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 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 2 shower rooms (located
on Hall 2) and 1 of 17 rooms (room [ROOM NUMBER]) reviewed for infection control.
Residents Affected - Few
The facility failed to ensure the shower room (located on Hall 2) was clean and the soiled towels were
removed promptly after use.
The facility failed to ensure soiled briefs were discarded appropriately from a resident room (room [ROOM
NUMBER]).
These failures could place residents and staff at risk for cross-contamination and the spread of infection.
Findings included:
During an observation on 09/26/2023 at 10:22 AM, the shower room commode located on Hall 2 had a
brown substance with a strong foul odor on the seat and down the sides. There was a stack of
approximately 5 wet towels in the shower stall floor.
During an observation on 09/26/2023 at 10:55 AM, a stack of approximately 5 wet towels laid in the shower
stall floor.
During an observation on 09/26/2023 at 11:10 AM, a stack of approximately 5 wet towels laid in the shower
stall floor.
During an observation of room [ROOM NUMBER] on 09/26/2023 at 02:10 PM, a soiled brief laid beside 2
dirty forks and several used dingy napkins with a crumpled plastic bag directly on the bathroom floor. There
was no trashcan observed in the bathroom.
During an observation of room [ROOM NUMBER] on 09/26/2023 at 03:40 PM, a soiled brief laid beside 2
dirty forks and several used dingy napkins with a crumpled plastic bag directly on the bathroom floor. There
was no trashcan observed in the bathroom.
During an interview on 09/26/2023 at 10:23 AM, CNA B said she was not aware that the commode needed
to be cleaned. CNA B said the CNAs should had cleaned up the soiled areas of any types of bodily fluids
then notified housekeeping for sterilization to prevent cross contamination.
(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 3
Event ID:
676049
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
676049
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/27/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Legend Healthcare and Rehabilitation - Paris
520 SE 8th St
Paris, TX 75460
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
During an observation and interview on 09/26/2023 at 3:58 PM, CNA C said she was assigned to Hall 2.
CNA C said she was not aware of the soiled commode and pile of towels in the shower room. CNA C said
she was not aware of the dirty brief on the resident's bathroom floor and was not able to say how that
happened. CNA C said she had not been in resident's bathroom all day. CNA C said the CNAs should had
cleaned up the soiled areas of any types of bodily fluids then notified housekeeping for sterilization to
prevent cross contamination. CNA C said the CNA should have immediately removed the soiled towels and
placed them in the designated laundry receptacle prior to exiting the shower room to prevent cross
contamination. CNA C said dirty linens and briefs should not be placed on the floor. CNA C said, Usually
we put dirty briefs in a plastic bag and remove from the room. CNA C said it was important to bag and
remove from the room and should never be placed on the floor to prevent the spread of infection. CNA C
confirmed no trashcan was in the residents' bathroom.
During an interview on 09/26/2023 at 04:00 PM, LVN A said she was the charge nurse assigned to Hall 2.
LVN A said she was not aware of the soiled commode and pile of towels in the shower room. LVN A said
she was not aware of the dirty brief on the resident's bathroom floor and was not able to say how that
happened. LVN A said she had not been in resident's bathroom all day. LVN A said the nurses and CNAs
should have cleaned up the soiled areas of any types of bodily fluids then notified housekeeping for
sterilization to prevent cross contamination. LVN A said the soiled towels should have been placed in the
designated laundry receptacle prior to exiting the shower room to prevent cross contamination. LVN A said
dirty linens and briefs should not be placed on the floor. LVN A said it was important to bag and remove
soiled items of bodily fluids from the room and should never be placed on the floor to prevent cross
contamination and infections. LVN A said that infection control is the responsibility of all staff.
During an interview on 09/27/2023 at 01:24 PM, Housekeeper A said she had seen dirty briefs trashcans
inside resident rooms a few times. Housekeeper A said she would just pick it up herself and dispose of it
especially if it was still there the next day. Housekeeper A said it was important to keep the facility clean
because an unclean environment would result in the residents being at risk of being sick with infections.
During an interview on 09/27/2023 at 01:26 PM, the Maintenance Supervisor said he was ultimately
responsible to ensure all residents and resident bathrooms had a trashcan. He said the importance of
providing rooms with trashcans was to prevent cross-contamination and keep debris and trash off the floor.
During an interview on 09/27/2023 at 01:37 PM, Housekeeper B said she was assigned to hall 2 on
09/26/2023. Housekeeper A said she had occasionally seen the CNAs leave dirty linens on the floor and
dirty briefs in the trashcans in resident rooms. Housekeeper A said it is important to keep the facility clean
because an unclean environment would result in the residents being exposed to things they should not be.
During an interview on 09/27/2023 at 02:40 PM, the DON said dirty linens should not be placed on the
floor. The DON said the charge nurses should be making sure the CNAs bag the dirty linens or place in the
appropriate area. The DON said it was important for the dirty linens to be bagged or placed in the
appropriate area because it was an infection control issue. The DON said placing the dirty linens on the
floor could lead to staff tracking it all over the facility and placed the residents at risk of getting sick. The
DON said it was important to keep all areas cleaned and sanitized and free of bodily fluids to prevent
infection by cross contamination. The DON said rounds are provided by different staff to ensure cleanliness
daily.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676049
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
676049
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/27/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Legend Healthcare and Rehabilitation - Paris
520 SE 8th St
Paris, TX 75460
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
During an interview on 09/27/2023 at 02:27 PM, the Administrator said the ADON and DON were
responsible for making sure infection control policies are followed properly. The Administrator said he
expected for all staff to perform adequate infection control. The Administrator said the charge nurses were
responsible for ensuring the CNAs did not place dirty linens, soiled briefs and any type debris on the floor in
the residents' rooms and shower room areas. The Administrator said it was important for cleanliness to
prevent cross contamination.
Record review of the facility's policy titled, Infection Prevention and Control Program, implemented on
06/2021, indicated, . c. Effective cleaning and disinfecting equipment as needed, to include bathing areas
between each resident use. 4. Facility personnel will handle, store, process, and transport linens so as to
prevent the spread of infection .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
676049
If continuation sheet
Page 3 of 3