Health inspection·March 15, 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 control program designed to prevent the development and transmission of infection for two of six residents (Resident #35 and #210) observed for infection control. Residents Affected - Few CNA A failed to perform hand hygiene during while providing incontinence care to Resident # 35. CNA B failed to perform hand hygiene during while providing incontinence care to Resident # 210. This failure could placed the residents at risk for infection. Findings include: Record review of Resident #35's face sheet dated 3/15/23 reflected he was [AGE] years old male. He was admitted to the facility on [DATE]. He was admitted with fracture of tibia (larger of the two bones in the lower leg), respiratory failure, heart failure, difficult walking and need for assistance with personal care. Review of Resident #35's care plan initiated 2/13/23 reflected the resident had an ADL self-care performance deficit related to Orthopedic surgery and the intervention was for the resident to be assisted by staff for toileting. Observation on 03/13/23 at 10:40 AM revealed CNA A providing incontinent care for Resident #35. CNA A was in Resident #45's room when she left and stated she was going to get wipes. When CNA A came back in the room, she gloved without performing hand hygiene and proceeded to providing the resident with care. CNA A cleaned the resident and removed the dirty brief, the resident was soiled in urine. CNA A then placed the dirty brief in the trash can and cleaned the resident's bottom. After cleaning the resident without any form of hand hygiene or change of gloves, CNA A applied the clean brief, fastened the brief, and assisted the resident to position in bed. After care, CNA A completed hand hygiene. In an interview on 03/13/23 1at 2:02 PM with CNA A regarding the Resident #35's care, CNA A stated she was supposed to complete hand hygiene before and after care. Asked about in between care, CNA A stated after cleaning the resident she was supposed to clean her hands and change gloves before applying the clean brief. CNA A stated she was supposed to complete hand hygiene to prevent the spread of infection. CNA A stated she had completed a hand hygiene and infection control in-service about two months ago. (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: 676243 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 676243 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Remington Transitional Care of Richardson 1350 E Lookout Dr Richardson, TX 75082 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)