Based on Centers for Disease Control and Prevention (CDC) guidance, policy review, observation, and interview, the facility failed to ensure practices to prevent the potential spread of infection were maintained when 1 of 2 nurses (Licensed Practical Nurse (LPN) #1) failed to perform hand hygiene for 1 of 3 sampled residents (Resident #28) observed during medication administration. The findings include: Review of the CDC guidance titled, Infection Prevention during Blood Glucose Monitoring and Insulin Administration, dated 2/2/2011, revealed .wear gloves .during any .procedure that involves potential exposure to blood or body fluids . Review of the facility's policy titled, Handwashing/Hand Hygiene, with a revision date of 8/2019, revealed hand hygiene should be performed after handling contaminated objects and when anticipating contact with blood or body fluids. The facility's policy also revealed .Integration of glove use along with routine hand hygiene is recognized as the best practice for preventing healthcare associated infections . Observation in the resident's room on 7/12/2021 at 8:20 AM, revealed LPN #1 touched Resident #28's over bed table, moved the bed covers, handed him a glass of water, removed a breakfast tray from the over bed table, took an alcohol prep pad out of his uniform pocket, and cleaned the resident's left lower abdomen. LPN #1 then administered the scheduled dose of insulin to Resident #28 without gloves or performing hand hygiene. Observation in the resident's room on 7/12/2021 at 8:30 AM, revealed LPN #1 entered Resident #28's room, moved a wheelchair, touched the over bed table, moved the resident's gown, took an alcohol prep out of his uniform pocket, and cleaned the back of the resident's left arm. LPN #1 then administered the sliding scale dose of insulin to Resident #28 without gloves or performing hand hygiene. During an interview on 7/14/2021 at 4:20 PM, the Director of Nursing (DON) confirmed that hand hygiene and donning gloves should be performed prior to administering insulin medication.

Based on policy review, temperature log review, observation, and interview the facility failed to ensure the low temperature (chemical sanitization) dish machine reached the required wash temperature of 120 degrees. The facility had a census of 14 residents and 14 of those residents received a tray from the kitchen. The findings include: The facility did not provide the owner's manual for use of the dish machine. Review of the facility's undated policy titled, DISHMACHINE TEMPERATURE RECORD (LOW TEMPERATURE MACHINE), revealed .CORRECTIVE ACTION: Stop using the machine and notify your supervisor if .the wash temperature is less than 120 [symbol for degrees Fahrenheit] .Do not use the dishmachine until your supervisor tells you that is can be used again . Review of the July 2021 dish machine temperature logs revealed, the breakfast wash temperature was less than 120 degrees Fahrenheit on 7/5/2021, 7/6/2021, 7/7/2021, 7/8/2021, 7/10/2021, 7/12/2021, 7/13/2021 and 7/14/2021. The lunch wash temperature was less than 120 degrees Fahrenheit on 7/13/2021 and 7/14/2021. The dish machine temperature log revealed no corrective action was documented. Observation of the dish machine in use on 7/14/2021 at 6:15 PM, revealed the temperature during the wash cycle was 98 degrees Fahrenheit on the dish machine thermometer. The Dietary Manager confirmed the dish machine wash cycle did not meet proper temperature. During an interview on 7/14/2021 at 6:34 PM, the Dietary Director stated that education needs to be done.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on policy review, observation, and interview, the facility failed to ensure food was served under sanitary conditions when 1 of 5 (Certified Nursing Assistant (CNA) #1) staff members placed a dirty meal tray on a cart with a clean undelivered meal tray and failed to perform hand hygiene during dining observations. The findings included: The facility's Handwashing/Hand Hygiene policy with a revision date of August 2015 documented, Policy Statement This facility considers hand hygiene the primary means to prevent the spread of infections .Policy Interpretation and Implementation .2. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors .7. Use an alcohol-based hand rub containing at least 62% [percent] alcohol; or, alternatively, soap (antimicrobial or non-antimicrobial) and water for the following situations .b. Before and after direct contact with residents .l. After contact with objects (e.g. [example], medical equipment) in the immediate vicinity of the resident .o. Before and after eating or handling food . Observations in the Skilled hall on 10/1/18 beginning at 12:43 PM, revealed CNA #1 entered Resident #84's room, delivered a meal tray to this resident, and picked up a dirty tray (Resident #84's tray from breakfast) and placed this tray in the cart with 1 clean tray still left to deliver. CNA #1 then entered Resident #83's room, delivered a meal tray to this resident, and did not perform hand hygiene. CNA #1 removed a pillow and adjusted this resident's bed, and continued to set up the tray without performing hand hygiene. Observations in the Skilled hall on 10/02/18 beginning at at 8:17 AM, revealed CNA #1 delivered a meal tray to Resident #20, adjusted Resident #20's bed, touching the bed, and continued to set up the meal tray without performing hand hygiene. CNA #1 then used hand gel prior to leaving the room. CNA #1 entered Resident #231's room, delivered a meal tray to this resident, adjusted the bed touching the bed, and continued setting up the meal tray without performing hand hygiene. CNA #1 then used hand gel prior to leaving the room. CNA #1 entered Resident #83's room, delivered a meal tray to this resident, adjusted the bed, touching the bed, and moved a pillow from under Resident #83's arm, then continued to set up the tray without performing hand hygiene. Interview with the Director of Nursing (DON) on 10/2/18 at 4:47 PM, in room [ROOM NUMBER], the DON was asked if a tray that had been in a room, had been uncovered, and that a resident had already eaten from the tray, should the tray be placed back on the cart with trays that had not been delivered. The DON stated, No. The DON was asked what should be done after assisting residents, touching objects, and before setting up a meal tray. The DON stated, .hand wash .