Health inspection·July 10, 2025

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few mattress and placed the soiled wipes on the resident's bedside table. The WCN used her soiled gloves to place a new draw sheet and brief beneath the resident. The WCN then removed the soiled wipes from the bedside table and placed them in the trash. The resident was turned to her right side and RN A cleaned stool off the resident and pulled out the soiled linen and brief. RN A used her soiled gloves to position the clean brief and draw sheet. The WCN used the same soiled gloves to apply Triad paste to the resident's buttocks and peri-area. The WCN changed gloves, but did not perform hand hygiene. RN A used her same soiled gloves to assist the WCN to pull up the sheets and place the resident's call light. RN A placed the soiled wipes container in the resident's drawer.An interview on 07/10/25 at 12:50 PM with the WCN revealed she was hired in February 2024. The WCN said she probably should have performed hand hygiene after changing gloves. The WCN said she did not perform hand hygiene between her glove changes because she usually double-gloved. The WCN said she had been trained to perform hand hygiene, but that she did not do patient care enough with changing briefs. The WCN said she soiled the wipes container, but that RN A threw the wipes container away. The WCN denied that she put soiled wipes on the bedside table. The WCN also denied using soiled gloves to apply the Triad paste. The WCN said failing to perform hand hygiene could place the resident at risk for infection.An interview on 07/10/25 at 12:55 PM with RN A revealed she had worked at the facility for just over a month. She said she did not change her gloves because while providing incontinence care she was working in a dirty field. RN A said that it was required that before cream was put on a resident, gloves were supposed to be changed. RN A refused to say if the WCN failed to change her gloves and perform hand hygiene prior to applying Triad paste to Resident #1. RN A said she did not need to change gloves or perform hand hygiene prior to putting on a new brief or pulling up the sheets because she was not working in a sterile field. RN A said she was going to clean Resident #1's bedside table.An interview on 07/10/25 at 2:00 PM with the Regional DON revealed she started covering the facility on 07/09/25. The Regional DON said staff were supposed to perform hand hygiene when changing gloves and were supposed to change gloves when going from dirty to clean during incontinence care. The Regional DON said applying Triad paste required clean gloves and that soiled wipes were supposed to be thrown in the trash and not placed on the bedside table. The Regional DON said the observed issues placed the resident at risk of transmission of infection. The Regional DON said the DON and nursing leadership had a shared responsibility for ensuring staff used infection control measures when caring for residents. She said the Infection Preventionist (not in the facility) performed hand hygiene observations quarterly and the staff had received in-services on infection control.Review of the Facility Policy, Infection Prevention and Control Program, dated 04/17/25, reflected: This facility has established and maintains 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 diseases and infections as per accepted national standards and guidelines.Review of the Facility Policy, Hand Hygiene, revised November 2024, reflected: Handwashing/hand hygiene is generally considered the most important single procedure for preventing healthcare associated infections. Antiseptics control or kill microorganisms contaminating skin and other superficial tissues. Although antiseptics and other handwashing/hand hygiene agents do not sterilize the skin, they can reduce microbial contamination depending on the type and the amount of contamination, the agent used, the presence of residual activity and the handwashing/hand hygiene technique followed. Antiseptics should not, as a rule, be used to disinfect inanimate surfaces.I. HANDWASHING When hands are visibly dirty or contaminated with proteinaceous material, are visibly soiled with blood or other body fluids, after going to the restroom, before eating, before performing an invasive procedure, and after providing care to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676449 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 676449 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ignite Medical Resort Fort Worth, LLC 6301 Oakmont Blvd Fort Worth, TX 76132 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 a resident with a spore-forming organism (e.g., C. difficile), perform hand hygiene with either a non-antimicrobial soap and water or an antimicrobial soap and water. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 676449 If continuation sheet Page 3 of 3