Park Villa: Nurse Used Same Gloves on Wound, Genitals - KS
The infection control violation occurred during what should have been routine wound and catheter care for Resident 6, who lay in bed with her eyes closed when Licensed Nurse H and Certified Nurse Aide M entered her room at 10:21 AM on April 15.
Both staff members donned gowns, N95 masks and gloves before explaining they would examine the wound on the resident's bottom and provide catheter care. They uncovered Resident 6, who had no incontinence brief on, and Licensed Nurse H helped turn her onto her left side.
CNA M separated the middle of the resident's buttocks, revealing an open area approximately 0.3 centimeters long by 0.2 centimeters wide. The aide then provided catheter care, starting from the insertion site and working down the tubing with a wet soapy washcloth, followed by a dry cloth.
What happened next violated the facility's own infection control policies.
Licensed Nurse H repositioned Resident 6 on her back and separated the resident's labia while wearing the same gloves that had been near the open wound. Without changing gloves, the nurse then pulled down the resident's front blouse and placed her contaminated hands on the cloth bed pad to help CNA M pull the resident up in bed.
The contamination spread further. Still wearing the same soiled gloves, Licensed Nurse H pulled the resident's sheet and blanket over her, placed the bed control in the resident's right hand, and used the control to raise the head of the bed. Only then did she remove and discard the gloves, gown and mask in a trash can.
When confronted by inspectors, Licensed Nurse H acknowledged the violation. She verified she had not changed gloves after examining Resident 6's genitals and stated she should have.
The failure created a clear pathway for potential infection. The same gloves that touched the open wound area made contact with the resident's genitals, clothing, bedding, and bed controls. Each surface became a potential reservoir for bacteria or other pathogens that could have originated from the wound site.
Administrative Nurse E confirmed the facility's expectations during an interview at 12:08 PM the same day. She stated she would expect staff to change gloves and wash hands when providing care, particularly when moving from dirty areas to clean ones.
The facility's own Infection Control Policy, revised just three months earlier on January 19, explicitly required what Licensed Nurse H failed to do. The policy instructed staff to remove soiled gloves, wash hands, and change gloves after contact with infectious material and before leaving the resident's environment. It also mandated immediate hand washing with antimicrobial soap.
The violation represents a fundamental breakdown in basic nursing care. Hand hygiene and glove changes between different body sites during patient care constitute elementary infection control practices taught in entry-level healthcare training.
Federal inspectors classified the violation as causing minimal harm or potential for actual harm, affecting few residents. However, the specific circumstances created multiple opportunities for cross-contamination that could have resulted in serious infection for a vulnerable resident with an existing open wound.
The incident occurred despite the facility having updated infection control policies just months before the inspection. The gap between written policy and actual practice suggests systemic issues with staff training or supervision of basic care procedures.
For Resident 6, the violation meant that what should have been protective medical care instead became a potential source of additional health risks. The resident's open wound, already a site of vulnerability, was unnecessarily exposed to contamination from her own body and environment through improper glove use.
The inspection report does not indicate whether Resident 6 developed any infections following the improper care, but the violation created conditions where such complications could easily have occurred.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Park Villa from 2026-04-15 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 12, 2026 · Our methodology
PARK VILLA in CLYDE, KS was cited for violations during a health inspection on April 15, 2026.
Both staff members donned gowns, N95 masks and gloves before explaining they would examine the wound on the resident's bottom and provide catheter care.
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.
Frequently Asked Questions
- What happened at PARK VILLA?
- Both staff members donned gowns, N95 masks and gloves before explaining they would examine the wound on the resident's bottom and provide catheter care.
- How serious are these violations?
- Violation severity varies from minor documentation issues to serious safety concerns. Review the inspection report for specific deficiency codes and scope. All violations must be corrected within required timeframes and are subject to follow-up verification inspections.
- What should families do?
- Families should: (1) Ask facility administration about specific corrective actions taken, (2) Request to see the follow-up inspection report verifying corrections, (3) Check if this represents a pattern by reviewing prior inspection reports, (4) Compare this facility's ratings with other nursing homes in CLYDE, KS, (5) Report any new concerns directly to state authorities.
- Where can I see the full inspection report?
- The complete inspection report is available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request a copy directly from PARK VILLA or from the state Department of Health. The report includes specific deficiency codes, facility responses, and correction timelines. This facility's federal provider number is 175492.
- Has this facility had violations before?
- To check PARK VILLA's history, visit Medicare.gov's Care Compare and review their inspection history, quality ratings, and staffing levels. Look for patterns of repeated violations, especially in critical areas like abuse prevention, medication management, infection control, and resident safety.