Federal inspectors found Hibbard Skilled Nursing & Rehabilitation Center failed to follow its own Enhanced Barrier Precautions policy during a December 30 complaint investigation. The resident, who suffers from peripheral vascular disease and chronic venous insufficiency, had visible wounds on the right leg that required daily treatment with multiple medications.
When inspectors observed the resident's room at 10:37 a.m., no warning signs were posted on the door or wall indicating special precautions were needed. The resident lay in bed with the right lower leg exposed, showing a wound that appeared treated with betadine.
Certified Nursing Assistant #1 told inspectors the resident "is not on EBP or any type of precautions." The assistant was unaware that enhanced barrier precautions were required.
Yet the resident's care plan explicitly stated: "The resident has a hx [history] of a venous wound on [his/her] right lower leg... follow EBP."
The facility's own policy, revised in March 2025, requires enhanced barrier precautions "for residents with wounds" including "chronic wounds (i.e. pressure ulcers, diabetic foot ulcers, venous stasis ulcers)." The policy states these precautions "remain in place for the duration of the resident's stay or until resolution of the wound" and mandates that "signs are posted in the door or wall outside the residents room indicating the type of precautions and PPE required."
Medical records showed the resident required extensive wound care. Active physician orders included daily cleansing of a right dorsal foot wound with normal saline, application of santyl and calcium alginate dressing. A separate order required cleansing the right lower extremity wound with betadine, leaving it open to air daily. A third order prescribed Santyl External Ointment for the foot wound.
Registered Nurse #2 had provided the resident's wound care eight times between December 18 and the day of inspection, according to treatment records. But when interviewed at 1:49 p.m., she told inspectors "she thinks Resident #1 was on EBP at some point, but that his/her wounds had also improved at one point, so he/she was taken off EBP."
The confusion extended to facility leadership. When inspectors spoke with the Infection Preventionist at 2:30 p.m., she explained that the facility discusses "all residents with open wounds and devices" every Friday during Risk meetings. She said Registered Nurse #2 "is usually the one who discontinues a resident's precautions because she does the wound treatments."
The Infection Preventionist then contradicted the facility's written policy, stating "if a wound is not draining the resident would not need to be on EBP." The facility's Enhanced Barrier Precautions policy makes no exception for non-draining wounds, requiring the precautions for all residents with chronic wounds.
Enhanced barrier precautions are designed to prevent transmission of multi-drug resistant organisms between residents. The policy requires staff training before caring for residents under these precautions and mandates visible warning signs to alert all personnel entering the room.
Without proper signage or staff awareness, any employee entering the resident's room could unknowingly expose themselves and other residents to potential infection. The breakdown occurred despite daily wound treatments that should have triggered consistent application of the facility's infection control measures.
The inspection findings were discussed with the Director of Nursing at approximately 2:45 p.m. on December 30.
The resident continues receiving daily wound care while living in a room where staff remain unaware of required infection control precautions.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Hibbard Skilled Nursing & Rehabilitation Center from 2025-12-30 including all violations, facility responses, and corrective action plans.