F0880

D

Failure to Enforce Droplet Precautions and Proper PPE Use

Terrell, Texas Survey Completed on 03-05-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to maintain an effective infection prevention and control program for a resident on droplet precautions. The resident was an adult female with chronic respiratory failure with hypoxia, bipolar disorder, and tracheostomy status, and had a care plan initiated for pneumonia. Physician orders dated 03/05/2026 directed that the resident be placed on droplet isolation precautions related to flu/pneumonia starting 03/04/2026. A droplet precaution sign was posted beside the resident’s doorframe, and a cart with face shields, face masks, gowns, gloves, and shoe covers was placed outside the room. However, the resident’s care plan did not address the use of droplet precautions.

On 03/04/2026 at 10:31 AM, a CNA was observed inside the resident’s room without any PPE, despite the posted droplet precaution sign and available PPE cart. After noticing the surveyor, the CNA exited the room, donned a face mask, face shield, and gown, and re-entered the room. When leaving the room, the CNA removed PPE in the hallway instead of before exiting the resident’s room. In a subsequent interview, the CNA stated she was not aware the resident required droplet precautions, said she had been in a rush and did not pay attention to the sign, and acknowledged that PPE should be removed before leaving residents’ rooms and that proper PPE use was important for infection control.

On 03/04/2026 at 11:13 AM, a medication aide donned a face mask, gown, and gloves, but not a face shield, before entering the resident’s room to administer medications, and then removed PPE in the hallway. The medication aide stated she did not need a face shield because she was not in the room for a long time and believed removing PPE in the hallway was appropriate. On 03/05/2026 at 8:21 AM, the same medication aide again wore a face mask, gown, and gloves to enter the room, exited into the hallway still wearing the gown and mask, removed only her gloves, performed hand hygiene, donned new gloves, prepared medications in the hallway, and administered them to the resident without removing the gown and mask before exiting the room. The DON stated that droplet precautions for this resident required staff to don a face mask, face shield, gown, and gloves prior to entering the room and to remove PPE before exiting, and the Administrator stated he expected staff to follow facility protocol. The facility’s written Infection Prevention and Control Program referenced educating staff and ensuring adherence to proper techniques but did not specifically address PPE requirements for droplet precautions, and a droplet-specific policy was requested but not provided.