F0880

D

Failure to Implement and Communicate Droplet Precautions for an Admitted Resident

Weslaco, Texas Survey Completed on 01-14-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to fully implement droplet transmission-based precautions for a cognitively impaired male resident who was readmitted from the hospital with rhino virus/possible flu and pneumonia and required droplet precautions. The resident had multiple diagnoses including TIA, hypertension, dementia, and dysphagia, and was dependent on staff for all self-care. His care plan reflected Enhanced Barrier Precautions (EBP) for prior conditions, including use of gown and gloves for high-contact care and optional mask/eye protection as indicated. Upon readmission, baseline/readmission documentation and hospital paperwork indicated that he required droplet precautions, and a nursing progress note documented that he was on single-room isolation. Orders were entered for droplet precautions due to influenza.

Despite this, surveyor observation on the morning after readmission showed that there was no droplet/isolation sign posted at the resident’s door and no PPE set up outside the room until after 8:40 a.m., when staff were seen placing the sign and hanging PPE. Multiple CNAs and nurses reported that, although some staff verbally knew the resident was on droplet precautions and individually obtained PPE from carts or the nurses’ station, the standardized visual cues and room setup (signage and PPE station) were not in place during the night and early morning. One CNA reported providing incontinence care around 6:30 a.m. wearing only gown and gloves based on the resident’s prior EBP status and stated she was not informed of droplet isolation until later that morning; she also reported having entered multiple rooms and assisted with breakfast before learning of the droplet status. Another CNA assigned to the hallway overnight stated there were no isolation signs or PPE set up at the door while she worked, although she personally used mask, shield, gown, and gloves based on verbal report.

Interviews with nursing staff and leadership revealed inconsistent understanding and execution of responsibilities for initiating and posting droplet precautions. One LVN who assisted with admission stated she knew from hospital report that the resident was on droplet precautions and used full PPE for the skin assessment but did not place signs or PPE at the door and could not recall if they were present. Another LVN on night shift stated she was aware of the droplet order, wore appropriate PPE, and verbally informed CNAs and a lab technician, but confirmed that signs and PPE were not posted at the door and cited limited access to certain supplies at night. A day-shift RN acknowledged that when he arrived, there were no precautions posted and that the admitting nurse was responsible for setting them up. The DON and Administrator both stated that when a resident is admitted or readmitted on droplet precautions, appropriate signage and PPE should be in place immediately based on hospital report and that nurses are responsible for clarifying isolation type and informing staff. The facility’s infection prevention and control policy requires that residents with communicable diseases be placed on transmission-based precautions per CDC guidelines and that staff use PPE according to policy, but in this case, the facility did not ensure that all staff were informed of the resident’s droplet status and did not ensure that droplet precaution signage was posted at the room entrance during the period the resident was on droplet precautions.