**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, review of the Food and Drug Administration's document, and review of the facility's documents and policy, the facility failed to prepare and serve food in accordance with professional standards for food service safety with incomplete documentation of hot and cold food temperatures, use of a cleaning cloth not sanitized after each use, and preparation of sanitizer at the wrong strength. This deficient practice had the potential to affect 44 current residents. The findings include: Review of the facility's policy titled, Sanitizing Solution-Quaternary, dated 2013, revealed containers used for sanitizing work areas, and the cleaning cloth, were changed every shift or as needed. Solutions and cloths could be changed more frequently if the workload warranted, producing a cloudy dirty solution. The policy stated the solution for sanitizing the work surface consisted of 1-1/2 gallons of warm water and one quaternary sanitizing tablet to equal 200 parts per million (PPM). Review of the Food and Drug Administration 2013 Kentucky Food Code 902 [Kentucky Administrative Regulation] [NAME] 45:005 revealed how to manage the sanitizer buckets. It stated to change the sanitizing solution in buckets when it became weak, diluted or cloudy, or as needed to maintain the proper concentration. Further, it stated to change sanitizer buckets at least every two to four hours, or more frequently if necessary. Review of the facility's document June 2025 Sanitize Sheet revealed the first and second shifts taped the sanitizer test strip, which indicated the sanitizing solution was at the proper strength, onto the sheet of paper per day and according to shift. Continued review revealed not all dates were completed. The first shift had only 20 days of test strips out of 30 days taped to the sheet; and the second shift had 17 days of test strips out of 30 days of test strips taped to the sheet. The results of the sanitizer test strips were not recorded for the PPM contained in the sanitizer from 06/01/2025 to 06/30/2025. Observation on 06/30/2025 at 11:13 AM of the lunch tray line and food preparations for supper revealed the Cook, positioned near the steam table, wiped the food off from the surface in front of the steam table pan, using a cleaning cloth that was kept on the side table near the steam table and not in the sanitizer bucket after each use. Also, no sanitizer bucket was in view. Observation of the sanitizer bucket with the [NAME] on 07/01/2025 at 8:55 AM revealed she did not know which bucket was the sanitizer. The [NAME] tried both buckets, the green and the red bucket. The sanitizer strip did not show any sanitizer in either bucket. The green bucket had the appearance of water, and the red bucket had soap suds on top of the water. In an interview with the [NAME] on 07/01/2025 at 8:57 AM, she stated she put two pumps of sanitizer in the bucket from the pot and pan sink, and the other bucket contained the dish detergent and water. She stated the cleaning cloth should be kept in the sanitizer bucket between uses to decrease the potential for bacteria to be spread. She stated the test strips for the sanitizer must not be the correct strips. She stated the sanitizer was changed every four hours. Review of the weekly menu spread sheets, dated 02/23/2025 to 07/01/2025, with the Dietary Manager on 07/01/2025 at 8:48 AM, revealed food temperatures were not recorded consistently on the weekly menu spreadsheets. In an interview with the [NAME] on 06/30/2025 at 11:15 AM, she stated she had recorded the food temperatures on the menu in the notebook. In an interview with the Dietary Manager on 07/01/2025 at 8:50 AM and 07/02/2025 at 9:45 AM, she stated the food temperatures were recorded on the menu for the week. However, she stated not all food temperatures were recorded on the weekly menu spreadsheet. She stated the concern for not recording food temperatures would be the potential for cross contamination if the food temperature was not in the safe temperature range. She stated the red bucket contained the sanitizer, and the green bucket contained the detergent with water. She stated the sanitizer was changed every four hours. She stated there was a potential for cross contamination by not using the correct product for cleaning and sanitizing. In an interview with the Director of Nursing on 07/02/2025 at 9:53 AM, she stated food could cause illness if not at the proper temperature, and germs and illness could spread if the cleaning cloth was not kept in the sanitizer bucket. In an interview with the Administrator on 07/02/2025 at 10:14 AM, she stated if the food temperatures were not recorded, it could lead to food safety concerns. She stated she expected staff to follow policy and guidance from the Food and Drug Administration (FDA).

Based on observation, interview, record review, review of a medication package insert, and review of the facility's policy, the facility failed to remove expired medications from 2 of the 2 medication carts and 1 of the 2 medication refrigerators. The findings include: Review of the facility's policy titled, Medication Storage, revised November 2020, revealed discontinued, outdated, or deteriorated drugs or biologicals were returned to the dispensing pharmacy or destroyed. 1. Observation on 08/07/2024 at 11:17 AM of the medication refrigerator in the second-floor medication room revealed a box of Fluzone High Dose influenza vaccine that had an expiration date of 06/2024. The box had contained 10 single-dose prefilled syringes, 0.7 milliliters each. There was one remaining syringe in the box. During interview with Certified Medication Technician (CMT) 3, at the time of the observation, she stated night shift nurses looked for expired medications in the cart. 2. a. Observation on 08/07/2024 at 10:42 AM of the medication cart on the second floor revealed a Proair 90 microgram (mcg) inhaler (albuterol, bronchodilator) that had an expiration date of 01/2024. The inhaler was for Resident (R) 9. There were no other Proair 90 mcg inhalers in the cart for R9. During interview with CMT3, at the time of the observation, she stated night shift nurses looked for expired medications in the cart. She also stated she did not notice the Proair inhaler had expired. b. Observation on 08/07/2024 at 10:44 AM of the medication cart on the second floor revealed an unopened Levemir (insulin) Flexpen in the top drawer for R19 which noted, refrigerate until opened. During interview with CMT3 at the time of the observation, she stated she did not know why it was in the drawer and not in the refrigerator. c. Observation on 08/07/2024 at 11:05 AM of the medication cart on the second floor revealed nystatin and triamcinolone cream (used to treat skin fungal infections) for R23 that had an expiration date of 01/2024. d. Observation on 08/07/2024 at 11:07 AM of the medication cart on the second floor revealed Biofreeze (used to relieve muscle and joint pain) for R3 that had an expiration date of 07/2024. During interview with CMT3 at the time of the observation, she stated the medications would not be effective, and the resident would not have pain relief if she used an expired medication. e. Observation on 08/07/2024 at 11:15 AM of the medication cart on the second floor revealed sugar free cough drops for R44 with an expiration date of of 12/2023. During interview with CMT3 at the time of the observation, she stated these expired cough drops might not be effective, and the resident would not get relief from her cough. 3. a. Observation on 08/07/2024 at 2:15 PM of the medication cart on the third floor revealed the Insulin lispro pen for R33 had an expiration date of 07/03/2024. During interview with CMT3 at the time of observation, she stated the insulin pens expired 30 days after opening. She stated the insulin might not be effective, and the resident could have a high blood glucose if R33 used this insulin. b. Observation on 08/07/2024 at 2:23 PM of the medication cart on the third floor revealed fluticasone nasal spray for R21, date opened 03/27/2024; refill 04/12/2024; and directions, one spray in both nostrils daily. Review of the manufacturer's guidelines (package insert), enclosed in the fluticasone box, revealed each bottle would provide 120 actuations (sprays). Also, it stated the bottle should be discarded after 120 sprays even though the bottle was not completely empty. The bottle should be discarded when the labeled number of actuations had been used. Review of R21's Medication Administration Record revealed R21 received 266 actuations from 03/28/2024 to 08/07/2024. During interview with the Director of Nursing on 08/07/2024 at 3:59 PM, she stated the third shift nurses removed expired and discontinued medications. She stated the night shift nurses either did not do their job or they did not see the expired medications. During interview with the Administrator on 08/07/2024 at 3:57 PM, she stated she expected all nurses to look for expired medications periodically. She stated it was in the night shift job description for staff to remove expired medications. She stated expired medications should not be used.

Based on observation, interview, record review and review of the facility's Policy, it was determined the facility failed to treat each resident with respect, dignity and care and in a manner and in an environment that promoted maintenance or enhancement of his or her quality of life, recognizing each resident's individuality, for one (1) of fourteen (14) sampled residents (Resident #6). Observation during initial tour of second floor on 12/03/19 revealed licensed staff member referring to Resident #6 as sweetheart and honey instead of his/her preferred name during wound care. The findings included: Review of the facility's policy, titled Resident Rights and Dignity, dated as revised on 04/2018, revealed the purpose of the policy was to provide general guidelines for resident rights and ensure each resident was cared for in a manner that promoted and enhanced quality of life, dignity, respect and individuality. Further review of facility policy revealed staff would receive in-service training on resident rights, which included dignity and respect, prior to providing direct resident care. Continued policy review revealed staff would treat residents with dignity and respect at all times, and would speak respectfully to residents during all interactions. Additional review of the facility's policy revealed staff would address residents by his/her name of choice/preference while assisting each resident to maintain and enhance feelings of self-worth and self-esteem. Review of the clinical record revealed the facility admitted Resident #6 on 02/20/17 with diagnoses to include Pressure Ulcer of the Right Heel (Unspecified Stage), Osteomyelitis, Venous Insufficiency (Chronic, Peripheral), Vascular Access Device, Macular Degeneration, Chronic Lymphocytic Leukemia of B-Cell Type (Never Having Achieved Remission), Malignant Neoplasm of Breast, Peripheral Vascular Disease, Pain, Major Depressive Disorder and Anxiety Disorder. Review of the Significant Change Minimum Data Set (MDS) Assessment, dated 11/11/19, revealed the facility assessed Resident #6 as having a Brief Interview for Mental Status (BIMS) score of six (6) out of fifteen (15), which indicated the resident was severely cognitively impaired. Further MDS review, revealed the facility assessed Resident #6 as requiring extensive physical assistance of two (2) for bed mobility, transfers, dressing, toilet use and personal hygiene. Continued MDS review revealed the facility assessed the resident as requiring total physical dependence of two (2) for locomotion on the unit and required extensive physical assistance of one (1) with eating. Additional review revealed the facility assessed Resident #6 as having functional limitation of range of motion to bilateral upper and bilateral lower extremities. The facility assessed Resident #6 as requiring a wheelchair and walker for mobility. Observations of the two-hundred (200)-East Hallway during initial tour, on 12/03/19 at 11:10 AM, revealed Resident #6 was sitting in his/her bedroom in a reclining chair with the bedroom door open. Continued observation revealed Resident #6 was yelling out at Licensed Practical Nurse (LPN) #1, who was positioned at the foot of the resident's reclining chair, in a squatting position. Further observations from resident's doorway revealed LPN #1 wearing gloves, and removing Kerlex dressing from resident's right foot and lower extremity with scissors obtained from a chair located just behind her. Continued observations revealed LPN #1 disposed of the soiled dressings in a plastic bag and placed the bag on a chair behind her next to the opened tube of Venelex cream, clean roll of Kerlex and scissors used to remove the soiled dressings. Further observations revealed LPN #1 obtained the open tube of Venelex cream from the chair, placed a small amount of cream on to her gloved hand and placed the cream on the resident's right foot wound. Additional observations revealed LPN #1, obtained Kerlex roll from the chair and, as Resident #6 continued to shout for LPN #1 to hurry up, LPN #1 wrapped the resident's right foot and lower extremity. LPN #1 then stated to the resident, Sweetheart, I'm sorry that it hurts but, I promise I will hurry and finish soon. Resident #6 did not respond. Further observations revealed LPN #1 removed her soiled gloves and washed her hands after placing the bag of soiled dressings in the resident's garbage. Continued observations revealed the resident continued to make requests of the nurse as she washed her hands. Additional observations revealed LPN #1 stated, I'm washing my hands honey, give me just a minute and I will get you something to drink. Interview with LPN #1, on 12/03/19 at 11:18 AM, revealed she worked the two-hundred (200) East-Hallway from eleven (11) AM to seven (7) PM since August 2019 and routinely provided wound care for Resident #6. Further interview with LPN #1 revealed she had been a nurse for nearly thirty (30) years and had recently received education and training on Resident Rights and Dignity. Continued interview revealed she was unaware of calling Resident #6 honey or sweetheart and stated she should have referred to the resident by his/her preferred name to maintain the resident's dignity. Additional interview with LPN #1 revealed Resident #6 could potentially feel disrespected or humiliated if referred to by any name other than their preferred or given name and she would be sure to use the resident's preferred name in future encounters. Interview with Director of Nursing (DON), on 12/04/19 at 9:20 AM, revealed she was aware of LPN #1's failure to respect Resident #6 prior to the interview and was very disappointed. Further interview with the DON revealed nursing staff had recently received in-service training on Resident Rights and Dignity and the DON was embarrassed by the LPN #1's actions. Further interview with the DON revealed it was her expectation that all staff refer to the residents by their given name or name of preference. Continued interview with the DON revealed staff were never to refer to any of the residents as honey or sweetheart as this could be disrespectful, demeaning, degrading or humiliating. The DON advised she expected all residents to be treated with respect and dignity at all times. Interview with Licensed Nursing Home Administrator (LNHA), on 12/05/19 at 4:42 PM, revealed her expectation was for staff to follow Resident Rights Policy and refer to all residents by their name of choice. Further LNHA interview revealed she expected staff to refer to residents by the name the resident wishes to be referred to when providing the resident care. Continued interview with LNHA revealed she expected staff to always be respectful and polite towards the residents while adhering to facility policy regarding Resident Rights.

Based on observation, interview, record review and review of the facility's Policy, it was determined the facility failed to provide personal privacy during medical treatment and personal care for one (1) of fourteen (14) sampled residents (Resident #6). Observation during initial tour of second floor, on 12/03/19, revealed licensed staff member performing wound care with a resident's bedroom door open, window shades not closed and the resident's lower extremities exposed to other residents, staff and visitors as they passed by the resident's room. The findings included: Review of the facility's policy, titled, Resident Rights: Confidentiality of Information and Personal Privacy, dated as revised on 04/2018, revealed the policy's purpose was to provide staff general guidelines for resident rights while providing direct resident care. Further review of the facility's policy revealed staff would receive in-service training on resident rights, including personal privacy and confidentiality, prior to providing direct resident care. Continued policy review revealed staff would close resident doors and provide for privacy, prior to performing any direct resident care. Additional review of the policy revealed the facility would protect and safeguard resident confidentiality and personal privacy regarding medical treatment, accommodations, and personal care at all times. Review of the clinical record revealed the facility admitted Resident #6 on 02/20/17 with diagnoses to include Pressure Ulcer of the Right Heel (Unspecified Stage), Osteomyelitis, Venous Insufficiency (Chronic, Peripheral), Vascular Access Device, Macular Degeneration, Chronic Lymphocytic Leukemia of B-Cell Type (Never Having Achieved Remission), Malignant Neoplasm of Breast, Peripheral Vascular Disease, Pain, Major Depressive Disorder and Anxiety Disorder. Review of the Significant Change Minimum Data Set (MDS) Assessment, dated 11/11/19, revealed the facility assessed Resident #6 as having a Brief Interview for Mental Status (BIMS) score of six (6) out of fifteen (15), which indicated the resident was severely cognitively impaired. Further MDS review, revealed the facility assessed Resident #6 as requiring extensive physical assistance of two (2) for bed mobility, transfers, dressing, toilet use and personal hygiene. Continued MDS review revealed the facility assessed the resident as requiring total physical dependence of two (2) for locomotion on unit and required extensive physical assistance of one (1) with eating. Additional review revealed the facility assessed Resident #6 as having functional limitation of range of motion to bilateral upper and bilateral lower extremities. The facility assessed Resident #6 as requiring a wheelchair and walker for mobility. Observations of the two-hundred (200)-East Hallway during initial tour, on 12/03/19 at 11:10 AM, revealed Resident #6 in his/her room, with the door open. Continued observation revealed Resident #6 was shouting to Licensed Practical Nurse (LPN) #1 who was positioned at the foot of the resident's recliner chair, in a squatting position. Further observations from resident's doorway revealed LPN #1 removing kerlex dressings from resident's right foot and lower extremity exposing resident's bare leg skin to hallway. Continued observations revealed resident's bedroom window blinds in the open position with the curtains present but not long enough to cover entire windowpane. Interview with LPN #1, on 12/03/19 at 11:18 AM, revealed she worked the two-hundred (200) East-Hallway since August 2019 and routinely provided wound care for Resident #6. Further interview with LPN #1 revealed she had been a nurse for nearly thirty (30) years and had recently received education and training on Resident Rights regarding Privacy and Confidentiality. Continued interview revealed she should have provided privacy for Resident #6 while performing wound care and closed the resident's door and blinds. LPN #1 reported she usually closed the resident doors when providing medical treatments and had no explanation for not doing so. Additional interview with LPN #1 revealed Resident #6 could potentially feel his/her privacy and confidentiality was not protected when other residents, visitors and/or staff not providing care to the resident were aware of medical treatment (wound care) he/she required. LPN #1 added she was aware her actions were in violation of Resident #6's right to personal privacy and confidentiality, as staff were required to remove all residents from public view and prevent exposure of body parts during direct care, including wound care. Interview with Director of Nursing (DON), on 12/04/19 at 9:20 AM, revealed she was aware of the staff's failure to respect Resident #6's right to personal privacy and confidentiality prior to this interview and was very disappointed. Further interview with the DON revealed nursing staff recently received in-service training on Resident Rights and the DON was embarrassed by the violation. Further interview with the DON revealed it was her expectation that all staff close resident doors, privacy curtains (if in a shared room) and window blinds prior to performing any direct resident care. Continued interview with the DON revealed staff were expected to safeguard resident personal and medical information and should never provide direct care in public view or in a location where it could be possible for other residents, facility visitors or staff not assigned to resident could see or otherwise obtain knowledge of the resident's personal or medical care needs. Additional DON interview revealed all residents have the right to privacy and confidentiality for all aspects of care and her expectation was for staff to ensure the resident's rights were protected at all times. Interview with Licensed Nursing Home Administrator (LNHA), on 12/05/19 at 4:42 PM, revealed she expected all staff to follow the facility's Resident Rights Policy and close resident doors, privacy curtains (if in a shared room) and window blinds prior to performing any direct resident care, including wound care. Further interview with LNHA revealed she expected staff to safeguard resident personal and medical information and provide all direct care in a private, discreet location. Continued LNHA interview revealed staff were expected to adhere to facility policy regarding Resident Rights while protecting resident rights to privacy and confidentiality.

Based on observation, interview, record review and review of the facility's Policies, it was determined the facility failed to establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections for one (1) of fourteen (14) sampled residents (Resident #6). Observations on 12/03/19 revealed staff failed to utilize proper hand hygiene and gloving technique during wound care. Additional observations during wound care revealed staff applied a potentially contaminated heel boot on the resident following wound care and failed to handle biohazardous waste in appropriate manner. The findings include: Review of the facility's Policy, titled Handwashing/Hand Hygiene, dated as revised on August 2015, revealed the facility considered hand hygiene the primary means to prevent the spread of infection. Continued review revealed all personnel would be trained and regularly in-serviced on the importance of hand hygiene in preventing the transmission of health-care associated infections. Further policy review revealed staff would follow handwashing/hygiene procedures to help prevent the spread of infections to residents, other staff members and visitors to facility. Additional policy review revealed staff were expected to wash hands before and after direct contact with residents, prior to performing any non-surgical invasive procedure, before gloves, before moving from a contaminated body site to a clean body site during resident care, after contact with blood or bodily fluids, after handling used dressings, contaminated equipment, and after removing gloves. Continued review of facility policy revealed hand hygiene was the final step after removing and disposing of personal protective equipment. Review of the facility's Policy, titled Dry Dressings/Clean, dated as revised on September 2013, revealed the purpose of the procedure was to provide guidelines for the application of clean, dry dressings. Further review revealed staff would establish a clean field of wound care supplies at the resident's bedside table, providing access to affected area, having a plastic bag either taped to the bedside table or utilizing a wastebasket below the table for soiled dressings. Continued policy review revealed staff would wash hands and apply clean gloves prior to the removal of the resident's soiled dressing. Further review revealed staff would remove soiled gloves, wash hands and apply clean gloves prior to the application of a clean dressing, utilizing clean technique. Additional review of the facility's Policy, revealed staff would wash their hands and remove biohazardous waste (soiled dressings) prior to exiting the resident room. Review of the facility's Policy, titled, Infection Control, dated as revised on October 2018, revealed it was the facility's intention to facilitate maintaining a safe, sanitary and comfortable environment and to help prevent and manage transmission of diseases and infections. Further review revealed the facility's infection control policies and practices applied equally to all personnel, consultants, contractors, residents, visitors, volunteer workers, and the general public alike in an effort to prevent, detect, investigate, and control infections in the facility. Review of the facility's Policy, titled Medical Waste, dated as revised on September 2010, revealed the purpose of the policy was to provide definition of and guidelines for safe and appropriate handling of medical waste. Further review revealed medical waste included human blood and blood-soiled articles, contaminated items (ex: soiled dressings), items contaminated with feces from a person diagnosed as having a disease transmitted through feces, and disposable sharps (ex: needles/scalpels). Review of the clinical record revealed the facility admitted Resident #6 on 02/20/17 with diagnoses to include Pressure Ulcer of the Right Heel (Unspecified Stage), Osteomyelitis, Venous Insufficiency (Chronic, Peripheral), Vascular Access Device, Macular Degeneration, Chronic Lymphocytic Leukemia of B-Cell Type (Never Having Achieved Remission), Malignant Neoplasm of Breast, Peripheral Vascular Disease, Pain, Major Depressive Disorder and Anxiety Disorder. Review of the Significant Change Minimum Data Set (MDS) Assessment, dated 11/11/19, revealed the facility assessed Resident #6 as having a Brief Interview for Mental Status (BIMS) score of six (6) out of fifteen (15), which indicated the resident was severely cognitively impaired. Further MDS review, revealed the facility assessed Resident #6 as requiring extensive physical assistance of two (2) for bed mobility, transfers, dressing, toilet use and personal hygiene. Continued MDS review revealed the facility assessed the resident as requiring total physical dependence of two (2) for locomotion on unit and required extensive physical assistance of one (1) with eating. Additional review revealed the facility assessed Resident #6 as having functional limitation of range of motion to bilateral upper and bilateral lower extremities. The facility assessed Resident #6 as requiring a wheelchair and walker for mobility. Review of the electronic clinical record revealed an active Physician's Orders, with a start date of 11/05/19, for off-loading heel lift boots to bilateral lower extremities at all times for skin prevention and healing related to deep tissue injuries. Further review revealed an active order, with a start date of 11/06/19, for Rocephin Solution one (1) Gram to be administered intravenously one time every day for osteomyelitis until 12/13/19. Continued clinical record review revealed an additional active order, with a start date of 11/12/19, for Venelex Cream/Ointment to the left heel deep tissue injury, right outer foot on fifth pinky toe (Stage I), and right inner foot by great toe on bunion (Stage I) every shift until healed. Additional review revealed an active order, dated 11/15/19, for Doxycycline 100mg tablet, to administer one (1) tablet by mouth twice daily for osteomyelitis until 12/13/19. Observations on 12/03/19 at 11:10 AM, revealed Resident #6 sitting in a recliner, in the bedroom with the door open with Licensed Practical Nurse (LPN) #1 positioned in the floor, at the foot of the resident's chair, in a squatting position. Further observations revealed LPN #1 wearing gloves, removing kerlex dressing from the resident's right foot and lower extremity with scissors obtained from second chair that was located behind her. Continued observations revealed LPN #1 disposed of the soiled dressings in a clear plastic bag placing the bag on a chair behind her, sitting it next to an opened tube of Venelex cream, an opened roll of kerlex wrap and scissors used to remove the resident's soiled dressings. Further observations revealed LPN #1 obtained the open tube of Venelex cream from chair, placed a small amount of cream on to her gloved hand and placed the cream on the resident's right heel wound. Additional observations revealed LPN #1, obtained the kerlex wrap from the chair and wrapped the resident's right foot and lower extremity. LPN #1 picked up the heel lift boot from the floor beneath the foot of the recliner chair the resident was sitting in and placed it on Resident #6's right foot. Further observations revealed LPN #1 placed a bag of soiled dressings in to the resident's garbage receptacle located beneath the sink. Continued observations revealed LPN #1 removed her soiled gloves and washed her hands, leaving the plastic bag of soiled dressings in the resident garbage can. Additional observations revealed LPN #1 dried her hands and walked over to speak with Resident #6 as he/she requested a drink. Further observations revealed LPN #1 drying her hands over the resident's head as she spoke with the resident. Continued observations revealed LPN #1 assisted Resident #6 with a drink of juice from a spouted cup and the exited the room without washing or sanitizing hands or removing the biohazardous waste from the resident's garbage receptacle. Interview with LPN #1, on 12/03/19 at 11:18 AM, revealed she worked the two-hundred (200) East-Hallway, unit on which Resident #6 resided, since August 2019, and routinely provided wound care for Resident #6. Further interview with LPN #1 revealed she had been a nurse for nearly thirty (30) years and was familiar with the facility's policy and practices regarding Infection Control and Standard Precautions. Continued interview revealed she should have set up a clean field of treatment supplies at the resident's bedside prior to providing wound care to ensure she performed a clean technique. LPN #1 advised she should have removed her gloves, washed her hands and applied clean gloves following removal of Resident #6 soiled dressing and prior to application of Venelex cream. LPN #1 advised she should have utilized a cotton-tipped swab for application of Venelex cream to the wound bed to prevent potential cross contamination from the gloves to the wound or from the resident's wound to her gloved hand. LPN #1 stated this was an infection control issue that she was aware of and stated, she had no explanation for her actions. Further interview revealed LPN #1 should have placed the resident's heel lift boot on his/her chair or in the resident's lap during wound care and never on the floor due to the potential for infection to the resident's wound by cross contamination from anything that could be living on the floor. Additional interview revealed LPN #1 should have removed the bag of soiled dressings from Resident #6 room and disposed of it in the biohazardous waste container located in the dirty utility room as per facility policy. LPN #1stated she did not recall drying her hands above the resident but reported this was an infection control concern due to the potential for cross contamination as well. Continued interview revealed LPN #1 should have washed her hands again prior to exiting Resident #6 room to prevent the potential spread of bacteria, germs, or other microorganisms to other staff members, residents, and visitors to facility. Interview with Staff Development Coordinator (SDC), on 12/05/19 at 2:53 PM, revealed she was responsible for providing educational material to licensed and certified staff members, which included training on Handwashing/Hand Hygiene, Infection Control and Wound Care. Further interview revealed the SDC was responsible for ensuring staff competency for providing care and services for residents. Continued interview with the SDC revealed LPN #1 had received education and training during orientation to the facility on Handwashing/Hand Hygiene, Infection Control and appropriate handling and disposal of Medical Waste. Additional interview revealed LPN #1 should have set up a clean field of wound care supplies, utilizing the resident's bedside table before providing wound care to ensure her supplies remained clean as she performed a clean technique. SDC advised LPN #1 should have washed her hands and applied clean gloves following removal of the resident's soiled dressing to prevent cross contamination of bacteria or other microorganisms from the resident's wound to her hands or from LPN #1's hands to the resident's wound. Further, the SDC interview revealed LPN #1 should have applied Venelex cream utilizing a clean cotton-tipped swab applicator to prevent the spread of germs/bacteria from her gloved hand to the resident's wound or from the resident's wound to her gloved hand. SDC advised LPN #1 should not take entire tube of cream to a resident's room and then place it back in to the treatment cart, as this was an infection control concern as well. SDC advised LPN #1 should have taken the amount of cream needed in a medication cup to the resident's room at the time of the treatment. SDC advised it was not appropriate to use gloved hands to apply cream to a staged wound bed. Continued interview with the SDC revealed LPN #1 should have removed her soiled gloves, washed her hands and applied clean gloves prior to placing Resident #6's heel lift boot to the right lower extremity. SDC stated it was not appropriate to place a heel lift boot on a resident after it had been on the floor as there was a potential for cross contamination from germs; bacteria and other microorganisms on the floor and could infect the open wound bed and cause severe infection. Further interview with SDC revealed LPN #1 should have elevated Resident #6's right lower extremity until she could retrieve a new heel lift boot. Additional SDC interview revealed LPN #1 should have removed the bag of soiled dressings (medical waste) from Resident #6's room and disposed of it in the biohazardous waste container located in the dirty utility room as per the facility's policy as this was an infection control concern and could potentially spread illness throughout the facility. SDC explained LPN #1 should have been aware of this information. Further interview revealed LPN #1 should have washed her hands prior to exiting Resident #6's room to prevent the potential spread of illness to other residents, staff and visitors to facility. Interview with Infection Control and Prevention Registered Nurse (ICP), on 12/05/19 at 3:38 PM, revealed she was responsible for ensuring staff received proper education and training regarding facility policies and practices regarding infection control and prevention. Further interview revealed LPN #1 should have set up a clean field at the resident's bedside prior to care on 12/03/19 to decrease the risk of potential cross contamination of bacteria and other microorganisms into Resident #6's wound. Continued interview revealed LPN #1 should have removed soiled gloves, washed hands and applied clean gloves prior to applying Venelex cream to the resident's wound. Additional ICP interview revealed LPN #1 should not apply cream to the wound bed with soiled gloves and should have used a cotton-tipped swab or other available treatment product such as a four (4) x (4) gauze pad to apply the cream. ICP advised utilizing proper procedure would assist to decrease the risk of potential cross contamination of bacteria and other germs to the wound or from the wound to LPN #1's gloved hand. Further ICP interview revealed following application of Venelex cream, LPN #1 should have removed the gloves, washed hands and applied clean gloves before application of kerlex wrap and heel lift boot to right lower extremity. Continued interview with ICP revealed LPN #1 should not place a heel lift boot from the floor onto a resident as this was an infection control issue and could cause germs and other bacteria from the floor to enter the resident's wound. ICP revealed LPN #1 should have elevated Resident #6 right lower extremity and retrieved a new heel lift boot. Further interview revealed LPN #1 should have washed her hands prior to exiting Resident #6 room and disposed of the soiled dressing (medical waste) in the dirty utility room in a biohazardous waste container as per the facility's policy to decrease the risk of cross contamination and potential illness/infection of other residents, staff and/or visitors to facility. Interview with Director of Nursing (DON), on 12/04/19 at 4:38 PM, revealed LPN #1 should have washed hands, applied gloves and set up a clean field of treatment supplies at the resident's bedside, as per the facility's policy prior to wound care on 12/03/19. The DON advised it was not appropriate to utilize a resident's personal chair as a supply field during delivery of wound care. Further interview revealed LPN #1 was familiar with Resident #6's treatment to the lower extremity and should have obtained the amount of Venelex cream needed from the tube, placed it in medication cup and placed it within the field of treatment supplies. Continued DON interview revealed LPN #1 should have removed her soiled gloves, washed her hands and applied clean gloves prior to the application of Venelex cream to the wound bed. The DON reported LPN #1 should have applied Venelex cream to the wound bed utilizing a cotton-tipped swab, to prevent potential cross contamination of germs, bacteria or other microorganisms from her soiled gloves to the resident's wound or from the resident's wound to LPN #1's gloved hand. Additional interview revealed LPN #1 should have removed her gloves, washed her hands and applied clean gloves prior to the application of kerlex wrap and repeated the process prior to the application of the heel lift boot to the resident's foot. Further DON interview revealed LPN #1 should have elevated Resident #6's right lower extremity and obtained new heel lift boot. The DON stated LPN #1 should not have placed a heel lift boot on the resident after it had been on the floor and this was an infection control concern as bacteria, microorganisms and other germs from urine, feces, blood and other body fluids could be on the floor and a potential for cross contamination into the resident's wound. Continued interview with the DON revealed LPN #1 should have removed gloves and washed hands prior to exiting the resident's room to prevent other residents, staff and visitors to facility from becoming ill due to the potential for cross contamination of germs or other microorganisms. Additionally, the DON revealed LPN #1 should have dried her hands completely prior to walking over to assist Resident #6. The DON stated drying hands above a resident could potentially cause cross contamination of germs and/or bacteria from LPN #1's hands to Resident #6 if the hands were not yet thoroughly dried, which could cause illness in resident. Further interview revealed LPN #1 should have removed the soiled dressing from the resident's room and disposed of it in the dirty utility room as this was biohazardous waste and should have been handled and disposed of properly and per the facility's policy. Interview with Licensed Nursing Home Administrator (LNHA), on 12/05/19 at 4:42 PM, revealed she expected staff to adhere to facility policies regarding Handwashing and Hand Hygiene, Clean/Dry Dressings and Infection Control during delivery of resident care. Further LNHA interview revealed she expected staff to wash hands prior to and following delivery of direct resident care to prevent the spread of germs/bacteria and potential illness and/or infection throughout the facility. Continued interview revealed LNHA would expect staff to remove soiled gloves, wash hands and apply clean gloves following removal of any wound dressing to prevent the spread of microorganisms, bacteria and other germs to the resident's wound or from the resident's wound to staff. Additional interview with LNHA revealed she expected staff would not place item obtained from the floor onto a resident's extremity as the item would most likely be contaminated and could potentially cause illness or infection in a resident. Further interview revealed LNHA expected staff would remove medical waste from a resident's room following the delivery of care and would dispose of the waste properly in a biohazardous waste container to decrease the likelihood of cross-contamination, which could cause illness or infection to other residents, staff, or visitors to her facility.