Health inspection·November 25, 2025

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that licensed nurses have the specific competencies, and skill sets necessary to care for two (2) residents' (Resident #1 and Resident #2) needs for one (1) of five (5) licensed nurses (the ADON) reviewed for staff competency. 1. While providing wound care for Resident #1 on 11/24/2025, the ADON did not fully cover the resident's wound bed with the calcium alginate dressing per physician order.2. While providing wound care for Resident #1 on 11/25/2025, the ADON did not date or initial the wound dressing.3. While providing wound care for Resident #2 on 11/25/2025, the ADON did not date or initial the wound dressing. These failures could place residents at risk for improper care and complications of residents' medical care.The findings included: 1. Record review of Resident #1's admission Record, dated 11/24/2025, reflected a [AGE] year-old female. She was admitted on [DATE] and re-admitted on [DATE]. Record review of Resident #1's Diagnosis Report, dated 11/24/2025, revealed diagnoses included enterocolitis (an inflammation that occurs in a person's digestive tract) due to clostridium difficile (a bacterium that causes severe diarrhea), diabetes mellitus (a condition that develops with the way the body regulates and uses sugar as fuel), and peripheral vascular disease (a circulatory condition in which narrowed blood vessels reduce blood flow to the limbs). Record review of Resident #1's Quarterly MDS, dated [DATE], revealed the resident had a BIMS score of 10, indicating she had moderate cognitive impairment. She had a diabetic foot ulcer with an application of dressings to the feet for treatment. Record review of Resident #1's Care Plan Report, undated and electronically accessed 11/24/2025, revealed the following focuses and corresponding interventions/tasks: - Focus: I have Diabetic Ulcer to right heel r/t Diabetes/PVD, date initiated 09/03/2025 and date revised 11/11/2025. - Intervention: Ensure appropriate protective devices are applied to affected areas., date initiated 09/03/2025. - Focus: Resident is at risk for pressure ulcers r/t decreased mobility., date initiated 09/18/2025 and revised 11/11/2025. Intervention: Administer treatments as ordered and monitor for effectiveness., date initiated 09/18/2025. Record review of Resident #1's Order Summary Report, dated 11/24/2025 at 04:47 p.m. with active orders as of 11/24/2025, revealed the following order:- Cleanse R heel with wound cleanser or normal saline [water with dissolved salt]. pat [sic] dry. Apply santyl [sic; a topical medication used to remove dead tissue from wounds and promote healing] and calcium alginate [a type of wound dressing that absorbs the secretions from a wound and promotes healing] to wound bed and cover with dry dressing. daily [sic] and prn. every [sic] day shift for wound care, order status noted as active and dated 11/24/2025. During an observation and interview on 11/24/2025 at 03:55 p.m., Resident #1 was observed lying in bed with heel protective booties on both feet. She revealed she had had a wound on her right foot for at least a week or two. She stated she was waiting for the nurse to provide treatment for it. She stated she was not concerned about the care provided by the nursing staff. During an observation on 11/24/2025 at 04:34 p.m., Page 1 of 8 745001 745001 11/25/2025 Estates at Shavano Park 4366 Lockhill Selma Shavano Park, TX 78249

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the ADON performed wound care for Resident #1. During wound care, the ADON cleansed the wound with wound cleanser and patted dry. She applied the Santyl ointment, followed by the calcium alginate dressing to the wound bed. The calcium alginate dressing was observed not applied to the center of the wound resulting in a visible portion of the medial (towards the center of the body) half of the wound not covered by the calcium alginate dressing. A dry dressing with the date and the ADON's initials was applied over the entire wound. 2. During an observation on 11/25/2025 at 10:34 a.m., the ADON performed wound care for Resident #1. During wound care the ADON was observed to apply the dry dressing to cover the wound. The dry dressing was undated and not initialed. 3. Record review of Resident #2's admission Record, dated 11/25/2025, reflected a [AGE] year-old male. He was admitted on [DATE] and re-admitted on [DATE]. Record review of Resident #2's Diagnosis Report, dated 11/25/2025, revealed diagnoses included unsteadiness on feet, moderate protein-calorie malnutrition (lack of proper nutrition), colostomy status (an opening in the colon that allows stool to exit the body into a pouch without going through the anus), and stage four pressure ulcer (defined as the most severe form of an injury to the skin and tissue below the skin caused by prolonged pressure on a specific area of the body with full-thickness tissue loss) of sacral region (the triangular region at the base of the spine and just above the buttocks). Record review of Resident #2's admission MDS, dated [DATE], revealed the resident had a BIMS score of 15, indicating he was cognitively intact. He had an ostomy (a surgically created opening in the body which may include a colostomy, which is a surgical opening in the intestine allowing organic matter to exit the body without going through the anus), one stage 4 pressure ulcer was present upon admission/entry or reentry, and surgical wound(s). This MDS revealed Resident #2's skin and ulcer/injury treatments included pressure ulcer/injury care, surgical wound care, application of nonsurgical dressings, application of ointments/medications other than to feet, and application of dressings to feet. Record review of Resident #2's Care Plan Report, undated and accessed 11/25/2025, revealed the following focuses and corresponding interventions/tasks: - Focus: Resident c stage IV pressure ulcer to coccyx. Resident is at risk for additional pressure ulcers r/t decreased mobility, malnutrition, & HX of pressure ulcers. State 4 Pressure Ulcer to Sacrum Onset: 8/05/24., date initiated 01/09/2025 and revised 10/22/2025. - Intervention: Administer treatments as ordered and monitor for effectiveness., date initiated 01/09/2025. - Intervention: Monitor dressing (FREQ) to ensure it is intact and adhering. Report lose dressing to Treatment nurse, date initiated and revised 01/09/2025. Record review of Resident #2's Order Summary Report, dated 11/24/2025 at 04:47 p.m. with active orders as of 11/24/2025, revealed the following orders:- Cleanse Coccyx [the tail bone located within the sacrum region] with wound cleanser or normal saline, pat dry, apply Santyl, hydroferablue [an antibacterial foam dressing that promotes healing while preventing infection] cut to fit. cover [sic] with dry dressing Daily and PRN. every [sic] day shift for Wound care, order status noted as active and dated 10/27/2025. During an observation on 11/25/2025 at 10:15 a.m., the ADON performed wound care for Resident #2. During wound care the ADON was observed to apply the dry dressing to cover the wound. The dry dressing was undated and not initialed. During an observation and interview on 11/25/2025 at 10:30 a.m., Resident #2 revealed he was excited to have returned to the nursing facility because his wounds were getting better. He revealed he had no complaints or concerns about the care provided by the nursing staff. During an interview on 11/25/2025 at 11:13 a.m. MD A revealed he was the facility's wound care physician for three (3) months. He stated the first time he made wound care rounds with the ADON he observed her wound care treatments. He stated he had not observed any identified concerns with the ADON's treatments. He stated he had not provided facility staff training on wound care or reviewed the staff competencies for wound care provisions. 745001 Page 2 of 8 745001 11/25/2025 Estates at Shavano Park 4366 Lockhill Selma Shavano Park, TX 78249

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 11/25/2025 at 11:48 a.m., the VPCS stated the facility did not have a policy on nurse competencies. During an interview on 11/25/2025 at 06:06 p.m., the ADON stated a prior ADON was responsible for assessing staff competencies. She did not identify the staff member currently responsible. She stated she was unsure if wound care competencies were part of the competency checks that were performed. The ADON stated the prior wound care nurse completed her competency check in August of 2025. She stated she made rounds with MD A for the past three (3) weeks. She stated she did not realize the calcium alginate dressing did not fully cover Resident #1's wound during the wound care treatment on 11/24/2025. She stated the error could possibly impact the improvement of Resident #1's wound. The ADON stated she did not realize she did not label the dry dressings for Resident #1 and Resident #2 during wound treatments on 11/25/2025. She stated a lack of labeling the dressing with a date and initial could result in another staff member not knowing when the dressing was last changed. During an interview on 11/26/2025 at 07:50 p.m., the VPCS stated she was not familiar with Resident #1's wound and could therefore not determine if or how much not fully covering the wound with the calcium alginate dressing would impact her wound treatment and status. During an interview on 11/26/2025 at 20:09 p.m., the ADMIN stated the expectation for staff to date and initial the wound dressings was for staff to date it immediately after completing the wound treatment so everyone coming after that staff member would know when the next wound care would need to be done. She stated the expectation was very important. Record review of facility document titled Licensed Nurse Competency, signed and dated 07/16/2025, indicated the ADON, hire date 08/15/2022, completed competency trainings and assessments. The document stated Training on the following topics was provided. (*Indicates competence). Under the section titled, Nursing Skills, a subsection titled Skin and Wound Care included: Arterial, diabetic, venous wounds and Pressure ulcer/injury prevention and management. Record review of the facility's policy, Wound Care, dated as reviewed December 2024, reflected: Policy: The purpose of this procedure is to provide guidelines for the care of wounds to promote healing.Steps in the Procedure. 11. Apply treatments as indicated. 12. Dress wound. [NAME] dressing with initials, time, and date. 745001 Page 3 of 8 745001 11/25/2025 Estates at Shavano Park 4366 Lockhill Selma Shavano Park, TX 78249

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 two (2) of two (2) residents (Resident #1 and Resident #2) reviewed for infection control. 1. The facility failed to post signage on 11/24/2025 to indicate Resident #1 was ordered to be on contact isolation precautions prior to or immediately upon notification of the order. While providing wound care for Resident #1 on 11/24/2025 and 11/25/2025, the ADON did not wash her hands prior to or after providing wound care to a resident who was on contact precautions. The ADON did not sanitize her hands between glove changes. While providing wound care for Resident #1 on 11/25/2025, the ADON placed open wound care supplies directly on the resident's bed. 2. While providing wound care for Resident #2 on 11/25/2025, the ADON did not sanitize her hands between glove changes. These failures could place residents at risk for infection due to improper care practices. The findings included: Record review of Resident #1's admission Record, dated 11/24/2025, reflected a [AGE] year-old female. She was admitted on [DATE] and re-admitted on [DATE]. Record review of Resident #1's Diagnosis Report, dated 11/24/2025, revealed diagnoses included enterocolitis (an inflammation that occurs in a person's digestive tract) due to clostridium difficile (a bacterium that causes severe diarrhea), diabetes mellitus (a condition that develops with the way the body regulates and uses sugar as fuel), and peripheral vascular disease (a circulatory condition in which narrowed blood vessels reduce blood flow to the limbs). Record review of Resident #1's Quarterly MDS, dated [DATE], revealed the resident had a BIMS score of 10, indicating she had moderate cognitive impairment. She had a diabetic foot ulcer with an application of dressings to the feet for treatment. She had an active diagnosis of pneumonia and received antibiotic medication during the last seven (7) days reviewed or since admission/entry or reentry. Record review of Resident #1's Care Plan Report, undated and electronically accessed 11/24/2025, revealed the following focuses and corresponding interventions/tasks: - Focus: I have Diabetic Ulcer to right heel r/t Diabetes/PVD, date initiated 09/03/2025 and date revised 11/11/2025. Intervention: Monitor/document/report to MD PRN any s/sx of infection: ., date initiated 09/03/2025.- Focus: Resident has a condition which requires contact isolation. [C-diff], date initiated and revised 09/18/2025. Intervention: Educate resident and family members on standard precautions., date initiated 09/18/2025. Intervention: In-service direct care staff on contact isolation techniques, date initiated 09/18/2025. Record review of Resident #1's Order Summary Report, dated 11/24/2025 at 04:47 p.m. with active orders as of 11/24/2025, revealed the following order:- Cleanse R heel with wound cleanser or normal saline [water with dissolved salt]. pat [sic] dry. Apply santyl [sic; a topical medication used to remove dead tissue from wounds and promote healing] and calcium alginate [a type of wound dressing that absorbs the secretions from a wound and promotes healing] to wound bed and cover with dry dressing. daily [sic] and prn. every [sic] day shift for wound care, order status noted as active and dated 11/24/2025.- Resident is on EBP and Standard Precautions R/T wound care- any skin opening that requires a drg.Don [put on] PPE inside the room. every [sic] shift for Enhanced barrier precautions related to medical condition Staff [sic] must don gown &gloves [sic] when performing high contact care such as.dressing changes., order status noted as active and dated 11/17/2025.- Resident is on strict isolation R/T (C-diff). Contact Isolation [sic] Resident will receive all services including but not limited to.treatments and nursing services in their room. every [sic] shift for Isolation medical condition, order status noted as active and dated 11/24/2025. Record review of Resident #1's Progress Note, dated 11/24/2025 for progress notes Residents Affected - Few 745001 Page 4 of 8 745001 11/25/2025 Estates at Shavano Park 4366 Lockhill Selma Shavano Park, TX 78249

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few effective 10/25/2025 to 11/25/2025, revealed:- a progress note dated 11/24/2025 at 02:27 p.m. revealed Resident #1 had a diabetic foot ulcer present on admission. - a progress note dated 11/24/2025 at 03:08 p.m. revealed Resident #1 arrived to the facility by ambulance. During an observation on 11/24/2025 at 03:51 p.m., Resident #1's door was observed to be open with the end of Resident #1's bed and her feet, in heel protective booties, visible from the hallway. Next to the door opening, a sign noted the resident was on enhanced barrier precautions. During an interview on 11/24/2025 at 03:55 p.m., Resident #1 revealed she had just returned, that same day, from the hospital. She stated she had gone to the hospital due to having diarrhea for a week prior to her transfer to the hospital. Resident #1 stated she had wounds on her feet prior to her admission to the facility and thought they were improving. She denied concerns regarding wound care provided by facility staff. She was unaware of contact precautions/ isolation during the interview. During an observation and interview on 11/24/2025 at 04:34 p.m., the ADON stated Resident #1 was on contact precautions for C-diff. The ADON stated the resident was just back from the hospital, that same day, and confirmed the contact precautions signage on the door was not present. The ADON performed wound care for Resident #1. The ADON entered the resident's room, sanitized her hands, put on a personal protective gown, put on gloves, entered the resident's attached restroom to obtain a disposable paper towel, placed the paper towel down on an empty side table located in the resident's room, placed her prepared treatment supplies down on the paper, and closed the resident door. Wearing the same gloves, the ADON removed Resident #1's right heel protective bootie, propped the resident's foot on the bootie, to allow the foot to rest on her lower calf or upper ankle and stay slightly elevated off the bed, and removed the old wound dressing. The ADON removed her gloves and put on new gloves without sanitizing or washing her hands in-between glove changes. She cleansed the wound with wound cleanser and patted dry. She applied the Santyl ointment, followed by the calcium alginate dressing to the wound bed. A dry dressing with the date and the ADON's initials was applied over the entire wound. The ADON reapplied Resident #1's right heel protective bootie and covered the resident's feet with her blanket. The ADON discarded the wound treatment supplies into the resident's trash, collected the resident's trash, and put the side table back toward the center of the room. On the way out of the room, the ADON removed her protective gown and gloves. She was then observed to sanitize her hands. She was not observed to wash her hands. During an interview on 11/24/2025 at 04:47 p.m., the ADON stated the signage for Resident #1's contact isolation was up. During an observation on 11/25/2025 at 10:34 a.m., contact precaution signage was noted outside Resident #1's door. The ADON performed wound care for Resident #1. The ADON entered the resident's room, sanitized her hands, put on a personal protective gown, put on gloves, entered the resident's attached restroom to obtain a disposable paper towel, placed the paper towel down on an empty side table located in the resident's room, placed her prepared treatment supplies down on the paper, and closed the resident door. Wearing the same gloves, the ADON removed Resident #1's right heel protective bootie, propped the resident's foot on the bootie, to allow the foot to rest on her lower calf or upper ankle and stay slightly elevated off the bed, and removed the old wound dressing. The ADON removed her gloves and put on new gloves without sanitizing or washing her hands in-between glove changes. She cleansed the wound with wound cleanser and patted dry. She applied the Santyl ointment. She picked up the packet that contained the calcium alginate dressing and the packet that contained the dry dressing, opened both packets, and placed both open packets directly on the resident's bed, next to the resident's right heal. The calcium alginate dressing, followed by the dry dressing was applied to the wound. The ADON reapplied Resident #1's right heel protective bootie and covered the resident's feet with her blanket. The ADON discarded the wound treatment 745001 Page 5 of 8 745001 11/25/2025 Estates at Shavano Park 4366 Lockhill Selma Shavano Park, TX 78249

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few supplies into the resident's trash, collected the resident's trash, and put the side table back toward the center of the room. On the way out of the room, the ADON removed her protective gown and gloves. She was then observed to sanitize her hands. 2. Record review of Resident #2's admission Record, dated 11/25/2025, reflected a [AGE] year-old male. He was admitted on [DATE] and re-admitted on [DATE]. Record review of Resident #2's Diagnosis Report, dated 11/25/2025, revealed diagnoses included unsteadiness on feet, moderate protein-calorie malnutrition (lack of proper nutrition), colostomy status (an opening in the colon that allows stool to exit the body into a pouch without going through the anus), and stage four pressure ulcer (defined as the most severe form of an injury to the skin and tissue below the skin caused by prolonged pressure on a specific area of the body with full-thickness tissue loss) of sacral region (the triangular region at the base of the spine and just above the buttocks). Record review of Resident #2's admission MDS, dated [DATE], revealed the resident had a BIMS score of 15, indicating he was cognitively intact. He had an ostomy (a surgically created opening in the body which may include a colostomy, which is a surgical opening in the intestine allowing organic matter to exit the body without going through the anus), one stage 4 pressure ulcer that was present upon admission/entry or reentry, and had surgical wound(s). His skin and ulcer/injury treatments included pressure ulcer/injury care, surgical wound care, application of nonsurgical dressings, application of ointments/medications other than to feet, and application of dressings to feet. Record review of Resident #2's Care Plan Report, undated and electronically accessed 11/25/2025, revealed the following focuses and corresponding interventions/tasks: - Focus: I have a condition that requires Enhanced Barrier Precautions. EBP are related to Colostomy & wound care-any skin opening that requires a drg., date initiated 08/05/2024 and revised 09/14/2025. - Intervention: Staff must don gown and gloves after entering the room to provide high contact resident care activities such as .wound care., date initiated 08/05/2024. - Focus: . Resident is at risk for additional pressure ulcers r/t decreased mobility, malnutrition, & HX of pressure ulcers. State 4 Pressure Ulcer to Sacrum Onset: 8/05/24., date initiated 01/09/2025 and revised 10/22/2025. - Intervention: Administer treatments as ordered and monitor for effectiveness., date initiated 01/09/2025. - Intervention: Monitor dressing (FREQ) to ensure it is intact and adhering. Report lose [sic] dressing to Treatment nurse, date initiated and revised 01/09/2025. Record review of Resident #2's Order Summary Report, dated 11/24/2025 at 04:47 p.m. with active orders as of 11/24/2025, revealed the following orders:- Cleanse Coccyx [the tail bone located within the sacrum region] with wound cleanser or normal saline, pat dry, apply Santyl, hydroferablue [an antibacterial foam dressing that promotes healing while preventing infection]cut to fit. cover [sic] with dry dressing Daily and PRN. every [sic] day shift for Wound care, order status noted as active and dated 10/27/2025.- Resident is on EBP and Standard Precautions R/T colostomy, &wound [sic] care- any skin opening that requires a drg.Don [put on] PPE Inside the room. every [sic] shift for Enhanced barrier precautions related to medical condition Staff [sic] must don gown &gloves [sic] when performing high contact care such as.dressing changes., order status noted as active and dated 11/17/2025. During an observation on 11/25/2025 at 10:15 a.m., the ADON performed wound care for Resident #2. After removing Resident #2's prior dressing, the ADON was observed to remove her gloves and put on new gloves without sanitizing or washing her hands in-between glove changes. She proceeded with wound care. On the way out of the room, the ADON removed her protective gown and gloves. She was observed to sanitize her hands. During an observation and interview on 11/25/2025 at 10:30 a.m., Resident #2 revealed he was excited to have returned to the nursing facility because his wounds were getting better. He revealed he had no complaints or concerns about the care provided by the nursing staff. During an interview on 11/25/2025 at 11:13 a.m. MD A revealed he 745001 Page 6 of 8 745001 11/25/2025 Estates at Shavano Park 4366 Lockhill Selma Shavano Park, TX 78249

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was the facility wound care physician for three (3) months. He stated he was okay with the nurse who was providing wound care to use hand sanitizer between wound care treatments but after three (3) residents, he would want them to wash their hands. He stated for a resident with C-diff, he would expect the staff member to wash their hands. He stated if a nurse put wound care supplies on the bed, it would be okay, and he would not have concerns about infection control unless the resident was on contact precautions. He stated he would prefer the supplies to be on the bedside table. He stated the risk of putting wound care supplies on the bed with a resident that had C-diff was the spores from C-diff could contaminate the supplies. During an interview on 11/25/2025 at 06:06 p.m., the ADON stated the expectation for hand hygiene was for the staff member to wash their hands in between residents or use hand sanitizer. She stated if the resident was on isolation precautions, the staff member was to wash her hands before and after wound care. She stated the impact of not sanitizing or washing their hands would be cross contamination. She stated she did not realize she did not sanitize her hands between glove changes. She stated for Resident #1 she did wash her hands after removing her gown. She stated she went back into the room, wiped the side table, and washed her hands. She stated she thought she washed her hands in Resident #2's bathroom prior to providing wound care to Resident #1 on 11/25/2025. She stated she used hand sanitizer prior to putting on her gloves before providing wound care to Resident #1 on 11/25/2025. During an interview on 11/26/2025 at 07:50 p.m., the VPCS stated a resident's door should have a sign indicating the type of isolation the resident was on. She stated the sign should be on the door when the need for isolation was identified. She stated the sign was a safety measure for the staff and visitors as it would let everyone know what types of PPE required. She stated her expectation was for staff to wash their hands before providing care, when they change gloves, and then following the provision of care. She stated she would have to refer to the facility policy to determine if hand sanitizer was appropriate to be used in place of hand washing before and after care. She stated the impact of not sanitizing or hand washing before, after, and in-between glove changes was that there was always a chance of contamination. She stated it could contaminate the wound or whatever the staff member was doing. During an interview on 11/26/2025 at 20:09 p.m., the ADMIN stated the standard was staff needed to wash their hands. She stated she did not know when sanitizer could be used in the place of hand washing. She stated the risk of inadequate hand hygiene was that there would be some potential infection control issues. She stated the expectation for isolation precautions as for the appropriate signage to be on the door and staff to adhere to the policies. She stated she expected the signage to be posted as soon as a resident arrived in the building and staff had the resident's paperwork. She stated staff would actually already know the condition of the resident prior to their arrival at the facility, so the staff should have the sign posted as part of making the room ready for the resident. She stated the signage should already be up prior to the resident's arrival. She stated the importance of posting the isolation precaution sign was that it alerted staff of the isolation precautions, so staff could prepare. Record review of the facility's policy, Hand-Washing/Hand Hygiene, dated as reviewed December 2024, reflected: Policy: This facility considers hand hygiene the primary means to prevent the spread of infections. Policy Interpretation and Implementation. 2. All personnel shall follow the hand-washing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors.6. Wash hands with soap (antimicrobial or non-antimicrobial) and water for the following situations: a. When hands are visibly 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. 7. Use an alcohol-based hand rub; or, alternatively, soap (antimicrobial or non-antimicrobial) and water for 745001 Page 7 of 8 745001 11/25/2025 Estates at Shavano Park 4366 Lockhill Selma Shavano Park, TX 78249

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the following situations: . b. Before and after direct contact with residents; . d. Before performing any non-surgical invasive procedures; . f. Before donning sterile gloves; g. Before handling clean or soiled dressings, gauze pads, etc.; . i. After contact with a resident's intact skin; j. After contact with blood or bodily fluids; k. After handling used dressings, contaminated equipment, etc.; . m. After removing gloves; n. Before and after entering isolation precaution settings; .8. Hand hygiene is the final step after removing and disposing of personal protective equipment. Record review of the facility's policy, Infection Control Guidelines for All Nursing Procedures, dated as reviewed December 2024, reflected: PurposeTo provide guidelines for general infection control while caring for residents.General Guidelines .3. Enhanced Barrier Precautions (EBP).employes targeted gown and glove use during high contact resident care activities.EBP are indicated for residents with any of the following: .Wounds.4. Employees must wash their hands for twenty (20) seconds or longer using antimicrobial or non-antimicrobial soap and water under the following conditions: a. Before and after direct contact with residents; . c. After contact with blood, body fluids, secretions, mucous membranes, or non-intact skin; d. After removing gloves; e. After handling items potentially contaminated with blood, body fluids, or secretions;. g. When there is likely exposure to spores (i.e., C. difficile or Bacillus anthracis) (Note: Alcohol-based hand rubs are inactive against spores. For effective mechanical removal of spores, wash hands for 30-60 seconds with soap and water or 2% chlorhexidine gluconate.)5. In most situations, the preferred method of hand hygiene is with an alcohol-based hand rub. If hands are not visibly soiled, use an alcohol-based hand rub containing 60-95% ethanol or isopropanol for all the following situations: a. Before and after direct contact with residents; b. Before donning sterile gloves; c. Before performing any non-surgical invasive procedures; . e. Before handling clean or soiled dressings, gauze pads, etc.; f. Before moving from a contaminated body site to a clean body site during resident care; g. After contact with a resident's intact skin; h. After handling used dressings, contaminated equipment, etc.; . j. After removing gloves. 745001 Page 8 of 8