Health inspection·August 24, 2022

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to 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 1 of 3 staff reviewed for infection control. (CNA A) Residents Affected - Few CNA A did not wash or sanitize her hands when changing gloves while performing incontinent care for Resident #223. This failure could place residents at risk of exposure to communicable diseases and infections. Findings included: During an observation on 8/23/2022 at 9:25 AM, CNA A was in Resident # 223's room to provide incontinent care. CNA A washed her hands in Resident #223's restroom, and she placed gloves on her hands. She opened the brief on Resident #223 and removed a wipe from the package and wiped both inner thighs in perineal area wiping from top to bottom and she then placed the wipe and gloves in the trash. She placed clean gloves on her hands without washing or sanitizing her hands. She removed another wipe from the package and assisted Resident #223 to roll onto his right side. She took the wipe and cleaned his rectal area from front to back, removed the brief and then placed the wipe, brief and gloves in the trash. She then placed a clean pair of gloves on her hands without washing or sanitizing her hands. She applied a barrier cream to Resident #223's rectal area and then removed her gloves and placed them in the trash. She placed a clean brief underneath Resident #223's buttocks along with a draw sheet. She then left the room to get more gloves and came back and washed her hands in the residents' restroom. She applied clean gloves and Resident #223 was positioned on his left side, draw sheet and brief rolled underneath the resident. CNA A secured the brief and resident was positioned in bed. She removed her gloves and placed them in the trash and took the trash outside in the hallway trash container and used hand sanitizer outside on the wall of Resident #223's door. During an interview on 8/23/2022 at 9:40 AM, CNA A said she was instructed to change gloves between cleaning and after 2 glove changes to wash or sanitize hands. She said she didn't wash or sanitize her hands with glove changes during incontinent care of Resident #223. She said the ADON was responsible for completing skills checkoff with the CNAs. She said the ADON, or DON would conduct trainings on incontinent care, handwashing and glove changes every other month. She said she was instructed if gloves were removed to sanitize. She said she thought when she finished up with providing incontinent care to a resident it was ok to wash or sanitize her hands when completed and just change gloves between clean to dirty. She said a resident could be at risk of infection if a staff did not wash or sanitize their hands between glove changes. (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: 675962 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 675962 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Southland Rehabilitation and Healthcare Center 501 N Medford Dr Lufkin, TX 75901 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)