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F0880
D

Failure to Follow Infection Control Practices During Medication Administration and Enhanced Barrier Precautions

Elkins, West Virginia Survey Completed on 08-05-2025

Penalty

Fine: $34,575
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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 maintain proper infection prevention and control practices as evidenced by two separate incidents involving medication administration and enhanced barrier precautions. In the first incident, a registered nurse was observed administering medications from blister packs to a resident. When two medications fell onto the uncovered medication cart, the nurse used her bare fingers to place the medications into a cup for administration, contrary to facility policy which prohibits touching medications with bare hands and requires discarding medications that fall onto surfaces. The Director of Nursing confirmed that these actions were not in accordance with facility policy. In the second incident, a licensed practical nurse was observed providing care to a resident with a gastrostomy tube and an order for enhanced barrier precautions due to wounds and the feeding tube. The nurse wore gloves but failed to wear a gown while flushing the gastrostomy tube and connecting enteral feeding, despite facility policy and posted signage requiring both gloves and a gown for such high-contact care activities. The Director of Nursing confirmed that a gown should have been worn during this procedure.

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