Penalty

No penalty information released

The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

Nurse #2 failed to follow the facility's infection control policy and procedures for Enhanced Barrier Precautions (EBP) during the administration of a nutritional supplement and water flushes through a feeding tube for Resident #45. The facility's policy, last revised on 6/13/24, required staff to wear a protective gown when providing high-contact care activities, including care involving a feeding tube for residents with an implanted medical device. During a continuous observation, an EBP sign was posted on the resident's door with instructions to wear a gown, and gowns were available in an over-the-door storage bin. Despite these measures, Nurse #2 did not wear a protective gown while performing the high-contact care activity. During interviews, Nurse #2 stated she believed the resident was no longer under any type of precautions and was unaware that EBP was still required at the time of care. The Staff Development Coordinator/Infection Preventionist and the Director of Nursing both confirmed that Nurse #2 should have worn a protective gown during the procedure. Resident #45 had a feeding tube, which is considered an implanted medical device, and was subject to EBP according to facility policy.