**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to apply and/or document refusals of a palm protector for one resident (R82) out of one reviewed for range of motion, resulting in the potential for contractures and/or delay in treatment. Findings include: On 1/30/2023 at 9:55 AM, an interview was conducted with R82 regarding their stay in the facility. R82 stated that they enjoyed being in the facility, however they would like their therapy to be a little more intense. R82 stated that they would like to work more on their hands and sitting up. Nothing was noted on R82's hands. A review of the medical record revealed that R82 admitted into the facility on 8/23/2022 with the following diagnoses, Muscle Wasting and Atrophy and Unspecified Injury at Unspecified Level of Cervical Spinal Cord. A review of the most recent Minimum Data Set assessment dated [DATE] revealed a Brief Interview for Mental Status score of 13/15 indicating an intact cognition. R82 also required total two-person assistance with bed mobility and transfers. A review of the physician orders noted the following, Order: Remove Palm Protectors and evaluate skin integrity of bilateral hands, replace palm protectors, notify provider of any skin issues. Directions: Every Evening Shift. Status: Active. Start Date:9/7/2022 15:00 (3:00 PM). Further review of the Treatment Administration Record for the month of January did not reveal any refusals of palm protector application. A review of the task noted the following, Wash bilateral hands, ensure care between fingers, dry thoroughly and replace palm protectors. Notify Nurse of any skin issues observed. Further review of the task list for the last thirty days did not reveal any refusals of palm protector application. On 1/31/2023 at 9:41 AM, R82 was observed in the bed with no palm protectors on. R82 stated that they have not worn them 'in a while' and that no one has tried to put them on. R82 stated that sometimes they will use a towel because the current splint they have is uncomfortable. On 1/31/2023 at 10:32 AM, an interview was conducted with Therapy A regarding R82 not being observed wearing palm protectors. Therapy A stated that R82 refused them all the time and Occupational Therapy (OT) has tried three different type of hand splints. Therapy A stated that they have asked the nursing staff to be sure they document refusals. On 1/31/2023 at 12:54 PM, an interview was conducted with the Director of Nursing (DON) regarding R82's palm protectors. The DON stated that their expectation is that if R82 is in fact refusing to wear the palm protectors then that should be documented in the medical record. A review of a facility policy titled, Assistive Devices and Equipment noted the following, Policy: The home maintains and supervises the use of assistive devices and equipment for members.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to don a gown for a contact precaution room for one resident (R82) out of one reviewed for isolation precautions, resulting in the potential for the spread of infection. Findings include: A review of the medical record revealed that R82 admitted into the facility on 8/23/2022 with the following diagnoses, Muscle Wasting and Atrophy and Unspecified Injury at Unspecified Level of Cervical Spinal Cord. A review of the most recent Minimum Data Set (MDS) assessment dated [DATE] revealed a Brief Interview for Mental Status score of 13/15 indicating an intact cognition. R82 also required total two-person assistance with bed mobility and transfers. A review of the physician orders noted the following, Order: Contact Precautions r/t (related to)continuing symptoms of ESBL(infection resistant to antibiotics)-post contact precautions sign outside the room and ensure visible (not on door)-PPE cart outside room with donning (putting on) sign-minimum of touchless trash can inside room with doffing (removal of) sign (may choose to use 3 bin cart .Status: Active. On 1/31/2023 at 9:40 AM, A contact precautions sign was observed in front of the room, as well as a Personal Protective Equipment (PPE) bin. On 1/31/2023 at 9:41 AM, Certified Nursing Assistant (CNA) D was observed at R82's bedside with gloves and no gown on. R82 stated that they were being cleaned up. On 1/31/2023 at 11:54 AM, an interview was conducted with Infection Control Preventionist (ICP) C regarding the observation. ICP C stated that if they are changing R82's (name of catheter) catheter then they should be wearing a gown, gloves, and goggles. ICP C stated that if they are going in to give care, they should be wearing a gown and gloves. A review of a facility policy titled, Isolation Precautions noted the following, Contact precautions are measures that are intended to prevent transmission of infectious agents, including epidemiologically important microorganisms, which are spread by direct or indirect contact with the member or the member's environment.