Health inspection·July 6, 2023

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 maintain an infection control program designed to prevent the development and transmission of infection for one staff (RN A) out of four staff observed for infection control. Residents Affected - Few The facility failed to ensure RN A performed hand hygiene while providing lunch services in the dining room area. This failure could place the residents at risk for infection. Findings include: Observation on 07/05/23 at 12:52 PM revealed RN A was feeding one resident . No hand hygiene done before, after, or during care. RN A then touched a second resident on the shoulder and spoke to the resident. No hand hygiene done, after, or during care. RN A walked over to a third resident and touched that resident back and removed clothing protector, placed on table, and then touched same resident's wheelchair to move her away from the dining room table. No hand hygiene done before, after, or during care. RN A removed clothing protector from a fourth resident and placed on the dining room table and touched same resident's wheelchair to move resident away from dining room table. No hand hygiene done before, after or during care. RN A touched a fifth resident on shoulder and spoke with same resident. No hand hygiene done before, after, or during care. RN A pulled out a chair and sat down to help a sixth resident eat. In an interview on 07/05/23 at 01:31 PM with RN A, she stated she does hand hygiene before and after feeding residents and after touching anything from patient to patient. She stated she should have done hand hygiene between helping residents. She stated she I probably didn't think of it when asked why she did not do hand hygiene between resident care. She stated doing hand hygiene was to prevent spreading germs or cross contamination. In an interview on 07/06/23 at 10:24 AM with the DON, she stated that staff were to complete hand hygiene after feeding a resident and moving on to feed another resident. DON stated the staff were to complete hand hygiene to prevent spread of infection. Record review of In-Service: ALL STAFF, dated 05/24/2023, with a title of HIPPAA and Infection Control revealed RN A name and signature. The policy, titled Standard Precautions Infection Control reflected, 1. Hand hygiene: a. During the delivery of resident care services, avoid unnecessary touching of surfaces in close proximity to the resident to prevent both contamination of clean hands from environmental surfaces and transmission of pathogens from contaminated hands to surfaces .e. Staff must perform hand hygiene .before and after direct contact with the resident . was attached and used (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: 676488 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 676488 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/06/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cedar Hollow Rehabilitation Center 5011 North US Hwy 75 Sherman, TX 75090 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)