Based on observation, interview and record review, the facility failed to ensure a residents urinary catheter tubing was kept off the floor for one resident (R26) reviewed for infection control with urinary catheter in the sample of 18. Findings include: On July 30, 2024, at 10:15 AM, R26 was in her bedroom, sitting in her wheelchair. R26's urinary catheter tube and bag were underneath her wheelchair. While R26 was talking to the surveyor, R26 kept moving her wheelchair back and forth while her indwelling urinary catheter tube was dragging on the floor. On July 30, 2024, at 1:26 PM, V2 (Director of Nursing/DON) stated the catheter tube shouldn't touch the floor to prevent potential infection. The facility's Urinary Catheter Care Policy and Procedure showed: Infection Control: 2. Maintain a clean technique when handling or manipulating the catheter tubing, or drainage bag. b. Be sure the catheter tubing and drainage bag are kept off the floor. 8. The use of gloves does not replace hand washing/hand hygiene. Integration of glove use along with routine hand hygiene is recognized as the best practice for preventing healthcare associated infections.

Based on observation, interview, and record review, the facility failed to follow standard infection control practices with regards to hand hygiene and gloving during provisions of care. This applies to 1 of 4 residents (R28) reviewed for infection control in the sample of 18. Findings include: 1. On July 29, 2024, at 4:55 PM, V5 (Certified Nursing Assistant/CNA) provided incontinence care to R28, who was wet with urine. V5 wiped/cleaned R28's perineum from front to back, placed a new incontinence brief, pulled his pants back in place, repositioned R28, placed the motorized wheelchair at bedside and assisted R28 to transfer from bed to wheelchair, while wearing the same soiled gloves all throughout the different tasks. On July 30, 2024, at 1:26 PM, V2 (Director of Director/DON) stated during provisions of incontinence care, staff must perform hand hygiene and change gloves before and after, and in between tasks to prevent cross contamination and spread of infection. The facility's undated Handwashing/Hand Hygiene policy and Procedure, showed: Policy Statement: This facility considers hand hygiene the primary means to prevent the spread of infections. Policy Interpretation and Implementation: 6. Use an alcohol-based hand rub containing at least 62% alcohol; or, alternatively, soap and water for the following situations: f. Before moving from a contaminated body site to a clean body site during resident care. g. After contact with a resident's intact skin. h. After contact with blood and body fluids. 1. After handling used dressings, contaminated equipment, etc. 8. Hand hygiene is the final step after removing and disposing of personal protective equipment.

Based on observation, interview and record review, the facility failed to label medications with the date when opened and failed to remove discontinued eye medication from the medication cart. This applies to 4 of 4 residents (R5, R10, R21, R63) reviewed for medication storage in the sample of 18. The findings include: On July 29, 2024, between 2:32 PM to 4:30 PM, the medication cart inspections were conducted with V3 (Registered Nurse/RN) and V4 (License Practical Nurse/LPN). The following was observed: 1. R63's Insulin Lispro Kwik Pen was opened and not dated. The Pharmacy's undated Insulin Storage Recommendation Beyond Use Date procedure showed to discard the insulin pen 28 days after opened. 2. R10's Humulin Lantus Solostar Injectable 100 ml (milliliters). was opened and not dated. The Pharmacy's undated Insulin Storage Recommendation Beyond Use Date procedure, showed to discard the insulin pen 28 days after opened. 3. R5's Netarsudil and Latanoprost 0.2%/0.005% eye drops were opened and not dated, with instructions to keep refrigerated. The Pharmacy's undated Recommendation for Eye Drop Storage procedure, showed that the eye drops can be stored up to 6 weeks after opened. 4. R21 Moxifloxacin 0.5% eye drops were opened and not dated. R21's Medication Administration Record (MAR) showed that this medication had been discontinued on July 9, 2024. On July 30, 2024 at 1:14 PM, V2 (Director of Nursing/DON) stated that staff must date the insulin, and the eye drops, when opened, to identify the expiration date of the medications. The facility's undated Medication Labeling and Storage Policy and Procedure showed Medication Storage: 3. If the facility has discontinued, outdated, or deteriorated medications or biologicals, the dispensing pharmacy is contacted for instructions regarding returning or destroying these items.

Based on observation, interview and record review, the facility failed to sanitize pots and pans per facility policy. This applies to all 81 residents receiving oral diets in the facility. The findings include: Long term Care Facility Application for Medicare and Medicaid, dated July 28, 2024, shows the facility census was 82. Diet Type Report dated July 28,2024, shows one resident did not receive an oral diet at the facility. On July 28, 2024, at 10:18 AM with V6 (Food Service Manager), the dish machine sanitizer temperature was measured using a 180 degree F (Fahrenheit) test strip. The test strip instructions showed the black indicator line on the test strip was to turn completely orange when 180 degrees F was reached during the sanitizing cycle of the dish machine. After running through a full cycle of the dish machine, the test strip indicator line remained gray. During the sanitizing cycle, the dish machine water temperature (as indicated by the dish machine thermometer) did not elevate above 174 degrees F. Instructions posted on the dish machine showed the minimum water temperature for the final rinse sanitizing water was 180 degrees F. V6 stated the local health department recommended the 180 degree F strips were utilized to check the sanitizing temperature of the dish machine. July Dish Washer Temperature Log, dated July 2024, shows none of the Dishwasher Temperature strips turned completely orange to indicate the dish machine reached the desired temperature of 180 degrees F. On July 29, 2024, at 11:15 AM, the facility's July dish machine sanitizing water temperature test strip results showed none of the test strips turned completely orange indicating the sanitizing water temperature reached 180 degrees F. V6 stated on July 28, 2024, facility maintenance identified that the switch on the booster heater was turned off. V6 stated the booster heater switch was turned on which provided sanitizing water at 180 degrees F to the final rinse of the dish machine. Facility Dishwashing Machine Use Policy/Procedure, reviewed July 30, 2024, shows, 2. Dishwashing machines may use hot water to sanitize must maintain the following: .b. 180 degrees F for a final rinse cycle (160 degrees F at the rack level/dish level surface reflects a 180 degree F temperature at the manifold, which is the area just before the final rinse nozzle where the temperature of the dish machine is measured 4. A supervisor or designee will check the machine for proper temperature and report inadequate temperatures for immediate correction. a. A secondary thermometer or temperature gauge will be run through machine to compare temperature to gauge on machine daily. b. If hot water temperatures do not meet requirements, cease use of dishwashing machine immediately until temperatures are adjusted. Dish machine test strips instructions showed, 1. Attach the test strip to a utensil or rack by wrapping around and slipping the color bar through the slit . Wash the item. 2. If the color bar has turned bright orange, the dishwasher is maintaining the proper temperature. 3. When finished with the test, sign, date and place the strip in dishwasher temperature log.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure residents were assessed for the ability to self administer medications. This failure affects two of residents (R54, R333) reviewed for medication use on the sample list of 30. Findings include: 1. R54's admission Record shows R54 was admitted on [DATE] with diagnoses including gout, right shoulder and left knee pain, and obsessive-compulsive disorder. R54's 12/03/2022 cognitive function care plan showed she has impaired cognitive function related to a diagnosis of dementia, and her [Minimum Data Set] (MDS) scoring does not reflect cognitive fluctuations and forgetfulness that is observed by staff. On 08/22/2023 at 10:29 AM, R54 had an unlabeled tube of topical menthol pain reliever gel and an antifungal powder container on her nightstand on the right side of her bed. On 8/22/2023 at 10:30 AM, R54 said she regularly bought the menthol gel from an online retailer. R54 said she ordered the medication so she can always have and use it when she wanted to. R54 said she uses the gel on any part of her body that is hurting and she cannot remember how many times a day she uses it. R54 said she uses the antifungal powder on her groin after going to the bathroom. On 08/24/2023 at 09:55 AM, V2 (DON-Director of Nursing) said it is the facility's policy that nurses will administer medications. V2 stated there are concerns if medications are kept at the bedside without an assessment and physician orders, including a risk for the patient to self-administer medications outside of parameters of the orders, causing over- or under-dosing. On 8/24/2023 at 10:30 AM, R54's August 2023 POS (Physician Order Sheet) showed an order for the menthol gel to be applied to the right shoulder, left knee and scapula, three times a day as needed, for pain. R54's August 2023 POS also showed R54's order for the antifungal powder was discontinued on 08/20/2023. R54's POS showed no orders to keep either medication at the bedside. 2. R333's Face Sheet showed his diagnoses include chronic obstructive pulmonary disease and muscle weakness. R333's 8/13/23 Minimum Data Set (MDS) showed he is cognitively intact. On 08/22/23 at 12:24 PM, an albuterol metered-dose inhaler was on R333's desk. The inhaler was visible from the doorway. R333 stated the inhaler was left by the nursing staff and was for his use. The next day at 9:15 AM, R333's inhaler was again seen on his desk. On 08/23/23 at 09:18 AM, V4 RN (Registered Nurse) stated as far as he knew, R333 was not assessed for keeping medications at the bedside, he did not have orders to keep medications there, and R333 did not have orders to self-administer his own medications. On 08/24/23 at 09:57 AM, V2 DON (Director of Nursing) stated if residents do not have a physicians order to keep medication at the bedside, then medication should be stored in the medication cart and the nurse should be the only person to administer medication.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 1. R54's admission Record shows R54 was admitted on [DATE] and her diagnoses include gout, right shoulder and left knee pain, and obsessive-compulsive disorder. R54's 12/03/2022 cognitive function care plan showed she has impaired cognitive function related to a diagnosis of dementia, and her [Minimum Data Set] (MDS) scoring does not reflect cognitive fluctuations and forgetfulness that is observed by staff. On 08/22/2023 at 10:29 AM, R54 had an unlabeled tube of topical menthol pain reliever gel and an antifungal powder container on her nightstand on the right side of her bed. On 8/22/2023 at 10:30 AM, R54 said she regularly bought the menthol gel from an online retailer. R54 said she ordered the medication so she can always have and use it when she wanted to. R54 said she uses the gel on any part of her body that is hurting and she cannot remember how many times a day she uses it. R54 said she uses the antifungal powder on her groin after going to the bathroom. On 08/24/2023 at 09:55 AM, V2 (DON-Director of Nursing) said all medications are kept in the medication carts or the medication room. V2 said all medications should be labeled and the facility does not allow medication from outside sources. V2 said if unlabeled medications were found, they are returned to the family and the facility will obtain physician orders and obtain the medication from facility's pharmacy. On 8/24/2023 at 10:30 AM, R54's August 2023 POS (Physician Order Sheet) showed an order for the menthol gel to be applied to the right shoulder, left knee and scapula, three times a day as needed, for pain. R54's August 2023 POS also showed R54's order for the antifungal powder was discontinued on 08/20/2023. R54's POS showed no orders to keep either medication at the bedside. Facility's November 2020 policy on Storage of Medications showed Policy heading: The facility stores all drugs and biologicals in a safe, secure, and orderly manner. 1. Drugs and biologicals used in the facility are stored in locked compartments . 3. The nursing staff is responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner . 4. Drug containers that have missing, incomplete, improper, or incorrect labels are returned to the pharmacy for proper labeling before storing. Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed . Facility's 1/29/2020 Policy on Labeling of Medication Containers showed .2. Any medication packaging or containers that are inadequately or improperly labeled are returned to the issuing pharmacy. For inadequately or improperly labeled medications from home or outside pharmacy, medication will be returned to patient representative or back to patient at time of discharge . 4. Labels for over-the-counter drugs include all necessary information, such as: a. The original label indicating the name, strength, and quantity of the medication; b. The expiration date when aplicable; c. Directions for use and appropriate accessory/cautionary statements 2. 1. R333's Face Sheet showed his diagnoses include chronic obstructive pulmonary disease and muscle weakness. R333's 8/13/23 Minimum Data Set (MDS) showed he is cognitively intact. On 08/22/23 at 12:24 PM, an albuterol metered-dose inhaler was on R333's desk. The inhaler was visible from the doorway. R333 stated the inhaler was left by the nursing staff and was for his use. The next day (8/23/23) at 9:15 AM, R333's inhaler was again seen on his desk. On 08/23/23 at 09:18 AM, V4 RN (Registered Nurse) stated as far as he knew, R333 was not assessed for keeping medications at the bedside, he did not have orders to keep medications there. On 08/24/23 at 09:57 AM, V2 DON (Director of Nursing) stated if residents do not have a physicians order to keep medication at the bedside, then medication should be stored in the medication cart. Based on observation, interview and record review, the facility failed to ensure residents' medications were secured and labeled. This applies to 2 residents of 20 residents (R54, R333) reviewed for medication storage on the sample list of 30. Findings include:

Based on interview and record review, the facility failed to ensure a resident receiving a transdermal medication patch, only had one medication patch in place during transdermal medication administration. This failure affects one of three residents (R1) reviewed for transdermal medication use on the sample list of six. Findings include: R1's face sheet (8/1/23) documents R1's diagnoses including Parkinson's Disease, Dementia, Anxiety Disorder, and Adult Failure to Thrive. R1's current Physician Order Sheet (POS) documents R1's orders including Exelon (Rivastigmine) (reversible cholinesterase inhibitor) transdermal patch 24-hour 4.6 milligram (mg), apply one patch transdermal at a time related to Dementia. On 8/1/23 at 10:58 AM, V5 (R1's husband) was wheeling R1 back to her room. V5 stated he had concerns with R1's Exelon transdermal patch. V5 stated on 7/2/23 and 7/26/23, R1 had two of the Exelon transdermal patches on her. V5 stated R1 is supposed to have only one patch on her at a time. On 8/1/23 at 3:36 PM, V11 (LPN- Licensed Practical Nurse) stated on 7/2/23, V11 took an Exelon transdermal patch off R1's back before applying a new patch on the other side of R1's back. V11 stated later that day, V5, R1's husband showed V11 that R1 had another patch on R1's arm and R1 had two patches on R1's body. V11 stated she did not see the second patch prior to V5 showing her the patch on R1's arm. V11 stated it did not occur to her to check if R1 had more patches on R1. On 8/1/23 at 4:02 PM, V12 (Agency LPN) stated on 7/26/23, V12 took an Exelon transdermal patch off R1 prior to applying a new patch. V12 stated V12 placed the new patch on R1's right chest. V12 stated V4, R1's daughter showed V12 that R1 had another patch to R1's right back, later after V12 had already removed a patch prior to placing a new patch. R1 had two Exelon transdermal patches on at the same time. On 8/2/23 at 9:37 AM, V2 (DON-Director of Nursing) stated R1 had two Exelon transdermal patches on her on two separate days: on 7/2/23 and 7/26/23. V2 stated R1's family informed V11 and V12 of the multiple patches. V2 also stated there should only be one Exelon patch on R1 per physician order because it can lead to adverse effects of the medication. On 8/2/23 at 9:13 AM, V13 (Pharmacist) stated R1 should have one patch on at a time. V13 stated the downside to having two patches on is that there could be augmentation of the adverse effects of the medication; some of the adverse effects includes increased tremors, increased sedation, upset stomach, diarrhea, feeling dizzy, sleepy and headache. The facility's Transdermal drug delivery system (patch) application (undated) states to remove old patch from body and apply new patch firmly against the skin.

Based on interview and record review the facility failed to administer an opioid medication to the correct resident. This applies to 1 of 1 resident (R1) reviewed for medications in a sample of 8. Finding include: On 2/22/23 at 3:42 pm V1 (Director of Nursing/DON) stated R1 was given a controlled medication in error by V8 (Registered Nurse/RN) back in June of 2022. On 2/22/23 at 3:20 pm, V8 (RN) stated she gave R1 the wrong pain medication. V8 stated R1 became nauseated and anxious after she was notified of the error. V8 stated the Nurse Practitioner ordered Narcan as a precaution. On 6/20/22 at 4:46 pm, Nurse practitioner progress note documents notification by staff that resident received Hydromorphone 2mg in error at 2 pm. Narcan 4 MG given to reverse the effects of narcotic. R1 to have increased vital sign monitoring for 24 hours. On 6/20/22, an order was entered into R1's EMR (Electronic Medical Record) for Narcan 4MG/0.1ML for narcotic administration was completed. Facility Administration Procedure for All Medications policy, dated July 2018, states to administer medications in a safe and effective manner review the 5 rights (right patient, right medication, right dose, right route, right time) 3 times. Check the Medication Administration Record/Treatment Administration Record for order. Identify resident using two identification methods before administering medication.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to treat a resident in a dignified manner by ensuring a resident's urinary drainage bag was covered while in common areas for one of three residents (R15) reviewed for catheters in the sample of 18. The findings include: On 09/06/22 at 10:29 AM, R15 was in her high back wheelchair in a common area during an exercise activity. R15's urinary drainage bag was visible and hanging to right of resident on the chair. The catheter tubing came down through R15's right pant leg. At 12:30 PM, R15 was in the high back chair seated at a dining room table. The dining room was full of residents. R15's urinary drainage bag remained visible and attached to her chair. On 09/08/22 at 08:37 AM, V10 MDS (Minimum Data Set) Coordinator said the purpose of a privacy bag is for dignity. It's meant to preserve the patient's privacy. Everyone doesn't need to know that R15 has an indwelling urinary catheter. Resident's with catheters should have a privacy bag even if they are in their room. R15's 9/7/22 face sheet showed a [AGE] year old female with diagnosis of encephalopathy palliative care, Type 2 diabetes, heart failure, hypertension, psychosis, vascular dementia, glaucoma, hemiplegia and hemiparesis, dysphagia, cerebral infarction and neuromuscular dysfunction of the bladder. R15's undated indwelling catheter care plan showed to use a privacy bag at all times. R15's 6/30/22 facility assessment showed total dependence of two plus persons for transfers, toilet use, and bathing. This assessment showed R15 required extensive assistance of two plus persons for bed mobility, and extensive assistance of one plus person for dressing and personal hygiene. The Illinois Department on Aging's Resident Rights for people in long term care facilities showed your medical and personal care are private. The facility's 9/29/19 Dignity Policy showed each resident shall be cared for in a manner that promotes and enhances quality of life, dignity, respect, and individuality. Staff shall promote, maintain, and protect resident privacy, including bodily privacy during assistance with personal care and during treatment procedures.

Based on observation, interview, and record review the facility failed to ensure residents were served menu items from the dietitian approved spreadsheet to meet the resident's nutritional needs. This applies to all 74 residents residing in the facility. The findings include: The Resident Census and Condition Report (Federal Form 672) shows that on 9/6/22, the facility housed 74 residents. The Spreadsheet for Tuesday's lunch includes tilapia, bowtie pasta, kale salad and pear halves for the resident's on a general diet. The Spreadsheet shows pureed tilapia, bowtie pasta, green beans and pears for the resident's on a pureed diet. On 9/6/22 at 10:31 AM, V6 (Cook) pureed the noon meal. V6 pureed fish and green beans. On 9/6/22 at 12:20 PM, V8 (Cook) did not have bowtie pasta on the steam table to be served. V8 served R4, R7, R15, R25 and R62 the prepared pureed meal. V8 stated, They are getting fish, mashed potatoes and peas. R4, R7, R15, R25 and R62 did not receive pureed pears or any dessert substitute. On 9/07/22 at 2:15 PM, V6 said that the spreadsheet showed that the residents were supposed to get bowtie pasta with the noon meal on 9/6/22 but the menu that was printed for the residents didn't include it. V6 said that she just went off of the menu and not the spreadsheet when she prepared the meal so no bowtie pasta was prepared. V6 said that the pureed desserts are usually done by the cooks on the unit. V6 said that she does not know why it was not done yesterday but the resident's on a pureed diet should have received a dessert. On 9/7/22 at 2:27 PM, V1 (Administrator) said that Diet Spreadsheets are reviewed by the dietician. V1 said that the spreadsheets should be followed to ensure that the residents receive the appropriate amount of nutrition daily. V1 said that the noodles were not transcribed over to the menu but the staff should have followed the spreadsheet. V1 said that dessert should have been pureed by the kitchen and served to the residents on a pureed diet. The facility's Menus Policy dated 4/3/19 shows, Menus will be planned that meet the nutritional needs of residents in accordance with the recommended dietary allowances of the Food and Nutrition Board Menus will provide a variety of foods from the basic daily food groups.

Based on observation, interview, and record review the facility failed to ensure food was stored and served in a sanitary manner, dishes were cleaned under sanitary conditions, and food temperatures were taken to prevent foodborne illnesses for all 74 residents residing in the facility. The findings include: The Resident Census and Condition Report (Federal Form 672) shows that on 9/6/22, the facility housed 74 residents. 1. On 9/6/22 at 10:15 AM, there were multiple opened food items in the dry storage area that were not dated with the date opened. These food items include: baking powder, lime gelatin, marshmallows, noodles, strawberry gelatin, brown sugar, 2 bags of pecans and sunflower kernels. A bag of pecans and a box of sunflower kernels were not sealed closed. There was a bag of white chocolate chips that were dated, Use by 2/22. On 9/6/22 at 10:15 AM, V1 (Administrator) said that all food should be labeled with the open date once it is opened. V2 said that it is important to know since different types of foods are only good for a certain amount of time after opening. The facility's undated Dining and Nutrition packet shows, When a product comes in, it needs to be labeled with the following: item name, day it was made or opened, shelf life of the product ., use by date, and employees name (Person that made the item or opened it). 2. On 9/6/22 at 10:44 AM, V9 (Dietary Aide) was hand washing pots and pans before putting them into the dishwasher. With the same gloves on, V9 went to the clean side of the dishwasher, wiped her gloves off with a hand towel and proceeded to put away clean pots and pans. On 9/6/22 at 1:30 PM, V1 (Administrator) said that staff should perform hand hygiene before touching clean dishes when they are using the dishwasher. The facility's Dishwashing Machine Use Policy dated 4/3/19 shows, Wash hands before and after running the dishwashing machine and during the process. The facility's Dining and Nutrition booklet shows, When putting away clean dishes, wash hands, put on gloves, then put them away. 3. On 9/6/22 at 12:07 PM, V7 (Cook) was serving the noon meal on the 2nd floor. V7 had a beard with no beard restraint on. At 12:20 PM, V8 (Cook) was serving the noon meal on the 3rd floor. V8 had a beard with no beard restraint on. On 9/7/22 at 2:15 PM, V6 (Cook) said that hairnets should be worn at all times. V6 said that if a staff member has a beard, they should wear a beard net at all times to ensure that hair does not get into the food. The facility's Preventing Foodborne Illness-Employee Hygiene and Sanitary Practice Policy dated 4/3/19 shows, Hair nets or caps and/or beard restraints must be worn to keep hair from contacting exposed food, clean equipment, utensils and linens. 4. The facility's 2nd floor Steam Table Temperature Logbook shows that food temperatures were not taken on 9/2/22 for the lunch and dinner meal, 9/3 for the lunch meal and 9/5 for lunch and dinner meal. The log book did not have a sheet for 9/4/22. The facility's Dining and Nutrition Booklet shows, Temperature control of food is important to prevent foodborne illnesses. All hot food in the warming pantries must be above 140 degrees Fahrenheit Food Temperature Logs will be kept in every warming pantry and country kitchen in a binder. You will record what food you are testing, the time and the temperature.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to socially distance residents who are on droplet isolation while in the dining room. This applies to two residents (R19, R21) outside the sample reviewed for infection control. This has the potential to affect all 74 residents in the facility. The findings include: The facility face sheet for R19 shows diagnosis to include dementia. The facility assessment dated [DATE] shows moderate cognitive impairment. The facility face sheet for R21 shows diagnosis to include Parkinson's Disease and dementia. The facility assessment dated [DATE] shows her to be cognitively intact. On 9/6/2022 at the noon meal, R19 was observed sitting next to another resident at a table in the dining room. The two residents were not sitting six feet away from each other. On 9/7/2022 during breakfast, R21 was observed sitting at the same dining room table across from another resident. The residents were not sitting six feet from each other. On 9/7/2022 at the noon meal, R19 and R21 were observed sitting at a dining room table with one other resident. The residents were not sitting six feet away from each other. The Physician order sheet dated September 2022 for R19 and R21 shows an order for droplet isolation. On 9/06/22 at 11:40 AM, V3 Infection Preventionist said, currently due to an outbreak, all residents not up to date are on isolation for 10 days starting on 9/3. For the resident who can not maintain isolation due to safety reasons, they should be 6 ft apart from anyone at all times and mask as much as possible/tolerable. If seen next to a resident, staff should re-direct from other residents. Try and have them eat in room but if they can not for safety reasons, I would prefer them to eat in the living room socially distanced from others and not in the dining room. The facility list of residents currently on isolation include R19 and R21 for not being up to date on COVID-19 vaccinations. The facility care plan for R19 shows risk for exposure to COVID-19 and to maintain social distancing, including dining and recreation services. The intervention for not complying with droplet precautions shows she may come out of her room during meals while observing social isolation. The facility care plan for R21 shows risk for exposure to COVID-19 and to maintain social distancing, including dining and recreation services. The intervention for inability to comply with precautions due to safety reasons the resident may come out of her room for meals while observing social distancing. The facility policy with a revision date of 5/31/22 shows residents who are not up to date with COVID-19 vaccinations are restricted to their rooms, even if testing is negative .they do not participate in group activities.