**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, resident record review, and a facility policy titled Weight Monitoring, the facility failed to ensure Resident Identifier (RI) #55 received an Ensure supplement as ordered with meals. This deficient practice affected RI #55 one of two residents sampled for nutrition. Findings include: A facility policy titled Weight Monitoring with a revised date of 04/2023 documented: . Compliance Guidelines: . 1. The facility will utilize a systemic approach to optimize a resident's nutritional status. This process includes: . c. Developing and consistently implementing pertinent approaches . RI #55 was admitted to the facility on [DATE] and readmitted on [DATE]. RI #55's physician orders for July 2023 documented an order dated 05/23/2023 for RI #55 to receive eight (8) ounces of Ensure supplement with all meals. RI #55 was observed during the supper meal on 07/25/2023 at 5:38 PM in RI #55's room. RI #55's meal tray was not served with eight ounces of Ensure supplement. RI #55 was observed during the lunch meal on 07/26/2023 at 11:16 AM in the dining room. RI #55's meal tray was not served with eight ounces of Ensure supplement. RI #55 was observed during the supper meal on 07/26/2023 at 05:56 PM in RI #55's room. RI #55's meal tray was not served with eight ounces of Ensure supplement. An interview was conducted on 07/26/2023 at 06:02 PM with Employee Identifier (EI) #4 CNA. EI #4 was asked if RI #55's dinner meal was served with an Ensure supplement. EI #4 said, no it was not but RI #55 was supposed to have an Ensure supplement with the meal. EI #4 was asked who was responsible for ensuring RI #55 had an Ensure supplement with each meal tray. EI #4 said, the kitchen staff was responsible for putting it on the tray. EI #4 was asked if the Ensure supplement was listed on RI #55's meal ticket. EI #4 said, no it was not listed on RI #55's meal ticket. An interview was conducted on 07/27/2023 at 8:54 AM with EI #2, Dietary Manager. EI #2 was asked about RI #55's Ensure supplement to be given with each meal. EI #2 said, RI #55 had an order for Ensure to be given with each meal. EI #2 was asked why RI #55 did not have an Ensure supplement during observed meals. EI #2 said, when the facility transferred to the new system, the resident's diet order was carried over, but the supplement was not carried over. EI #2 said, the resident's supplement order should have been carried over to the new system and listed on the meal ticket. EI #2 was asked what was the concern with RI #55 not getting Ensure supplement as ordered. EI #2 said, weight loss and lack of nutrition.

Based on observation, interview, the facility's Diet Manual, the facility's policies for Menu Planning and Portion Control, and the facility's 2023 Spring/Summer Menus for Week 2, Wednesday; the facility failed to ensure the residents on Mechanical Soft and Puree diets received the portion sizes per the approved menu at lunch on Wednesday, July 26, 2023. This had the potential to affect 23 of 53 residents receiving meals from the kitchen. Findings include: The facility's Diet Manual, dated 2008, included the following: . Mechanical Soft (Dental Soft) Diet A Mechanical Soft or Dental Soft Diet is used for individuals who have difficulty chewing regular textured foods. Foods that are difficult for the individual to chew are chopped, ground, shredded and/or soft cooked to facilitate chewing and ease of swallowing. Dysphagia Puree (Level 1) Diet The Dysphagia Puree (Level 1) Diet is used only for individuals who have severe chewing and/or swallowing problems. All foods are pureed to simulate a soft food bolus, eliminating the whole chewing phase. Pureed Diet menus follow the foods on the Regular Diet as closely as possible with the main difference being food consistency . The facility's policy for Menu Planning, dated 2010, included the following: Policy: Nutritional needs of individuals will be provided in accordance with the recommended dietary allowances of the Food and Nutrition Board of the National Research Council, National Academy of Sciences . through nourishing, well-balanced diets . Procedure: . 3. Regular and therapeutic menus are written by the facility's food and nutrition professional in accordance with the facility's approved diet manual. The facility's policy for Portion Control, dated 2010, included the following: Policy: Individuals will receive the appropriate portions of food as planned on the menu. Control at the point of service is necessary to assure that only the standard portion is served. Procedure: . 2. The menu should list the specific portion size for each food item. Menus should be posted at the tray line for staff to refer to for proper portioning of servings for each diet. 3. Serve the food with ladles, scoops, spoodles and spoons of standard sizes. Portions that are too small result in the individual not receiving the nutrients needed. Serving Utensils (chart for scoop [s] size conversion to cups or ounces) #8 s (equals) 1/2 cup (equals) 4 ounces (oz) #10 s (equals) 3/8 cup (equals) 3-4 ounces #12 s (equals) 1/3 cup (equals) 2.67 ounces #16 s (equals) 1/4 cup (equals) 2 ounces . The facility's 2023 Spring/Summer Menus for Week 2 at lunch on Wednesday, July 26, 2023 included the following for the Mechanical Soft Diet: . 3 oz Gr (ground) Chicken Breast . The facility's 2023 Spring/Summer Menus for Week 2 at lunch on Wednesday, July 26, 2023 included the following for the Puree diet: . 3 oz Pur (pureed) Chicken 4 oz Pur [NAME] Pilaf 4 oz Pur Lima Beans 2 oz Pur Bread . The tray line for the residents' lunch meal was observed on 07/26/2023. Employee Identifier (EI) #3, the AM Cook, served the hot food for the lunch meal. At 11:15 AM, the following was observed: • A #16 scoop (blue handle), yielding 2 ounces, was used to portion each serving of Ground Chicken onto plates for the Mechanical Soft diets. • A #8 scoop (grey handle), yielding 4 ounces, was used to portion each serving of Pureed Chicken onto plates for the Puree diets. • A #12 scoop (green handle), yielding 2.67 ounces, was used to portion each serving of Pureed [NAME] Pilaf onto plates for the Puree diets. • A #16 scoop (blue handle), yielding 2 ounces, was used to portion each serving of Pureed Lima Beans onto plates for the Puree diets. On 07/26/2023 at 12:02 PM, EI #3, the AM Cook, was interviewed. EI #3 said she checked the menu to know what to prepare for each meal. EI #3 said the menus were usually posted on the pantry door or were at the Dietary Manager's desk. EI #3 further said she usually reviewed the menu items with the Dietary Manager to ensure she was cooking the right thing. EI #3 also said this was a brand new menu from a new company and they were on Week 2. EI #3 said she had not yet seen any recipes to go with the new menus. When asked about the Pureed Chicken and Pureed Bread, EI #3 said she added the bread to the pureed meat. EI #3 said she prepared six portions of Pureed Chicken for lunch because there were 5 residents on the Puree Diet and she added a portion to be sure there was enough. EI #3 said she used frozen diced chicken to prepare the Pureed Chicken and she used a 4-ounce ladle to measure it out prior to cooking. EI #3 said she added 6 slices of white loaf bread, one slice per serving, when pureeing the chicken. EI #3 said she did not have a recipe for pureed meats. EI #3 said the menus stated how much to serve for each food item. When asked if there was a conversion chart that she could use to determine which portion scoops to use for service; EI #3 said they did have a conversion chart, but it was discarded about a year ago when the cabinets were changed. EI #3 said they had not had a conversion chart for scoops for at least a year. EI #3 used the Wednesday, July 26, 2023 menu as a reference and said, a three ounce portion should be served for Ground (Mechanical Soft) Chicken and Pureed Chicken. EI #3 said, a four ounce portion should be served for Pureed [NAME] Pilaf and Pureed Lima Beans. EI #3 was asked about the observed lunch service on Wednesday, July 26, 2023. EI #3 said, she thought the #16 scoop (blue handle) that was used to portion each serving of Ground Chicken onto plates, was three ounces. EI #3 said, the #12 scoop (green handle) being used for Pureed [NAME] Pilaf would have been three ounces. EI #3 said, the #16 scoop (blue handle) being used for Pureed Lima Beans, was about three and a half ounces if rounded, not leveled off. EI #3 then said, she really did not know because there was no (ounce to scoop conversion) chart. On 07/26/2023 at 4:32 PM, EI #2, the Dietary Manager, was interviewed. Upon being asked how did the cooks know what to prepare for each meal, how to prepare it, and how much to prepare, EI #2 said at this point, they come to me. EI #2 further said, they have a new system and new menus. EI #2 said the new recipes were currently in a file cabinet and needed to be placed in a binder. EI #2 said, for now the staff had to ask for recipes as needed. When asked if there was a recipe for pureed meats, EI #2 said there was a description for puree at the bottom of each menu sheet: Pureed: Holds shape on spoon; smooth texture; No separated liquid; not firm/sticky. Upon being asked about bread being pureed with meat, EI #2 said, that was due to past training the staff received and that the pureed bread and pureed meat should be separate. EI #2 said, the staff knew how much to serve for each food item at meals because it was listed on the daily expanded menu. When asked if there was a conversion chart available that the staff could use to determine which portion scoops to use, EI #2 said, she did not know of one, but could get one. EI #2 used the Wednesday, July 26, 2023 menu as a reference when asked about portion sizes, and said, three ounces Ground (Mechanical Soft) Chicken and Pureed Chicken should be served. EI #2 said, five to six ounces of Pureed Chicken should have been used since bread was added. EI #2 said a four ounce portion should be served for Pureed [NAME] Pilaf and Pureed Lima Beans. EI #2 explained the scoops as follows: • A #16 scoop (blue handle) was 1/4 cup or 2 ounces. • A #12 scoop (green handle) was 1/3 cup or 2.67 ounces. • A #8 scoop (grey handle) was 1/2 cup or 4 ounces. EI #2 was asked about the observed lunch service on Wednesday, July 26, 2023: • EI #2 said, a #16 scoop (blue handle) being used to portion each serving of Ground Chicken onto plates was not correct and it should have been at least 3 ounces. EI #2 further said a #10 scoop would have been good to use. • EI #2 said, a #12 scoop (green handle) being used for Pureed [NAME] Pilaf was not correct, and it should have been a #8 scoop for a serving of four ounces. • EI #2 said, a #16 scoop (blue handle) being used for Pureed Lima Beans was not correct and it should have been a #8 scoop for a serving of four ounces. • EI #2 said, a #8 scoop (grey handle) being used to portion each serving of Pureed Chicken was not correct, because the bread was included. • EI #2 was asked the concern if residents received portions less than specified on the approved menu. EI #2 answered, weight loss and a lack of nutrition.

Based on observation, interviews, medical review, and a facility policy titled Standard Precautions: Infection Control, the facility failed to ensure a Licensed Practical Nurse (LPN), Employee Identifier (EI) #3, washed her hands or used hand sanitizer after she removed her gloves, touched the top of the waste container on the left side of the medication cart with both hands, and prior to touching Resident Identifier (RI) #24's medication cup, on the medication tray on top of the medication cart. This affected one of two Licensed Nurses and one of three residents observed during medication pass. Findings Include: A review of a facility policy titled Standard Precautions Infection Control, with a date implemented of 11/28/2017, revealed . Policy Explanation and Compliance Guidelines: . (p. 1) e. Perform hand hygiene: . vi. After removing gloves . (p. 5) After touching . contaminated items; immediately after removing gloves . On 9/25/19 at 8:17 a.m., the surveyor observed EI #3, a LPN, apply gloves on both of her hands, crush RI #24's medication in a plastic sleeve, and put RI #24's medication in a cup. EI #3 then removed her gloves and touched the top of the waste container, on the left side of the medication cart, with both ungloved hands. EI #3 then placed the plastic sleeve in the waste container, picked up a plastic cup on top of the medication cart with both hands, and touched the lid of the waste container with both hands, to open the waste container. EI #3 did not wash her hands, or use hand sanitizer after completing tasks around the med cart. EI #3 then touched one of RI #24's medication cups on the medication tray with her ungloved hands, prior to picking up the medication tray, on top of the medication cart, with both hands. On 9/25/19 at 3:07 p.m., an interview was conducted with EI #3, LPN. EI #3 was asked what should she have done after she removed her gloves, touched the top of the waste container on the left side of the medication cart with both hands, and prior to touching RI #24's medication cup on the medication tray on top of the medication cart, during the medication pass. EI #3 stated she should have used hand sanitizer. EI #3 was asked why did she not wash her hands or use hand sanitizer after you removed your gloves and before touching a new medication cup. EI #3 stated she did not think about the lid of the waste container being contaminated at the time, but she knew that she should have used hand sanitizer prior to touching the top of the medication cup. EI #3 was asked what was the facility policy on hand hygiene after you remove your gloves. EI #3 replied the policy stated to wash your hands or use hand sanitizer after you touched contaminated items and after you removed your gloves. EI #3 was asked what would be the concern in not washing your hands or using a hand sanitizer after you removed gloves and prior to have touching a medication cup. EI #3 stated the resident could possibly contract an infection. On 9/25/19 at 3:21 p.m., an interview was conducted with EI #2, the Director of Nursing/Infection Control Preventionist. EI #2 was asked what was the facility policy on hand hygiene after you removed your gloves. EI #2 stated you should wash your hands or use hand sanitizer after you removed your gloves. EI #2 was asked what would be the concern in not washing your hands or using a hand sanitizer after you removed your gloves, touched the top of the waste container with both ungloved hands, and prior to touching RI #24's medication cup. EI #2 stated it could cause contamination and possibly cause an infection.

Based on observation, interview and review of a facility policy titled, Cleaning Dishes/Dish Machine, the facility failed to ensure that food dish pans were allowed to air dry prior to stacking and storing. This had the potential to affect 67 of 67 residents receiving meals from the kitchen. Findings include: A review of an undated policy Titled, Cleaning Dishes/Dish Machine revealed: .9. Allow dishes to air dry .10 .inspect for cleanliness and dryness . On 09/23/19 at 5:45 p.m., during the initial tour of the kitchen with Employee Identifier (EI) #4 Dietary Manager, an observation was made of two separate stacks of food pans stored on the shelf under the prep table. The food pans were nesting one on top of the other. The surveyor asked EI #4 to remove several pans, one at a time, from the stack. Each pan removed was noted to have clear wet substance running off. EI #4 then stated, Well, you got me. They are all wet. EI #4 removed the wet pans from the shelf and took the wet pans to the dish washing area. On 09/25/19 at 3:30 p.m., an interview with (EI) #4 was conducted. EI #4 was asked, what was the facility policy for food utensils/dish storage. EI #4 replied that the food utensils/dishes should be stored in a dry location, free from water splashes, or any other particles. EI #4 was then asked, how the food pans were stored on the shelf under the prep table on 9/23/2019. EI #4 responded that they were stacked wet. EI #4 was asked, how the food pans should have been stored after they were washed. EI #4 stated, they needed to be stacked dry, they should be allowed to air dry then stacked or put away. EI #4 was asked, what would be the potential harm in storing the pans nesting and wet. EI #4 answered, there could be contamination with mold growing. EI #4 was then asked, who was responsible for ensuring that the facility policy was followed with food utensil/dish storage and EI #4 replied, she was.

Based on observation, interview, a facility policy titled, Garbage Disposal and the 2017 Food Code the facility failed to ensure that the outside garbage disposal area was free of debris. This had the potential to affect all 69 residents residing in the facility Findings include: A policy titled, Garbage Disposal Revised September 2018 documented: .will be observed for continued compliance by Maintenance and Housekeeping departments . A review of the 2017 Food Code U.S. Public Health Service documented: . 5-501.15 Outside receptacles . (B) Receptacles and waste handling units for REFUSE . shall be installed so that accumulation of debris and insects and rodent attraction and harborage are minimized and effective cleaning is facilitated around and . under the unit . On 09/25/19 at 11:46 a.m. an observation with Employee Identifier (EI) #4, Dietary Manager, was made of trash items on the ground behind the 2 dumpster's, just off of the concrete pad. Items noted were 4 blue gloves, 2 clear bottles, several paper items, and a clear plastic item. A white plastic fork and a white plastic straw were on the ground, on the concrete pad beside the dumpster's. On 09/25/19 at 3:30 p.m. an interview with EI #4 was conducted. EI #4 was asked what was the facility policy for garbage/refuse disposal. EI #4 replied that it was the facility policy to keep the doors closed, free from leaks, and the area free from debris or trash. EI #4 was then asked, what items were noted to be on the ground around the dumpster's. EI #4 replied, there were water bottles, gloves, and a straw. EI #4 was asked how the dumpster area should be maintained and EI #4 answered that it should be free from debris and dry. EI #4 was asked what would be the potential harm of garbage being on the ground around the dumpster's. EI #4 stated it could attract pest and the pest could get in the facility. EI #4 was then asked how often were the dumpster's emptied. EI #4 replied the dumpster's were emptied twice a week. EI #4 was then asked who was responsible for ensuring the dumpster area was maintained per the facility policy. EI #4 replied anyone that came out to the area should look and make sure it was clean, but maintenance and housekeeping were appointed.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical records, interviews, and a facility document titled, Comprehensive Resident Assessment (Minimum Data Set), the facility failed to ensure a Significant Change in Status Minimum Data Set (MDS) was completed on three sampled residents after being admitted to hospice. This affected Resident Identifier's (RI) #2, 43 and 115, three of six facility residents on hospice. Findings Include: A review of a facility policy titled Comprehensive Resident Assessment (Minimum Data Set), with an implemented date of 10/01/1991, documented: The facility shall conduct a comprehensive, accurate .assessment of each resident's functional capacity .2. Promptly after significant change in the resident's physical or mental condition . 1. RI #2 was admitted to the facility on [DATE]. On 08/28/2018 at 11:10 a.m., a review of RI #2's Physician Order, dated 05/12/2018, revealed a new medical diagnosis of Failure to Thrive and an order to admit RI #2 to hospice with a diagnosis of Degenerative Disease of the Nervous System (DDNS). A review of RI #2's MDS's revealed no Significant Change in Status MDS was completed, within the fourteen day time frame, after RI #2 was admitted to hospice on 05/12/2018. On 08/29/18 at 05:30 p.m., an interview was conducted with Employee Identifier (EI) #2, Registered Nurse and MDS Coordinator. EI #2 was asked when was RI #2 was admitted to hospice. EI #2 stated that RI #2 was admitted to hospice on 05/12/2018. EI #2 was asked if there was a Significant Change in Status MDS completed on RI #2 when the resident was admitted to hospice. EI #2 replied, no. EI #2 was asked why was a Significant Change in Status MDS not completed, on RI #2, when the resident was admitted to hospice. EI #2 replied she was unsure of the new regulations, but now understood that the new regulations state that you must have a significant change within fourteen days of a resident being admitted , discharged , or changing providers of a hospice service. EI #2 was asked why should a Significant Change in Status MDS be completed on a resident when they are admitted to hospice. EI #2 stated that the Significant Change in Status MDS gives an overall picture of the resident, and this helps provide the care that the resident needs. 2.) RI #43 was readmitted to the facility on [DATE] with diagnoses including, Degenerative Disease of the Nervous System. A review of RI #43's Physician's Orders revealed the following: .6/18/18 ADMIT TO SERVICES OF (Name of Hospice Company.) . A review of RI #43's Minimum Data Set (MDS) Significant Change in Status assessment dated [DATE], documented hospice treatment while a resident, was checked under Section O. This assessment was completed 25 days after RI #43's hospice benefits began. On 08/29/18 at 5:33 p.m., an interview was conducted with Employee Identifier (EI) #2, Registered Nurse (RN)/MDS Coordinator. EI #2 was asked when was RI #43 admitted to hospice services. EI #2 replied, 06/18/18. EI #2 was asked was there a Significant Change in Status MDS completed when RI #43 elected hospice services. EI #2 said she did one but it was completed on 07/13/18, which was after the 14 day time frame. EI #2 was asked why was a Significant Change MDS not completed before 07/13/18. EI #2 stated she was not aware of new regulations which stated that you must have a significant change within 14 days of being admitted , discharged or changing providers of hospice services. 3.) RI #115 was readmitted to the facility on [DATE] with diagnoses including, Neoplasm of Uncertain Behavior of Bladder. A review of RI #115's Physician's Orders revealed the following order: .8/2/18 0910 Admit to (Name of Hospice Company) . A review of RI #115's medical record revealed no Significant Change MDS after election of hospice benefits was completed. On 08/29/18 at 5:36 p.m., an interview was conducted with RI #2, RN/MDS Coordinator. EI #2 was asked when was RI #115 admitted to hospice services. EI #2 said, 08/02/18. EI #2 was asked was there a Significant Change in Status MDS completed within 14 days of RI #115 receiving hospice benefits. EI #2 said no, she was unsure of new regulations.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and review of a facility policy titled, Medications Multi-Dose Vials, the facility failed to ensure Resident Identifier (RI) #16's vial of insulin contained an opened date on the vial and package containing RI #16's insulin. This deficient practice affected RI #16, one of 7 residents observed during medication administration. Findings Include: A review of a facility policy titled, Medication Multi-Dose Vials Revised 01/29/13, revealed: .POLICY: To assure safety and infection control when multi-dose vials are utilized. PROCEDURE: 1. When a multi-dose vial (MDV) is opened initially, it should be dated. 2. There is a 28 day limitation on the use of MDV Insulins. RI #16 was readmitted to the facility on [DATE] with diagnoses including, Chronic Kidney Disease. On 08/28/18 at 10:43 a.m. during a medication pass, Employee Identifier (EI) #4, Licensed Practical Nurse (LPN), was observed administering medications to RI #16. EI #4 took a package containing Novolog insulin from the refrigerator, took out a vial of insulin and drew up 2 units of Novolog in a syringe. There was no opened date observed on the package or on the vial of insulin. On 08/29/18 at 11:05 a.m., an interview was conducted with EI #4, LPN. EI #4 was asked, what should be done when a bottle of insulin is opened. EI #4 said, it should have an opened and expiration date. It is 28 days. EI #4 was asked, did the package and/or vial of Novolog for RI #16 have a opened date on it. EI #4 replied, no. EI #4 was asked, what was the concern with insulin not having an opened date. EI #4 said she would not know for sure when it was opened if it did not have an opened date on it and it should be discarded after 28 days.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, medical record reviews and review of facility policies titled, Glove Usage and Handwashing/Hand Sanitizing, the facility failed to ensure: 1. a licensed nurse did not place gloves, a vial of medication and Resident Identifier (RI) #55's nebulizer mask on unclean surfaces during medication pass and 2. a licensed nurse washed her hands before preparing RI #59's medications and before applying her gloves to break one of RI #59's medications. These deficient practices affected RI #55 and RI #59, two of seven residents, and two of four nurses observed during medication administration. Findings Include: RI #55 was admitted to the facility on [DATE]. On 08/28/18 at 8:26 a.m. during a medication pass, the surveyor observed Employee Identifier (EI) #5, Licensed Practical Nurse (LPN), enter RI #55's room and lay a pair of gloves and a vial of nebulizer medication on RI #55's overbed table. EI #5 then entered the bathroom, washed her hands, walked back to the table and applied the gloves and picked up the vial of medication and poured it into the reservoir. After treatment, EI #5 was observed removing RI #55's nebulizer mask and placing it on the overbed table. EI #5 was then observed unplugging the nebulizer and moving it to the nightstand and lying the nebulizer mask on the nightstand, without a barrier, before picking it back up and placing it in a plastic bag. On 08/28/18 at 8:37 a.m. an interview was conducted with EI #5, LPN. EI #5 was asked should a vial of medication and gloves be placed on an unclean surface and then be used to prepare a nebulizer treatment. EI #5 said no, she knew when she did it that she should have put down a barrier. EI #5 was asked where did she place RI #55's nebulizer mask when she took it off. EI #5 stated the overbed table. EI #5 was asked where did she put the mask when she moved RI #55's nebulizer machine. EI #5 replied on RI #55's nightstand. EI #5 was asked should the mask be placed on unclean surfaces. EI #5 responded, no. EI #5 was asked what was the concern with placing items on unclean surfaces. EI #5 answered, infection control. 2.) RI #59 was readmitted to the facility on [DATE]. A review of a facility policy titled. Glove Usage with an original date 4/15/17, revealed: .Wash hands before gloves are applied and when gloves are removed. A review of a facility policy titled, Handwashing/ Hand Sanitizing with a last revised date of 4/15/2017, documented: .All personnel working in the facility are required to thoroughly clean their hands before and after resident contact . On 08/28/18 at 4:53 p.m. during a medication pass, EI #3, Registered Nurse (RN) was observed preparing RI #59's medications without washing or gelling her hands. EI #3 was then observed applying gloves without washing her hands after touching RI #59's overbed table and the bathroom door knob. EI #5 then picked up a pill from RI #59's medication cup and broke it in half wearing the gloves. On 08/29/18 at 6:17 p.m. an interview was conducted with EI #3, RN. EI #3 was asked when was she supposed to wash or gel her hands during medication administration. EI #3 replied before she applied gloves if she did any kind of eye drops, nose drops or fingerstick's before and after. EI #3 was asked did she gel or wash her hands before preparing RI #59's medications on 08/28/18. EI #3 said she did not think she did. EI #3 was asked when should she wash her hands when using gloves. EI #3 responded before putting them on and after taking them off. The surveyor asked EI #3 did she wash her hands before applying gloves that she got from RI #59's bathroom. EI #3 said no, she did not. EI #3 was asked what was the concern with not washing her hands at these times. EI #3 answered infection control. On 0829/18 at 6:27 p.m. an interview was conducted with EI #1, RN/Director of Nursing/Infection Control Coordinator. EI #1 was asked when should a nurse wash her hands during medication pass. EI #1 said before preparing medications and after contact with a resident. EI #1 was asked when should an employee wash their hands when using gloves. EI #1 replied before they glove and when they take them off wash again. EI #1 was asked should a nurse place gloves, a vial of medication and a nebulizer mask on an unclean overbed table and unclean nightstand. EI #1 stated not without a barrier down for it to be placed on.