VI AT SILVERSTONE

Based on observations, staff interviews, and policies and procedures, the facility failed to ensure that infection control standards were followed by failing to ensure the toilet seat riser available for resident use was cleaned for two residents (#1 and #2); and, failed to ensure the oxygen tubing were properly stored when not in use for two residents (#2 and #3). Findings include: Regarding resident #1 -Resident #1 was admitted on August 24, 2022 with diagnoses that included cancer, diabetes, and multiple-resistant organisms. Review of the quarterly MDS (minimum data set) assessment dated May 22, 2023 revealed a BIMS (brief interview of mental status) score of 14 indicating the resident had no cognitive impairment. Per the MDS, the resident was frequently incontinent of bowel and bladder and required extensive assistance with toileting and hygiene needs. During an observation conducted on August 2, 2023 at 10:00 a.m., resident #1 had a gray toilet seat riser that was placed over the regular toilet located in her bathroom. The toilet seat riser had multiple dried feces underneath the right arm rest, and underneath the toilet seat. An interview with resident #1 was conducted immediately following the observation. Resident #1 stated that the toilet seat was not cleaned regularly; and, her private caregiver assisted her as needed to use the toilet but cleaning it was not a part of her job. Regarding resident #2 -Resident was admitted on February 3, 2023 with diagnoses of pneumonia, malnutrition, and respiratory failure. The significant change MDS assessment dated May 25, 2023 revealed a BIMS score of 14 indicating resident had no cognitive impairment. Per the MDS, the resident had an indwelling Foley catheter, required extensive assistance with toilet use and personal hygiene and was always incontinent of bowel function. The MDS also included that the resident was receiving oxygen therapy while a resident at the facility. An observation was conducted on August 2, 2023 at 10:13 a.m. Resident #2 was in bed with an oxygen concentrator at the bedside, the oxygen tubing attached on the concentrator, and the nasal cannula was coiled and tucked in on the handle of the oxygen concentrator. There was an emergency oxygen tank attached to a wheelchair located in the resident's bathroom. An oxygen tubing was attached to the emergency oxygen tank and the nasal cannula was hanging on the right arm of the wheelchair. In the resident's bathroom, a gray toilet seat riser was placed on top of a regular toilet. The toilet seat riser had multiple dried feces on the toilet seat, the handle, and the front silver metal bar where the toilet seat was attached. In an interview with resident #2 conducted immediately following the observation, resident #2 stated that he uses the oxygen daily and as needed when in bed or in a wheelchair; and goes to the bathroom with the assistance of the staff. Resident #2 stated he thinks the staff cleans the toilet seat riser after each use but he was not sure. Regarding resident #3 -Resident #3 was admitted on May 7, 2023 with diagnoses of malnutrition and hypertension. The 14-day MDS assessment dated May 11, 2023 revealed a BIMS score of 13 indicating the resident had intact cognition. The assessment included that the resident required extensive assistance with ADLs (activity of daily living); and that, the resident was on oxygen therapy while a resident in the facility. During an observation conducted on August 2, 2023 at 10:06 a.m. the resident was found sitting in a chair near the window. The resident had an oxygen concentrator at the bedside with an oxygen tubing attached. However, the oxygen cannula was lying directly on the bed, away from the resident. Resident #3 stated that she uses oxygen daily and the staff helps her in placing the oxygen in her nose. An interview was conducted on August 2, 2023 at about 2:00 p.m. with a certified nursing assistant (CNA/ staff #21) who stated the CNAs and the housekeeping were responsible for cleaning the toilet seat riser if they see it dirty. She stated the toilet riser should not have dried feces if it was cleaned every day. In an interview with a housekeeper (staff #11) conducted on August 2, 2023 at 2:20 p.m. the housekeeper said that if the resident's toilet riser was not clean and was with feces, the nurses were responsible for cleaning it and were supposed to call the housekeeping to disinfect the toilet riser. During an interview with the director of nursing (DON/ staff #22) conducted on August 2, 2023 at 2:40 p.m., the DON stated it was her expectation that nursing staff should be cleaning the DMEs (durable medical equipment) such as the toilet seat riser when there were visible feces on it. She stated the risk if the DMEs were not cleaned or disinfected included cross contamination and potential infection outbreak. Regarding the oxygen, the DON stated that it was her expectation that the oxygen tubing/nasal cannula is placed in a bag if not in use and changed every week. She stated the risk if oxygen tubing were not placed in the bag, included respiratory infections and MRSA (multiple resistant staphylococcus aureus). Review of the facility policy on Respiratory Therapy-Infection Control, with a revision date of December 2017 included a process to keep oxygen cannula and tubing used as needed in a plastic bag when not in use. The facility policy on Communicable Disease Outbreak Management Protocol, revealed the dedicated or disposable noncritical resident-care equipment is used or if not available, then equipment is cleaned and disinfected according to manufacturer ' s instructions using an EPA-registered disinfectant for healthcare setting prior to use on another resident.

§483.80 Infection Control The facility must establish and 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 diseases and infections. §483.80(a) Infection prevention and control program. The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements: §483.80(a)(1) A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to §483.70(e) and following accepted national standards; §483.80(a)(2) Written standards, policies, and procedures for the program, which must include, but are not limited to: (i) A system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility; (ii) When and to whom possible incidents of communicable disease or infections should be reported; (iii) Standard and transmission-based precautions to be followed to prevent spread of infections; (iv)When and how isolation should be used for a resident; including but not limited to: (A) The type and duration of the isolation, depending upon the infectious agent or organism involved, and (B) A requirement that the isolation should be the least restrictive possible for the resident under the circumstances. (v) The circumstances under which the facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease; and (vi)The hand hygiene procedures to be followed by staff involved in direct resident contact. §483.80(a)(4) A system for recording incidents ide

Based on observations, staff interviews, and policies and procedures, the facility failed to ensure that infection control standards were followed by failing to ensure the toilet seat riser available for resident use was cleaned for two residents (#1 and #2); and, failed to ensure the oxygen tubing were properly stored when not in use for two residents (#2 and #3). The deficient practice could result in the spread of infection. Findings include: Regarding resident #1 -Resident #1 was admitted on August 24, 2022 with diagnoses that included cancer, diabetes, and multiple-resistant organisms. Review of the quarterly MDS (minimum data set) assessment dated May 22, 2023 revealed a BIMS (brief interview of mental status) score of 14 indicating the resident had no cognitive impairment. Per the MDS, the resident was frequently incontinent of bowel and bladder and required extensive assistance with toileting and hygiene needs. During an observation conducted on August 2, 2023 at 10:00 a.m., resident #1 had a gray toilet seat riser that was placed over the regular toilet located in her bathroom. The toilet seat riser had multiple dried feces underneath the right arm rest, and underneath the toilet seat. An interview with resident #1 was conducted immediately following the observation. Resident #1 stated that the toilet seat was not cleaned regularly; and, her private caregiver assisted her as needed to use the toilet but cleaning it was not a part of her job. Regarding resident #2 -Resident was admitted on February 3, 2023 with diagnoses of pneumonia, malnutrition, and respiratory failure. The significant change MDS assessment dated May 25, 2023 revealed a BIMS score of 14 indicating resident had no cognitive impairment. Per the MDS, the resident had an indwelling Foley catheter, required extensive assistance with toilet use and personal hygiene and was always incontinent of bowel function. The MDS also included that the resident was receiving oxygen therapy while a resident at the facility. An observation was conducted on August 2, 2023 at 10:13 a.m. Resident #2 was in bed with an oxygen concentrator at the bedside, the oxygen tubing attached on the concentrator, and the nasal cannula was coiled and tucked in on the handle of the oxygen concentrator. There was an emergency oxygen tank attached to a wheelchair located in the resident's bathroom. An oxygen tubing was attached to the emergency oxygen tank and the nasal cannula was hanging on the right arm of the wheelchair. In the resident's bathroom, a gray toilet seat riser was placed on top of a regular toilet. The toilet seat riser had multiple dried feces on the toilet seat, the handle, and the front silver metal bar where the toilet seat was attached. In an interview with resident #2 conducted immediately following the observation, resident #2 stated that he uses the oxygen daily and as needed when in bed or in a wheelchair; and goes to the bathroom with the assistance of the staff. Resident #2 stated he thinks the staff cleans the toilet seat riser after each use but he was not sure. Regarding resident #3 -Resident #3 was admitted on May 7, 2023 with diagnoses of malnutrition and hypertension. The 14-day MDS assessment dated May 11, 2023 revealed a BIMS score of 13 indicating the resident had intact cognition. The assessment included that the resident required extensive assistance with ADLs (activity of daily living); and that, the resident was on oxygen therapy while a resident in the facility. During an observation conducted on August 2, 2023 at 10:06 a.m. the resident was found sitting in a chair near the window. The resident had an oxygen concentrator at the bedside with an oxygen tubing attached. However, the oxygen cannula was lying directly on the bed, away from the resident. Resident #3 stated that she uses oxygen daily and the staff helps her in placing the oxygen in her nose. An interview was conducted on August 2, 2023 at about 2:00 p.m. with a certified nursing assistant (CNA/ staff #21) who stated the CNAs and the housekeeping were responsible for cleaning the toilet seat riser if they see it dirty. She stated the toilet riser should not have dried feces if it was cleaned every day. In an interview with a housekeeper (staff #11) conducted on August 2, 2023 at 2:20 p.m. the housekeeper said that if the resident's toilet riser was not clean and was with feces, the nurses were responsible for cleaning it and were supposed to call the housekeeping to disinfect the toilet riser. During an interview with the director of nursing (DON/ staff #22) conducted on August 2, 2023 at 2:40 p.m., the DON stated it was her expectation that nursing staff should be cleaning the DMEs (durable medical equipment) such as the toilet seat riser when there were visible feces on it. She stated the risk if the DMEs were not cleaned or disinfected included cross contamination and potential infection outbreak. Regarding the oxygen, the DON stated that it was her expectation that the oxygen tubing/nasal cannula is placed in a bag if not in use and changed every week. She stated the risk if oxygen tubing were not placed in the bag, included respiratory infections and MRSA (multiple resistant staphylococcus aureus). Review of the facility policy on Respiratory Therapy-Infection Control, with a revision date of December 2017 included a process to keep oxygen cannula and tubing used as needed in a plastic bag when not in use. The facility policy on Communicable Disease Outbreak Management Protocol, revealed the dedicated or disposable noncritical resident-care equipment is used or if not available, then equipment is cleaned and disinfected according to manufacturer's instructions using an EPA-registered disinfectant for healthcare setting prior to use on another resident.