Health inspection·February 9, 2024

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few entered the resident room. She placed the supplies on the edge of the sink in the resident room which was not on a sanitized or prepared surface. The supplies were kept in their original wrappers. Treatment Nurse B washed her hands in the bathroom sink, donned (put on) new gloves and then proceeded to assist the resident to standing, handling both the resident and the rollator (walker with wheels). Treatment Nurse B pulled down Resident #3's pants, removed the side of his brief to expose his buttocks and provided wound care to the sacrum all without changing gloves. Treatment Nurse B did not remove her gloves during from start until finish until after she pulled up Resident #3's pants after the treatment was completed. During an observation of wound care on 2/08/2024 at 3:19 p.m., Treatment Nurse B entered Resident #3's room and placed wound care supplies, still in their original packaging on the nightstand which was cluttered with personal items without sanitizing or preparing the surface. The Treatment Nurse did not wash or sanitize her hands upon entry to the room. After donning gloves, she unwrapped Resident #3's arm and removed the old dressing. Treatment Nurse B doffed (took off) the gloves after removing the old dressing but did not wash or sanitize her hands before placing on new gloves. Treatment Nurse B cleaned the wound and applied a new dressing before doffing gloves. Treatment Nurse B again did not wash or sanitize her hands before once again donning gloves and re-wrapping Resident #3's arm in kerlix and an ace bandage. During an interview on 2/08/2024 at 3:37 p.m., Treatment Nurse B stated she did not wash or sanitize her hands during either of Resident #3's separate wound care observations. Treatment Nurse B stated she did wash her hands at the beginning and at the end and did change her gloves several times. She stated she did not change her gloves during the first wound care observation because Resident #3 was standing, and she did not want to leave him alone to go wash her hands. She stated if Resident #3 had been in bed for the wound care or if the wound had been more serious, she would have washed her hands. The Treatment Nurse stated a more serious wound was a larger open area and she did not consider the small opening of Resident #3's sacral wound to be serious because the opening was very small, and the wound was almost healed. Treatment Nurse B stated with the arm wound care she did change her gloves more often but did not wash or sanitize her hands. She stated she did not perform hand hygiene because there was no hand sanitizer in the room. Treatment Nurse B stated she could have gone outside of the room to sanitize her hands. She stated she should have but did not because at the last place she worked the hand sanitizer had been in the resident room and that was what she was used to. Treatment Nurse B stated she did have hand sanitizer on the treatment cart but she did not think she was supposed to bring it into the residents room. The Treatment Nurse stated she did not wash her hands because she was nervous. The Treatment Nurse stated she typically just washes her hands before wound care and after wound care and then if she has to leave the room for any reason, she will use hand sanitizer before re-entering the room. Treatment Nurse B stated she had been trained to keep the supplies in their original wrapper which could be placed on any surface. She stated she was trained to sanitize her hands between glove changes and when going from dirty to clean, when working on different wounds or different body parts. During an interview on 2/09/2024 at 10:57 a.m., the Infection Preventionist stated wound care should be completed with the following steps: .knock on door, wash hands, make sure surface where supplies will be used was clean by using a sanitizing wipe on the surface and then allowing it to dry, put a napkin or tray down on the clean surface, place supplies in small amounts in medication cups and ensuring applicators available for application of medication, place on the cleaned area, wash hands again, don gloves, place patient close, expose area needed with gloves on, remove old dressing and throw in trash, wash hands, put on clean gloves, clean the wound from dirty to clean, pat dry and apply medication with applicator, cover with dry dressing .discard all trash, take gloves (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676216 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 676216 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Remington Transitional Care of San Antonio 5423 Hamilton Wolfe Rd San Antonio, TX 78229 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 off, wash hands .The Infection Preventionist stated she expected the Treatment Nurse to wash her hands after doffing gloves and before donning new gloves. She stated she expected the Treatment Nurse to sanitizer her hands with alcohol-based sanitizer if she was not able to leave the resident but if no hand sanitizer was available the Treatment nurse should wash her hands with soap and water. The Infection Preventionist stated infection prevention during wound care was important to prevent the spread of infection, to protect oneself and to protect the patient (resident) from pathogens. Record review of Treatment Nurse B's annual wound care competencies dated 11/18/2023 revealed the Treatment Nurse had met the competencies for application of wound dressing with the following critical element steps: 2. Gather supplies 3. Uses personal protective equipment as indicated. 4. Cleans over-bed table. 5. Places clean barrier on the over the bed table and places supplies on barrier 11. Cleans hands 12. If patient has multiple wounds; b. in separate locations: treats each as a separate procedure 13. If breaks aseptic technique (a method of procedures used by healthcare professional to prevent cross contamination) , removes gloves, cleanses hands, and applies clean gloves 14. Opens supplies without contaminating. Keeps the dressing/gauze within the open packet and places it directly on top of barrier 15. Prepared medications/ointments, if indicated by placing on inner sterile package 16. Exposes area to be treated. Applies clean gloves and removes soiled dressing 17. Discards dressing and gloves according to infection control policy 18. Cleans hands 19. Applies gloves 20. Cleanses/irrigates the wound as ordered 21. Wipes an excess fluid from the surrounding skin using a dry, gauze wipe 22. if gloves become contaminated, removes gloves, cleanses hands and applies clean gloves 24. Applies and secures clean dressing 25. Removes gloves and discards according to infection control procedures. 27. Cleanses hands. Record review of a facility policy, titled Hand Hygiene dated 10/24/2022 revealed: All staff will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. This applies to all staff working in all locations within the facility. Hand hygiene is a general term for cleaning your hands by handwashing with soap and water or the use of an antiseptic hand rub, also known as alcohol-based hand rub (ABHR). 1. Staff will perform hand hygiene when indicated, using proper technique consistent with accepted standards of practice. 6. Additional considerations: a. The use of gloves does not replace hand hygiene. If your task requires gloves, perform hand hygiene prior to donning gloves, and immediately after removing gloves. During an interview on 2/09/2024 at 11:22 a.m., the Administrator stated the facility did not have a policy that specifically addressed application of wound care or wound care technique. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676216 If continuation sheet Page 3 of 3