Based on interview and record review, the facility failed to maintain an infection prevention and control program designed to help prevent the development and transmission of communicable disease and infections. This had the potential to affect all residents residing within the facility at the time of an outbreak on 1/2/25. This outbreak involved 49 out of 83 residents and 37 staff. As of 1/2/25, the facility was in a GI (gastrointestinal) outbreak with 2 staff and 1 resident with noted signs and symptoms of GI outbreak. - Facility staff line listings were not completed contemporaneously. - Temporary Care plans were not started for residents with GI signs and symptoms. - Residents with orders for Laxatives and Diuretics continued to take their prescribed medication without any monitoring for dehydration or bowel movement consistency and frequency. - Staff returned to work too soon following GI signs and symptoms. - Facility does not indicate when residents were taken off precautions following GI signs and symptoms. - Housekeeping did not ensure they cleaned non symptomatic resident rooms prior to those residents with GI signs and symptoms. - Housekeeping did not use any type of clothing barrier (e.g., apron) when sorting dirty laundry. - Facility did not notify DPH (Department of Public Health) of the outbreak until 1/6/25. The outbreak started on 1/2/25. - Facility did not complete a timeline of the outbreak. - Facility did not complete lessons learned following the GI outbreak. - Facility did not have an Ad Hoc QAPI meeting to discuss the GI outbreak. The facility's failure to mitigate the spread of the GI outbreak created a finding of immediate jeopardy that began on 1/3/25. NHA A (Nursing Home Administrator) and DON B (Director of Nursing) were notified of the immediate jeopardy on 4/10/25 at 2:46 PM. The immediate jeopardy was removed on 1/14/25; however, the deficient practice continues at a severity/scope level of F (potential for more than minimal harm/widespread) as the facility continues to implement its action plan. This is evidenced by: The facility policy titled, Norovirus Prevention and Control, last reviewed 1/2025, states in part . Policy: This facility will implement infection control measures to prevent the transmission of norovirus infection. Procedure: 1. Place residents with symptoms of norovirus gastroenteritis on Contact Precautions in a private room. If a private room cannot be accommodated efforts must be attempted to separate symptomatic resident from asymptomatic residents. 2. Residents with norovirus gastroenteritis will be placed on Contact Precautions for a minimum of 48-72 hours after the resolution of symptoms. Longer periods of isolation or cohorting for medically complex residents may be considered. 3. Minimize symptomatic resident's movements within the unit; restrict recovering residents during 48-72 hour recover time frame also from leaving the resident-care area unless it is for essential care or treatment; and suspend group activities (e.g., dining events) for the duration of an outbreak. 4. During outbreak, frequent hand hygiene after providing care or having contact with residents suspected or confirmed with norovirus gastroenteritis. 5. Transfers may be limited to Contact Precautions are not able to be maintained; or transfers may be postponed until residents no longer require Contact Precautions. 6. Perform additional cleaning and disinfection of frequently touched environmental surfaces and equipment in resident care areas, resident with isolation and cohorted areas, as well as high-traffic clinical areas. Frequently touched surfaces include, but not limited to, commodes, toilets, faucets, hand/bed railing, telephones, door handles, computer equipment, and kitchen preparation surfaces. Clean and disinfect shared equipment between residents using EPA-registered products with label claims for use in healthcare which lists activity against norovirus. Follow the manufacturer's recommendations for application and contact times. 7. Clean and disinfect surfaces starting from the areas with a lower likelihood of norovirus (e.g., toilets, bathroom fixtures). Change mop heads when a new bucket of cleaning solution is prepared or after cleaning large spills of emesis or fecal material. 8. During outbreaks, change privacy curtains when they are visibly soiled and upon resident discharge or transfer. 9. Handle soiled linens carefully, without agitating them, to avoid dispersal of virus. Use Standard Precautions, including the use of appropriate PPE (e.g., gloves and gowns), to minimize the likelihood of cross-contamination. 10. Staff who work with, prepare or distribute food will be excluded from duty immediately if they develop symptoms of acute gastroenteritis. Any staff presenting with norovirus symptoms will be off work and not to return until a minimum of 48 hours after the resolution of symptoms or longer upon recommendation from Infection Control Preventionist or Infection Control Committee. The facility policy titled, Infection Control Program Introduction, last reviewed 1/2025, states in part . Introduction: Infections are among the most frequent and significant problems facing nursing facility residents today. They account for a large proportion of morbidity and mortality, and for many hospital transfers. This Infection Control Manual will provide information for the essential functions and practices of the facility and also be flexible enough to fit a facility's specific environment and able to accommodate new issues or requirements. Purpose of Infection Control Program: The major purposes of Infection Control Programs in the nursing facility are to minimize the effects of infections on residents and employees, and to educate the staff. A successful Infection Control Program requires an underlying commitment and facility-wide participation. It should not just be seen as a way to meet paperwork requirements but as a way to analyze and use information effectively to improve and prevent problems. Coordination and Oversight: The Director of Nursing has the responsibility of coordination and oversight of the Infection Control Program. The Director of Nursing may appoint a clinical staff person with interest and additional training in infection prevention and control to assist in the coordination and oversight of the Infection Control Program. All infections are tracked and logged regularly. The Infection Control Committee or its equivalent should review Elements of an Infection Control Program: The success of this Infection Control Program is base as facility-wide effort involving all disciplines and individuals. It should also be considered an integral part of a facility's overall quality assurance and performance improvement program, and have the active support of administration, residents, families, clinical, support staff, and attending physicians. The Centers for Medicare & Medicaid Services (CMS) require the long-term care facilities to establish and maintain an Infection Control Program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of disease and infection. All infections are tracked and to be logged regularly. The Infection Control Committee or its equivalent should review summaries of this information at least quarterly. Policies and Procedures: This review should also assess how well and how consistently the staff has complied with existing policies and regulations, and any trends or significant problems since the previous review. Surveillance: Surveillance refers to a system for recognizing the occurrence of infections, recording their number and frequency, detecting outbreaks and epidemics, monitoring employee infections, and detecting unusual pathogens with infection control implications. Prevention and treatment begin with recognizing the kinds of infections that occur and the signs and symptoms of their onset. Infections among the residents are not always obvious. Therefore, medical criteria and standardized definitions of infections are needed to help recognize and manage infections, (Corporation Name) will utilize McGeer's criteria to assist in the recognition of infections and ensure antibiotic usage is appropriate as part of their Stewardship program. The facility policy titled, Cleaning and Disinfecting Residents' Rooms, undated, states in part . Resident Room Cleaning: 9. When possible, precaution/isolation rooms should be cleaned last, and water discarded after cleaning room. 11. Clean curtains, window blinds and walls when they are visibly soiled and dirty. The facility policy titled, Standard Precautions, undated, states in part . Gowning: Wear a gown that is appropriate to the task, to protect skin and prevent soiling or contamination of clothing during procedures and resident-care activities when contact with blood, body fluids, secretions, or excretions is anticipated. Appropriated handling of laundry: Handle, transport, process used linen to avoid contamination of air, surfaces and persons. All soiled linens should be bagged prior to exiting room. Washing of linens will be in accordance with CMS (Centers for Medicare and Medicaid) requirements and per Chapter 5, Water Temperatures; Maintenance Manual. On 12/31/24, two staff members developed signs and symptoms related to GI outbreak. CNA (Certified Nursing Assistant) Q (NOC shift) was placed on the line list with vomiting and diarrhea and BOM (Business Office Manager) P was placed on the line list for diarrhea. On 1/2/25, R17, a resident on the 200 wing was placed on the line list for GI (gastrointestinal) s/sx (signs and symptoms). R17's symptoms included nausea, vomiting, and diarrhea. Surveyor reviewed R17's eMAR (electronic medication administration record) and eTAR (electronic treatment administration record) and noted that the facility was monitoring R17's bowel movements but not the consistency or frequency. On 1/3/25, R8, R18, R34, R64, and R70, were all noted to have GI s/sx. These five residents encompassed all 4 units of the facility. Surveyor reviewed R8's eMAR and eTAR. R8 had orders for Senokot tablet 8.6 mg (milligrams). Give 1 tablet PO (by mouth) daily for constipation, once daily. During the period in which R8 was experiencing s/sx of GI outbreak she continued to receive her Senokot without bowel monitoring in place for frequency and consistency. The facility did not update the physician or consider holding the medication while R8 was experiencing GI related s/sx. R8 had orders in the eMAR and eTAR to enter a progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/5/25 to 1/6/25. R8 was noted to be added to the line list for the GI outbreak on 1/3/25 with a well date of 1/4/25, indicating R8 was not being monitored for GI s/sx until after her well date. Surveyor reviewed R18's eMAR and eTAR. R18 had orders for furosemide tablet 20 mg (a diuretic.) Take 1 tablet by mouth daily for fluid in the lungs due to chronic heart failure. During the period in which R18 was experiencing s/sx of GI outbreak he continued to receive his furosemide without fluid monitoring. The facility did not update the physician or consider holding the medication while R18 was experiencing GI related s/sx. R18's eMAR and eTAR note that the facility was monitoring R18's bowel movements but not the consistency or frequency. Surveyor reviewed R34's eMAR and eTAR. R34 had orders for furosemide tablet 40 mg. Give 1 tablet daily for high blood pressure. During the period in which R34 was experiencing s/sx of GI outbreak she continued to receive her furosemide without fluid monitoring. The facility did not update the physician or consider holding the medication while R34 was experiencing GI related s/sx. R34's eMAR and eTAR note that the facility was monitoring R34's bowel movements but not the consistency or frequency. R34 had orders in the eMAR and eTAR to enter progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/5/25 to 1/7/25. R34 was noted to be added to the line list for the GI outbreak on 1/3/25 with a well date of 1/5/25, indicating R34 was not being monitored for GI s/sx until after her well date. Surveyor reviewed R64's eMAR and eTAR. R64 had orders for Senna-S tablet 8.6-50 mg. Take 1 tablet by mouth daily for constipation. During the period in which R64 was experiencing s/sx of GI outbreak she continued to receive her Senna-S without bowel monitoring in place for frequency and consistency. The facility did not update the physician or consider holding the medication while R64 was experiencing GI related s/sx. eMAR and eTAR note that the facility was monitoring R64's bowel movements but not the consistency or frequency. R64's eMAR and eTAR also include orders to monitor GI symptoms: Monitor lung sounds, vitals, and for additional symptoms Q (every) shift x (times) 72 hours TID (three times a day), start date 1/5/25 and end date 1/7/25. R64's GI s/sx started on 1/3/25 with a well date of 1/6/25, indicating R64 was not being monitored for GI s/sx until 2 days after he began experiencing s/sx. Surveyor reviewed R70's eMAR and eTAR. R70 had orders for Senokot-S tablet 8.6-50 mg. Give 2 tablets by mouth 2 times a day for constipation prevention. Hold for loose stools. During the period in which R70 was experiencing s/sx of GI outbreak he continued to receive his Senokot-S without bowel monitoring in place for frequency and consistency. The facility did not update the physician or consider holding the medication while R70 was experiencing GI related s/sx. R70 has orders in the eMAR and eTAR to enter progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/5/25 to 1/6/25. R70 was noted to be added to the line list for the GI outbreak on 1/3/25 with a well date of 1/4/25, indicating R70 was not being monitored for GI s/sx until after her well date. On 4/9/25 at 9:30 AM, Surveyor interviewed RNC/IP C (Regional Nurse Consultant/infection preventionist). Surveyor asked RNC/IP C when outbreak should have been called. RNC/IP C stated, after the second resident but can't give you the date. Surveyor gave RNC/IP C the infection control logs to review. RNC/IP C stated, 1/2/25 would have been the outbreak but I was not the IP at that time and cannot say when she called the outbreak. I was not notified of any outbreak until 1/4/25. Note: The facility should have considered this an outbreak starting on 1/2/25. However, the facility has no evidence they identified the outbreak until they contacted DPH (Department of Public Health) on 1/6/25. Note: Facility has no timeline or documentation to show when the outbreak was identified. Note: The facility has no documentation that shows that they updated any of the residents' PCPs (Primary Care Physicians) or the Medical Director of the outbreak. On 1/4/25, R1, R12, R38, R40, R46, R50, R60, R71, and R240 were all noted to be experiencing GI s/sx. These nine residents encompassed the 200, 300, and 400 units of the facility. Surveyor reviewed R1's eMAR and eTAR. R1's eMAR and eTAR note that the facility was monitoring R64 's bowel movements but not the consistency or frequency. R1's eMAR and eTAR include orders to monitor for 72 hours lung sounds and VS (vital signs) due to GI illness starting on 1/4/25 and ending on 1/5/25 and to enter progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/5/25 to 1/7/25. R1 was noted to be added to the GI outbreak line list on 1/4/25 with a well date of 1/8/25, indicating monitoring of R1 did not start until the day after sx began and ended a day prior to symptoms ending. R1's eMAR and eTAR also indicate R1 was placed on contact precautions on 1/4/25 and precautions were discontinued on 1/7/25. R1 had a well date of 1/8/25, indicated precautions were stopped the day prior to R1's well date. Surveyor reviewed R12's eMAR and eTAR. R12 had orders for furosemide tablet 20 mg, give 1 tablet PO daily for visible water retentions and furosemide 0.5 mg tablet (10 mg) PO in the afternoon for visible water retention. During the period in which R12 was experiencing s/sx of GI outbreak she continued to receive all but one dose of her furosemide without fluid monitoring. The facility did not update the physician or consider holding the medication while R12 was experiencing GI related s/sx. R12's eMAR and eTAR note that the facility was monitoring R12's bowel movements but not the consistency or frequency. R12 had orders in the eMAR and eTAR to enter progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/5/25 to 1/8/25. R12 was noted to be added to the line list for the GI outbreak on 1/4/25 with a well date of 1/9/25, indicating R12's monitoring did not start until the day after sx began and ended a day prior to symptoms ending. Surveyor reviewed R38's eMAR and eTAR. R38 had orders for Miralax 17 gram/dose, dissolve 17 grams into at least 8 ounces of beverage of choice and drink daily for bowel management, hold for loose stools/high volume ostomy output, increase to 2x (two times) daily if constipation and Sennosides-docusate sodium tablet 8.6-50 mg, take 1 tablet by mouth 2 times a day for bowel management, hold for loose stools/high volume ostomy output. During the period in which R38 was experiencing s/sx of GI outbreak he continued to receive his Miralax and Sennosides-docusate sodium without bowel monitoring in place for frequency and consistency. R38's eMAR and eTAR note that the facility was monitoring R38's bowel movements but not the consistency or frequency. R38 had orders in the eMAR and eTAR for GI symptoms: Monitor for and chart symptoms and temp Q shift x72 hours, start 1/7/25 to 1/7/25. R38 was noted to be added to the line list for the GI outbreak on 1/4/25 with a well date of 1/5/25, indicating R38's monitoring did not start until 3 days after s/sx began and 2 days after R38's well date. R38's eMAR and eTAR also indicate that R38's isolation precautions were discontinued on 1/7/25. Facility does not have time of well date for discontinuation of isolation precautions, unable to determine from documentation and interviews if precautions discontinued appropriately. Surveyor reviewed R40's eMAR and eTAR. R40 had orders in the eMAR and eTAR to enter progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/5/25 to 1/6/25. R40 was noted to be added to the line list for the GI outbreak on 1/4/25 with a well date of 1/5/25, indicating R40's monitoring did not begin until her well date and ended the following day. R40's eMAR and eTAR also indicates that R40's isolation precautions were discontinued on 1/7/25. Facility does not have time of well date for discontinuation of isolation precautions, unable to determine from documentation and interviews if precautions discontinued appropriately. Surveyor reviewed R46's eMAR and eTAR. R46's eMAR and eTAR note that the facility was monitoring R46's bowel movements but not the consistency or frequency. R46 also has orders to encourage fluids each shift, this is signed out every shift but does not include amounts of intake. R46's eMAR and eTAR orders include GI Symptoms: Monitor lung sounds, vitals, and for additional symptoms Q shift x 72 hours, start 1/5/25 to 1/7/25. R46 was added to the line list for the GI outbreak on 1/4/25 with a well date of 1/5/25, indicating R46's monitoring did not start until her well date. Surveyor reviewed R50's eMAR and eTAR. R50 had orders for Miralax 17 gram/dose. Give 17g (grams) PO BID (twice a day) for emptying of the bowel, titrate to have 1 BM (bowel movement) per day and Senokot-S tablet, 8.6-50 mg, take 1 tab PO BID for constipation. R50 was added to the GI line list for s/sx on 1/4/25 with a well date of 1/5/25. During the time that R50 was experiencing GI s/sx she continued to receive Miralax and Senokot-S BID. R50's eMAR and eTAR note that the facility was monitoring R50's bowel movements but not the consistency or frequency. R50 had orders in the eMAR and eTAR to enter progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/5/25 on PM shift and ending 1/7/25 on PM shift. R50's eMAR and eTAR also includes vitals x 72 hours each shift, plus lung sounds, start date 1/4/25 at 11:00 PM and ending on 1/5/25 at 11:00 PM. According to eMAR and eTAR R50's isolation precautions were discontinued on 1/7/25. Facility did not document the time of R50's last symptoms making it difficult to determine if isolation precautions were discontinued appropriately. Surveyor reviewed R60's eMAR and eTAR. R60 had orders for furosemide 20 mg, administer 1 tablet (20 mg) by mouth daily for hypertension. R60 was added to the GI line list for s/sx on 1/4/25 with a well date of 1/5/25. During the period in which R60 was experiencing s/sx of GI outbreak she continued to receive all doses of her furosemide without fluid monitoring. The facility did not update the physician or consider holding the medication while R60 was experiencing GI related s/sx. R60's eMAR and eTAR note that the facility was monitoring R60's bowel movements but not the consistency or frequency. R60's eMAR and eTAR includes an order for GI Symptoms: Monitor and chart for symptoms and temp Q shift x 72 hours, start date of 1/5/25 and end date of 1/7/25. R60's eMAR and eTAR note that the facility was monitoring bowel movements but not the consistency or frequency. Note: R60's monitoring for GI symptoms did not begin until her well date. Surveyor reviewed R71's eMAR and eTAR. R71 was added to the facility line listing for GI s/sx on 1/4/25 and a well date of 1/5/25. R71's eMAR and eTAR note that the facility was monitoring R71's bowel movements but not the consistency or frequency. R71 had orders in the eMAR and eTAR to enter progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/5/25 on PM shift and ending 1/7/25 on NOC (night) shift. R71's well date on the GI line list is documented as 1/5/25. R71's monitoring did not begin until the date of his listed well date. R71's eMAR and eTAR indicates Vitals x 72 hours each shift, plus lung sounds each shift, start date 1/4/25 and end date 1/5/25. Note: The vitals monitoring for R71 were started on 1/4/25 but only completed on 1/5/25. Surveyor reviewed R240's eMAR and eTAR. R240 was added to the facility line listing for GI s/sx on 1/4/25 and a documented well date 1/5/25. R240's eMAR and eTAR note that the facility was monitoring R240's bowel movements but not the consistency or frequency. R240 had orders in the eMAR and eTAR to enter progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/5/25 on PM shift and ending 1/7/25 on PM shift. Facility does not have time of well date for discontinuation of isolation precautions, unable to determine from documentation and interviews if precautions discontinued appropriately. On 1/5/25, R10, R56, and R239 were noted to be experiencing GI s/sx. These three residents encompassed the 200, 300, and 400 units. Surveyor reviewed R10's eMAR and eTAR. R10 was added to the facility line listing for GI s/sx on 1/5/25 and a documented well date of 1/6/25. R10 had orders for sennosides-docusate sodium tablet 8.6-50 mg. Give 2 tabs po BID for constipation. Torsemide tablet 10 mg (a diuretic.) Give 1 tablet (10 mg) with 20 mg tablet for total of 30 mg daily for edema. Torsemide tablet 20 mg. Give 1 tablet (20 mg) with 10 mg tablet for total of 30 mg daily for edema. During the period in which R10 was experiencing s/sx of GI outbreak she continued to receive all doses of torsemide and sennosides-docusate sodium without fluid monitoring. R10's eMAR and eTAR note that the facility was monitoring R10's bowel movements but not the consistency or frequency. R10 had orders in the eMAR and eTAR to enter progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/5/25 on PM shift and ending 1/8/25 on NOC shift. Facility does not have time of well date for discontinuation of isolation precautions on 1/8/25; unable to determine from documentation and interviews if precautions discontinued appropriately. Surveyor reviewed R56's eMAR and eTAR. R56 was added to the facility line listing for GI s/sx on 1/5/25 and a documented well date of 1/6/25. R56 had orders for Miralax 17 grams. Give 17 g PO daily for constipation. HOLD for loose stools. During the period in which R56 was experiencing s/sx of GI outbreak she received Miralax as scheduled aside from 1/6/25 when medication was held. R56's eMAR and eTAR notes that the facility was monitoring R56's bowel movements but not the consistency or frequency. R56's eMAR and eTAR include an order for GI Symptoms: Monitor and chart for symptoms and temp Q shift x 72 hours, start date of 1/5/25 AM shift and end date of 1/7/25 PM shift. Surveyor reviewed R239's eMAR and eTAR. R239 was added to the facility line listing for GI s/sx on 1/5/25 and a documented well date of 1/6/25. R239 had orders for Citrucel tablet 500 mg. Take 1 tab PO BID for constipation. Take with plenty of water. During the period in which R239 was experiencing GI s/sx her Citrucel was held on only 2 occasions, 1/5/25 AM shift and 1/7/25 PM shift. R239 received all other doses during this time frame. R239's eMAR and eTAR notes that the facility was monitoring R239's bowel movements but not the consistency or frequency. R239 had orders in the eMAR and eTAR to enter progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/5/25 on PM shift and ending 1/8/25 on PM shift. On 1/6/25, R5, R9, R16, R21, R22, R51, R54, R67, R80, and R242 were noted to be experiencing GI s/sx. These residents resided among all four units of the facility. There were also six staff (COTA (Certified Occupational Therapy Assistant) GG, AA (Activities Assistant) HH, PT (Physical Therapist) II, CNA JJ, CNA KK, CNA LL) that were experiencing GI s/sx. COTA GG was placed on the staff GI line list on 1/6/25 with symptoms of vomiting and diarrhea. COTA GG has no well date or return to work date listed. AA HH was placed on the staff GI line list on 1/6/25 with symptoms of nausea, vomiting, and abdominal cramping. AA HH has no well date listed but returned to work on 1/13/25. PT II was placed on the staff GI outbreak line list on 1/6/25 with symptoms of nausea, vomiting, and diarrhea. PT II has no well date or return to work date listed. CNA JJ was placed on the staff GI outbreak line list on 1/6/25 with symptoms of nausea, vomiting, and diarrhea. CNA JJ has no well date listed but returned to work on 1/9/25. CNA KK was placed on the staff GI outbreak line list on 1/6/25 with symptoms of nausea, vomiting, and diarrhea. CNA KK has no well date listed but returned to work on 1/12/25. CNA LL was placed on the GI outbreak line list on 1/6/25 with symptoms of nausea and vomiting. CNA LL has no well date listed but returned to work on 1/10/25. On 1/6/25, DPH was notified of the facility GI outbreak by the DON (Director of Nursing). At this point the facility had 28 residents and eight staff with GI signs and symptoms. Surveyor reviewed R5's eMAR and eTAR. R5 was added to the facility line listing for GI s/sx on 1/6/25 and a documented well date of 1/7/25. R5 had orders for furosemide tablet 20 mg for accumulation of fluid resulting from CHF (congestive heart failure), edema. Miralax 17 gram/dose. Mix 17 grams in drink of choice PO every other day for constipation and Senokot-S tablet 8.6-50 mg. Give 1 tablet PO daily for constipation. During the period in which R5 was experiencing s/sx of GI outbreak she continued to receive all doses of furosemide without fluid monitoring. R5 also continued to receive all doses of Miralax and Senokot-S. R5's eMAR and eTAR notes that the facility was monitoring R5's bowel movements but not the consistency or frequency. Surveyor reviewed R9's eMAR and eTAR. R9 was added to the facility line listing for GI s/sx on 1/6/25 and a documented well date of 1/7/25. R9's eMAR and eTAR notes that the facility was monitoring R9's bowel movements but not the consistency or frequency. R9's eMAR and eTAR include an order for GI Symptoms: Monitor and chart for symptoms and temp Q shift x 72 hours, start date of 1/6/25 AM shift and end date of 1/8/25 NOC shift. Surveyor reviewed R16's eMAR and eTAR. R16 was added to the facility line listing for GI s/sx on 1/6/25 and a documented well date of 1/9/25. R16 had orders for senna tablet 8.6 mg. Give 2 tablets by mouth daily for constipation. During the period in which R16 was experiencing s/sx of GI outbreak she continued to receive all doses of senna without monitoring frequency or consistency of bowel movements. R16 had orders in the eMAR and eTAR to enter progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/6/25 on PM shift and ending 1/9/25 on NOC shift. Surveyor reviewed R21's eMAR and eTAR. R21 was added to the facility line listing for GI s/sx on 1/6/25 and a documented well date of 1/7/25. R21 had orders for furosemide 20 mg. Give 0.5 tablet (10 mg) PO daily for chronic BLE (bilateral lower extremity) edema and Senna with Docusate Sodium tablet 8.6-50 mg. Give 2 tablets po BID for constipation. Hold for loose stools. During the period in which R21 was experiencing s/sx of GI outbreak she continued to receive all doses of furosemide and Senna with Docusate Sodium without monitoring frequency or consistency of bowel movements or fluid hydration. R21 had orders in the eMAR and eTAR to enter progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/6/25 on PM shift and ending 1/9/25 on NOC shift. Surveyor reviewed R22's eMAR and eTAR. R22 was added to the facility line listing for GI s/sx on 1/6/25 and a documented well date of 1/7/25. R22 had orders for Miralax 17 grams/dose. Give 17 grams PO in beverage of choice daily for constipation and psyllium husk powder. Give 3.4 grams in beverage of choice BID for constipation. During the period in which R22 was experiencing s/sx of GI outbreak he continued to receive all doses of Miralax and psyllium husk powder without monitoring frequency or consistency of bowel movements. Surveyor reviewed R51's eMAR and eTAR. R51 was added to the facility line listing for GI s/sx on 1/6/25 and a documented well date of 1/7/25. R51's eMAR and eTAR notes that the facility was monitoring R51's bowel movements but not the consistency or frequency. R51 had orders in the eMAR and eTAR to enter progress note every shift to include symptoms present/not present related to acute gastroenteritis: nausea, vomiting, diarrhea, abdominal cramping, fever, chills, start 1/6/25 on AM shift and ending 1/8/25 on NOC shift. R51's eMAR and eTAR include an order for GI Symptoms: Monitor and chart for symptoms and temp Q shift x 72 hours, start date of 1/6/25 AM shift and end date of 1/6/25 PM shift, this was documented as completed. Facility does not have time of well date for discontinuation of isolation precautions on 1[TRUNCATED]