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F0880
E

Failure to Maintain Infection Control: Uncovered Linen Cart and Improper Biohazard Disposal

Fort Worth, Texas Survey Completed on 12-11-2025

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, as evidenced by two specific incidents involving staff and environmental management. In one instance, a clean linen cart located in the 100 hall was observed with its cover left open, exposing the linen to potential environmental contamination. Multiple staff members, including an LVN, a CNA, and a medication aide, were present and acknowledged that the cart should have been covered when not in use to prevent contamination and unauthorized access. Staff interviews confirmed that it was the responsibility of all staff to ensure linen carts remained covered and sanitary. In a separate incident, a sealed red biohazard bag containing potentially infectious materials was found left on the floor in the hallway outside a resident's room in the 300 hall. Staff interviews revealed that the bag had been dropped by an LVN after wound care and was not immediately picked up or reported by another CNA who noticed it. The bag was eventually disposed of properly, but only after being left unattended in a public area, contrary to facility policy and infection control protocols. Both the LVN and CNA acknowledged the importance of immediate and proper disposal of biohazard materials to maintain a sanitary environment. Record review of the facility's Infection Control Policy and Procedure Manual confirmed that clean linen must be stored in a secured, covered cart and that biohazard materials must be properly labeled and disposed of immediately. The manual also specifies that all staff are responsible for maintaining sanitary conditions and preventing contamination. Interviews with the Administrator and DON further confirmed that these were the expected standards and that the observed lapses constituted a failure to follow established infection control procedures.

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