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F0880
D

Failure to Use PPE During High-Contact Care for Resident on Enhanced Barrier Precautions

Terrell, Texas Survey Completed on 08-15-2025

Penalty

Fine: $36,060
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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 deficiency occurred when a licensed vocational nurse (LVN) failed to don personal protective equipment (PPE) prior to performing high-contact care activities for a resident on enhanced barrier precautions. The resident, a male with a history of cerebrovascular accident and dysphagia requiring tube feeding, was identified as being on enhanced barrier precautions due to the presence of an indwelling medical device. Facility policy required staff to wear gloves and gowns during high-contact activities such as medication administration via feeding tube, but the LVN only performed hand hygiene and did not use the required PPE while stopping the tube feeding, administering medication, and restarting the feeding. The LVN acknowledged awareness of the resident's precaution status and the need for PPE, stating she had received recent in-service training on enhanced barrier precautions. The Director of Nursing (DON) confirmed that staff were expected to use appropriate PPE for residents on enhanced barrier precautions and that staff had been trained on these protocols. Facility policy outlined the necessity of PPE use to prevent the transmission of multidrug-resistant organisms (MDROs) during high-contact care for residents with indwelling medical devices.

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