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F0880
E

Deficient Infection Control in Whirlpool Tub Disinfection and AC Unit Maintenance

Bowdle, South Dakota Survey Completed on 07-25-2025

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

Surveyors identified deficiencies in the facility's infection prevention and control program, specifically related to the cleaning and disinfection of a whirlpool tub and the maintenance of in-room air conditioning (AC) units. Observations and staff interviews revealed that the whirlpool tub was not disinfected according to the manufacturer's recommendations. Certified nursing assistants (CNAs) described a cleaning process that involved filling the tub with water, adding an incorrect amount of disinfectant, running the jets, and wiping down surfaces. The posted cleaning instructions in the whirlpool room were outdated and did not match the manufacturer's guidelines. Additionally, the sanitizer function on the whirlpool tub had been broken for an extended period, and maintenance staff were unaware of the issue or the existence of the sanitizer function. Further observations in multiple resident rooms showed that AC units were not being routinely or adequately cleaned. Many units had indicator lights signaling that filters needed servicing, and visible dust and debris were present on intake and outflow vents. In some cases, a black substance was observed on the exit air flow vents. Interviews with maintenance and housekeeping staff confirmed that cleaning practices were inconsistent and insufficient, with staff only dusting the exterior of the units and not performing deeper cleaning between vents or servicing filters as required. The facility was unable to provide a policy for cleaning the in-room AC units when requested by surveyors. The lack of proper cleaning and maintenance of both the whirlpool tub and AC units, as well as the absence of up-to-date procedures and staff training, contributed to the identified deficiencies in infection prevention and control.

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