**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, record review, and review of a facility document titled, Hand Hygiene, the facility failed to ensure a licensed nurse washed her hands prior to administering Resident Identifier (RI) #15's medications, after touching contaminated items, including the door/door knob and privacy curtain. Further, after administering RI #15's medication, the licensed nurse removed her right glove, placed it in the garbage can, and returned to the medication cart, without first washing her hands. This deficient practice affected RI #15, one of three residents observed, and one of three licensed nurses observed during medication pass observations. Findings Include: A review of a facility policy titled, Hand Hygiene with a review date of 11/15/2018 revealed, .PURPOSE To . reduce the transmission of pathogenic microorganisms.PROCESS 1. Perform hand hygiene: 1.1 Before patient care . 1.4 After patient care . RI #15 was admitted to the facility on [DATE]. On 6/19/19 at 9:40 a.m., the surveyor observed Employee Identifier (EI) #1, a Registered Nurse, during a medication pass. EI #1 entered RI #15's room, closed the door with both hands, touched the door knob with her right hand, and pulled the curtain to the left side of RI #15's bed with both hands, but did not wash her hands prior to giving RI #15's oral medication. After EI #1 gave RI #15's inhaler medication, the surveyor observed EI #1 walk out of RI #15's room with her right gloved hand holding RI #15's inhaler. EI #1 then removed her glove from the right hand, put the glove in the garbage can, and did not wash her hands. EI #1 placed RI #15's inhaler on top of the medication cart, and opened the Medication Administration Record Book on top of the medication cart with both hands. On 6/19/19 11:41 at a.m., an interview was conducted with EI #2, a Registered Nurse/Infection Control Preventionist. EI #2 was asked what should you do prior to giving a resident a oral medication. EI #2 stated you should wash your hands. EI #2 was asked what should you do after giving a resident an inhaler medication, and removing gloves, prior to opening a Medication Administration Record Book on top of the medication cart. EI #2 stated you should wash your hands. EI #2 was asked what is your facility policy on hand hygiene regarding patient care. EI #2 stated you should wash your hands prior to and after patient care. EI #2 was asked why should you perform hand hygiene prior to giving a resident a medication and after giving a resident a medication. E #2 stated it is to prevent cross contamination. On 6/19/19 at 12:09 p.m., an interview was conducted with EI #1. EI #1 was asked if she washed her hands after she entered RI #15's room, closed the door with both hands, and pulled the curtain, prior to giving RI #15's oral medication. EI #1 stated no, she did not wash her hands. EI #1 was asked why she did not wash your hands. EI #1 stated she was not thinking. EI #1 stated she should have washed her hands in order to prevent infection to a resident. EI #1 was asked if she washed her hands after she gave RI #15's inhaler medication and removed her glove and put it in the garbage can, prior to returning to the cart and touching the Medication Administration Record Book. EI #1 stated no. EI #1 stated she should have washed her hands in order to prevent infection to a resident.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, record review and review of a facility policy titled, Privacy Rights: Patient, the facility failed to ensure a Registered Nurse, Employee Identifier (EI) #2, did not leave Resident Identifier (RI) #52's Medication Administration Record (MAR) visible and unattended exposing RI #52's personal information and medications taken. This was observed on 09/11/18, during the morning medication administration pass. This deficient practice affected RI #52, one of five residents observed during the medication administration pass, and EI #2, one of four nurses observed administering medications. Findings Include: Review of a facility policy titled, Privacy Rights: Patient, with a revision date of 11/18/16, documented: POLICY The patient has a right to personal privacy and confidentiality of his/her personal and medical records. Personal privacy includes . medical treatments . RI #52 was admitted to the facility on [DATE], and readmitted on [DATE]. On 09/11/18 at 8:19 a.m., the surveyor observed an opened MAR left on top of an unattended medication cart. The MAR revealed RI #52's face, allergies, diet, code status and some of the resident's medications. EI #2 walked to the medication cart and the surveyor shared with EI #2 that RI #52's medical information was visible. The surveyor asked EI #2 what would it be considered when a resident's MAR was left visible where anyone walking by could see the MAR. EI #2 said it would be a privacy issue. On 09/13/18 at 10:00 a.m., the surveyor conducted an interview with EI #1, the Director of Nursing. The surveyor asked EI #1 what should the nurse do, concerning the resident's MAR, when he/she left the medication cart. EI #1 said the nurse should close the MAR. The surveyor asked EI #1 what was it considered when the MAR was left in a position where anyone walking by could observe the resident's information. EI #1 said that would be a privacy concern.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, record review and review of facility policies titled, Medication Administration: Oral and Linen Handling, the facility failed to ensure: 1) a medication nurse, Employee Identifier (EI) #2, sanitized her hands after administering medications to Resident Identifier (RI) #1, and before signing the Medication Administration Record (MAR) on 09/12/18, during the morning medication administration pass; and 2) linen did not touch the uniform of EI #3, a laundry staff member on 09/12/18, when EI #3 was folding the linen (sheets). These deficient practices affected RI #1, one of five residents observed during the medication administration pass, and EI #2, one of four nurses observed administering medications. It also affected EI #3, a laundry staff member and had the potential to affect the resident who would receive that linen. Findings Include: 1) A review of the facility policy titled, Medication Administration: Oral with a revision date of 05/04/15, revealed: .3. Administer medication . 4. Cleanse hands. 5. Document: .Administration of medication . RI #1 was admitted to the facility on [DATE], and readmitted on [DATE]. On 09/12/18 at 8:10 a.m., the surveyor observed EI #2 prepare all, except two, of RI #1's medications. EI #2 walked to where RI #1 was and administered the medications to RI #1. On 09/12/18 at 8:36 a.m., EI #2 went to central supply to obtain a stock medication for RI #1, then walked back to the medication cart. Without sanitizing her hands, EI #2 put gloves on, then opened and dated the stock medication. EI #2 prepared the other two medications for RI #1. On 09/12/18 at 8:43 a.m., EI #2 administered the medications to RI #1. On 09/12/18 at 8:46 a.m., EI #2 went back to the medication cart, and without sanitizing her hands, initialed the MAR. The surveyor asked EI #2 what should she have done before she initialed the MAR. EI #2 said used hand sanitizer. The surveyor asked EI #2 what could it be considered when she touched several items/things, then came back to the medication cart and initialed the MAR. EI #2 replied contamination. On 09/13/18 at 8:13 a.m., the surveyor conducted an interview with EI #5, the Infection Control Nurse. The surveyor asked EI #5 what should the nurses do, before touching anything, when returning to the medication cart after administering medications. EI #5 said use hand sanitizer or wash their hands, if they were visibly soiled. The surveyor asked EI #5 what would it be considered if that was not done. EI #5 replied, she guessed that would be cross contamination. 2) Review of a facility policy titled, Linen Handling, with an effective date of 09/01/04, documented: . PROCESS . 3. Cleanse hands before handling clean linen; do not allow linen to touch uniform . On 09/12/18 at 10:36 a.m., the surveyor observed EI #3, a laundry staff member folding linen (sheets). EI #3 held the sheets up against her shirt and pants when folding them, then placed the sheets on a shelf. On 09/12/18 10:40 a.m., the surveyor observed EI #3 continue to fold sheets while holding the sheets up against her shirt and pants. The surveyor asked EI #3 how should linen be handled when being folded. EI #3 said staff's hands were washed before the linen was folded. The surveyor asked EI #3 should linen be held up against her clothes when being folded. EI #3 replied no. The surveyor asked EI #3 what would that be considered when linen was held up against her clothes. EI #3 said contamination. The surveyor shared with EI #3 the observation of her folding the sheets up against her shirt and pants. EI #3 said she did not realize she was doing that. On 09/12/18 at 10:45 a.m., the surveyor conducted an interview with EI #4, the Laundry Manager. The surveyor asked EI #4 should linen that was being folded be held up against staff clothing. EI #4 said no. The surveyor asked EI #4 how should the linen be held or folded. EI #4 replied, away from your clothes. EI #4 was asked when not held away from your clothes, what would that be considered. EI #4 said contamination. On 09/13/18 at 08:23 a.m., the surveyor conducted an interview with EI #5, the Infection Control Nurse. The surveyor asked EI #5 how should laundry staff handle linen when the linen was being folded. EI #5 said the linen was not supposed to touch a person's clothes or uniform when being folded.