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F0880
D

Infection Control Failures in Wound Care, Peri-Care, and Blood Glucose Monitoring

Fremont, Michigan 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

The facility failed to implement proper infection control practices during wound care, peri-care, and blood glucose monitoring for three residents. In one instance, an LPN performed surgical wound care on a resident with necrotizing fasciitis and diabetes, changing gloves without performing hand hygiene and allowing the tail end of the wound packing gauze to touch the resident's clean brief and leg. After completing the dressing change, the LPN removed her gown and gloves, fixed her hair without hand hygiene, and left the room to find hand sanitizer. The facility's policy required hand hygiene between glove changes and after glove removal, as well as preventing clean dressing materials from contacting unclean surfaces. In another case, a CNA provided peri-care to a male resident with severe cognitive impairment and total dependence, cleaning the perineal area in an incorrect sequence that could introduce microorganisms into the urethra. After care, the CNA did not sanitize the broda chair that had been in contact with the resident's urine-soaked clothing. Additionally, an LPN was observed performing a blood glucose test on a resident in a communal dining area, without providing privacy, contrary to facility policy and best practices. The DON confirmed that this practice was not acceptable and did not align with facility procedures.

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