Health inspection·August 31, 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 disease and infection for 1 of 2 residents (Resident #1) reviewed for infection control, in that: Residents Affected - Few While providing incontinent care for Resident #1 CNA B did not wash or sanitize her hands between change of gloves before touching the resident's clean brief and after cleaning the resident's buttocks' area. The soiled brief and draw sheet came in contact with the inside of the new brief. These deficient practices could place residents at-risk for infection due to improper care practices. The findings included: Record review Resident #1's face sheet, dated 08/31/2023, revealed an admission date 12/17/2018 and, a readmission date of 06/09/2023 with diagnosis including: Dementia(decline in cognitive abilities), Chronic kidney disease(gradual loss of kidney function), Hypertension(High blood pressure), anemia(blood disorder in which the blood has a reduced ability to carry oxygen) Record review of Resident #1's Quarterly MDS, dated [DATE], revealed the resident had a BIMS score of 0 indicating severe cognitive impairment. Resident #1 required extensive assistance, was always incontinent of bladder and bowel. Observation on 08/31/23 at 11:30 a.m. while providing perineal care for Resident #1, CNA B, after cleaning the resident buttocks, changed her gloves but did not sanitize her hands. The resident had a loose bowel movement and the CNA had feces on her gloves. While changing the soiled briefs and draw sheet, NA A and CNA B rolled the soiled items against the resident then placed the new briefs an draw sheet under the soiled sheet and brief. When they rolled the resident the dirty draw sheet, which was stained with feces, came in contact with the inside of the new brief. During an interview with CNA B on 08/31/2023 at 11:47 a.m , she confirmed she should have sanitized or washed her hands between changing gloves and understood it could cause a risk of cross contamination. She forgot to use sanitizer. She confirmed she received training for infection control and hand hygiene. She did realize she was contaminating the new brief and thought she was using the proper way to change the linen and brief. (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: 676242 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 676242 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/31/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ganado Nursing and Rehabilitation Center 107 E Rogers Ganado, TX 77962 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)