Regency Park: Infection Control Failures - GA
The resident, identified in the report as R3, had been admitted with multiple serious conditions including MRSA infection, osteomyelitis of his ankle and foot, acute respiratory failure, and a traumatic brain hemorrhage. He required an indwelling catheter due to neurogenic bladder and was considered cognitively intact with a mental status score of 13.
During the 11:11 a.m. observation on August 14, Certified Nursing Assistant AA removed a soiled pair of gloves after cleaning the resident's perineal area. Without performing any hand hygiene, she immediately put on new gloves and continued wiping the area before disposing of soiled cleaning materials.
She then removed those gloves and put on a third pair, again without washing her hands or using alcohol-based hand sanitizer. The assistant completed the procedure by adjusting the resident's incontinence brief, never performing visible hand hygiene between any of the glove changes.
When interviewed 46 minutes before the observation, CNA AA confirmed to inspectors that she did not perform hand hygiene between glove changes.
The facility's own hand hygiene policy, revised March 20, 2024, explicitly requires healthcare personnel to perform hand hygiene "after removing gloves or other personal protective equipment." The policy states that hand hygiene must be performed either by washing hands with antimicrobial soap or using alcohol-based hand rub.
R3's care plan specifically noted he was at risk for multi-drug-resistant organisms due to his Foley catheter, and Enhanced Barrier Precautions had been implemented for that risk. The resident's medical record showed he carried multiple high-risk conditions beyond the MRSA infection, including neuromuscular dysfunction of his bladder requiring the permanent catheter.
The Director of Nursing told inspectors during an interview at 10:35 a.m. that it was her expectation that hand hygiene be performed between glove changes.
Federal inspectors determined the deficient practice had the potential to transfer pathogens and increase the risk of infection transmission for R3. The violation was classified as having minimal harm or potential for actual harm.
The inspection was conducted in response to a complaint. Inspectors observed catheter care practices for four residents with catheters and found the hand hygiene failure affected one of the four residents reviewed.
R3's complex medical situation made proper infection control particularly critical. His combination of MRSA infection, bone infection in his foot and ankle, and dependence on an indwelling catheter created multiple pathways for dangerous bacteria to spread or worsen existing infections.
The facility had documented the resident's infection risks in his care plan, acknowledging the heightened danger posed by his catheter and implementing enhanced precautions. Yet the basic infection control measure of hand hygiene between glove changes was not followed during his intimate care.
Gloves alone do not prevent contamination between different body areas or procedures on the same patient. Healthcare workers' hands can become contaminated on the outside of gloves during care, making hand hygiene essential when changing to clean gloves, particularly for residents with known infections like MRSA.
The assistant's failure to wash hands between the three sets of gloves during catheter care meant potential pathogens from the resident's perineal area could have been transferred to clean areas or equipment during the procedure.
MRSA infections are particularly dangerous in nursing home settings because the bacteria resist many common antibiotics. Residents with catheters face elevated infection risks under normal circumstances, and those risks multiply when basic hygiene protocols are ignored during care.
The inspection found that few residents were affected by the deficient infection control practices, but the violation occurred during care of one of the facility's most vulnerable residents - someone already fighting a serious antibiotic-resistant infection while dependent on medical devices that create additional infection pathways.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Regency Park Health and Rehabilitation from 2025-08-14 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 20, 2026 · Our methodology
REGENCY PARK HEALTH AND REHABILITATION in DALTON, GA was cited for violations during a health inspection on August 14, 2025.
He required an indwelling catheter due to neurogenic bladder and was considered cognitively intact with a mental status score of 13.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.