Inspection·August 14, 2024

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few In an interview with LVN B on 08/14/24 at 03:26 PM, he reported that he has worked at this facility about two years, first on double weekends, and more recently on the evening shift. He reported that staff should perform hand hygiene when they come into the residents' room and when they leave. In-between, he reported that the gloves would need to be changed and hands washed in-between when providing wound care and incontinence care. He reported that he had received infection control and handwashing in-service since being hired. He reported that failing to change gloves between clean and soiled parts of wound care could result in infection spreading. In an interview with CNA C on 08/14/24 at 03:50 PM, she reported that she had worked at this facility about seven years on both the evening and day shifts. She reported that when she entered a room to provide personal care, she washed her hands and put on gloves. She reported she removed her gloves after providing care and washed her hands. She reported that she changed her gloves and washed her hands during care when the gloves become soiled or when finishing cleaning the resident before starting clean activities. She stated she did this to prevent the spread of infection. She reported she had received infection prevention and handwashing teaching this past year. In an interview on 08/14/24 at 04:00 PM with ADON, she reported that she was the facility wound care nurse and had worked at the facility about 2.5 years. She reported that she expected staff to change their gloves and wash their hands as soon as they entered the room, after they completed their task, and if possible, in between. She stated they would need to sanitize their hands in-between care if for any reason they needed to change gloves before putting on another pair. She reported that during wound care staff were supposed to wash their hands, put on gloves, take off the old bandage, and change gloves and wash their hands before putting on the new bandage. She stated that infection could be a result of not doing this. She reported that staff had received handwashing and infection control prevention teaching at the beginning of this year (2024). In an interview on 08/14/24 at 04:27 PM, the DON reported that she was also the facility Infection Preventionist. She reported that staff should wash their hands before, after, and in between care. She stated that if their gloves were soiled, they should change them. For wound care, she reported that the hands should be washed before, after, and in-between before putting on a clean dressing. She reported all staff had received training for handwashing and infection control within the last month or so. She reported that staff who fail to wash their hands when going from dirty to clean activities could cause cross contamination and that this could cause the patient to get an infection. She reported that she, as the Infection Preventionist and the DON, was responsible for making sure that these things were being done. She reported she provided the staff with regular in-service training, that the staff had annual competencies, and that she watched staff to monitor for compliance with hand hygiene and infection control practices. In an interview on 08/14/24 at 05:00 PM, Administrator reported she had worked as the Interim Administrator since January (2024). She reported that she expected the employees to follow the facility's policies. She stated that when providing wound care, staff should not go from clean to dirty without hand hygiene and changing gloves. She stated that failing to do this could open the door for infection to occur. She reported the DON was responsible for ensuring the policy was being followed and providing in-services for the staff. Review of the facility policy titled, Handwashing/Hand Hygiene noted dated 2001 and revised August 2015, was reviewed. Number two of the policy states, All personnel shall follow the handwashing/hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. This policy states that an alcohol-based hand rub containing at least 62% alcohol; or, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676080 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 676080 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Town Hall Estates Arlington, Inc. 824 W Mayfield Rd Arlington, TX 76015 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 alternatively, soap (antimicrobial or non-antimicrobial) and water will be used before handling clean or soiled dressings, gauze pads, etc.; and before moving from a contaminated body site to a clean body site during resident care, after contact with a resident's intact skin, after contact with blood or bodily fluids, and after handling used dressings, contaminated equipment, etc., after removing gloves. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676080 If continuation sheet Page 3 of 3