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F0880
D

Failure to Implement PPE Use for Resident on Enhanced Barrier Precautions

Montrose, California Survey Completed on 04-10-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A Certified Nursing Assistant (CNA) failed to follow the facility's policy and procedure regarding the use of personal protective equipment (PPE) while in the room of a resident placed on Enhanced Barrier Precautions (EBP) due to a history of multidrug-resistant organism (MDRO) infection. During an observation, the CNA entered the resident's room, which had an EBP sign posted, and did not wear PPE while touching the resident's nightstand, table, and the resident, who was sitting in a wheelchair. The CNA acknowledged being aware of the EBP status and that PPE should have been worn, as instructed by the Infection Preventionist Nurse (IPN). The resident involved had diagnoses including Parkinson's Disease, difficulty walking, and dysphagia, and required substantial to maximal assistance with daily activities. The facility's policy required staff to perform hand hygiene and wear gowns and gloves for any care activity involving contact with environmental surfaces likely contaminated by the resident. The Director of Nursing (DON) confirmed that PPE use was necessary not only for direct care but also when touching the resident's bedside and surroundings, as these areas were likely contaminated.

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