Health inspection·September 27, 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, 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. Page 1 of 3 676049 676049 09/27/2023 Legend Healthcare and Rehabilitation - Paris 520 SE 8th St Paris, TX 75460

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. 676049 Page 2 of 3 676049 09/27/2023 Legend Healthcare and Rehabilitation - Paris 520 SE 8th St Paris, TX 75460

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 . 676049 Page 3 of 3