiency anemia, impacted cerumen (ear wax), personal history of Covid-19, other reduced mobility, encounter for screening for other viral diseases, unspecified glaucoma, dysphagia, oral phase, need for assistance with personal care, unspecified sequelae of cerebral infarction (long-term effects of a stroke), emphysema, chronic obstructive pulmonary disease with respiratory infection, chronic obstructive pulmonary disease, unspecified protein-calorie malnutrition, dysphagia, oropharyngeal phase, abnormal posture, cognitive communication deficit, muscle weakness, unspecified lack of coordination, other chronic pain, chronic pain syndrome, unspecified hearing loss, essential (primary) hypertension, unspecified atrial fibrillation, heart failure, gastro-esophageal reflux disease without esophagitis, abnormal results of thyroid function studies, long-term use of anticoagulants, constipation, systemic lupus erythematosus (the most common type of lupus), unsteadiness on feet, other lack of coordination. Record review of Resident #1's quarterly MDS dated [DATE] documented a BIMS score of 03 out of 15 indicating that Resident #1 was severely cognitively impaired. Resident #1 required extensive assistance of 2 plus people for bed mobility and transfers. Resident #1 required extensive assistance with eating, dressing and toilet use. Record review of Resident #1's care plan dated 8/29/23 documented the following: Focus: I am at risk of falls related to a previous CVA (cerebral vascular accident) event with left-sided paralysis (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675945 If continuation sheet Page 2 of 9 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 675945 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Care Center 1506 Childress St Wellington, TX 79095 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 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few and a diagnosis of Lupus. Goal: I will be free of falls and will not sustain serious injury through the next review date. Interventions/Tasks: Be sure call light is within reach and encourage resident to use it for assistance as needed. Focus: I have an ADL self-care performance deficit related to Lupus, paraplegia on left side related to a CVA event in 2000 and chronic pain. Goal: I will maintain current ADL status or have no preventable decline by review date. Interventions/Tasks: Encourage resident to use bell to call for assistance. Resident #1 was not available for interview, during the time of this survey, due to severe cognitive impairement and extensive hearing loss. In an observation on 9/28/23 at 7:34 PM it was noted that Resident #7's call light was clipped to the underside of her pillow. In an interview on 9/28/23 at 7:36 PM Resident #7 stated that she could not see the call light string and it would have to be in a position where she could both see and/or feel for it, or she would have to be verbally guided, for it to be used. She stated that she knows how to use the call light, but unless she knows exactly where it is placed, due to her poor eye sight, it cannot be used In an interview on 9/28/23 at 7:42 PM the Administrator stated that all call lights should be in working order and within reach of every resident. The Administrator was asked for the policy regarding call light maintenance and use. The Administrator stated that the facility did not have a call light policy . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675945 If continuation sheet Page 3 of 9 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 675945 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Care Center 1506 Childress St Wellington, TX 79095 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure all residents had the right to formulate an advanced directive for 1 (Resident #10) of 12 residents reviewed for advanced directives. Resident #10 had a DNR is her record that had information for only one physician in section F. The facility's failure to ensure the accuracy of a residents advanced directive such as a DNR (Do Not Resuscitate), recognized under State law (whether statutory or as recognized by the courts of the State), relating to the provision of health care could place residents a risk for not receiving healthcare as per their or their legal representatives wishes. Findings include: Resident #10 Record review of the face sheet dated 9-27-2023 in the clinical record for Resident #10 revealed a [AGE] year-old female resident admitted to the facility originally on 5-29-2018 and readmitted on [DATE] with diagnoses to include seizures (sudden, uncontrolled body movements and changes in behavior that occur because of abnormal electrical activity in the brain, generalized anxiety disorder (a mental health disorder characterized by feeling of worry, anxiety, or fear that are strong enough to interfere with one's daily activities), dysarthria and anarthria (difficult or unclear articulation of speech that is otherwise linguistically normal), dysphagia(difficulty swallowing food or liquids arising from the throat or esophagus), anorexia (an eating disorder causing people to obsess about weight and what they eat), spastic quadriplegia cerebral palsy (a form of cerebral palsy (a cognitive disorder of movement, muscle tone, or posture) that affects both arms and legs and often the torso and face), malnutrition, (lack of proper nutrition), anoxic brain injury (caused by a complete lack of oxygen to the brain, which results in the death of brain cells after approximately four minutes of oxygen deprivation), multiple contractures (a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints), pain, and altered mental status. Under the section Advanced Directives Resident #10 was listed as a DNR. Record review of the clinical record for Resident #10 revealed the last MDS completed was an annual dated 7-27-2023 with a BIMS 0f 3 indicating she was severely cognitively impaired, and she required assistance of one to two people with all her activities. Record review of the clinical record for Resident #10 revealed a care plan with a last reviewed date of 7-27-2023 with the following: Resident #10 had an order for Do Not Resuscitate (DNR)-Date initiated 5-30-2018 Record review of the clinical record for Resident #10 revealed an Order Summary with active orders as of 9-27-2023 with the following order: DNR (with an order date of 10-8-2021) Record review of the clinical record for Resident #10 revealed a DNR dated 11-11-2015 and signed by (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675945 If continuation sheet Page 4 of 9 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 675945 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Care Center 1506 Childress St Wellington, TX 79095 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 0578 FM C/Power of Attorney with the following: Level of Harm - Minimal harm or potential for actual harm Section F: Directive by two physicians on behalf of the adult, who is incompetent or unable to communicate and without guardian, agent, proxy, or relative. Residents Affected - Few Under Attending Physician there was a physician signature, printed name, date, and license number. There was no second physician signature or information. Section: Physician Statement also has no information for the physician signature or information. Section: All persons who have singed above must sign below, acknowledging that this document has been properly completed. -there is no second physician signature. During an interview on 09-27-2023 at 02:58 PM this surveyor contacted FM C/Power of Attorney for Resident #10. FM C/Power of Attorney insisted this surveyor would have to talk with Family Friend D concerning Resident #10's condition. FM C/Power of Attorney would not confirm any other information and ended the phone call. During an interview on 09-28-2023 at 11:19 AM the Administrator reported that she had just recently performed and audit of all the DNR's and that they should all be correct. During an interview on 09-27-2023 at 03:03 PM this surveyor contacted Family Friend D listed in Resident #10's chart and FF D advised this surveyor that I called the wrong number. This surveyor verified the contact information for Family Friend D was correct per the DON. During an interview on 09-28-2023 at 02:21 PM LVN A (the nurse responsible for Resident #10 this shift) reported that if Resident #10 was found without a pulse or not breathing, basically coding then LVN A would start the code, send a staff member to check Resident #10's code status in the computer system, and if the Resident #10 was a DNR then LVN A would stop the code. LVN A reported that she thought Resident #10 was a full code at this time but would have to check the computer to verify. LVN A checked the computer and noted that Resident #10 was a DNR and again reported that if resident #10 was in a code situation LVN A would start the code, determine the code status, then stop the code once the DNR status was verified. LVN A was asked to review Resident #10's DNR which she pulled up in the computer and printed. LVN A reviewed the DNR in the computer and LVN B (who was also present during the interview) reviewed the printed form. LVN A reported that the DNR form did not have a second physicians' signature in the section for two physicians' signatures and did not have the second physicians' signature on the bottom section. LVN B also reported that there needed to be a second physicians' signature and the second physician signature at the bottom of the DNR form was missing. When asked both LVN's stated that the DNR was not valid and that if Resident #10 was to code they would start CPR. LVN A reported that if a DNR was not completed correctly that staff could get into trouble, there could be a lawsuit, that it could result in a resident not getting what they wished. They could get compressions (from the CPR process). During an interview on 09-28-2023 at 02:43 PM the DON (with the Administrator present) reviewed Resident #10's DNR and confirmed that the DNR was incorrect, that the physician did sign in the wrong spot, and that Resident #10 was going to be a full code until a new DNR could be completed. The DON did verify that they would contact FM C/POA and start the process to get a new DNR. The Administrator (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675945 If continuation sheet Page 5 of 9 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 675945 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Care Center 1506 Childress St Wellington, TX 79095 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 0578 Level of Harm - Minimal harm or potential for actual harm reported if a DNR is not completed correctly then a lawsuit could happen and the DNR would not hold up in court. The Administrator also reported that she felt that Resident #10's wishes would be honored because FM C/POA was very specific that she wanted Resident #10 to be a DNR and that staff would review the clinical record and the face sheet and note that Resident #10 was a DNR, that they would not review the DNR itself for accuracy so Resident #10's and FM C/POA's wishes would be honored. Residents Affected - Few Record review of facility provided policy titled Do Not Resuscitate Order, revised 10-12-2013, revealed the following: Out of Hospital DNR Form The Out of Hospital DNR form was designed by the Texas Department of Human Services to comply with the requirement as set forth in the Health and Safety Code for the purpose of instructing Emergency Medical personnel and other health care professionals to forgo resuscitation attempts. 11. All validly executed DNR orders will be honored by the facility. Record review of OUT-OF-HOSPITAL DO-NOT-RESUSCITATE (OOH-DNR) ORDER-TEXAS DEPARTMENT OF STATE HEALTH SERVICES, undated revealed the following: -The original or a copy of a fully and properly completed OOH-DNR Order or the presence of an OOH-DNR device on a person is sufficient evidence of the existence of the original OOH-DNR Order and either one shall be honored by responding health care professional FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675945 If continuation sheet Page 6 of 9 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 675945 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Care Center 1506 Childress St Wellington, TX 79095 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations , interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timeframes to meet a resident medical, nursing, mental, and psychosocial needs for 2 (Resident #3, #7) of 15 residents reviewed for care plans. Residents #3 and #7 did not have interventions of a fall mat implemented that was listed in care plans. Resident #7's care plan was not revised after intervention of fall mat was discontinued. This failure can result in residents not receiving appropriate needs based on interventions listed in resident's care plans. Findings Included: Resident #3 Record review of Resident #3's face sheet on 9/28/23, revealed a [AGE] year-old female admitted to the facility on [DATE] and a re-entry on 6/13/2023. Diagnoses include but are not limited to major depressive disorder, lack of coordination, muscle weakness, difficulty and walking, atherosclerotic heart disease of native coronary artery without angina pectoris (hardening of arteries due to gradual plaque buildup), and acute embolism and thrombosis of unspecified deep veins of left lower extremity (blood clot forms in a vein deep in the body). Record review of Resident #3's face sheet on 9/28/23, revealed a BIMS score of 03 indicating severe impairment of cognition. Record review of Resident #3's care plan, dated 8/17/23, page 17, listed a focus of alteration in musculoskeletal status r/t : fall prior to entry with several fx (fractures) Fall since entry with fall mat now beside bed with an intervention of fall mat beside bed due to trying to get up on her own. An observation on 9/27/23 at 1:53 PM with Resident #3 revealed resident lying on bed in lowest position with no fall mat in place. An observation on 09/28/23 at 8:39 AM, Resident #3's bed in lowest position with a fall mat in place. Resident #7 Record review of Resident #7's face sheet, dated 9/28/23, revealed a [AGE] year-old female admitted to the facility on [DATE]. Diagnoses included but are not limited to unspecified dementia, vascular dementia (brain damage due to impaired blood flow), schizoaffective disorder (mental illness that affects thoughts, mood, and behavior), and displaced intertrochanteric fracture of right femur (hip fracture or a broken hip). Record review of Resident #7's Quarterly MDS, dated [DATE], revealed resident has a BIMS of 06 that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675945 If continuation sheet Page 7 of 9 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 675945 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Care Center 1506 Childress St Wellington, TX 79095 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 0656 indicated moderate impairment. Level of Harm - Minimal harm or potential for actual harm Record review of Resident #7's care plan , dated 8/15/23, revealed a Focus that Resident #7 has limited physical mobility related to fracture of right femur with an intervention of fall mat beside bed when in bed. Residents Affected - Few An observation on 09/28/23 at 02:41 PM revealed Resident #7 lying in bed with no fall mat in place. An observation on 09/28/23 at 03:33 PM revealed Resident #7 lying in bed with no fall mat beside bed. An observation on 09/28/23 at 04:07 PM revealed Resident #7 lying in bed with no fall mat on floor. An observation on 09/29/23 at 10:05 AM revealed Resident #7 with no fall mat in place while resident was in bed. An observation on 09/29/23 at 10:41 AM revealed Resident #7 with no fall mat on floor while Resident #7 was lying in bed. In an interview on 09/29/23 10:42 AM, LVN A unaware if fall mat was care planned. LVN A indicated the DON updates employees on care plan items and does this once or twice a month. LVN A stated a negative outcome could be that she, Resident #7, can break her hip or bruise her face. In an interview on 09/29/23 at 10:44 AM, LVN F stated Resident #7 was not to have a fall mat. LVN F indicated that she was not care planned for it. LVN F stated that she would go look. LVN F confirmed that there was no fall mat on the floor. LVN F indicated she reviewed care plans once a week. LVN F stated a negative outcome would be increased or severe injury. In an interview on 09/29/23 at 10:48 AM, ADON stated Resident #7 doesn't have a fall mat. ADON stated Resident #7 did but doesn't need it anymore. ADON stated care plans reviewed with any new fall and quarterly. ADON confirmed there was not fall mat on floor. ADON stated a negative outcome was Resident #7 could hurt herself . In an interview on 09/29/23 at 10:51 AM, DON stated Resident #7 was not care planned for a fall mat and confirmed one was not on the floor. DON stated the fall mat was usually found in the care plan and kiosk (device staff used for chart access). DON stated she was the one that updates staff on care plans. DON stated care plans are looked at quarterly or with a significant change. DON stated a negative outcome was the resident could fall. In an interview on 09/29/23 at 10:55 AM, ADON stated there was no order now for a fall mat and it was off Resident #7's care plan. It was there and it is not now. ADON stated that was our bad. Record review of Comprehensive Care Planning, no date provided, states, the facility will establish, document and implement the care and services to be provided to each resident to assist in attaining or maintaining his or her highest practicable quality of life. The comprehensive care plan will reflect interventions to enable each resident to meet his/her objectives. Interventions are the specific care and services that will be implemented. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675945 If continuation sheet Page 8 of 9 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 675945 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/29/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Wellington Care Center 1506 Childress St Wellington, TX 79095 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to store, prepare distribute, and serve food in accordance with professional standards for food service safety for 1 of 1 kitchens observed. Residents Affected - Few DM failed to follow policy on hand hygiene prior to preparing trays for lunch by not practicing hand hygiene prior to serving food after leaving the kitchen area and touching surfaces. This failure can result in a risk of infection and cross contamination to residents of the facility. Findings included: An observation on 9/27/23 at 12:21 PM showed DM walking out of the kitchen, moving cart, moving orange Wet Floor cone, and touching the beverage area. DM walked back into the kitchen and began service on three trays that were sitting on the service line of the steam table. No hand hygiene was practiced prior to serving the food on the trays. An interview on 9/28/23 at 2:23 PM with DM revealed that hand washing should take place after using the restroom and in between what you are doing, after eating or drinking. DM indicated she oversaw the training, and training happens every day if items are noticed. DM stated that other trainings are in-services provided to dietary staff. DM stated a negative outcome could be making people sick if hand hygiene is not practiced. An interview on 9/28/23 at 2:23 PM with DM present, DA E indicated hand washing after everything; if you touch anything, you sanitize. DA E stated DM oversaw training, and it was every day verbally. DA E stated that a negative outcome could be cross contamination if hand hygiene is not practiced. Record review of Sanitation and Infection control, dated 2012, section IC 00-1.0; Infection Control, Line 2 states, Careful handwashing by personnel will be done in the following situations: Line B: between handing of dirty dishes, boxes, or equipment and handling clean food or utensils. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 675945 If continuation sheet Page 9 of 9