| 40 |
LEXINGTON MANOR SENIOR CARE, LLC |
255091 |
56 ROCKPORT ROAD |
LEXINGTON |
MS |
39095 |
2016-08-17 |
441 |
E |
0 |
1 |
BYHQ11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review, staff interview, and facility policy review, the facility failed to provide Foley/incontinent care in a manner to prevent the possible spread of infection, for two (2) of five (5) care observations. (Residents #4 and #8) Findings include: Observation of Foley catheter care on Resident #4, on 8/17/16 at 2:33 PM, with Certified Nursing Assistant (CNA) #2 and CNA #3, revealed CNA #3 removed the Foley catheter draining bag from the resident's bed frame and placed it on the resident's bed, adjusted the bed frame with bare hands, then donned gloves without hand hygiene. She then repositioned the Foley catheter bag on the bed and removed the catheter strap from the resident's left thigh. CNA #3 provided Foley catheter care. CNA #3 applied the leg strap back onto the resident's left thigh, while CNA #2 applied the Foley catheter tubing to the leg strap, and picked up the Foley catheter drainage bag from the bed linens, and hung it to the bed frame. CNA #2 and CNA #3 repositioned the resident in bed with the cotton pad without changing gloves and performing hand hygiene. CNA #3 pulled up the bed frame with while wearing the same soiled gloves used to clean the resident's perianal area. Staff interview with CNA #2 and CNA #3 on 8/17/16, at 2:50 PM, revealed both CNAs confirmed having a break in infection control during Resident #4's Foley catheter care. CNA #2 and CNA #3 both confirmed repositioning the bed rail, Foley catheter, resident and bed linens with soiled gloves. Staff interview with LPN #3/Staff Development Nurse, on 8/17/16 at 3:05 PM, confirmed there was a break in infection control when CNA #2 and CNA #3 provided Foley catheter care on Resident #4. She said CNA #2, and CNA #3, should have washed their hands when going from dirty to clean care during the resident's Foley catheter care. Review of the facility's face sheet revealed the facility readmitted Resident #4 on 7/05/15, with [DIAGNOSES REDACTED]. Review of the Quarterly Minimum Data Set (MDS), with an Assessment Reference date (ARD) of 7/12/16, revealed Resident #4 had a Brief Interview of Mental Status (BIMS) score of 8, indicating Resident #4 had moderate cognitive impairment. Resident #8 Observation of incontinent care on Resident #8, on 8/16/16 at 10:32 AM, with CNA #4 and CNA #5, revealed CNA #4 pulled back the resident's bed covers, without washing her hands, then pulled clean wet wipes from the wipes container and placed them on the towel atop the bedside table. CNA #5 used the wipes which were laid upon the bedside table to perform incontinent care on the resident. After completion of incontinent care, CNA #4, and CNA #5 placed a clean cloth pad underneath the resident, repositioned the resident and her linens without the use of hand hygiene or change of gloves. Staff interview with CNA #4 on 8/17/16 at 3:20 PM, confirmed she had a break in infection control when she pulled back Resident #8's bed covers and proceeded to pull wet wipes from the wipes container and placed them on the bedside table for CNA #3 to use for incontinent care on the resident. She confirmed not washing her hands and changing gloves after incontinent care, and before repositioning the resident and her bed covers. Staff interview with CNA #5, on 8/17/16, at 3:25 PM, confirmed she had a break in infection control when she used the wet wipes which CNA #4 pulled from the wipes container and placed them on the bedside table for her to use for incontinent care on Resident #8. She confirmed not washing her hands and changing gloves after incontinent care, and before repositioning the resident and her bed covers. Review of the facility's face sheet revealed the facility admitted Resident #8 on 5/11/16, with [DIAGNOSES REDACTED]. Resident #8's most recent MDS with an ARD of 8/9/16, revealed a BIMS score of 2, indicating Resident #8 had severe cognitive impairment. |
2020-09-01 |