Based on interview and record review, the facility failed to notify appropriate parties of a resident's significant change of status for 2 of 5 residents reviewed for nutrition. The Medical Doctor (MD) or Registered Dietician were not notified of a significant weight loss, and the Doctor was not notified of a five pound weight gain as indicated in a weight order. (Resident 3, Resident 9) Findings include: 1. On 2/19/24 at 11:14 A.M., Resident 3's clinical record was reviewed. Diagnosis included, but were not limited to, anxiety and depression. The most recent quarterly MDS (minimum data set) assessment, dated 12/8/23, indicated a mild cognitive impairment, and no weight loss or gain. Current physician orders included, but were not limited to: Weight once a day, dated 2/16/24. Monthly weight and vital signs on the first of the month, dated 11/1/23. A current nutritional status care plan, dated 9/5/23, included but was not limited to the following intervention: Monitor/record weight routinely, notify MD/RD (Registered Dietician) of significant weight changes, dated 9/5/23. Resident 3's weights included, but were not limited to, the following: 10/3/23 130.2 11/1/23 115.6 (11.21% decrease in one month) Resident 3's clinical record lacked a notification to the MD or Registered Dietician of the significant weight loss that occurred on 11/1/23. On 2/22/24 at 2:00 P.M., the Regional Clinical Support indicated notification following Resident 3's significant weight loss on 11/1/23 could not be located. 2. On 2/19/24 at 10:36 A.M., Resident 9's clinical record was reviewed. Diagnosis included, but were not limited to, anxiety and depression. The most recent Quarterly MDS Assessment, dated 1/14/24, indicated a mild cognitive impairment, and no weight loss or gain. Current physician orders included, but were not limited to: Weight three times weekly. Notify MD if weight gain is 2 lbs (pounds) daily or 5 lbs in a week, dated 10/11/23. A current nutritional status care plan, dated 10/11/23, included but was not limited to, the following intervention: Monitor/record weight routinely, notify MD/RD of significant weight changes, dated 10/11/23. Resident 9's weights included, but were not limited to, the following: 2/7/24 235 lbs 2/9/24 240.8 lbs (5.8 lb increase in two days, 2/7-9/24)) 2/12/24 240.5 lbs (5.5 lb increase in five days, 2/7-12/24) Resident 9's clinical record lacked a notification to the MD of the weight gain that occurred on 2/9/24 and 2/12/24. On 2/22/24 at 2:00 P.M., the Regional Clinical Support indicated notification following Resident 9's weight gain on 2/9/24 and/or 2/12/24 could not be located. On 2/22/24 at 8:47 A.M., Licensed Practical Nurse (LPN) 5 indicated if a resident had a discrepancy in their weight, they should be re-weighed. The nurse working the floor was in charge of contacting the MD if the resident gained 2 lbs in a day or 5 lbs in a week. Once the MD was notified, it should be documented under the physician notification on the Medication Administration Record (MAR), and if a new order were to be obtained, it would be documented in the progress notes. On 2/26/24 at 12:05 P.M., a current Change in a Resident's Condition or Status policy was provided, revised 10/2010, and indicated Our facility shall promptly notify the resident, his or her Attending Physician, and representative (sponsor) of changes in the resident's medical/mental condition and/or status . The Nurse Supervisor/Charge Nurse will notify the resident's Attending Physician or On-Call Physician when there has been . A significant change in the resident's physical/emotional/mental condition . The Nurse Supervisor/Charge Nurse will record in the resident's medical record 3.1-5(a)(2)

Based on observation, interview, and record review, the facility failed to ensure infection control practices were implemented and maintained during 2 of 3 observations of care. Staff did not perform hand hygiene after removal of gloves during care and staff failed to properly sanitize an insulin pen prior to use. (Resident C, Resident D) Findings include: 1. During an observation on 10/10/23 at 11:52 A.M., LPN 4 was assessing Resident C's blood sugar levels with a glucometer. After washing hands and donning (putting on) gloves, LPN 4 pricked Resident C's finger to obtain a blood drop for the glucometer machine, however the glucometer failed to read the blood sugar level. LPN then removed gloves and donned new gloves with no hand hygiene. LPN 4 again attempted to read Resident C's blood sugar level and the glucometer gave an error message. LPN 4 returned to the medication cart, removed gloves, pulled another glucometer machine from the cart and donned new gloves without performing hand hygiene. After reading Resident C's blood sugar level, LPN 4 went to administer Resident C's insulin by preparing 10 units via Humalog KwikPen. While preparing the insulin pen, LPN 4 failed to wipe the end of the pen with an alcohol wipe prior to screwing on the needle. 2. During an observation on 10/10/23 at 1:27 P.M., CNA 8 and LPN 4 were assisting Resident D with incontinence care. CNA 8 pulled a stack of wet wipes from a package and provided peri care by pulling from the stack of wipes on 3 occasions. CNA 8 then applied cream and powder to Resident D's peri area. CNA 8 removed gloves and did not perform hand hygiene. CNA 8 assisted Resident D to pull her pants up and adjusted the resident in bed, pulled blankets over the resident, and then put the unused stack of wet wipes back into the original package. CNA grabbed a bag of trash and exited the room. During an interview on 10/10/23 at 1:40 P.M., CNA 7 indicated staff should perform hand hygiene after removing gloves. On 10/10/23 the IP (infection preventionist) supplied a facility policy titled Hand Washing/Hand Hygiene Policy, dated 3/24/16 as well as an undated Insulin Pen Skills Validation form. The Hand Washing/Hand Hygiene Policy included, .5. Employees must wash their hands for at least twenty seconds using antimicrobial or non-antimicrobial soap and water under the following conditions . v. After removing gloves . 6. In most situations, the preferred method of hand hygiene is with an alcohol-based hand rub . If hands are not visibly soiled, us an alcohol-based hand rub containing 60-95% ethanol or isopropanol for all the following situations: b. Before donning sterile gloves . f. Before moving from a contaminated body site to a clean body site during resident care . j. After removing gloves . 8. The use of gloves does not replace handwashing/hand hygiene . The Insulin Pen Skills Validation included, .12. Pull off pen cap 13. Wiped [sic] rubber stopper with alcohol swab 14. Removed [sic] protective cover from disposable needle and screw on pen . This Federal tag relates to complaint IN00417072. 3.1-18(b) 3.1-18(l)