F0880

D

Failure to Adhere to PPE Requirements for Transmission-Based Precautions

Poughkeepsie, New York Survey Completed on 03-18-2026

Penalty

No penalty information released

Summary

Surveyors identified a deficiency in the facility’s infection prevention and control program related to improper use of personal protective equipment (PPE) during an abbreviated survey. The facility’s infection control policy, last reviewed in January 2025, required the use of transmission-based precautions when more stringent measures than standard precautions were needed, and its PPE policy required appropriate barrier use based on the nature of resident interaction and likely mode of transmission, with supplies readily accessible. Despite these policies, on 3/2/2026 at 12:04 p.m., a Certified Nurse Aide (CNA #1) was observed entering the room of Resident #2, who had a contact precaution sign posted on the door, without donning any PPE prior to entry.

During an interview immediately following this observation, CNA #1 stated they believed Resident #2 was on contact precautions due to “something with their head,” acknowledged they had entered the room without PPE, and admitted they should have applied PPE because the resident was on contact precautions, explaining they forgot and were rushing to answer the call bell. On 3/3/2026 at 10:37 a.m., another aide (CNA #2) was observed correctly donning PPE to enter the room of Resident #3, who was on droplet precautions. However, at 10:50 a.m., CNA #2 was observed in the hallway still wearing the mask used in the droplet precaution room. In a subsequent interview, CNA #2 acknowledged wearing the mask in the hallway and stated it should have been removed, and also reported that the facility does provide infection control training but could not recall when they were last trained, while stating they understood that PPE must be applied when residents are on precautions and removed after care is completed.