How to read MD LEAS sesegiatens GetoFaclity inspection’ Printing So, te-Facility’s List epartment of Public ane Ocoee BEMTENGE, Reston AN sccurence fastrucions Se mepaction Citation’s Text CEA MULLER ULM Sol Rcd SoA Shc UL dM oe dno ied ok dabei coda nce Facility ID: 020408 Facility Name: CHERRY CREEK NURSING CENTER Inspection ID: HWZ711 Inspection Exit Date: 9/26/2019 Citation Code: 0880 Citation Title: Infection Prevention & Control Scope and Severity (S/S): F Notes: Citation code "0000" and "9999" are initial and final Comments of an inspection. Citation Text Based on observations, record review and interview, the faciity failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary environment to help prevent the development and potential transmission of communicable diseases anc infections. Specifically, the facility fated to Perform proper hand hygiene prior to tracheostomy care, and after resident care for Resident #108; Ensure wheelchairs were adequately cleaned for Residents #48 anc #82; Ensure oxygen rooms were Kept clean on all three nursing units (Eldoraco, Golden Gate, and Summit Park); and, [Ensure shower raoms were cleaned after use on Golden Gate unit and Summit Park unit Findings include: |. Professional reference According to Centers for Disease Contral (CDC) Control and Prevention, "Hand Hygiene Basis’, retrieved from: http://wnw.cde.gov/handhygiene/Basics.htmt (2019), It readin pertinent part, ‘Healthcare providers should practice hand hygiene at key paints in time to disrupt the transmission of microorganisms to Patients including: before patient contact; after contact with blood, bedy fluids, or contaminated surfaces (even if gloves are worn); before invasive procedures; and after removing gloves (wearing loves isnot enough to prevent the transmission of pathogens in healthcare settings)” 1. improper hand hygiene ‘A. Resident #108 observation (On 9/24/19 at 9:57 a.m, Registered nurse (RN) #6 was observed in room #110. The resident was asking her for help In the bed and she informed the resident she could not it her in bed alone, the resident repositioned herself, then RN #6 left room #110 and entered room #112, she didnot perform hand hygiene prior to entering or exiting room #110, Resident #108 was observed In his room #112, awake in bed. RN #6 went to the resident’ bedside table and started moving items off the tale, asked Resident #108 if he needed to be suctioned, he shook his head and eyes upward. She placed a single vial of normal saline (HS) on his bedside table, and then she Searched thraugh the resident's boxes that were on a dresser next to the wall, She said she needed to gather more supplies and she let the room, she did not perform any hand hygiene before leaving the room. RN #6 returned to the room after a cauple of minutes at 10:02 a.m. and set the suction kit down on the bedside table, she grabbed gloves out of a box that ‘was hanging on the wall and placed them on the bedsi¢e table. Then she opened the trach kt, pulled the sterile gloves out ofthe kit and set the glaves Girecty on the bedside table, and she opened a small sterile bottle of water. Then she went tothe sink and washed her hands With soap and water for nine seconds, dried her hands and shut the water off with the paper towel She donned sterile gloves that were placed on the bedside table, opened the saline and asked Resident #108 if he wanted to use the saline in which he replied no, Then she removed the sterile suction tubing from the container with her right hand, she tumed on the suction machine with her left hand, and used her left thumb to caver the suction device, she placed the tip ofthe tube with her right hand in the sterile water to ensure the suctian machine was working, propery, She provided effective suctioning to Resident #10, She dofted the green sterile gloves, and donned clean gloves and proceeded to ask the resident questions, ensuring his comfort with repositioning of his upper extremities. She did net perform hand hygiene priar to donning lean gloves. Then she turned off the resident’ gastrointestinal tube (G-tube) feeding ane ‘went to the sink and rinsed the resident's tube feeding cylinder, she checked his G-tube for residual, and disconnected the resident tube feecing and she Goffed her gloves. Sne didnot perform hand hygiene after doffing her gloves. “The resident wanted to ask her a question, so RN #6 grabbed Resident #108 Alphabet communication board. Resident #108 said he said he wanted to speak with the surveyor later, RN #6 asked the resident if ne wanted the cannula to his tracheostomy changed and he said yes. RN #6 set Resident #108 Communication board down, and grabbed a new cannula out of a bax on the dresser. She donned gloves, removed the residents inner cannula then threw it in fhe trash, doffed gloves, donned new gloves and put the new inner cannula in te residents tracheostomy, and then she doffed those gloves, A resident was heard from the next room yelling out for help. RN #6 left the room, she did not perform hand hygiene after taking out the old trach and before donning new lovesRN #6 entered room #110 she asked the resident what she needed, RN #6 said she would return, she left the room and did not perform han hygiene. Then RN {#6 pusned her medication cart down to tne enc of the haliway, she opened the bottom drawer and removed the power cord and plugged in her computer. “Then RN #6 walked to the nurses station on 500 hallway anc started speaking to a physician for a couple of minutes and she walked back to her cart where she was interviewee. RN #6 was interviewed on 9/24/19 at 10:39 a.m. She sal she worked at the facility forfour years. She sal she had a bad night and did not sleep. She sad she could not repeat the steps that she took with hand hygiene and donning and dotting her gloves. She said "f you observed poor infection contra you were probably right.” She said sve thought she washed her Mands for atleast 19 seconds. She said she was nervous, and usually she would have washed my Nands for 20 seconds, prior to touching everything, She said she knew she needed to wash her hands after glove use for 20 seconds or perform hand hygiene before, turing, and after resident care I, Failure to ensure wheelchairs were cleaned A. Resident #48 Resident #48 was observed sitting in his electric wheelchair on 9/23/19 at 3:41 p.m. There was food debris and crumbs visible tothe resident’ wheelchair Resident #48 was observed in bed on 9/25/19 at 1:87 p.m. There was food debris and crumbs visibie tothe residents wheelchair and underneath his cushion Resident #48 was observed sitting in his room in his electric wheelchair on 9/26/19 at 9:15 a.m, There was food debris, crumbs, still visible in his chalr, he sald po one had come to clean I B. Resident #82 Resident #82 was observed sitting in her electric wheelchair on 9/23/19 at 9: residents clothing, there was food and dust debris tothe wheelchair. 5 au. There was a strong urine smell to chair, no sigs of incontinence to the Resident #82 was interviewed on 9/26/19 at 9:17 a.m. She said it had been a tong time since someone had cleaned her electric wheelchair She sad they used tohave a cleaning schedule for her wheelchair ut no one had cleaneé he chair recently. . Recoré review ‘copy of the wheelchair cleaning schedule was provided by the nursing home administrator (NHA) on 9/26/19 at 9:28 a.m. Resident #82' wheelchair was supposed to be cleaned on Manday, and Resident #48s wheelchair was supposed to be cleaned on Saturday. IV. Unsanitary conditions |. Shower room observations and interview “The shower room on the 1100 front hallway there were two shower rooms an either side of the hallway one was observed on 9/24/19 at 9:20 a.m. The shower nozzle was on the floor anc running, no staff were present, trash was observed in the trash can, there were used towels on a shower chair. “AL 9:21 a.m. the shower room on the other side of 1100 hallway was observed. There was one towel onthe floor next to a shower char, three mechanical lifts, two st to stancs, ane Hoyer life, anc one electric wheelchair. CNA #2 entered the shower raom and exited with bagged towels, CNA #2 saic the mechanical lifts were kept inthe shower room on the right side of the hall and the staff usually oni used the shower room to the left side of hall 1100 “The shower room on the 2100 hallway was observed on 9/24/19 at 9:32 a.m. The shower room humid like it had just been used, there were no trash bags in the trash can, there was a used glove turned inside out inthe trash can a Used glove turned inside out was on the ‘loor, there were used towels in a green laundry basket, they were not bagged 8. Oxygen rooms “The oxygen room on the 1200 hallway was observed on 9/25/19 12:24 p.m. There was dust debris and water bottle caps on the floor. ‘The oxygen room on the 200 hallway was abserved on 9/26/19 at 9:20 a.m. There was plastic and wrappers observed on the floor, a used pair of gloves that were turned inside out, dust debris tothe flor and vent fan full of lint V. Facility observations and staff interviews Unit manager (UM) #1 was interviewed on 9/26/19 at 9:18 a.m. She sad the night shift certified nurse aides (CNAS) were supposed to clean the resident’ wheelchairs and she would provide a wheelchair cleaning schedule Resident #82 was observed with the NHA and the director of nursing (DON) on 9/26/19 at 9:38 a.m. They acknowledged the chair had food and dust debris, and needed to be cleaned. “The Eldorado oxygen room was observed with the assistant director of nursing (ADON) on 9/26/19 9:42 a.m. She acknowledged the room needed to be swept to clean the trash, two portable oxygen tanks sitting on the flor, a used glove turned inside out on the oor along with the vent which was full of tint. She said maintenance was responsible for cleaning the vent and staf were responsibie for Keeping the oxygen area clean. She said the O2 tanks should not be Stored on the floor “The shower rooms on the 1100 hallway were observed with the ADON on 9/26/19 at 9:52 a.m. The ADON sald all of the Hoyer its were stored in the shower oom notin use fora short period of time, unl an open area was cleaned to store them. The ADON observed the axygen room on Golden Gate, there was Cust debris on the floor she said It needed to be cleaned. Immediately ater she observed Resident 448s wheelchair which had food and dust debris, she acknowiedged the chair needed to be cleaned, “At 10:02 a.m. the Sumit Park oxygen room was observed with the ADON, there was dust and trash debris to the floor with multiple portable oxygen tanks on the floor, she agreed the tanks should not be stored on the floor, she said they were supposed to have hooks to hang the tanks, She removed all the oxygen anks from the floor, and sald they should nat be stored on the floor. She asked the housekeeper to clean the room right then, “At 10:08 AM the shower room on 2100 hallway was observed with ADON there were several used towels observed in the large green laundry bin, there was no“The ADON said at minimum there should be a bag to the bin She sald she would educate the staff right then. VL. Faclity follow-up ‘The ADON was interviewed a second time on 9/26/19 at 10:27 a.m. She saié the nursing staff should clean the shower rooms after use she said they should remove used ‘nen after use, and they removed the green hamper/bin from the shower room on the Surnmit Park uni. She sad the O2 vent was cleaned in the Eldorado oxygen room, and the rooms were swept and oxygen tanks removed from the flor. She said they were in the process of placing hooks in the oxygen, rooms to hang oxygen tanks. She saié she had started the process of training staff that day related to the Infection conto\ findings “The DON was interviewed on 9/26/19 at 11:53 a.m. She said they provided a recent, hand hygiene training during ther all staff meeting, The DON provided infection control training on 8/21/19 using hand gel, all staf training on 9/4/19 which included hand hygiene, and a hand hygiene training on 9/18/19, RN #6 {id not signoff on any of the training that was provided. The DON said she planned to review hana hygiene with RN #6 as she hac not signed off on the all Staff training on infection control.