Wurtland Nursing & Rehabilitation

F-F677 for specific findings.)

2. Based on observation, interview, and record review, Resident R124, Resident R80, and Resident R36 failed to receive care as needed. Staff incorrectly applied medicated treatments, failed to properly clean a resident's prosthetic eye, and failed to change a dressing as ordered. (Refer to

F-F684 for specific findings.)

3. Based on observation, interview, and record review, Resident R27 and Resident R10 developed facility-acquired pressure ulcers after staff failed to provide pressure prevention approaches including incontinence care and turning/repositioning. (Refer to

F-F686 for specific findings.)

4. Based on observation, interview, and record review, Resident R1 and Resident R125, who each had a catheter, failed to receive care in a manner to prevent and/or timely treat urinary tract infections. (Refer to

F-F690 for specific findings.)

5. Based on interview and record review, Resident R62 was hospitalized for dehydration and hypernatremia after failing to receive all ordered nutrition and fluids through a feeding tube, (Refer to

F-F693 for specific findings.)

6. Based on interview and record review, Resident R119 failed to receive pain medication as ordered after nursing staff failed to order it in a timely manner. (Refer to

F-F697 for specific findings.)

Review of the facility policy titled, Staffing, effective 10/01/2024, revealed the purpose was to provide sufficient care team members with appropriate competencies and skill sets to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. The census, acuity and diagnoses of the resident population would be considered based on the facility assessment. Further review of the facility policy revealed the company would supply services by sufficient numbers of each of the following care team member types on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans: licensed nurses and other nursing personnel, including but not limited to State Registered Nurse Aides (SRNAs).

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 29 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0725 Review of the facility document titled, Facility Assessment Tool (FAT) dated 11/2023-12/2024 revealed the purpose was to determine what resources were necessary to care for residents competently during both Level of Harm - Minimal harm or day-to-day operations and emergencies. The assessment was used to make decisions about direct care staff potential for actual harm needs as well as the facility's capability to provide services to the residents in the facility and was focused on ensuring each resident was provided care that allowed the resident to maintain or attain their highest Residents Affected - Many practicable physical, mental, and psychosocial well-being.

Continued review of the document, dated 11/2023-12/2024, revealed the intent of the facility assessment was for the facility to evaluate its resident population and identify the resources needed to provide the necessary person-centered care and services the residents require. Additional review of the FAT, Page 3, revealed the facility average daily census was 109 and Page 18 revealed the facility had assessed the need for 12-18 nurse SRNAs per day, four to ten on the day shift and four to eight on the night shift, as well as, the need for four to seven nurses per day, two to five on the day shift and two to four on the night shift. Per the FAT, the facility estimated caring for an average of 35 residents who were dependent of staff for toileting needs with an additional 61 residents requiring assistance of one or two staff members for toileting. Additionally, the facility estimated all residents required some form of assistance with eating, eight of which were totally dependent and an additional three who required substantial/maximal assist. The general facility process section of the FAT outlined to ensure the facility had sufficient staff to meet the needs of the residents at any given time was documented as refer to the Centers for Medicare and Medicaid (CMS) Minimum Staffing Rule.

Review of the facility's PBJ [NAME] report for the fourth quarter of the Fiscal Year 2024 (July 1 - September 30) revealed the facility had a One Star Staffing Rating and submitted weekend staffing data was excessively low.

Initial review of the Detailed Hours Report (DHR) which documented actual hours staff were punched in for work for hours worked on weekend shifts for 09/07/2024, 09/08/2024, 09/15/2024, 09/21/2024, 10/05/2024, and 10/06/2024, 10/20/2024 revealed:

7. On 09/07/2024, five SRNAs worked from 6:00 AM-6:00 PM and an additional one SRNA worked from 8:00 AM to 2:00 PM, indicating from 6:00 AM to 8:00 AM and from 2:00 PM to 6:00 PM each SRNA was responsible for the care of 22 residents and from 8:00 AM to 2:00 PM each SRNA was responsible for the care of 18 residents.

On 09/08/2024, six SRNAs worked from 6:00 AM-6:00 PM indicating each SRNA was responsible for the care of 18 residents.

On 09/15/2024 four SRNAs worked from 6:00 AM-6:00 PM indicating each SRNA was responsible for the care of 27 residents.

On 09/21/2024 six SRNAs worked from 6:00 AM-6:00 PM indicating each SRNA was responsible for the care of 18 residents.

On 10/05/2024 six SRNAs worked from 6:00 AM-6:00 indicating each SRNA was responsible for the care of 18 residents.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 30 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0725 On 10/06/2024 five SRNAs worked from 6:00 AM-6:00 indicating each SRNA was responsible for the care of 22 residents. Level of Harm - Minimal harm or potential for actual harm On 10/20/2024 four SRNAs worked from 6:00 AM-6:00 PM each SRNA was responsible for the care of 27 residents. Residents Affected - Many

Review of the DHR dated 10/14/2024 revealed one nurse was working from 6:00 PM to 12:00 AM and was responsible for the care of all the facility's residents.

Review of the facility DHR dated 01/21/2025 revealed five SRNAs were working from 6:00 PM-6:00 AM requiring each SRNA to be responsible for the care of 22 residents.

Review of the DHR dated 01/24/2025 revealed four SRNAs worked from 6:00 PM-6:00 AM and one SRNA worked from 6:00 PM to 12:00 AM, requiring each SRNA to be responsible for the care of 21 residents from 6:00 PM to 12:00 AM and 27 residents from 12:00AM to 6:00 AM.

Review of the DHR dated 01/25/2025 revealed three SRNAs worked from 6:00 PM-9:00 PM, requiring each SRNA to be responsible for the care of 37 residents until an additional two SRNAs arrived at 9:00 PM, totaling five SRNAs who worked from 9:00 PM-6:00 AM requiring each SRNA to be responsible for the care of 22 residents.

Review of the facility document titled Daily Staffing (DS) sheet dated 01/26/2025 revealed the facility scheduled a total of four SRNAs from 6:00 PM-6:00 AM, requiring each SRNA to be responsible for the care of 27 residents.

Review of the DS dated 01/28/2025 revealed six SRNAs worked from 6:00 PM-6:00 AM, requiring each SRNA to be responsible for the care of 18 residents.

Review of the DS dated 01/29/2025 revealed three SRNAs worked from 1:00 AM-6:00 AM, requiring each SRNA to be responsible for the care of 36 residents.

Review of the DS dated 02/01/2025 revealed six SRNAs worked from 6:00 AM-6:00 PM, requiring each SRNA to be responsible for the care of 18 residents.

Review of the facility document titled, Engagement Survey Results, dated 11/2024 revealed documented comments from staff citied the chronic frustrations with the need for more SRNAs 17 times. One comment stated, We need more SRNAs, the workload is horrible and to get everyone changed you sometimes have to miss showers.

Review of the facility document Detailed Hours, dated 07/23/2024 revealed a total of seven SRNAs working from 6:00 AM until 2:00 PM and six SRNAs working from 2:00PM until 6:00 PM. Further review revealed a total of five SRNAs working 6:00 PM until 6:00 AM. Review of the staffing sheet for 07/23/2024 revealed a facility census of 115.

8. a. Review of a Report of Concern, dated 07/02/2024, Family Member (F) 52 reported a concern of Resident R52's call light not being answered timely. The Executive Director (ED) marked the grievance as confirmed and wrote that nurses were educated about call light wait times.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 31 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0725 In an interview on 01/27/2025 at 9:47 AM, F52 stated she reported to the facility that there had been multiple times the family had waited with Resident R52 for over 20 minutes after pressing the call light. She further stated when Level of Harm - Minimal harm or they had been waiting, they would go down to the nurse's desk to find nurses sitting there. Per interview, F52 potential for actual harm stated the ED took notes of the concerns and said she would talk to staff. F52 continued to state administration told her they would put it in Resident R52's Care Plan that she needed to be toileted more frequently Residents Affected - Many than every two hours. F52 added that Resident R52 had a doctor's appointment on 07/24/2024 and was supposed to receive a shower on the evening of 07/23/2024 and wear the clean clothes F52 put out on Resident R52's wheelchair. Per interview, when F52 met Resident R52 at the doctor's office, Resident R52 was still wearing the clothes she was wearing

during the day on 07/23/2024, not the clean ones. Resident R52's hair was dirty and unbrushed. She stated she filed a grievance with the ED, who told her the aide had not given the shower but had charted that she had by mistake. In further interview, F52 stated the ED told her if she did not like the care provided to Resident R52, she could take Resident R52 home.

Review of the facility time punch document, Detailed Hours, dated 11/02/2024 revealed a total of six SRNAs working from 6:00 AM until 6:00 PM. Further review revealed a total of four SRNAs working from 6:00 PM until 6:00 AM. Review of the facility staffing sheet for 11/02/2024 revealed the census was 115.

b. Review of a Report of Concern, dated 11/02/2024, revealed F52 filed a grievance when she found Resident R52 sitting in briefs and clothes soiled with urine and noted urine dripping into the floor beneath Resident R52's wheelchair. Further review revealed the ED marked the grievance as confirmed and noted the care team member was terminated on 11/04/2024.

In an interview on 01/27/2025 at 9:47 AM, F52 stated on 11/02/2024, she came in to find Resident R52's briefs, clothing, and wheelchair saturated with urine and urine puddled in the floor beneath Resident R52's wheelchair. F52 asked an aide, whose name she could not recall, to clean Resident R52 up. F52 stated the staff member told her she could not help until she had picked up dinner trays.

In an interview on 02/01/2025 at 6:28 PM, the Executive Director (ED) stated she recalled F1's grievance related to Resident R52 being left wet on 11/02/2024. She further stated that in investigating the grievance, she confirmed Resident R52 had been wet with urine and the SRNA who responded was rude to F52.

c. Review of the facility time punch document, Detailed Hours, dated 11/22/2024 revealed a total of five SRNAs working 6:00 PM until 6:00 AM. Review of the facility staffing sheet dated 11/22/2024 revealed the facility census was 109.

In an interview on 01/27/2025 at 9:47 AM, F52 stated that on 11/22/2024, she waited one hour and three minutes for staff to answer Resident R52's call light when the resident needed assistance with toileting/incontinence care. Per interview, F52 timed the wait on her phone and took a video.

d. Review of the facility time punch document Detailed Hours, dated 12/04/2024 revealed six SRNAs working from 6:00 AM until 6:00 PM, with two additional SRNAs working 10:00 AM until 4:00 PM, and one SRNA working 6:00 AM until 4:00PM. Further review revealed four SRNAs working 6:00 PM until 6:00 AM. Review of the facility staffing sheet dated 12/04/2024 revealed the facility census was 103.

In an interview on 01/27/2025 at 9:47 AM, F52 stated that on the evening of 12/04/2024, she waited a prolonged period of time for staff to answer Resident R52's call light when the resident needed assistance with toileting and incontinence care.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 32 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0725 e. Review of the facility time punch document, Detailed Hours, dated 01/14/2025, revealed six nurse aides working 6:00 AM until 6:00 PM, one SRNA working 12:30 PM until 5:00 PM, one SRNA working 10:00 AM Level of Harm - Minimal harm or until 6:00 PM, and the wound care SRNA working 9:00 AM until 5:00 PM. Review of the facility staffing sheet potential for actual harm dated 01/14/2025 revealed the census was 108.

Residents Affected - Many In an interview on 01/27/2025 at 9:47 AM, F1 stated she came in the afternoon of 01/14/2025 to find Resident R52 in a soaked brief and clothes wet with urine.

f. Review of the facility time punch document Detailed Hours, dated 01/15/2025, there were six SRNA working 6:00 AM until 6:00 PM, with two additional SRNAs working partial shifts. Further review revealed five SRNAs working from 6:00 PM until 1:00 AM, and 4 SRNAs working from 11:00 PM until 7:00 AM. Review of

the facility staffing sheet for 01/15/2025 revealed the facility census was 109.

In an interview on 01/27/2025 at 9:47 AM, F52 stated she came in the afternoon of 01/15/2025 to find Resident R52 in

a soaked brief and clothes wet with urine.

9. a. Observation on 01/29/2025 at 4:42 PM revealed three call lights, both visual and audible, were alerting

on the back hall. A male resident was overheard stating, Can someone help me, I am a mess. Licensed Practical Nurse (LPN) 2 stated, You will need to wait, buddy.

b. Observation, on 01/29/2025 at 4:45 PM, during dining service, revealed the call light for room [ROOM NUMBER], both visual and audible, was alerting on the front hall. LPN6 was observed sitting at the nurse's station with the call light board behind him alarming and illuminated and he did not get up to assist with answering the call light.

c. Observation on 01/29/2025 at 4:46 PM during dining service, revealed a call light for room [ROOM NUMBER], both visual and audible, was alerting on the front hall. The Activities Director (AD) walked past

the room and did not address the call light.

d. Observation on 01/31/2025 at 10:53 AM revealed two call lights illuminated and audible on the South Hall. LPN1 and LPN2 were observed sitting at the nurse's station with the call light board behind nurses' station illuminated and audible. Neither LPN1 nor LPN2 got up to answer the call lights.

e. Observation on 01/31/2025 at 4:45 PM of one SRNA in the dining room sorting meal tickets while six meal trays were waiting in the pass through ready to be given to the residents and four call lights on the North Hall were illuminated and audible.

f. Observation on 01/31/2025 at 7:50 AM revealed the call light for room [ROOM NUMBER] was lit above the resident's door. Further observation revealed the call light board at the nurse's station displayed a light indicating room [ROOM NUMBER]'s call light was on, as well as making an intermittent beep to alert staff to

the call light. Continued observation revealed LPN1 and LPN2 sitting at the nurse's desk, in view of the control board, where the beeping could be heard, Neither LPN looked over at the control board to see which light was on, nor did they get up to look in the hallway. Per observation, the call light for room [ROOM NUMBER] sounded for four minutes without any response from the LPNs.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 33 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0725 In an interview on 01/31/2025 at 8:00 AM, LPN1 and LPN2 stated it was everyone's responsibility to answer call lights. When asked about the call light that had sounded for several minutes prior to the interview, the Level of Harm - Minimal harm or LPNs asked the survey team if the sound went off at the nurse's station. When the survey team confirmed potential for actual harm that the sound went off, the LPNs failed to provide any response to why they had not acknowledged the call lights. Residents Affected - Many g. Observation on 02/01/2025 at 10:08 AM revealed the call light for room [ROOM NUMBER] was on. No SRNAs were seen in the hallway. Qualified Medication Aide (QMA)8 was present, preparing medicine. The Maintenance Director walked past room [ROOM NUMBER] without turning his head. Observations at 10:12 and 10:13 AM revealed the Social Services Director (SSD) also walked by room [ROOM NUMBER] while the call light was on, without turning her head to look in the resident's room. Observation at 10:17 AM revealed

the call light was still going off (nine minutes after first observed) when ED2 entered the room, asked the resident what he needed and stated he would go get the nurse. The call light remained lit until 10:19 AM when LPN4 entered, asked the resident if he wanted a breathing treatment, and began to administer it, then walked away while it was going in.

10. a. During an interview on 01/26/2025 at 4:40 PM with Resident R90, she stated she had been sitting in a wet bed for a couple hours, had put her call light on twice and was told by the SRNAs they had a new admission and were busy. Observation during this interview revealed the resident's brief appeared heavy with urine.

Review of the DHR, dated 01/26/2025, revealed six SRNAs worked from 6:00 AM-6:00 PM and one SRNA worked from 8:00 AM to 5:00 PM. During the time that Resident R90 was left sitting in the wet bed, each SRNA was responsible for the care of 18 residents from 8:00 AM to 5:00 PM and 22 residents from 6:00AM to 8:00 AM and from 5:00 PM to 6:00 PM.

b. During an interview on 01/26/2025 at 1:58PM with Resident R362, she stated on 01/24/2025 at 6:00 PM during shift change, she requested help having her brief changed. She stated it took staff until after 10:00 PM for them to come and change her brief. Resident R362 stated having to lay in her waste made her feel humiliated/nasty. She stated it took staff so long to come in and change her that some of her body fluid had leaked on her right leg splint where she had broken her leg back in December. Resident R362 also indicated on her cell phone where she had tried to call the facility for help, and no one would answer the phone.

c. During an interview on 01/26/2025 at 2:03 PM, Resident R79 stated she also had to wait at least four (4) hours on 01/24/2025 for staff to come in and change her. Resident R79 stated she felt nasty having to lay in bed waiting for help to change her. She stated she had a stroke and needed assistance in cleaning herself. She stated one staff member came in her room and turned off the call light and disappeared without providing assistance.

During an interview on 01/28/2025 at 9:06 AM with SRNA4, she stated when there were four SRNA's on the back (North) hall, they had between 12-15 residents apiece. When there were only three SRNAs, they had approximately 20 residents apiece. She stated the back hall had many residents who were overweight and were a higher level of care and she needed SRNA3, who was in training, to help out.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 34 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0725 During an interview on 01/29/2025 at 10:27 AM with SRNA7, she stated staffing had been an issue at the facility for a while. SRNA7 stated that although she could not remember the exact date, there was one night Level of Harm - Minimal harm or there were three SRNAs for the entire building. SRNA7 further stated it was hard to get staff to come to work, potential for actual harm as well as, retain new staff due to the heavy workload.

Residents Affected - Many During an interview on 01/30/2025 at 9:41 AM with SRNA3, she stated she had been at the facility about a month, worked day shift and was typically assigned 16-18 residents. However, one Saturday, the facility was short staffed, and she had 22 residents to care for which she felt was not safe. She stated she often felt like

she was drowning and even though residents with behaviors required more care, 22 residents felt like a lot to care for anywhere. SRNA3 stated she tried to answer all the lights and had been told it was the SRNAs job to answer them. SRNA3 stated the Certified Medication Technicians (CMTs) would help when they could, but the nurses did not get up to answer call lights. She further stated residents have complained to her about long waits for their call light to be answered and there had been mealtimes when there was only one SRNA

in the dining room when there should be two. During mealtimes, there were four - five residents that needed total assist with eating, and she has had to sit all those residents at the same table and feed two residents at

a time. After the meal and upon her return to her assigned hall, SRNA3 stated she would often see several call lights on and no staff visible. SRNA3 stated on this day she had 14 residents and felt like she was rushing around.

Further, on 01/30/2025 at 9:41 AM, SRNA3 stated she was supposed to complete check and change rounds every two hours; however, it was easy to fall behind when caring for a resident that urinated more frequently or in larger amounts. SRNA3 stated on her first round before breakfast, she had walked into a resident's room after a night shift SRNA had told her the resident had been changed. However, she found the resident's bed was soaked and it looked like he had been a mess for hours which she could tell because the longer they sit, the darker the yellow ring (urine-soakage) was. SRNA3 stated it was hard to complete every two-hour rounds on every resident and complete four showers. She stated sometimes she did not take a lunch or would have to leave a resident soiled longer while she finished another resident's shower. Ideally, SRNA3 stated she would like to be able to get to every resident before they soiled themselves so she could assist them to the bathroom if possible. She stated she had to prioritize care based on which residents were

the heaviest care need and there were some residents that did not get the attention they deserved, and she felt bad about that. SRNA3 stated sometimes residents ask her to sit and talk with them, adding, she does not have time to do it.

During an interview on 01/30/2025 at 9:41 AM with SRNA12, she stated she had been at the facility since January 2024. SRNA13, who was present, stated she had been at the facility since July 2024 and neither SRNA had been issued a name tag. Both SRNAs agreed that in an average day, they cared for 15-20 residents and were responsible for meals, baths/showers and changing briefs/clothes/beds as needed, assisting with transportation to activities/smoke breaks, and individual resident care requests. SRNA12 and SRNA13 stated they would lose their bonus if they did not take a lunch, so they would punch out for lunch but then worked through to keep their bonus. SRNA12 and SRNA13 stated many SRNAs have left because of the workload and the nurses did not help out. They further stated they worked short last week, there were only three SRNAs on each hall (18 residents per SRNA) and sometimes they were only staffed for two SRNAs on each hall (27 residents per SRNA).

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 35 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0725 Furnter, SRNA12 and SRNA13 stated, on 01/30/2025 at 9:41 AM, there was usually one SRNA in the dining room who was responsible for sorting the meal tickets, passing the trays, and feeding the assisted diners Level of Harm - Minimal harm or and there had been times they would have to sit all the assisted diners at the same table and feed one while potential for actual harm the others watched and had to wait, which was painful for staff to watch. SRNA12 and SRNA13 stated the facility was short staffed five to seven days a week and especially on the weekend. They stated with three Residents Affected - Many SRNAs on each hall, they would have to split showers and get done as much as they could. They added there was never any time to sit with residents and just talk with them, even with four SRNAs on each hall. SRNA13 stated that most of the nurses were not supportive of the SRNAs and their work but would add tasks like applying a medicated cream or shampoo. They stated Nurses did not come into the room to pause

a tube feeding so the SRNA could check and change a resident, they would tell the SRNA to pause the feed and restart it when care was completed.

During an interview on 01/30/2025 at 11:47 AM with SRNA11, she stated it was hard to get all her responsibilities of oral care, hair combing, toileting, and feeding done and a lot of times they were short staffed. She stated she usually had to also complete three showers in a day and with four SRNAs on each hall, it was still a struggle. SRNA11 stated on this day she had 14 residents and felt like maybe she could complete a check and change every two hours on most of them. She stated her charting recorded the task was done for the resident but not how many times in the shift it was done. SRNA11 stated when they had enough staff, they could complete more showers, do nail care, and help out with work for the next shift. When they worked short, SRNA11 stated sometimes residents did not get their shower and she hoped to be able to pick up that shower the next day. SRNA11 stated that when she alerted management she was unable to complete her work, she was told, We are short and can only do what we can.

In continued interview, on 01/30/2025 at 11:47 AM, SRNA11 stated the nurses would get up from the nurses' station to pass a medication or to do wound care but did not do general rounds on the residents. She stated

the nurses have asked the SRNAs to put on a medicated cream or shampoo and asked her to come back and tell them what the skin looked like. SRNA11 stated the SRNAs would help each other but some were too busy with their own work and the nurses did not help. She remembered one time she entered a droplet precaution room without full personal protective equipment (PPE), only a mask, because she was so far behind, she did not take the time to put on the additional PPE. She further stated it was hard to find anyone to help due to the short staffing. She stated call lights seemed to come on one right after the other and she tried to glance in on the residents that cannot use the call light. Additionally, SRNA11 stated she had no time to just visit with the residents and felt like since staff were all the family the residents had, not being able to spend more time with them could make the residents emotionally depressed.

During an interview on 01/30/2025 at 2:32 PM with SRNA2, she stated she had worked at the facility for three years. She stated staff had been hired and it seemed like she had trained many, but no one would stay. SRNA2 stated she had gotten used to working short and sometimes resident showers did not get done, but she tried to at least get them dressed and wiped off. She stated everyone deserved their shower and she tried to make it up the next day. SRNA2 stated the residents did complain about their call lights not being answered and stated residents would say, I've been waiting so long, but the SRNA came in and shut the light off and left, or said, The aide said they were going to get you and then didn't come back.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 36 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0725 During an interview on 01/30/2025 at 3:25 PM with SRNA10, he stated he had been an SRNA for thirteen years and started at the facility in 10/2024. He stated he did not know who the Director of Nursing Services Level of Harm - Minimal harm or (DNS) was until the state survey team entered the building, as he had never seen her. He added he did not potential for actual harm know who the Assistant Director of Nursing Services (ADNS) was until two months after he started. SRNA10 stated typical staffing on the weekends was two SRNAs on each hall (27 residents to each SRNA) and Residents Affected - Many sometimes there was a float SRNA available. He stated there were a lot of call offs on the weekends and there had been times the SRNAs were responsible for 30-35 residents each, which he felt was unsafe. SRNA10 stated management did not pitch in if short on the weekends, and he had not really seen management at all until State Surveyors showed up, then Everyone came out of the woods or something to help. He stated he believed it was everyone's responsibility to answer a call light, but the nurses did not answer a call light or change a resident. In fact, they would walk farther to try and find an SRNA instead of answering a light or changing a resident themselves. SRNA 10 stated when he was responsible for 30-35 residents, he could not get them changed every two hours, they would have to wait, and some would end up sitting for three to three and a half hours.

State Registered Nurse Aide (SRNA)10 stated, on 01/30/2025 at 3:25 PM, that residents complained and told him it was ridiculous they had been laying in their urine and feces and they were upset. He stated some would end up with skin breakdown and it hurt them. Additionally, SRNA 10 stated he rarely saw nurses just round on and talk to the residents and he rarely saw management walking in the halls, they mostly stayed in their offices and the ADON only came out of her office when there was something wrong. He stated he charted at the end of the shift but knew a lot of SRNAs did all their charting in the morning which he felt was wrong because you should not chart what you had not done. He stated it got so crazy it felt like there was not enough time to get everything done and if charting was not done, staff would lose their bonus for the week. SRNA10 stated it was hard enough to care for 15 residents, let alone 35 residents and he went home feeling bad because he felt like he had given poor care and the residents had not been cared for how they should be. Finally, SRNA 10 stated he has had to use at mechanical lift alone and risk resident injury due to not enough staff to help.

In an interview on 02/01/2025 at 11:07 AM, SRNA5 stated at the time of interview, she was finishing the first round of incontinence care for the residents in her assignment. Per interview, she stated she was responsible for 25 residents. In continued interview, SRNA5 stated management did not help with incontinence care, and she had rarely seen a member of management on the floor during a weekend. SRNA5 stated when she was responsible for that many residents, she did not have time to perform oral care or showers, and those tasks would only be completed if there was a float aide working.

In an additional interview on 02/01/2025 at 8:04 PM, SRNA5 stated that when the facility was short staffed,

the SRNAs did not typically get the support they needed to care for the residents according to their care plans.

During an interview on 01/29/2025 at 7:31 AM with the Nurse Practitioner (NP) he stated he had worked at

the facility for one year. The NP stated the SRNAs were great, but based on resident condition, he felt they needed more education on the importance of hygiene, position changes, and that relationship to skin breakdown. The NP also stated staffing was an uphill battle across the board and although it was improving, there was still a high turnover.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 37 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0725 During an interview on 01/29/2025 at 4:22 PM with the Scheduler (SCH) she stated she had been at the facility for thirteen years and had been the scheduler since 2020. SCH stated staffing was census based and Level of Harm - Minimal harm or the facility was considered full at 100 residents. SCH stated her staffing goal for each of the two halls was potential for actual harm one to two licensed nurses on each hall, one Certified Medication Technician (CMT) on each hall and four nurse SRNAs on each hall for the day shift. On night shift, her goal was to have one licensed nurse on each Residents Affected - Many hall, one CMT on each hall, and four SRNAs on each hall. SCH stated she was available 24 hours a day, seven days a week to work the schedule to find coverage for call offs. She stated there was never a time where no one was available to help, and all the staff pitched in, and all staff were responsible for answering call lights. She also stated the company had their own staff float pool as a resource and the facility did not use agency staff. SCH stated during the time of the low staffing indication on the PBJ [NAME] report, nothing unusual was going on but it was warm outside and that may have accounted for increased call offs. SCH stated she felt like there was enough staff to provide for resident needs.

During an interview on 02/01/2025 at 1:30 PM with the Infection Preventionist/Staff Developmen [TRUNCATED]

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 38 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 44001 potential for actual harm Based on observation, interview, record review, review of the Centers for Disease Control and Prevention Residents Affected - Some (CDC) guidelines, review of manufacturer's directions for use (DFU), and review of the facility's policies, the facility failed to implement its infection prevention and control policies and procedures and identify and correct problems relating to infection prevention practices to help prevent the development and transmission of communicable diseases and infections. Additionally, the facility failed to ensure that food items used

during medication administration were properly dated when opened and kept on ice during use, for 5 of 5 medication carts observed, 3 medication carts on the Back Hall and 2 medication carts on the Front Hall.

1. Observation of room [ROOM NUMBER], a droplet precaution room, on 03/31/2025 revealed a CDC Droplet Precaution sign on the door. However, the facility did not ensure that a personal protective equipment (PPE) cart was available outside the room for staff to use to provide PPE before entering.

2. Observation of room [ROOM NUMBER], a droplet precaution room, on 04/01/2025 revealed staff failed to ensure the door to the room was closed according to CDC guidelines related to transmission-based precautions (TBP).

3. The facility failed to ensure staff cleaned and sanitized shared equipment according to the Environmental Protection Agency (EPA) registered disinfectant manufacturer's DFU.

a. Observation of the Front Hall on 04/01/2025 revealed Licensed Practical Nurse (LPN) 9 failed to properly clean and sanitize a glucometer (a blood sugar monitoring device) after use according to the EPA registered disinfectant manufacturer's DFU. Additionally, LPN9 failed to perform hand hygiene after removing her gloves.

b. Observation of the Back Hall on 04/01/2025 revealed LPN11 failed to properly clean and sanitize bandage scissors at the point of care and walked through the hall and entered the nurses' station holding the contaminated bandage scissors with bare hands. Additionally, LPN11 failed to properly clean and sanitize

the bandage scissors according to the EPA registered disinfectant manufacturer's DFU.

4. Observation of the Back Hall on 04/01/2025 revealed LPN8 failed to properly bag and transport contaminated cups away from her person when she disposed of them.

5. Observations made on 03/31/2025 and 04/01/2025 of the Front and Back Halls, revealed the facility did not ensure that food items used during medication administration were properly dated when opened and kept

on ice during use of medication carts. Multiple observations revealed opened pudding and applesauce containers that were neither dated nor stored on ice during or after medication administration.

The findings include:

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 39 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Review of the CDC's Guidelines Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings, dated 04/12/2024, revealed hand hygiene should be performed immediately after Level of Harm - Minimal harm or glove removal. Additionally, the guidelines stated facilities should ensure proper selection and use of PPE potential for actual harm based on the nature of the resident interaction and potential for exposure to infectious materials.

Residents Affected - Some Review of the CDC's Guidelines, provided by the facility, Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, updated 09/10/2021, revealed reusable medical equipment should be cleaned and disinfected according to manufacturer's instructions or the facility's policies before and after use. Further review of the guidelines revealed staff should be trained in the correct steps for cleaning and disinfection of shared equipment.

Review of the facility's policy titled, Infection Prevention and Control Program [IPCP], dated 01/02/2024, revealed the facility maintained an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections per accepted national standards and guidelines. Per the policy, all staff was responsible for adhering to IPCP policies, including the use of PPE and hand hygiene according to established procedures. Continued review revealed all reusable resident care equipment would be cleaned and disinfected in accordance with current facility procedures.

Review of the facility's policy titled, Standard Precautions, revised 03/05/2025, revealed the charge nurse was responsible to check PPE supply carts twice per shift and replenish as needed.

Review of the facility's policy titled, Glucometer Disinfection, undated, revealed the facility would ensure glucometers would be cleaned and disinfected after each use and according to the manufacturer's instructions for multi-resident use, using an EPA registered disinfectant. According to the policy, nursing staff would remove and discard their gloves and perform hand hygiene before leaving the room. Nursing staff would then reapply gloves and take two disinfectant wipes from the container. Per the policy, the first wipe was used to clean and remove any heavily soiled blood or other contaminants from the surface of the glucometer. The policy stated, after cleaning, the second wipe was used to thoroughly disinfect the glucometer, following the manufacturer's instructions.

Review of the cleaning and disinfecting DFU for the Evencare ProView Meter, undated, revealed the meter should be clean and disinfected between each resident use. Per the directions, perform hand hygiene and put on gloves; clean the glucose meter, including the front, back, and sides; use a second wipe and follow

the disinfectant's instructions for the dwell time (time a surface must remain visibly wet after the application of

a disinfectant) listed on the disinfecting wipes DFU.

Review of the cleaning and disinfecting DFU for the Super Sani-Cloth Germicidal Wipes container, undated, revealed for cleaning, to use one or more wipes as necessary to thoroughly clean the surface. Then, the DFU stated to use a second wipe to thoroughly wet all surfaces to be treated. According to the DFU, all surfaces must remain visibly wet for a two-minute dwell time to assure complete disinfection of all pathogens and let air dry.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 40 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 1. Observation, upon initial entrance to the facility, of the Front Hall on 03/31/2025 at 1:35 PM, revealed room [ROOM NUMBER] was designated as a TBP room. The entrance door to the room had a CDC Droplet Level of Harm - Minimal harm or Precaution sign on it. However, observation revealed there was no PPE cart available outside the room for potential for actual harm staff to put on before entering. Further observation revealed there was no PPE cart near room [ROOM NUMBER] or anywhere in the hallway. Residents Affected - Some

During an interview with Qualified Medication Aide (QMA) 7 on 03/31/2025 at 1:40 PM, she stated PPE carts should be located outside any TBP room or nearby, allowing staff easy access to the necessary PPE to care for residents. She stated she was unaware the room lacked a PPE cart. She further stated having PPE readily available was important not only for the protection of staff, but also to help prevent the spread of infection.

During an interview with LPN1 on 03/31/2025 at 1:50 PM, she stated PPE supply carts should be positioned outside any TBP room or in close proximity, ensuring staff had easy access to the necessary equipment to care for residents. She stated she was not aware room [ROOM NUMBER] did not have a PPE cart. LPN1 stated the Infection Preventionist/Staff Development Coordinator (IP/SDC) ensured carts were available and stocked. LPN1 stated having PPE available was important to protect staff and prevent the spread of infection within the facility.

During an interview with the IP/SDC on 04/01/2025 at 10:50 AM, she stated the residents in room [ROOM NUMBER] were COVID-19 positive. She stated she did not know why there was not a PPE cart outside the room and, There is one there now. She stated everyone was responsible for ensuring there were PPE supply carts available and stocked.

2. Observation of the Front Hall on 04/01/2025 at 8:54 AM revealed room [ROOM NUMBER] was designated as a TBP room. However, the entrance door to the room was open, and a CDC Droplet Precaution sign was displayed on the door which indicated the door should remain closed.

During an interview with LPN1 on 04/01/2025 at 8:55 AM, she stated room [ROOM NUMBER] had been designated as a droplet precaution room because the two residents in the room were diagnosed with COVID-19. LPN1 stated she was unsure why the door had been left open. She stated, according to CDC guidelines, the door must remain shut to prevent the spread of infection.

During continued interview with the IP/SDC on 04/01/2025 at 10:50 AM, she stated the door should remain closed at all times according to signage on the door and CDC guidelines because infection could be transmitted through respiratory droplets produced by a patient [resident] who was coughing or sneezing.

During an interview with the Assistant Director of Nursing Services (ADNS) on 04/02/2025 at 4:10 PM, the ADNS stated that doors to droplet precaution rooms should remain closed to prevent droplets produced from coughing or sneezing from spreading into the hall.

During an interview with the Director of Nursing Services (DNS) on 04/02/2025 at 6:40 PM, she stated doors to droplet precaution rooms should remain closed to prevent infection spreading.

During an interview with Executive Director 2 on 04/01/2025 at 8:58 AM, he stated the door should remain closed in accordance with CDC guidelines.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 41 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 During additional interview with Executive Director 2 on 04/01/2025 at 4:37 PM, he stated, upon inspection, room [ROOM NUMBER]'s door latch was not functioning properly, preventing the door from closing securely. Level of Harm - Minimal harm or He stated he had requested for maintenance to repair the door, and it was now functioning properly. potential for actual harm 3.a. Observation of the Front Hall on 04/01/2025 at 4:10 PM revealed LPN9 exited room [ROOM NUMBER] Residents Affected - Some holding a glucometer with gloved hands. She disposed of the lancet, placed the glucometer on top of the medication cart, and removed her gloves. She did not perform hand hygiene before opening the container of Super Sani-Cloth Germicidal Wipes. She then wiped down the glucometer with one germicidal wipe for 21 seconds and placed it on a barrier sheet. She did not keep the glucometer wet for the required two-minute dwell (time that a device is placed in a specific area). Additionally, LPN9 did not sanitize the top of the medication cart.

During an interview with LPN9 on 04/01/2025 at 4:14 PM, she stated she performed hand hygiene after removing her gloves and put on gloves to clean the glucometer. She stated she cleaned the glucometer with

a disinfection wipe and placed it on the barrier sheet to dry. She stated each medication cart had a second glucometer to alternate while one was drying. She stated the dwell was the time the glucometer must dry between uses.

During additional interview with the IP/SDC on 04/02/2025 at 12:00 PM, she could not explain the steps for cleaning and disinfecting the glucometer. She stated items should be cleaned for one minute and left to air dry. She stated once cleaned and disinfected, the glucometer could be placed on the medication cart because the cart is clean. The IP/SDC did not mention the use of barriers to prevent cross-contamination of disinfected shared equipment. She stated nursing staff was educated to use the two glucometers on the medication carts: one to use and one to dry. She stated everyone should perform hand hygiene before and

after resident care to prevent the spread of infection.

During continued interview with the ADNS on 04/02/2025 at 4:10 PM, she stated nurses had been educated

on how to clean shared glucometers. She stated each treatment cart was equipped with two glucometers to use alternately. She stated nurses should use two wipes to clean and disinfect the glucometer and then wrap

it to keep it wet for the allotted dwell time. She stated dwell times varied depending on the product used. She stated the glucometer should be allowed to air dry. The ADNS stated staff should not place glucometers on a bare surface, but a barrier should be used when the glucometer was set down.

3.b. Observation of the Back Hall on 04/01/2025 at 6:50 PM revealed LPN11 walked down the entire hall and approached the nurses' station while holding contaminated bandage scissors wrapped loosely in a glove.

She requested disinfecting wipes from another staff member. LPN11 used her contaminated hand to take the wipes, removed the lid, and reached inside the container for a wipe without first performing hand hygiene. LPN11 cleaned the bandage scissors for 33 seconds using one Super Sani-Cloth Germicidal Wipe and then closed the blades while still wet. She did not allow the scissors to remain wet for the required two-minute dwell time, nor did she ensure that all surfaces were air-dried.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 42 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 During an interview with LPN11 on 04/01/2025 at 6:53 PM, she stated she used scissors to cut a resident's cushion. She stated she discovered there were no wipes available in the Front Hall, which prompted her to Level of Harm - Minimal harm or walk from the Front Hall to the Back Hall in search of disinfecting wipes. LPN11 stated she should have potential for actual harm placed the bandage scissors in a container for transport, rather than carrying them with a contaminated glove. She stated she should have gathered her supplies in advance to bring to the point of care. Residents Affected - Some Additionally, LPN11 stated she should have performed hand hygiene and put on gloves to prevent contamination before opening the container of wipes and cleaning the bandage scissors. LPN11 stated she had received IPCP training on multiple occasions since her hire.

During continued interview with the ADNS on 04/02/2025 at 4:10 PM, she stated it was her expectation that nursing staff cleaned and disinfected shared equipment according to CDC guidelines and that all nurses followed the facility's policy related to cleaning and disinfecting shared equipment. She stated it was important to prevent the spread of infection.

During continued interview with the DNS on 04/02/2025 at 6:40 PM, she stated it was her expectation that nursing staff used the designated disinfectant on any shared items before and after use. She stated, This means that when a nurse picks up a piece of equipment, it should be clean and ready for them to use. She stated any equipment used on one resident should be thoroughly cleaned before it was used on another resident.

4. Observation of the Back Hall on 04/01/2025 at 6:25 PM revealed LPN8 took two large stacks of small plastic drink cups off of the medication cart and transported the cups away, holding them against her scrub top.

During an interview with LPN8 on 04/01/2025 at 6:27 PM, she stated she had observed a resident approach

the medication cart, touch multiple cups, and take some. She stated she was removing the cups because

they were contaminated. She further stated to prevent cross-contamination, she should have used a trash bag to dispose of the cups and not transported them against her person. LPN8 stated she had received multiple training modules related to IPCP during her employment at the facility.

During continued interview with the IP/SDC on 04/02/2025 at 12:00 PM, she stated while transporting any items, especially items for residents' use or contaminated items, staff should ensure the items were held away from their person to prevent cross-contamination.

5.a. Observation of the Back Hall on 03/31/2025 at 1:35 PM, revealed three of three medication carts observed each had one opened applesauce container that was not dated and was not being stored on ice to keep it chilled.

5.b. Observation of the Front Hall on 03/31/2025 at 1:45 PM revealed two of two medication carts observed each had opened, undated pudding that was not stored on ice to keep it chilled.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 43 of 44 185261 Department of Health & Human Services Printed: 09/09/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 185261 B. Wing 02/11/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Wurtland Nursing and Rehabilitation 100 Wurtland Avenue Wurtland, KY 41144

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 During additional interview with QMA7 on 03/31/2025 at 1:48 PM, she stated she was in the middle of medication administration and had just opened the pudding but had not yet dated the container. She stated Level of Harm - Minimal harm or typically, at the end of each medication administration, there was usually no pudding or applesauce left, and potential for actual harm any remaining portions were discarded. She also stated she was getting ice to keep the pudding and applesauce cold when she was approached by the State Survey Agency (SSA) Surveyor for an interview. Residents Affected - Some QMA7 stated food used for medication administration should be dated when opened and placed on ice for

the remainder of medication administration. She stated unused food should be discarded at the end of administration. She stated she received IPCP education. QMA7 stated properly storing residents' food was important to control infection and prevent foodborne illnesses.

During continued interview with the IP/SDC on 04/02/2025 at 12:00 PM, the IP/SDC stated food used for medication administration should be dated when opened and placed on ice for the remainder of the administration. She stated unused food should be discarded. She stated staff members were educated on how to prevent foodborne illnesses.

During continued interview with the ADNS on 04/02/2025 at 4:10 PM, she stated food used for medication administration should be dated when opened and placed on ice for the remainder of the administration. She stated nurses should discard unused food at the end of each administration and should replace them with fresh food items. She stated staff members were educated on the prevention of foodborne illness.

During additional interview with the DNS on 03/31/2025 at 1:35 PM, she stated food used for medication administration should be dated when opened and placed on ice for the remainder of medication administration. She stated unused food should be discarded at the end of the administration. She stated clinical staff licensed to administer medications were educated on this. She stated it was important to prevent foodborne illness.

During continued interview with the IP/SDC on 04/02/2025 at 12:00 PM, she stated it was her expectation that all staff adhered to infection control policies and procedures. She stated all facility staff had received infection control training, which she provided and reviewed many times throughout the year. She stated it was important to follow CDC guidelines to prevent the spread of infection and cross-contamination.

During continued interview with the DNS on 04/02/2025 at 6:40 PM, she stated adhering to infection control guidelines was important to prevent the spread of infection and disease to both residents and staff.

During additional interview with Executive Director 2 on 04/02/2025 at 4:00 PM, he stated it was his expectation that all staff followed facility polices related to infection control to help prevent the spread of infection and diseases.

During an interview with the Medical Director on 04/02/2025 at 4:53 PM, he stated it was his expectation that all staff followed facility polices related to infection control to help prevent the spread of infection and diseases.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 44 of 44 185261