Based on observation, staff interview, and policy review the facility failed to use appropriate personal protective equipment (PPE) when laundering soiled items. The facility reported a census of 61 residents. Findings include: During an observation on 12/11/24 at 8:09 AM Staff B, laundry aide, put on gloves and took plastic laundry bags out of bins and placed them onto the sorting counter. She then failed to put on a gown, sorted the linens, and placed them into bins. She then tossed the plastic bags in the garbage. Staff B cleaned the counter and performed hand hygiene. In an interview on 12/11/24 at 8:03 AM the Environmental Supervisor explained soiled laundry arrived in plastic bags in a covered yellow cart. The laundry then got sorted into bins. She explained items from isolation rooms go into a separate red bin. Staff wore a gown and goggles when handing isolation laundry. She noted no PPE is worn during sorting of general soiled laundry aside from gloves. In an interview on 12/12/24 at 9:06 AM the Administrator/Infection Preventionist explained she expected staff to put on an apron or gown when handling laundry from an isolation room. She noted she was not sure what PPE was required when handling general soiled laundry and stated the Environmental Supervisor would know. She acknowledged she was unaware of the need for staff to wear a gown when handling any soiled laundry. The facility policy titled Infection Prevention and Control Program (IPCP) Guidelines, revised 9/22 educated staff hand washing facilities as well as appropriate personal protective equipment (i.e. gloves and gowns) are available in the laundry area for workers to wear while sorting linens.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, policy review, and staff interview, the facility failed to carry out physician's orders for 2 of 24 residents reviewed (Resident #13 and #14). The facility reported a census of 58 residents. Findings: 1. The Minimum Data Set (MDS) Assessment Tool, dated 10/13/22, listed diagnoses for Resident #13 included Type 2 diabetes, chronic kidney failure, and history of stroke. The MDS documented the resident required extensive assistance of 2 staff for bed mobility, transfers, dressing, toilet use, and personal hygiene, and total dependence of 1 staff for bathing. The MDS listed the resident's Brief Interview for Mental Status (BIMS) score as 8 out of 15, indicating a moderate cognitive impairment. A Physician Order, dated 6/2/21, directed staff to notify the Physician if the resident's blood sugar reads below 60 milligrams per deciliter (mg/dl) or above 450 mg/dl. The facility lacked documentation of a Physician notification for a blood sugar reading of 488 mg/dl on 11/5/22. A Physician Order, dated 7/28/22, directed staff to hold 10 units of Novolog (insulin) if the resident's blood sugar is below 150 mg/dl. A 11/15/22 Incident Report-Medication Event 24 hour Follow-Up Progress Note indicated the resident received 10 units of Novolog after a blood sugar result of 99 mg/dl. The resident became lethargic. A second blood sugar resulted in a reading of 43 mg/dl. The resident required an emergency 1 gram injection of glucagon. 2. The MDS Assessment Tool, dated 12/2/22, listed diagnoses for Resident #14 included chronic heart failure, morbid obesity, and a surgical wound. The MDS documented the resident required extensive assistance of 2 staff for bed mobility, transfers, walking, and toilet use. Also extensive assistance of 1 staff for dressing, and personal hygiene. The MDS listed the resident's BIMS score as 12 out of 15, indicating a moderate cognitive impairment. A Physician Order, dated 10/14/22, directed staff to weigh Resident #14 daily and notify the Physician of weight gain of 3 lbs (pounds) in one day, or 5 lbs in one week. A review of the clinical health record lacked a documented daily weight on: 10/16/22, 10/19/22, 10/20/22. 10/22/22, 10/24/22, 10/26/22, 10/29/22, 10/30/22, 10/31/22, and on 11/7/22. A review of the clinical health record lacked documentation of a physician notification for a 3 lbs one day weight gain for the following days: a. On 11/4/22 weight of 307.2 lbs, 11/5/22 weight of 316.8 lbs. - gain of 9.6 lbs b. On 11/10/22 weight of 311.6, 11/11/22 weight of 315 - gain of 3.4 lbs c. On 11/13/22 weight of 315.6, 11/14/22 weight of 319.6 - gain of 4 lbs d. On 11/19/22 weight of 320.2, 11/20/22 weight of 325 - gain of 4.8 lbs A Daily Skilled Progress Note, dated 11/25/22, revealed the resident began to become confused and experienced shortness of breath during therapy. The resident started use of oxygen after a pulse oximeter reading of 71%. Hospital records, dated 11/27/22, revealed weight gain, shortness of breath, and hypoxia (low oxygen level) the reason for admission. A review of the clinic record indicated on 11/25/22 the residents weighed 322.2 lbs. At readmission on [DATE] the resident weighed 300.8 lbs. During an interview on 12/8/22 at 9:29 AM, Staff A, Certified Nursing Assistant (CNA) stated the resident's weight should be taken daily. Staff A stated the Unit Nurse is informed of the weight and completes the documentation. During an interview on 12/8/22 at 9:36 AM, Staff B, CNA stated the resident's weight should be taken daily. Staff B stated the Unit Nurse is informed of the weight and completes the documentation. Staff B denied being aware that the resident gained weight, but the nurse will ask for a reweigh if needed. During an interview on 12/8/22 at 11:35 AM, Staff C, Registered Nurse (RN) stated the resident is weighed daily, and if there is a weight gain of 3 lbs in one day, or 5 lbs in a week the Physician is to be notified. Staff C stated she would document the weight gain and notification of the physician with a progress note in the Electronic Health Record (EHR) During an interview on 12/8/22 at 2:28 PM, the Director of Nursing (DON) stated she would expect the nurse to call the Physician any time a resident has a result within an order's specific parameters. The DON stated the staff should have notified the Physician of Resident #13 11/5/22 blood sugar reading of 488 mg/dl as the order stated to notify the physician of a result above 450 mg/dl. The DON stated the staff should have notified the physician of Resident #14's one day weight gain of 3 pounds or more as the order started to notify the physician of a weight gain of 3 pounds or more in one day. The DON stated she would expect the staff to document all physician notifications in a progress note in the EHR. The facility policy, revised date of 4/2012, titled Family and Physician Notification Relating to Accident or Change in Medical Condition directed staff to immediately notify the physician of any change in the resident's medical condition; and to document the change.