**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, it has been determined that the facility failed to ensure that each resident receives assistive devices to prevent accidents relative to the placement of a TekTone device (a device that allows at-risk residents to move freely about a facility, while preventing them from exiting the facility) for 1 of 1 resident who successfully eloped from the facility and sustained a major injury, Resident ID #1. Findings are as follows: Review of the facility policy titled Elopement Assessment dated 10/27/2022 states in part, .It is the facility policy to maintain a safe and secure environment for all residents. In order to achieve this goal residents who are at risk for wandering/elopement need to be identified and a care plan developed with interventions to minimize or eliminate the risk as outlined below .Residents who are at risk for elopement include those with dementia, confusion .may warrant close watching .if the resident is assessed to be at risk for elopement, then the necessary and appropriate intervention must be put in place immediately to keep the resident safe i.e , wander guard bracelet, frequent checks, etc . Review of an additional facility's policy titled Wanderguard [TekTone device] System and Assessments Checks dated 2/7/2025 states in part, .The bracelet will be checked each shift to assure placement, the nurse will sign this as checked in the treatment record . Record review of a facility reported incident sent to the Rhode Island Department on Health on 6/16/2025 revealed that Resident ID #1 was found in the rear parking lot of the facility by a staff on the overnight shift on 6/12/2025. S/he was noted to have a large hematoma above the left eye and his/her left leg was externally rotated and s/he complained of pain. S/he was tranferred to an acute care hospital where s/he was diagnosed with a left hip fracture. Record review revealed Resident ID #1 was admitted to the facility's semi-secure unit in March of 2022 and readmitted in April of 2025 with diagnoses including, but not limited to, altered mental status, cognitive communication deficit, insomnia, and muscle weakness. Review of the Quarterly Minimum Data Set (MDS) assessment dated [DATE] revealed the resident scored a 6 out of 15 on his/her Brief Interview for Mental Status (BIMS) assessment, indicating severe cognitive impairment. Record review of a care plan dated 6/9/2025 revealed the resident is at risk for wandering and elopement related to diagnoses of dementia and cognitive decline with a goal for the resident to remain on the unit at all times unless leaving with staff or family. Staff interventions include but are not limited to, Frequent visual checks .Redirect away from exits .Engage in activities if applicable . Record review of a physician's order dated 4/17/2025 revealed to check the placement of the TekTone elopement prevention bracelet every shift. Further review revealed that the frequency of this order was transcribed incorrectly. The order was transcribed to be completed once daily on Mondays, indicating that the placement would be checked one time a week and not every shift as ordered by the physician. Review of the resident's MDS Assessments Summary dated 4/18/2025 section P Restraints and Alarms failed to reveal evidence that the resident was coded as having a TekTone elopement prevention bracelet in place. Review of the June 2025 Treatment Administration Record revealed the resident's TekTone bracelet was last checked on 6/9/2025 during the 11:00 PM to 7:00 AM shift, which was three days prior to the elopement incident on 6/12/2025 night. Record review of a progress note dated 6/13/2025 at 1:36 AM authored by Registered Nurse, Staff A, revealed that the resident was found by staff in the rear parking lot at approximately 11:15 PM lying on the ground. The TekTone monitoring device was not located on the resident. The resident was alert and confused, with a large hematoma (a collection of blood outside of a blood vessel, often caused by injury) above his/her left eye, his/her left leg was noted to be externally rotated and s/he was complaining of pain. Further record review revealed the resident was transferred to an acute care hospital and was diagnosed with a left hip fracture. Review of a physician's order dated 4/23/2025 revealed that the resident is to receive the following medications at bedtime every day: - Melatonin 5 MG (milligrams) for insomnia - Trazodone 12.5 MG for insomnia - Eliquis 2.5 MG for blood clot - Tylenol 1000 MG for pain - Omeprazole 40 MG for stomach ulcer or heart burn - Latanoprost eye drops 0.005% for glaucoma - Methenamine hippurate 1 gram for urinary tract infections prevention. Review of the June 2025 Medication Administration Record failed to reveal evidence that the above-mentioned bedtime medications were signed off as administered on 6/12/2025 before his/her elopement incident. During a surveyor interview on 6/18/2025 at 1:26 PM with Staff A, he indicated that the resident's bedtime medications were not administered because s/he wasn't in his/her room at 11:15 PM at the time of the administration. When Staff A was asked as to why he waited until 11:15 PM to give the resident his/her bedtime medications, he indicated that it was a busy night and that he had not see the resident from the start of his shift (9:00 PM) until s/he was found outside of the facility. Additionally, Staff A, revealed that the resident did not have a TekTone elopement prevention device on when s/he was found on the ground outside of the facility on the night of 6/12/2025. During a surveyor interview with Nursing Assistant (NA), Staff B, on 6/18/2025 at 3:22 PM, he stated that he had last seen the resident in his/her room at approximately 10:30 PM during the rounds on the evening of 6/12/2025. Additionally, Staff B stated that he was unable to recall if the resident had a Tektone monitoring device on him/her during evening rounds. During a surveyor interview with NA, Staff C, on 6/20/2025 at 4:24 PM, he revealed that on 6/12/2025 at approximately 11:40 PM, he was routinely checking the outside of the facility when he saw something on the ground behind the kitchen. However, he thought it was a trash bag that was left out by staff. He indicated that when he got closer, he observed Resident ID #1 laying on the ground, calling for help. Further, Staff C revealed that he ran back into the building to alert the staff on Resident ID #1s unit that s/he was outside. This indicates that approximately 1 hour and 10 minutes had passed since s/he was last seen by staff in the facility. During a surveyor interview on 6/18/2025 at 12:03 PM with Director of Nursing Service, she indicated that she was unsure which door the resident exited the facility from. She indicated that the resident may have exited the building from the exit door closest to his/her room. Additionally, she revealed that all exit doors would have locked if the resident had been wearing a TekTone device. Furthermore, she acknowledged that the resident did not have a TekTone device on when s/he was found on the ground outside of the facility on 6/12/2025 at 11:15 PM. Lastly, she was unable to provide evidence that the facility's policy to check the TekTone device each shift to assure placement was followed. During a surveyor interview on 6/23/2025 at approximately 1:00 PM with the Nurse Practitioner, she revealed that two weeks prior to the elopement, it was reported to her that the resident had taken off the Tektone bracelet. Additionally, she indicated that she would have expected the staff to frequently check the TekTone elopement bracelet every shift daily for the safety of the resident. The facility's failures to follow their policy to ensure placement of the TekTone device every shift, and correctly transcribe the physician's order to verify the placement of a TekTone bracelet three times daily, resulted in a cognitively impaired resident who was identified as a wander risk, not having a TekTone device in place. Because the assistive device was not in place, s/he was able to exit the facility through unlocked doors (that would have locked if s/he had been wearing a TekTone device), placing him/her at risk for more than minimal harm, impairment, or death. Cross reference F 842.

Based on record review and staff interview, it has been determined that the facility failed to ensure that resident records are complete and accurately documented, relative to the monitoring of an elopement prevention device, a TekTone device (a device that allows at-risk residents to move freely about a facility, while preventing them from exiting the facility), for 1 of 1 resident reviewed who eloped from the facility and sustained a hip fracture, Resident ID #1. Findings are as follows: Review of a facility's policy titled Wanderguard [TekTone device] System and Assessments checks states in part .The bracelet will be checked each shift to assure placement, the nurse will sign this as checked in the treatment record . Record review of a facility reported incident submitted to the Rhode Island Department on Health on 6/16/2025 revealed that Resident ID #1 was found in the rear parking lot of the facility by a staff on the overnight shift on 6/12/2025. S/he was noted to have a large hematoma above the left eye, his/her left leg was externally rotated and s/he complained of pain. Record review revealed the resident was admitted to a semi-secured unit of the facility in March of 2022 and readmitted in April of 2025 with diagnoses including, but not limited to, altered mental status, cognitive communication deficit, muscle weakness, and insomnia. Review of the Quarterly Minimum Data Set Assessment revealed the resident scored a 6 out of 15 on his/her Brief Interview for Mental Status assessment, indicating severe cognitive impairment. Record review of a care plan dated 6/9/2025 revealed the resident is at risk for wandering and elopement related to diagnoses of dementia and cognitive decline with a goal for the resident to remain on the unit at all times unless leaving with staff or family. Staff interventions include but are not limited to, Frequent visual checks .Redirect away from exits .Engage in activities if applicable . Record review of a physician's order dated 4/17/2025 revealed to check the placement of the TekTone elopement prevention bracelet every shift. Further review revealed that the frequency of this order was transcribed incorrectly. The order was transcribed to be completed once daily on Mondays, indicating that the placement would be checked one time a week and not every shift as ordered by the physician. Record review of the June 2025 Treatment Administration Record revealed the placement of the TekTone device was last checked on 6/9/2025 on the 11:00 PM to 7:00 AM shift which was 3 days prior to the resident's elopement on 6/12/2025. Record review failed to reveal evidence that the resident's TekTone device was being checked every shift as ordered since it was last checked on 6/9/2025. Record review of a progress note dated 6/13/2025 at 1:36 AM authored by Registered Nurse, Staff A, revealed that the resident was found by staff in the rear parking lot at approximately 11:15 PM lying on the ground. The TekTone monitoring device was not located on the resident. The resident was alert and confused, with a large hematoma (a collection of blood outside of a blood vessel, often caused by injury) above his/her left eye, his/her left leg was noted to be externally rotated and s/he was complaining of pain. Further record review revealed the resident was transferred to an acute care hospital and was diagnosed with a left hip fracture. During a surveyor interview on 6/18/2025 at 1:26 PM with Registered Nurse, Staff A, he revealed that the resident didn't have the TekTone elopement prevention device on when s/he was found on the ground outside of the facility on the night of 6/12/2025. During a surveyor interview with Nursing Assistant, Staff A, on 6/18/2025 at 3:22 PM he stated that he was unable to recall if the resident had a TekTone monitoring device on him/her on the last round during the evening shift of 6/12/2025. During a surveyor interview with the Director of Nursing Services, on 6/18/2025 at approximately 3:30 PM, she revealed that the order dated 4/17/2025 was transcribed in error, and the TekTone monitoring device should have been checked for placement every shift, every day. During a surveyor interview on 6/23/2025 at approximately 1:00 PM with the Nurse Practitioner, she revealed that two weeks prior to the resident's elopement, it was reported that the resident had taken off the TekTone elopement prevention device. Additionally, she indicated that she would have expected the staff to follow the physician order which is to check the device placement daily on every shift for the safety of the resident. Due to the facility's failure to accurately transcribe and implement a physician's order regarding the monitoring the placement of the TekTone device, a cognitively impaired resident-identified as a known wander risk, exited the facility, fell and sustained a hip fracture. This failure placed the resident at risk for more than minimal harm, impairment, or death. Cross reference F689

Based on record review and staff interview if has been determined that the facility failed to provide treatment and care in accordance with professional standards of practice and failed to promptly identify and intervene during an acute change in a resident's condition, related to vomiting and an unknown cardiac event for 1 of 1 resident reviewed, Resident ID #38. Findings are as follows: Review of a facility policy titled, Resident Change in Condition dated 10/17/2023 states in part, .Changes in condition require assessment by the RN [registered nurse] and notification to the MD [Medical Doctor] (both to be done timely). Timely depends upon the level/severity of the change and RN should use professional assessment and judgement to make that decision. Timely is certainly no later than the shift of the change . Record review of a closed record revealed that Resident ID #38, was admitted to the facility in July of 2020 with diagnoses including, but not limited to, vascular dementia and nontraumatic intracerebral hemorrhage (emergency condition in which a blood vessel in the brain ruptures and causes bleeding inside the brain). Review of the progress notes revealed the following: 2/9/2024 at 9:39 PM - Yelling out for assist. 1 episode of vomiting. Vitals stable, taking fluids well. Rapid covid negative. 2/10/2024 at 6:20 AM - Reported from previous shift res [resident] had diarrhea and vomiting previous shift. Res vomited large amount of undigested food x 3. No further diarrhea. Res pale, tired. HOB [head of bed] elevated. Repositioned to side. Call light within reach. Frequent checks 2/10/2024 at 8:21 AM - PT [patient] found unresponsive [at] 7:43am, prior to unresponsive pt was alert, talking and able to make needs known, no complaints. unable to find pulse at that time, CPR [cardiopulmonary resuscitation] started and 911 was called at 7:47am. 911 in and CPR continued, pt is being transferred to [hospital] . Review of the emergency room documentation dated 2/10/2024 at 8:47 AM revealed that the resident had been transferred to the hospital by Emergency Medical Services (EMS) after being found unresponsive and CPR being administered. Additionally, it revealed that when EMS initially assessed the resident s/he was found to be in ventricular fibrillation (life threatening heart rhythm that results in a rapid, inadequate heartbeat). Further review revealed that due to the resident remaining in persistent asystole (heart stops pumping) in the setting of an unwitnessed cardiac arrest, resuscitation efforts were terminated and the resident was declared dead at 8:36 AM. Record review failed to reveal evidence of an assessment completed to include complete vital signs on 2/9/2024 during the 3:00 PM to 11:00 PM shift although the resident had vomited. Further review failed to reveal evidence that a doctor had been notified of the resident's vomiting. During a surveyor interview on 3/21/2024 at 11:45 AM with the Director of Nursing Services (DNS), she acknowledged that she was the nurse on duty on 2/9/2024 during the 3:00 PM to 11:00 PM shift. Additionally, she revealed that she did obtain the residents vital signs however, she did not document them. The DNS further acknowledged that she did not complete a full assessment and did not report the resident vomiting to the physician. Additional record review failed to reveal evidence of an assessment completed to include complete vital signs on 2/10/2024 during the 11:00 PM to 7:00 AM shift although the resident had vomited 3 times and appeared pale and tired. Further review failed to reveal evidence that a doctor had been notified of the residents change in condition. During a surveyor interview on 3/21/2024 at 3:10 PM with RN, Staff A, she revealed that she was the nurse on the 11:00 PM to 7:00 AM shift on 2/10/2024. Additionally, she revealed that the resident was uncomfortable on her shift and was vomiting. Staff A acknowledged that she did not complete a full assessment to include vital signs and she did not report the resident's vomiting to the physician. Furthermore, she revealed that she would have reported abnormal vital signs to the physician but she did not obtain them. During a surveyor interview on 3/21/2024 at 12:30 PM with Nurse Practitioner (NP), Staff B, she revealed that she would consider a resident vomiting a change in condition and would expect the staff to notify her of the change. Additionally, she revealed that if she had been aware of the resident vomiting, she would have ordered the staff to perform an assessment to include a complete set of vital signs. During a surveyor interview on 3/22/2024 at 9:30 AM with the DNS she was unable to provide evidence that the staff completed an assessment after a change in condition or reported the change in condition to the physician by the end of each shift per the policy. The facility's failure to perform an assessment of a resident including vital signs with multiple episodes of vomiting and failure to promptly identify and intervene during an acute change in a resident's condition had the potential to result in the resident's harm or death.

Based on record review, surveyor observation and staff interview it has been determined that the facility failed to maintain an infection prevention and control program to help prevent the transmission of communicable diseases and infections relative to Respiratory Syncytial Virus (RSV) for 1 of 2 nursing units and affecting Resident ID #s 1,2,3,4,5, 6 and 7. Findings are as follows: Review of the Centers for Disease Control and Prevention (CDC) Appendix A, Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007) revealed precautions for RSV should include standard, droplet and contact precautions throughout the duration of the illness. Review of a facility policy titled, Isolation last reviewed 8/2015 revealed in part, It is the policy of this facility to prevent the spread of infection within the facility through the use of isolation precautions .Transmission Based Precautions, as defined by the CDC, will be employed for known or suspected infections for which the route of transmission/prevention is known . Review of a facility provided document titled, RSV in Adults states in part, .RSV can survive up to 6 hours on surfaces, from cloth gowns and paper tissue for 30-45 min [minutes], and from skin for up to 20 minutes. Good hand hygiene and environmental cleaning is very important to prevent the spread. 1. Record review revealed that Resident ID #2 was admitted to the facility in November in 2023 with diagnoses including, but not limited to, chronic obstructive pulmonary disease and compression fracture of the vertebrae. Review of a progress note dated 12/8/2023 revealed that the resident had abnormal lung sounds with a fever of 102.2 degrees (normal 97.8-100.3), pulse of 156 beats per minute (bpm) (normal 60-100 bpm) and a pulse oximetry level of 85% (normal 90-100) on 4 liters of oxygen. Additionally, it revealed that the resident was transferred to the hospital. Review of a hospital Discharge Summary Final Report dated 12/11/2023 revealed that the resident was admitted to the hospital with positive RSV, bacterial pneumonia, and septic shock on 12/8/2023. Further review revealed the resident expired on 12/11/2023. Review of a facility provided document titled, Respiratory Illness Outbreak: Cumulative Line List for Residents dated November 2023 failed to reveal that Resident ID #2 was on the facility line list for RSV. 2. Record review revealed Resident ID #1 was admitted to the facility in October of 2021 with diagnoses including, but not limited to, hypertension and heart failure. Review of a facility provided document titled, Respiratory Illness Outbreak: Cumulative Line List for Residents dated November 2023 revealed Resident ID #1's date of illness onset was 12/7/2023. Additional record review of a clinical laboratory final report dated 12/8/2023 revealed s/he is positive for RSV. Review of a physician's order dated 3/1/2022 states in part, symptom monitoring for Covid 19: Assess for fever respiratory symptoms (cough, new or worsening, SOB [shortness of breath], sore throat .If symptoms are present initiate contact/droplet precautions . During a surveyor observation on 12/12/2023 at 10:21 AM of the resident's room revealed a sign for droplet precautions for staff entering the room to wear eye protection and a mask. The signage failed to include the need for a gown and gloves per the CDC guidance. During the same surveyor observation, 2 staff members, Staff E and Staff F were observed in the residents room with only a surgical mask in place. During a surveyor interview directly following the above observation with Certified Nursing Assistant (CNA), Staff E, she revealed that she only was required to wear a surgical mask and her personal glasses in the room. Additionally, she was unable to tell the surveyor what the resident was on precautions for. During a subsequent interview with Housekeeper, Staff F, she acknowledged that she did not have the appropriate personal protective equipment (PPE) per the sign on the door. Additionally, she was unable to tell the surveyor what the resident was on precautions for. During a surveyor interview on 12/12/2023 at 10:57 AM with the Infection Preventionist (IP) and the Director of Nursing Services (DNS) they were unable to provide evidence that the staff were wearing the proper PPE for a resident with positive RSV. Additionally, they acknowledged that the precautions of only droplet precautions were not adequate to prevent the spread of RSV per the CDC guidelines. 3. Record review revealed that Resident ID #3 was readmitted to the facility in November of 2023 with diagnoses including, but not limited to, dementia, asthma, and pneumonia due to inhalation of food or vomit. Review of a facility provided document titled, Respiratory Illness Outbreak: Cumulative Line List for Residents dated November 2023 revealed Resident ID #3's date of illness onset was 12/10/2023. Review of a physician's order dated 5/2/2023 states in part, symptom monitoring for Covid 19: Assess for fever respiratory symptoms (cough, new or worsening, SOB [shortness of breath], sore throat .If symptoms are present initiate contact/droplet precautions . Review of a progress note dated 12/9/2023 revealed the resident had a fever of 101.5 degrees and a pulse oximetry level of 88% without oxygen. Review of a progress note dated 12/10/2023 revealed s/he required 3 liters of oxygen to maintain an oxygen saturation level of 94%. Review of a clinical laboratory final result document dated 12/12/2023 revealed s/he is positive for RSV. During a surveyor observation on 12/12/2023 at 10:17 AM of the residents room revealed signage for droplet precautions and staff must wear eye protection and a mask. The signage failed to include the need for a gown and gloves per the CDC guidance. During the above surveyor observation, a Speech Therapist, Staff G, was observed in the residents room with only a surgical mask in place. Staff G failed to wear the appropriate PPE to prevent the spread of RSV including a gown, eye protection and gloves. Staff G acknowledged she was not wearing the PPE per the signage on the door. During a surveyor interview on 12/12/2023 at 10:19 AM with RN, Staff H, she revealed that the staff should be wearing respiratory precautions in the resident's rooms with symptoms to include a gown, mask and eye protection. 4. Record review revealed that Resident ID #6 was admitted to the facility in November 2023 with diagnoses including, but not limited to, left femur fracture and pneumonia due to inhalation of food or vomit. Review of a physician's order dated 11/8/2023 states in part, symptom monitoring for Covid 19: Assess for fever respiratory symptoms (cough, new or worsening, SOB [shortness of breath], sore throat .If symptoms are present initiate contact/droplet precautions . Review of a progress note dated 12/11/2023 revealed the resident was transferred to the hospital secondary to increased white blood cell count. Review of a progress note dated 12/12/2023 revealed the resident was admitted to the hospital with septic shock due to positive RSV. Review of a facility provided document titled, Respiratory Illness Outbreak: Cumulative Line List for Residents dated November 2023 revealed Resident ID #6 was not listed on the line list. 5. Record review revealed that Resident ID #4 was admitted to the facility in December of 2023 with diagnoses including, but not limited to, dementia and chronic kidney disease. Review of a facility provided document titled, Respiratory Illness Outbreak: Cumulative Line List for Residents dated November 2023 revealed Resident ID #4's date of illness onset was 12/10/2023. Review of a physician's order dated 12/5/2023 states in part, symptom monitoring for Covid 19: Assess for fever respiratory symptoms (cough, new or worsening, SOB [shortness of breath], sore throat .If symptoms are present initiate contact/droplet precautions . Review of a progress note dated 12/9/2023 revealed the resident was in respiratory distress with use of accessory muscles to breath and pulse oximetry level of 80-82% on room air. Review of a progress note dated 12/10/2023 revealed the resident required 5 liters of oxygen to maintain an oxygen saturation level of 91%. During a surveyor observation on 12/12/2023 at 10:17 AM, of the resident's room revealed signage for droplet precautions and staff must wear eye protection and a mask. The signage failed to include the need for a gown and gloves per the CDC guidance. During the above surveyor observation Staff G was observed in the residents room with only a surgical mask in place. Staff G failed to wear the appropriate PPE to prevent the spread of RSV including a gown, eye protection and gloves. Staff G acknowledged that she was not wearing the PPE per the signage on the door. During a surveyor interview on 12/12/2023 at 10:19 AM with Staff H, she revealed that the staff should be wearing respiratory precautions in the resident's rooms with symptoms to include a gown, mask and eye protection. Review of a clinical laboratory final result document dated 12/12/2023 revealed s/he is negative for RSV however, continues with abnormal respiratory symptoms. 6. Record review revealed that Resident ID #5 was admitted to the facility in December of 2023 with diagnoses including, but not limited to, weakness and Alzheimer's disease. Review of a facility provided document titled, Respiratory Illness Outbreak: Cumulative Line List for Residents dated November 2023 revealed Resident ID #5's date of illness onset was 12/10/2023. Review of a physician's order dated 12/5/2023 states in part, symptom monitoring for Covid 19: Assess for fever respiratory symptoms (cough, new or worsening, SOB [shortness of breath], sore throat .If symptoms are present initiate contact/droplet precautions . Review of a progress note dated 12/9/2023 revealed the resident's oxygen saturation level was 79-81% on room air. Further review revealed the resident required humidified oxygen at 4.5 liters to maintain an oxygen saturation level at 92%. During a surveyor observation on 12/12/2023 at 10:12 AM revealed signage for droplet precautions and staff must wear eye protection and a mask. The signage failed to include the need for a gown and gloves per the CDC guidance. During the above surveyor observation, a Housekeeper, Staff I was observed in the resident's room with a gown, gloves, and surgical mask but without eye protection. During a surveyor interview immediately following the observation Staff I acknowledged that she was not wearing eye protection as the signage states. Additionally, she was unable to tell the surveyor why the resident was on precautions but only that it is not Covid. During a surveyor interview on 12/12/2023 at 10:19 AM with Staff H, she revealed that the staff should be wearing respiratory precautions in the resident's rooms with symptoms to include a gown, mask and eye protection. Review of a clinical laboratory final result document dated 12/12/2023 revealed s/he is negative for RSV however, continues with abnormal respiratory symptoms. 7. Record review revealed that Resident ID #7 was admitted to the facility in November of 2023 with diagnoses including, but not limited to, asthma and urinary tract infection. Review of a physician's order dated 11/28/2023 states in part, symptom monitoring for Covid 19: Assess for fever respiratory symptoms (cough, new or worsening, SOB [shortness of breath], sore throat .If symptoms are present initiate contact/droplet precautions . Review of a progress note dated 12/12/2023 revealed the resident began with a moist nonproductive cough. During a surveyor observation on 12/13/2023 at 8:25 AM the resident was in bed and noted to be coughing. Further observation failed to reveal evidence that the resident had been placed on contact or droplet precautions. During a surveyor interview on 12/13/2023 at approximately 8:30 AM with the DNS, she acknowledged the resident's respiratory symptoms and revealed that the practitioner was made aware and ordered for Covid testing. Review of a clinical laboratory final result document dated 12/13/2023 revealed s/he is positive for RSV. During a surveyor interview on 12/12/2023 at approximately 2:30 PM with the DNS in the presence of the Administrator, she acknowledged the incorrect signage and PPE use to prevent the spread of RSV per CDC guidelines. As a result of the facility's failure to promptly identify respiratory symptoms in ill residents and properly follow the CDC guidance relative to RSV precautions this facility is currently experiencing an RSV outbreak with death resulting.