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F0880
E

Failure to Follow Infection Control Protocols During Resident Care

Kerrville, Texas Survey Completed on 06-06-2025

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 maintain proper infection prevention and control practices for five of seven residents reviewed. Specifically, a medication aide (MA) did not sanitize a wrist blood pressure cuff between use on two different residents, despite having received training and being assessed as satisfactory in infection control practices. The MA acknowledged forgetting to sanitize the equipment and recognized the risk of spreading germs. Both residents involved had diagnoses of hypertension and were receiving blood pressure monitoring and medication administration as part of their care. Additionally, a licensed vocational nurse (LVN) did not perform hand hygiene between feeding and assisting three different residents during breakfast. The LVN admitted to not washing or sanitizing her hands between residents, citing a desire to ensure timely feeding, and acknowledged awareness of infection control protocols. The LVN had previously been assessed as competent in hand hygiene and standard precautions. Facility policy required hand hygiene before and after resident contact and cleaning of reusable equipment between residents, but these protocols were not followed during the observed incidents.

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