cms_NE: 78
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| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 78 | HOMESTEAD REHABILITATION CENTER | 285049 | 4735 SOUTH 54TH STREET | LINCOLN | NE | 68516 | 2019-09-30 | 880 | E | 1 | 1 | UZYC11 | **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Licensure Reference Number 175NAC 12-006.117D Based on observation, record review, and interview the facility failed to ensure that handwashing was performed after glove removal during resident cares and wound cares for 4 residents (Residents 21, 10, 77 and 86). This had the potential to cause cross contamination between dirty and clean areas. The facility failed to ensure that handwashing to prevent the potential for cross contamination occurred during activities of daily living (ADLs). This had the potential to affect 2 residents (Residents 10 and 38). The facility census was 123. Findings are: Record review of the facility policy titled Handwashing/Hand Hygiene dated (MONTH) 2012 revealed the following steps: 1. All personnel shall be trained and regularly in-serviced on the importance of hand hygiene in preventing the transmission of healthcare-associated infections. 2. All personnel shall follow he handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. 5. Employees must wash their hands for at least Fifteen (15) seconds using antimicrobial or non-antimicrobial soap and water under the following conditions: 5 c. Before and after direct resident care (for which hand hygiene is indicated by acceptable professional practice); 5 g. Before and after assisting a resident with personal care; 5 o. After handling soiled or used linens, dressing, bedpans, catheters, and urinals; 5 p. After handling soiled equipment or utensils; 5 r. After removing gloves [NAME] Observation on 9/25/19 at 7:34 AM revealed that nursing assistant I (NA I), certified nursing assistant O (CNA O), and Registered Nurse P (RN P) entered the room of Resident 86. NA I entered the resident bathroom and turned the water on in the sink. NA I placed soap on NA I hands and immediately placed the hands under the running water while scrubbing the hands under the running water for 15 seconds. NA I dried the hands and turned the water off with a new paper towel and put on gloves. NA I talked to Resident 86 and explained the cares that would be provided to the resident. NA I removed the gloves and obtained a trash bag and placed it at the foot of the resident bed. NA I entered the resident bathroom and put soap on the hands and scrubbed the hands under running water for 5 seconds and dried the hands. NA I put on new gloves. NA I obtained a disposable wipe and wiped the perineal area (the genitals and anal area) turning the disposable wipe after each wipe. NA I removed and discarded the gloves and put new gloves on with no handwashing performed. NA I obtained a new disposable wipe and completed washing of the resident front perineal area. NA I removed the gloves and put on new gloves with no handwashing performed. NA I repositioned Resident 86 onto the resident's right side and removed the resident brief from the resident buttocks. NA I wiped the resident anal area from front to back and then disposed of the wipe and removed the gloves. NA I put on new gloves with no handwashing performed. NA I applied skin protectant lotion to the resident anal area and buttocks. NA I removed the gloves and put on new gloves with no handwashing performed. NA I placed a new brief underneath the resident's buttocks and secured the brief on the resident. NA I removed the gloves and put on new gloves with no handwashing performed. CNA O removed gloves from CNA O's hands and put on new gloves with no handwashing performed. NA I dressed the resident putting elastic hose on both resident legs and then placed the soiled soaker pad from under the resident into the trash bag at the foot of bed. NA I removed NA I's gloves and put on new gloves with no handwashing performed and put pants on the resident. NA I untied and removed the gown from Resident 86 and put a shirt on the resident. NA I placed the resident gown in the trash bag at the foot of the resident's bed and removed the gloves. NA I put on new gloves with no handwashing performed. NA I placed a lift sling underneath the resident. CNA O removed the gloves from CNA O's hands and no handwashing was performed. NA I placed shoes on the resident's feet. NA I positioned the total body lift (a mechanical device used to lift and transfer residents from one surface to another) and connected the lift straps to the lift. NA I informed Resident 86 of the transfer to the resident's wheelchair from the bed. The resident was transferred from the bed into the wheelchair by NA I and CNA O. NA I moved the mechanical lift away from the resident wheelchair and removed the gloves. NA I performed handwashing for 3 seconds scrubbing with soap under running water. RN P placed a sweater on Resident 86 and placed a lap blanket over the resident's legs and lap. NA I put on gloves and applied denture adhesive to the resident's upper and lower dentures. NA I placed the lower denture in the resident's mouth and then placed the upper denture in the resident's mouth. NA I removed the gloves and performed soap handwashing under running water for 3 seconds and dried the hands and put on new gloves. NA I wet a wash cloth and cleaned Resident 27's face. NA I patted the resident face dry with a dry cloth and then removed the gloves and put on new gloves with no handwashing performed. B. Observation of wound care on 9/25/19 at 1:13 PM in Resident 21's room. LPN D entered the resident room and removed the band aid from the resident's left 4th toe. LPN D performed handwashing with soap in the bathroom sink and obtained a wash cloth soaked with soap and water and cleaned the wound area on the top of the left 4th toe. LPN D dried the area lightly with a new wash cloth. LPN D put a glove on the right hand of LPN D and squeezed the Silver [MEDICATION NAME] 1% cream (a topical antibiotic used on skin wounds to prevent infection) from the tube directly onto the glove and then applied the cream to the 4th left toe wound of the resident. LPN D removed the glove from the right hand and discarded it. No handwashing was performed. LPN D applied a band aid to the resident's left 4th toe to cover the wound. LPN D gathered the Silver [MEDICATION NAME] 1% cream and the soiled wash cloths and exited the resident room and walked to the soiled room on the 100 hall. LPN D entered the soiled room and then exited holding the Silver [MEDICATION NAME] 1% cream container. LPN D walked to the 200 nurse station and started to chart on the computer at the nurse's station. No handwashing was performed. Interview with the Director of Nursing (DON) on 9/26/19 at 10:44 AM confirmed that hand washing is to be performed by staff each time after glove removal. Interview with on 9/26/19 at 10:57 AM the facility Infection Control Coordinator U (ICC U) confirmed that the facility hand washing procedure directed staff to scrub the hands with soap for a minimum of 15 seconds over the sink and not scrub under running water before rinsing the soap off. ICC U confirmed that staff are to complete hand washing each time gloves are removed. C. Observations of Resident 77's wound care on 9/24/19 from 7:17 AM until 7:45 AM with LPN-T (Licensed Practical Nurse) and NA-I (Nurse Assistant) revealed the following: -LPN-T donned gloves to provide cares to resident's legs and feet, -LPN-T removed gloves and washed hands less than 10 seconds -LPN-T donned gloves and provided ordered cream to resident legs -NA-I removed gloves but failed to wash or sanitize hands and left resident room -LPN-T removed gloves but failed to wash or sanitize hands -NA-I applied gloves after reentering the room but failed to wash or sanitize hands -LPN-T applied gloves and provided ordered lotion to residents legs -LPN-T removed gloves but failed to wash or sanitize hands -LPN-T applied gloves and washed area on back of left leg, and applied a [MEDICATION NAME] boarder (a versatile all-in-one bordered foam dressing, that minimizes patient pain and trauma to the wound and surrounding skin at removal while reducing the risk of maceration (occurs when skin is in contact with moisture for too long, skin looks lighter in color and wrinkly, it may feel soft, wet or soggy to touch) -NA-I removed gloves and washed hands less than 10 seconds and exited the resident room -LPN-T removed gloves and washed hands less than 10 seconds -LPN-T applied gloves and sterilized (cleansed with alcohol pad) scissors and proceeded to cut Interdry roll (fabric is a moisture-wicking antimicrobial silver that effectively manages complications associated with skin folds) -LPN-T removed gloves but failed to wash or sanitize hands -LPN-T applied gloves and placed the cut Interdry in abdomen folds -LPN-T removed gloves but failed to wash or sanitize hands -LPN-T applied gloves and cleansed the basin -LPN-T removed gloves but failed to wash or sanitize hands, removed trash and the linen bag -LPN-T left the resident room and obtained a container of chlorox wipes (a disinfecting wipe used to remove germs, and bacteria) -LPN-T applied gloves and wiped off the scissors and basin with chlorox wipes -LPN-T removed gloves but failed to wash or sanitize hands -LPN-T applied gloves and put the basin in a plastic bag -LPN-T removed gloves but failed to wash or sanitize hands -LPN-T put gloves in trash bag, box of gloves in the bathroom, and washed hands less than 10 seconds -LPN-T left resident room During an interview on 9/25/19 at 7:48 AM, LPN-U (Licensed Practical Nurse) verified that NA-I and LPN-T should have washed or sanitized hands before starting resident cares, before putting on clean gloves and after removing soiled gloves. D. The CDC (Center for Disease Control and Prevention) Campaign 4 Moments of Hand Hygiene (MONTH) 15, (YEAR). Hand hygiene should be performed before gloves are removed from the glove box (non-sterile) or package (sterile) to prevent contamination of the box or package and to ensure hands are clean under the gloves. If possible, leave the gloves in their original box or package until they are donned (applied). Gloves that touch anything unclean (e.g. surfaces, objects, face, pockets) are contaminated and become a means for spreading micro-organisms. Record review of the facility policy titled Handwashing/Hand Hygiene dated (MONTH) 2012 revealed the following steps: 1. All personnel shall be trained and regularly in-serviced on the importance of hand hygiene in preventing the transmission of healthcare-associated infections. 2. All personnel shall follow he handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. 5. Employees must wash their hands for at least Fifteen (15) seconds using antimicrobial or non-antimicrobial soap and water under the following conditions: 5 c. Before and after direct resident care (for which hand hygiene is indicated by acceptable professional practice); 5 f. Before and after eating or handling food (hand washing with soap and water); 5 g. Before and after assisting a resident with personal care; 5 k. Before and after assisting a resident with toileting (hand washing with soap and water); 5 o. After handling soiled or used linens, dressing, bedpans, catheters, and urinals; 5 p. After handling soiled equipment or utensils; 5 r. After removing gloves Record review of Resident 10's MDS (Minimum Data Set) (dated 9/16/19 revealed resident is always incontinent of bowel and bladder; no current bowel program. Observation on 09/23/19 at 10:50AM revealed LPN ( Licensed Practical Nurse) A arrived to resident room knocked on door, entered room, did not perform hand hygiene, applied gloves, asked resident to spread her legs to view private area, nurse stated area on labia is red and raw, resident then asked bottom to be looked at, resident turned on side, bowel movement present nurse preformed perineal care and removed gloves, no hand hygiene preformed, new gloves applied; bottom area assessed no red area noted. Bed pad was removed and placed on floor not in a bag. New pad was placed under resident. Nurse then went into restroom to get trash bag for soiled bed pad, removed gloves and took bed pad trash bag out of room, leaving bowel movement and wipes in trash with soiled gloves. Nurse did not perform hand hygiene before leaving residents room. Record Review of TAR (Treatment Administration Record) dated 07/16/2019 revealed an order to treat wounds to Resident 10's bilateral lower legs: lotion to all areas (other than open areas) daily. Record review of TAR dated 08/13/2019 revealed the following order wound care order: wash bilateral legs daily and apply [MEDICATION NAME] (topical antibiotic used to prevent infections or treat burns) ointment to open areas, apply ABD's (Abdominal pads) (used to cover large wound areas), gauze wrap and tub grip (a comfortable skin friendly tubular support bandage that easily contours to body) on Mondays, Wednesdays, and Fridays. Observation on 09/25/19 from 10:25 AM - 11:03 AM revealed LPN (Licensed Practical Nurse) T washed hands for 20 seconds, applied new gloves, removed towel covering resident's legs, removed gloves, and applied new gloves. Opened cream tube, placed cap from tube on bed face down. Removed ointment from tube with Q-tip applied to areas on left leg and right leg, removed gloves. Preformed hand hygiene for 20 seconds. Applied new Gloves, lotion applied to remaining areas. LPN -T washed hands for 12 seconds. Gloves applied, ABD's were applied to legs. Bilateral legs wrapped with gauze starting at top of leg working down. Tearing tape during procedure contaminating entire roll of tape. Hand washing completed for 20 seconds. Nylons applied to resident's feet/ legs. NA (Nursing Assistant) I entered room washed hands for 3 seconds, removed gloves from pant leg pocket and applied them, assisted in applying tub grip. NA-I removed gloves. Applied new gloves again from pant pocket. NA Reese washed hands for 8 seconds. ICC (Infection Control Coordinator) U assisted with holding residents legs, then washed hands for 8 seconds. An interview on 09/26/19 at 2:30 PM with DON confirmed hand hygiene should be performed for 15-20 seconds following facility policy and gloves should not be carried in staff pockets and used. E. An observation on 09/25/19 at 10:23 AM of Perineal care for Resident 58 - NA [NAME] performed Hand Hygiene from 10:33:12 to10:33: 27 (15 seconds). The wheel chair pedals were removed from the wheelchair. Resident 58 was transferred with one person assist and a gait belt to the bed via pivot transfer. NA [NAME] gloves were donned gloves while Resident 58 was able to get into the bed from the bed side without assistance. Resident 58's pants were pulled down to the residents ankles and the resident was exposed (no blanket covered the resident) the brief was removed and the resident had been incontinent. Perineal care was completed. Gloves doffed and hand hygiene was performed with hand sanitizer, gloves donned bed pan was placed per resident request. NA [NAME] removed the gloves. Resident 58 requested to be covered. The NM (Nurse Manager) had to exit room to ask staff to get a cover. The resident asked for privacy and was given privacy. NA [NAME] performed hand hygiene from 10:45:07-10:45:17 (8 seconds). NA [NAME] donned gloves and perineal care was completed. NA [NAME] performed hand hygiene from10:51:59-10:52:05 (6 seconds). An interview on 09/25/19 11:01 AM with NA [NAME] confirmed; that hand hygiene, lathering of the hands should be for 20 seconds. Hand washing policy dated (MONTH) 2012 revealed; that Employees must wash hands for 20 seconds using antimicrobial or non antimicrobial soap and water. | 2020-09-01 |