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F0880
D

Failure to Follow Infection Control Practices During Medication Administration

Seguin, Texas Survey Completed on 12-10-2025

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

A deficiency was identified when a nurse failed to follow proper infection control practices during medication administration for a resident with multiple diagnoses, including Dry Eye Syndrome, Constipation, Hemiparesis, Hemiplegia, and Hyperlipidemia. During observation, the nurse placed a Gabapentin capsule on a piece of paper on top of the medication cart, rather than directly into a medication cup, and subsequently picked up the capsule with her bare hand before administering it to the resident. The nurse admitted there was no reason for placing the capsule on the cart and acknowledged that this action could put the resident at risk for infection, noting that medications should be handled in a clean manner and that hand hygiene should be performed. Further interview with the Assistant Director of Nursing confirmed that placing medication on top of the cart was not acceptable due to the risk of cross contamination, and that medications should be transferred directly from the blister pack or bottle to a medication cup. Review of the facility's medication administration policy also indicated that medications are to be administered in a manner that prevents contamination or infection, specifically instructing staff not to touch medications with bare hands. The observed actions were not in accordance with these established procedures.

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