Based on observation, staff interview, record review, and facility policy review the facility failed to prevent the possible spread of infection as evidenced by placing a pulse oximeter in a nurse's uniform pocket during a medication pass for one (1) of three (3) nebulizer treatments observed. Resident #31 Findings include: Record review of the facility policy titled, Cleaning and Disinfection of Resident Care Equipment, undated, revealed Policy: Resident care equipment can be a source of indirect transmission of pathogens. Reusable resident-care equipment will be cleaned and disinfected in accordance with current Centers for Disease Control and Prevention (CDC) recommendations in order to break the chain of infection . An observation, during medication pass, on 2/7/24 at 8:40 AM, revealed Licensed Practical Nurse (LPN) #1 administered a nebulizer treatment to Resident #31. LPN #1 entered Resident #31's room with medications on a tray. She placed the tray on the over bed table and then removed a pulse oximeter from her uniform pocket and checked the resident's oxygen saturation level and pulse. She then removed the oximeter and placed it back in her uniform pocket. She removed the meter from her pocket and rechecked the oxygen saturation when the nebulizer treatment was complete. She put the pulse oximeter back in her pocket and continued with her medication pass. LPN #1 did not clean the pulse oximeter before or after use on the resident. Upon return to the medication cart, LPN #1 cleaned the medication tray and placed it back in the cart but left the pulse oximeter in her pocket. A telephone interview on 02/08/24 at 8:50 AM, with LPN #1 confirmed the pulse oximeter was in her pocket. She stated that she keeps it in her pocket until she gets in the room. When asked by the surveyor if that could cause any problems, she stated it could if her pockets were dirty. She stated she remembered gloves should not be in your pockets, but she didn't think about the pulse oximeter. She stated that could pass germs to the resident. An interview, with LPN #2 on 02/08/24 at 08:56 AM, revealed that she cleans the pulse oximeter at the beginning of her shift and then cleans it between each resident. She stated that she never puts it in her pocket because they are dirty and would contaminate it. An interview, on 02/08/24 at 09:07 AM with the Director of Nursing (DON) stated the pulse oximeter should be cleaned and ready for use at the beginning of the shift and cleaned again when staff exit the resident's room after use and stored on the cart. It should not be in the staff's pocket at anytime. Record review of the Physician Orders List for Resident #31 revealed an order date of 2/1/14 under Special Requirements with Brief Instructions: . Document O2 (oxygen) Sat (saturation) before and after respiratory treatment . Review of the In-service Form dated 11/06/23, titled Weekly Infection Control-Nurses and CNA's revealed .Maintain clean and operable equipment and to prevent growth and spread of bacteria in our facility . Review of the list of attendees revealed LPN #1 attended the in-service. Review of the in-service form dated 11/06/23, titled Weekly Infection Control-Nurses and CNA's revealed it's purpose was to maintain clean and operable equipment and to prevent growth and spread of bacteria in the facility. Review of the list of attendees revealed LPN #1 attended the in-service. Review of the facility Face Sheet for Resident #31 revealed an admission date of 10/25/2019 with diagnoses that included Chronic Obstructive Pulmonary Disease. Review of the quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 1/8/24 revealed a Brief Interview for Mental Status (BIMS) score of 15 which indicated Resident #31 was cognitively intact.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, and record review, the facility failed to provide a safe homelike environment in resident rooms as evidenced by furniture being in poor condition observed on one (1) of three (3) halls during the survey. Findings include: Record review of a statement on facility letterhead, undated and signed by the facility Administrator revealed (Proper Name of Facility) does not have a written policy at this time on environmental cleanliness or maintenance of the environment fixtures within the facility that would support providing a homelike environment. An observation, on 2/6/24 at 1:15 PM, revealed the bedside tables, dresser, and closet doors were scuffed and in poor condition in room [ROOM NUMBER]. The furniture was medium brown in color. The edges of the top of the A bedside tables were worn to a a light beige color and had rough areas. The B bedside table corner was rough with tiny splinters and the drawer pull for the top drawer was missing. The closet doors had numerous areas where varnish was scuffed off and the lower edge of the closet doors had an area that measured two (2) feet from the bottom that had rough gouges. The dresser in the room had numerous 1 to 3 inch scuffs and scrapes over it. An observation and interview, on 2/7/24 at 12:20 PM, with Certified Nursing Assistant (CNA) #1 confirmed the rough edges on the bedside table. She stated that the rough edges could cause an abrasion or someone could get a splinter from it. An observation and interview on 2/7/24 at 3:15 PM, with the Administrator (ADM) confirmed the condition of the furniture and stated that all of the furniture in the building needed to be replaced to provide the residents with a nice and safe homelike environment. An interview, on 2/8/24 at 10:30 AM, with the ADM revealed the facility did not a have a policy at this time on environmental cleanliness or maintenance of environmental fixtures within the facility that would support providing a homelike environment and provided a statement reflecting there was not a policy for environmental cleanliness.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interview, record review, and facility policy review, the facility failed to develop a comprehensive care plan for Resident #2 and #36 for Foley Catheter and Resident #26 for Urinary Tract Infection (UTI); three (3) of 19 care plans reviewed. Findings Include: Review of the facility's policy, Care Plans, last updated 3/28/18, revealed: Each resident will have a person-centered plan of care to identify problems, needs and strengths that will identify how the interdisciplinary team will provide care. Resident #26 Review of Resident #26's medical record revealed the Resident was admitted to the hospital on [DATE], with a Urinary Tract Infection (UTI) and returned to the facility on 9/24/19. There was no evidence to indicate a care plan was developed upon her return from the hospital for the new diagnosis of UTI. On 11/14/19 at 11:07 AM an interview with the Director of Nursing (DON) revealed she was not here during that time and the MDS Nurse was new and was in orientation. On 11/14/19 at 11:08 AM, an interview with the Administrator revealed the DON at the time was responsible for developing new care plans. The Administrator stated the facility has always brought new orders to the stand up meeting daily, but will now start updating and developing care plans during the stand up meeting. The Administrator stated development of care plans and updating care plans has been a problem, and will be monitored during stand up meetings. Resident #36 A review of Resident #36's medical record revealed she was admitted to the facility on [DATE], with a Foley catheter. Review of Resident #36's current care plan revealed the facility failed to develop a care plan related to the Foley catheter. On 11/13/19 at 2:40 PM, an interview with the DON revealed the resident was admitted on [DATE], with the Foley catheter due to Urinary Retention and staff failed to care plan the Foley catheter. During an interview on 11/13/19 at 2:47 PM, the Minimum Data Set (MDS) Coordinator stated upon admission, she assesses the resident and care plans any problem areas. The MDS Coordinator stated she failed to recognize the Resident had a Foley catheter and did not care plan the catheter. K. [NAME] Resident #2 On 11/13/19 at 2:00 PM, observation revealed Resident #2 had a Foley catheter. Record reveal revealed Resident #2 had a Foley Catheter inserted on 02/13/19, and the resident had a physician's order dated 02/13/19, to change the Foley catheter and irrigate with 50 milliliters (ml) of normal saline as needed. Review of Resident #2's current care plan revealed the resident did not have a care plan to monitor the care of the Foley catheter. Review of the quarterly Minimum Data Set (MDS), with an Assessment Reference Date (ARD), dated 08/05/19, revealed the resident had a catheter, but the facility failed to develop a care plan. An interview with the Director of Nursing (DON) on 11/13/19 at 2:20 PM, confirmed the resident did not have a care plan for the Foley catheter and stated, I guess it just got over looked and no one developed a care plan. During an interview with the MDS Nurse on 11/13/19 at 2:40 PM, she stated she had began the MDS position in September. She reviewed the record and stated she did not find a care plan for the Foley catheter for Resident #2 and stated, We will have to add a care plan for the catheter right away. The DON and the MDS Nurse both confirmed, during their respective interviews, that they have weekly high risk meetings and discuss residents with catheters, but they did not check to verify the resident had a care plan for the Foley catheter during those meetings. They confirmed that the only time they evaluated for a care plan is during the quarterly or annual MDS assessments.