Health inspection·November 3, 2022

F 0759 Ensure medication error rates are not 5 percent or greater. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure a medication error rate of less than or equal to 5%. The medication error rate was 7.5% with 3 errors in 40 opportunities for 1 (Medication aide B) of 2 staff and 1 (Resident #25) of 2 resident reviewed for medication pass. Residents Affected - Few Medication Aide B failed to obtain physician orders to crush medications prior to administering crushed to Resident #25. These facility failures can cause residents to not receive their medications as prescribed according to physician's orders and could cause residents to miss medications or cause other residents' risk of picking up medications that do not belong to them. Findings Include: Record review of physician orders for Resident #26 dated 10/13/2022 revealed the following orders: (There were no orders to crush for any of the medications listed): *AmLODIPine Besylate Tablet 10 MG Give 1 tablet by mouth one time a day related to ESSENTIAL (PRIMARY) HYPERTENSION, *Calcium Tablet 600-200 MG-UNIT (Calcium-Vitamin D) Give 1 tablet by mouth two times a day for Supplement, *Ferrous Sulfate Tablet 325 (65 Fe) MG Give 1 tablet by mouth one time a day every other day for supplement, *Lidocaine Patch 5 % Apply to lower back topically onetime a day for pain and remove per schedule, *Magnesium Tablet 400 MG Give 1 tablet by mouth one time a day for low magnesium level, *Oxycodone HCl Tablet 20 MG Give 1 tablet by mouth every 12 hours for Severe Pain related to LOW BACK PAIN, *Potassium Chloride ER Tablet Extended Release 20 MEQ Give 40 mEq by mouth three times a day related to HYPOKALEMIA UNSPECIFIED, *Protein Liquid Give 30 cc by mouth two times a day for Wound Healing, *Senna Tablet 8.6 MG (Sennosides) Give 2 tablet by mouth one time a day for Constipation Prevention, *Sodium Chloride Tablet 1 GM Give 2 tablet by mouth two times a day for Na-128, Page 1 of 13 676279 676279 11/03/2022 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0759 Level of Harm - Minimal harm or potential for actual harm *Thera-M Tablet (Multiple Vitamins-Minerals) Give 1 tablet by mouth one time a day for Supplement, *Torsemide Tablet 20 MG Give 1 tablet by mouth one time a day related to HEART FAILURE, *Cholecalciferol Tablet 25 MCG (1000 UT) Give 5 tablet by mouth one time a day for Supplement, *Docusate Sodium Capsule 100 MG Give 1 capsule by mouth two times a day for Constipation Prevention, and Residents Affected - Few *Milk of Magnesia Concentrate Suspension 2400 MG/10ML (Magnesium Hydroxide) Give 30 ml by mouth as needed for Constipation. bservation during medication pass with Medication Aide B on 11/02/2022 at 9:18 am for Resident #25 revealed Medication Aide B had placed all necessary medications( AmLODIPine Besylate Tablet 10 MG, Calcium Tablet 600-200 MG-UNIT, Ferrous Sulfate Tablet 325, Lidocaine Patch 5 %, Magnesium Tablet 400 MG, Oxycodone HCl Tablet 20 MG, Potassium Chloride ER Tablet Extended Release 20 MEQ, Protein Liquid Give 30 cc, Senna Tablet 8.6 MG, Sodium Chloride Tablet 1 GM, Thera-M Tablet (Multiple Vitamins-Minerals), Torsemide Tablet 20 MG, Cholecalciferol Tablet 25 MCG, Docusate Sodium Capsule 100 MG, Milk of Magnesia Concentrate Suspension 2400 MG/10ML (Magnesium Hydroxide) Give 30 ml), in medicine cup the Medication Aide B realized she did not have a small plastic bag to crush the medications. Medication Aide B proceeded to get a plastic bag and crushed the medications. When Medication Aide B was looking at the MAR, she was asked about orders to crush the pills. Medication Aide B stated she did not see any orders to crush the pills and proceeded to crush the pills anyway. Medication Aide B placed all medications from the open medication cup into one plastic bag and proceeded to crush the pills together. Interview with Medication Aide B on 11/2/2022 at 9;50 am, stated she did not know if there was an order to crush the medications, but she did not see one. Medication Aide B stated that she crushed the medications because Resident #25 has a hard time swallowing and would not be able to take the medications whole. Medication Aide B stated that she does know that there should be an order to crush, and it would be the responsibility of the nurse to make sure to place and order if there was not one. Medication Aide B stated that she does know that she should have made sure to have all of her supplies on hand before medication administration. Medication Aide B stated that she has been trained in school and on the computer. Medication Aide B stated that the negative potential outcome for administering medications without, and order was that she would not be following physician orders and could be administering medications incorrectly. Interview with DON on 11/2/2022 at 10:43 am, the DON was informed of medication error rate and errors made by medication aide A and B. The DON stated that she expected both medication aides A and B to have all their supplies on hand prior to administration of medications. The DON stated that this was unacceptable, and the medication aides will both be consulted with as well as an in-service completed. The DON stated that competency checks have been completed with the CMA's and she will consult with the medication aides again. The DON stated she was unaware there was no crush order for Resident #25, and she would look at the orders and place the orders if needed. Record Review of facility provided policy labeled, Administration of Oral Medications, date revised in October 2010 revealed: Purpose: The purpose of this procedure is to provide guidelines for the safe administration of oral medications. 676279 Page 2 of 13 676279 11/03/2022 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0759 Preparation: Level of Harm - Minimal harm or potential for actual harm 1. Verify that there is a physician's medication order for this procedure. Residents Affected - Few 2. Assemble the equipment and supplies as needed. Equipment and Supplies: 1. . Pill crushing device, if needed 676279 Page 3 of 13 676279 11/03/2022 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview and record review, the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for 3 of 3 staff (Dietary staff A, B and C) in 1 of 4 kitchens (Ruby unit), in that: 1)The facility failed to ensure the high temperature dishwasher provided required wash and rinse temperatures and Dietary staff (A and B) were knowledgeable of required sanitizing temperatures and testing methods, 2) The facility failed to ensure Dietary staff (Dietary staff A) used good hygienic practices in food preparation areas (personal drink storage ), 3) The facility failed to ensure foods were not held beyond expiration dates (hardboiled eggs), and 4) The facility failed to ensure Time/Temperature Controlled for Safety (TCS)/Potentially Hazardous (PHF) pureed foods were rapidly reheated to 165 degrees F. (Pureed Chicken Fried Steak). These failures could place residents at risk for food contamination and foodborne illness. The findings include: The following observations were made during a kitchen tour that began on 11/01/22 at 8:51 AM and concluded at 9:29 AM: Dishes and food equipment was being washed upon entering the kitchen. The high temperature dishwasher was running, and the digital display indicated the wash temperature was 102 degrees Fahrenheit and the rinse was 173 degrees Fahrenheit. The wash temperature was not at the required 150 degrees Fahrenheit nor was the final rinse temperature at the required 180 degrees Fahrenheit. During an observation and interview on 11/01/22 at 9:00 AM Dietary Staff A attempted to test the high temperature dishwasher with quaternary sanitizer test strips (QT 40). She stated, she normally tested the dishwasher with the quaternary test strips. She stated she used these test strips to test the dishwasher since she started working at the facility (approximately 8 months ago). At this time, she further stated, she was aware that the dishwasher was a high temperature dishwasher and that she does document the results of her tests for the dishwasher (in the Dishwasher Temperature Log). She stated the wash and rinse numbers, documented on the Dishwasher Temperature Log, were obtained from the digital display on the front of the dishwasher. She stated the correct rinse temperature was 165 to 185 degrees Fahrenheit and the correct wash temperature was 135 or 136 degrees Fahrenheit. She stated that she tested the dishwasher two or three times during the breakfast run, one time during lunch and twice during the supper meal. During an interview on 11/01/22 at 9:14 AM Dietary Staff A stated she initially received a week of training in the dietary department. She also stated that she had been working in the facility for eight months. There was a plastic package of two hard boiled eggs in the resident dining area refrigerator. The 676279 Page 4 of 13 676279 11/03/2022 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0812 package was labeled Use by 10/20/22. The package was puffed/distended. Level of Harm - Minimal harm or potential for actual harm On 11/01/22 at 9:25 AM an interview was conducted with the Dietary Manager regarding how she ensured there were no expired foods in the resident use refrigerator. She stated, the CNAs and dietary staff check the refrigerator twice weekly and, on the weekends, to ensure foods were not expired. Residents Affected - Some Record review of the Dishwasher Temperature Log dated September 2022 revealed, of the 30 days, the dishwasher rinse temperature did not reach the required 180°F on 22 of 30 days. The temperature range was 171°F to 179°F. On 30 of 30 days the wash temperature was documented as not reaching the required 150°F. The temperature range for the wash temperature was 134°F to 147°F. Nineteen of the temperatures were initialed as checked by Dietary staff A and B. It was further documented that the log's Black/Brown - Good column was checked on all 30 days indicating that the temperatures for the dishwasher were correct as indicated on temperature test strips. Record review of the Dishwasher Temperature Log for October 2022 revealed, of the 31 days, there were five days where there was no documentation of taking any temperatures for the dish machine. Of the remaining 26 days, it was documented that the dishwasher did not reach the required sanitizing rinse temperature of 180°F on 11 of the 26 days. The temperature range for the rinse was documented as 174°F to 179°F. Record review of the wash temperatures for the remaining 26 days revealed that the wash temperature was documented as not reaching the required 150°F on 26 of 26 days. The temperature range was documented as 106°F to 129°F. Further record review of the October 2022 Dishwasher Temperature Log revealed that all temperatures taken where indicated/checked in the Black/Brown column as Good (reaching the required temperature). It was also documented that from 10/26/22 through 10/31/22 both columns were marked as Black/Brown - Good (reaching the required temperature) and Clear - No Good (not reaching the required temperature). Staff signatures through 5 of 6 of those dates were Dietary staff A and B. Record review of the Dishwasher Temperature Log for November 2022 revealed that there was documentation for only November 1st and the rinse temperature was documented as not reaching the required 180°F and was documented as 173°F. The wash temperature was also documented as not reaching the required temperature of 150°F and was documented as 110°F. Record review of the November 2022 Dishwasher Temperature Log revealed that on 11/1/22 the dishwasher was marked Black/Brown - Good. This was documented by Dietary staff A. On 11/01/22 at 3:23 PM an interview was conducted with Dietary Staff A regarding the documentation for the dishwasher temperatures. The Dishwasher Temperature Log columns documented, Black/Brown - Good and Clear - No Good. Regarding the meaning of these phrases, she stated, she did not know what they meant. She further stated that she had asked someone about it but could not remember what they told her. She was then told that there were slash marks under both columns that were initialed by her. She stated she just followed the previous marks made on the sheet by others. - The following observations were made during a kitchen tour that began on 11/01/22 at 11:53 AM and concluded at 12:50 PM: Dietary staff C prepared the purees for the unit. He placed a chicken fried steak, white gravy, water and potato flakes in the processor and pureed the mixture. After pureeing, he microwaved the mixture for 20 seconds. No temperature check was conducted after microwaving to ensure the food reached the required 165 degrees Fahrenheit. He then took the processor parts and placed them in the dishwasher. The dishwasher wash temperature was 121 degrees Fahrenheit, and the rinse was 183 degrees 676279 Page 5 of 13 676279 11/03/2022 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Fahrenheit, according to the digital display. The wash temperature failed to reach the required temperature of 150 degrees Fahrenheit. He then placed a bowl of carrots in the processor and pureed them. After pureeing, he took the processor parts to the dishwasher and place them in the dishwasher. The dishwasher wash temperature was 125 degrees Fahrenheit, and the rinse temperature was 185 degrees Fahrenheit, according to the digital display. The wash temperature failed to reach the required temperature of 150 degrees Fahrenheit. Next, he placed a slice of Key Lime Pie and milk in the processor and pureed it. He placed the processor parts in the dishwasher and the wash temperature was 128 degrees Fahrenheit and the rinse temperature was 183 degrees Fahrenheit, according to the digital display. The wash temperature failed to reach the required temperature of 150 degrees Fahrenheit. On 11/01/22 at 12:15 PM an interview was conducted with Dietary staff C regarding the correct temperatures for the wash and the rinse for the dishwasher. He stated, the wash should be 150 and the rinse should be 180 . On 11/01/22 at 12:16 PM temperatures were taken on the service line as follows: Pureed chicken fried steak was in a bowl and not placed on a direct heat source. Observation on 11/01/22 at 12:18 PM revealed the pureed chicken fried steak was 148.9 degrees Fahrenheit. This food was not rapidly reheated to 165 degrees Fahrenheit as required. The puree chicken fried steak, pureed roll, pureed carrots was served to Resident #51 at 12:30 PM on 11/01/22. On 11/03/22 at 11:02 AM an interview was conducted with Dietary staff C regarding the reheating methods for the purée. He stated, when I add the water, the food decreases in temperature, so he reheats the food in the microwave. He stated that 150 degrees F. was the correct temperature to reheat foods to. He added, staff usually take the food from the microwave and take the temperature right before it was served. Regarding any training related to the correct temperature to reheat food to (165°F), he stated, he may have forgot. He stated, residents could get sick, and bacteria could grow if foods were not reheated to the correct temperature. On 11/01/22 at 12:52 PM Dietary Staff A was observed walking from the dining room/food service area and through the kitchen drinking a personal drink (Styrofoam cup). She then placed the personal drink and cell phone on the prep table near a white mixer. On 11/01/22 at 4:25 PM an interview was conducted with the Dietary Manager regarding the dishwasher testing. She stated she obtained new (high) temperature dishwasher test strips . She added, she was absent from the facility for 5 months and Dietary staff A was hired while she was gone. She stated that the other staff in the other 3 units were knowledgeable of the dishwasher temperature test strips. - The following observations were made during a kitchen tour that began on 11/02/22 at 9:04 AM and concluded at 9:20 AM: Dietary staff B loaded and ran the dish machine, and the wash temperature was 110 degrees Fahrenheit, and the rinse was 183 degrees Fahrenheit. During an interview on 11/02/22 at 9:11 AM, the Dietary Manager stated, the Dishwasher Vendor Representative came a couple of weeks ago and would come today and check the dishwasher (electrical) panel and the motherboard. The Dishwasher service reports were requested at this time, but none were 676279 Page 6 of 13 676279 11/03/2022 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0812 provided at the time of exit on 11/03/22 at 2:30 PM. Level of Harm - Minimal harm or potential for actual harm During an observation and interview on 11/02/22 at 9:13 AM, Dietary Staff B stated, the dishwasher wash temperature should be 110 degrees and the rinse 180 degrees Fahrenheit. She added, the temperature strips ran out on Sunday (10/30/22). She stated she was instructed that the wash temperature should be 110 and it was that way in all the houses/unit. She stated that posted signs confirmed this. She then pointed to the posted signs in the kitchen area which stated, Caution hot water may exceed 110 degrees Fahrenheit. These signs were located above the three-compartment sink and in the dishwasher soiled side area. Further observation of the signs revealed the graphic on the sign was of hand washing, not dishwashing. Dietary staff B further stated she had worked in the facility for approximately a year and her initial training lasted a week or two. She added that she was unsure if they covered dishwasher temperatures in her training. Residents Affected - Some On 11/02/22 at 10:24 AM an interview was conducted with the Dietary Manager regarding the wash temperatures. She stated the Dishwasher Vendor Representative was present and he replaced the motherboard. She added that the temperature was up to 145 degrees Fahrenheit now and he would check the other homes/units. On 11/02/22 at 10:40 AM an interview was conducted with the Dishwasher Vendor Representative regarding the dishwasher temperature. He stated, the motherboard failed, and he replaced it today. He added he reset it a week or two ago. Observation of the dishwasher cycle at this time revealed that the wash was 150 degrees Fahrenheit, and the rinse was 185 degrees Fahrenheit. He added, regarding his last visit, he pressed the reset button on the motherboard, but it did not continue to work after he left. ~ The following observations were made during a kitchen tour that began on 11/03/22 at 8:40 AM and concluded at 8:53 AM: An interview and observation were conducted with Dietary staff B on 11/03/22 at 8:40 AM. She stated, residents could get sick if the dishwasher was not at the correct temperature levels. She added if the water is not hot enough it won't kill the germs. She further stated that the dish machine was not currently operating at 100% but that the repairman was coming back today. She added, the Dishwasher Vendor Representative said it needed a relay (part). She further stated that she ran the dishwasher this morning and it was at 142° for the wash cycle. She ran the dish machine at this time and the wash temperature indicated Lo on the digital display and the rinse was 185°F. She ran the dishwasher a second time and the wash temperature was 112°F and the rinse was 189°F. She added, when she finishes the last two loads of dishes on her shift, she documents the temperatures. She stated that she does not check for correct temperatures on the dish machine when she first runs it and only checks and documents the temperatures on the final two loads of dishes washed. She checked the dishwasher a third time and the wash temperature was 124°F and the rinse temperature was 186°F. She added that she does not conduct pre-wash/priming runs for the dishwasher for temperatures to elevate to the correct level before washing dishes. During an interview on 11/03/22 at 8:51 AM, the Dietary Manager stated she in-serviced staff on the correct temperatures for the dishwasher and added, staff are to inform her immediately if the temperatures are incorrect. Record review of the dietary related in-services conducted between 6/16/22 and 10/31/22 revealed there were two dietary specific in-services conducted during that period that indicated the following: 676279 Page 7 of 13 676279 11/03/2022 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some *The in-service dated 8/2/22 had the Subject documented as Mock Survey. The Summary of The Subject Matter was documented as follows: Test strips for three compartment sink. Make sure all foods are dated and sealed. Date mark is in and out. Silverware always facing down. Tea lids on after tea is brewed . *The in-service dated 6/16/22 had a Subject of General and the Summary of Subject Matter was as follows: Kitchen to be cleaned at all times. Stay ready. Grills, stove top, stoves, floors. Sweep and mop before you leave. Dates and labels. Books up to date. Grease holders emptied daily. Put dishes up in the evenings, close of kitchen . These two in-services did not specifically cover dishwasher temperatures, hygienic practices, food reheating temperatures and monitoring expiration dates of foods. On 11/03/22 at 11:22 AM an interview was conducted with the Dietary Manager regarding dietary sanitation issues discovered in the dietary department. She stated she has instructed staff to run the dishwasher twice (in the [NAME] unit) until it is repaired. She stated, Dietary staff A was nervous. She added that staff needed retraining and refreshing, such as with the markings on the Dishwasher Temperature Log. She stated she ensured that dietary staff conduct the correct dietary sanitation procedures, by providing in-services. She added the Dietitian visits one time a week in each house/unit. The system is in place, and it needs to be refreshed again with the staff. She further stated she checks the houses/units Monday and Fridays and checks the resident refrigerators. She stated the dietary staff and Dietary Manager, ultimately, were responsible to ensure that correct dietary sanitation procedures were followed. She stated she expected dietary staff to conduct the correct dietary sanitation procedures. She further stated residents could get sick and infection control issues could arise if dietary staff continued with the abovementioned incorrect dietary sanitation issues. During an interview on 11/03/22 at 12:28 PM, the Administrator was informed of the dietary sanitation issues discovered in the dietary department. She stated, she expected staff to know the correct temperatures for the foods and for the dishwasher. She stated, if the dietary sanitation issues continued, it could place residents at risk for infection control issues and residents could get sick especially with the out of date/expired hard boiled eggs. Record review of the facility's policy, Sanitation, Revised October 2008, revealed the following documentation, Policy Statement. The food service area shall be maintained in a clean and sanitary manner. Policy Interpretation and Implementation 8. Dishwashing machines must be operated using the following specification: High Temperature Dishwasher (Heat Sanitization) a. Wash temperature (150 degrees Fahrenheit - 165 degrees Fahrenheit) for at least forty-five (45) seconds; b. Rinse temperature (165 degrees Fahrenheit - 180 degrees Fahrenheit) for at least twelve (12) seconds . Record review the facility's policy, food preparation and service, revised April 2019 revealed the following documentation, Policy Statement. Food and nutrition services employees prepare and serve food in a manner that complies with safe food handling practices. Policy Interpretation and Implementation. Food Preparation Area . 5. Food preparation staff adhere to proper hygiene and sanitary practices to prevent the spread of foodborne illness Food Preparation, Cooking and Holding 676279 Page 8 of 13 676279 11/03/2022 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Time/Temperatures 2. Potentially hazardous foods include meat, poultry, seafood, cut melon, eggs, milk, yogurt and cottage cheese 9. Previously cooked food is reheated to an internal temperature of 165°F for at least 15 seconds. Reheated food that are not consumed within two hours or discarded . 11. Mechanically altered hot foods prepared for a modified consistency that remain above 135°F during preparation or they are reheated to 165°F for at least 15 seconds Food Service/Distribution 3. Steam tables are never used to reheat foods . Record review of the facility's policy titled Preventing Food Borne Illness - Employee Hygiene and Sanitary Practices, dated October 2017, revealed the following documentation, Policy Statement. Food and nutrition services employees will follow appropriate hygiene and sanitary procedures to prevent the spread of foodborne illness. Policy Interpretation and Implementation. 1. All employees who handle, prepare or serve food will be trained in the practice of safe food handling and preventing foodborne illness. Employees will demonstrate knowledge and competency in these practices prior to working with food or serving food to residents . 676279 Page 9 of 13 676279 11/03/2022 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to implement an infection prevention and control program (IPCP) that is designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for 2 of 4 medication aides ( Medication aide A and Medication aide B) reviewed for infection control practices during medication pass. Residents Affected - Few The facility medication aides failed to perform hand hygiene prior to administering medications. The facility medication aide failed to perform hand hygiene upon entering and exiting contact precautions room. These failures could place residents at risk of exposure to various types of infection. Findings included: Observations made on 11/02/2022 at 8:15 AM of medication pass with Medication Aide Ashe did not perform hand hygiene prior to preparing medications for Resident #179. Resident #179 was on contact precautions and Medication Aide A did not wash hands prior to entering the room, administering medications, or exiting the room. A contact precautions sign placed outside of the residents door read: Everyone Must clean their hands, including before entering and when leaving the room. Observations made on 11/02/2022 at 8:35 AM of medication pass with Medication Aide A= she did not perform hand hygiene prior to preparing medications for Resident #26. Medication Aide A was observed opening a lidocaine patch and warming it with her bare hands and placed lidocaine patch on Resident #26 without ever performing hand hygiene. During an interview with Medication Aide A on 11/02/2022 at 8:51 AM, she stated that she has been trained in infection control practices and hand hygiene. Medication Aide A stated that she does her training on the computer with Relias (computer-based training) and she has had to take it twice this year. Medication Aide A stated that she has not done any hand hygiene skills checks this year. Medication Aide A stated it was the responsibility of the DON to make sure that staff training was completed. Medication Aide A stated that she did not realize that she should have washed hands prior to preparing medications. Medication Aide A stated that she did realize that she messed up when she entered the contact precaution room and did not wash her hands, but stated she was nervous from being watched. Medication Aide A stated that the negative potential outcome for residents with her not performing hand hygiene was she could spread infections. Observations made on 11/02/2022 at 9:18 AM of medication pass with Medication Aide B she did not perform hand hygiene prior to preparing medications for Resident #25Medication B was observed administering the medications to Resident #25 and exiting the room without performing hand hygiene. Observations made on 11/02/2022 at 9:32 AM of medication pass with Medication Aide B. she did not perform hand hygiene prior to preparing medications for Resident #14. Medication B was observed administering the medications to Resident #14 but did perform hand hygiene upon exit of Resident #14's room. During an interview with Medication Aide B on 11/02/2022 at 9:50 AM, she stated that she did not 676279 Page 10 of 13 676279 11/03/2022 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few think about washing hands. Medication aide B stated, I guess I didn't think about it. Medication aide B stated that she has been trained in hand hygiene and that the training they receive was skills check lists and computer training with Relias. Medication aide B stated that it was the responsibility of the DON and administrator to make sure that staff have completed their training. Medication aide B stated that the negative potential outcome for not washing hands would be spreading of germs and infections to other residents. During an interview with the DON on 11/02/2022 at 10:43 am, she stated that it was her expectations that all staff perform hand hygiene. The DON stated that the staff was trained in hand hygiene on the computer with Relias and skills checks. The DON stated that she will do an in-service with the medication aides for performing hand hygiene. The DON stated that she was responsible for making sure that all training with nursing staff was completed. The DON stated that the negative potential outcome for not performing hand hygiene was the spread of infection. The DON stated that both medication aides just completed skills checks on 10/24/2022 and there was no reason that they should have failed to provide hand hygiene. The DON stated that she will visit with both medication aides to retrain and go over competency checks again. During an interview with the Administrator on 11/02/2022 at 11:10 am, she stated that her expectations was that all staff practice effective hand hygiene and infection control practices. Administrator stated that the staff have been trained in hand hygiene and she will address this matter and make sure that a one on one was completed with coaching and return demonstration. Administrator stated that counseling with the medication aide is going to be completed and close monitoring. Administrator stated that the negative potential outcome was that the staff could spread infections by not washing their hands. Record review of facility provided skills check sheet, labeled, Oral Medication Administration Skills Checklist, dated 10/24/2022, listed under Medication Aide A's name, revealed: 5. Prepare Meds: a). Wash hands Record review of facility provided employee coaching sheet, labeled, Infection Control, dated 10/24/2022, listed under Medication Aide B's name and instructor's signature, revealed: 1. Verbalizes importance of performing proper hand hygiene. 2. Demonstrates proper method to perform hand hygiene using alcohol-based hand rub. 3. Demonstrates proper method to perform hand hygiene with soap and water. Record review of facility provided employee coaching sheet, labeled, Competency Assessment Administering Oral Medications, dated 11/02/2022, listed under Medication Aide A's name and signature, 676279 Page 11 of 13 676279 11/03/2022 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0880 revealed: Level of Harm - Minimal harm or potential for actual harm Steps in the Procedure: 1. Residents Affected - Few Wash hands 23. Wash hands Record review of facility provided employee coaching sheet, labeled, Competency Assessment Administering Oral Medications, dated 11/02/2022, listed under Medication Aide B's name and signature, revealed: Steps in the Procedure: 2. Wash hands 23. Wash hands Record review of facility's provided policy, labelled, Handwashing/Hand Hygiene, dated with revision in August 2019 stated: Policy Statement: This facility considers hand hygiene the primary means to prevent the spread of infection. Policy Interpretation and Implementation: 2. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. 5. Wash hands with soap (antimicrobial or non-antimicrobial) and water for the following situations: a). When hands are visibility soiled and b). After contact with a resident with infectious diarrhea including, but not limited to infections caused by norovirus, salmonella, shigella, and C. difficile. 6. Use an alcohol based-hand rub containing at least 62% alcohol; or, alternatively, soap (antimicrobial or non-antimicrobial) and water for the following infections: b). Before and after direct contact with residents. c). Before preparing or handling medications. i). After contact with a resident's intact skin. 676279 Page 12 of 13 676279 11/03/2022 Crown Point Health Suites 6640 Iola Avenue Lubbock, TX 79424

F 0880 n). Before and after entering isolation precautions settings. Level of Harm - Minimal harm or potential for actual harm 7. Hand hygiene is the final step after removing and disposing protective equipment. Residents Affected - Few 8. The use of gloves does not replace hand washing/hand hygiene. Integration of glove use along with routine hand hygiene is recognized as the best practice for preventing healthcare-associated infection. 9. Single use disposable gloves should be used: c). When in contact with a resident, or the equipment or environment of a resident, who is on contact precautions. Record review of facility's provided policy, labelled, Administration of Oral Medications, dated with revision in October 2010 stated: Purpose: The purpose of this procedure is to provide guidelines for the safe administration of oral medications. Steps in Medication Preparation: 1. Preform hand hygiene. 14. Preform hand hygiene. 676279 Page 13 of 13