Springbrook Center

F-F656 would be recited for the same issue: failure to implement a comprehensive person-centered care plan for each resident.

On 9/23/24 at 4:15 p.m., during and interview, the above was confirmed with the Administrator and Director of Nursing.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 15 of 17 205068 Department of Health & Human Services Printed: 09/17/2025 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 205068 B. Wing 07/19/2024

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

Springbrook Center 300 Spring St Westbrook, ME 04092

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 37648 potential for actual harm Based on facility policy, record reviews, observations and interviews, the facility failed to maintain and Residents Affected - Some implement an infection control program to help prevent the development and transmission of disease and infection related to Multidrug-Resistant Organisms (MDRO's) colonized in sputum and wound care for a 2 of 2 sampled residents (Resident #48 and #79) for 1 of 1 day of survey (9/23/24). This has the potential to affect all 21 residents on the Wayside Gardens unit.

Findings:

Facilities procedure for Enhanced Barrier Precautions, revised 5/1/24 states, all patients with any of the following: Infection or colonization with a targeted MDRO (Multidrug-resistant organisms) . and Chronic wounds and/or indwelling medical devices (e.g. central line, urinary catheter, enteral feeding tube, tracheostomy, or ventilator) regardless of MDRO colonization status. PPE (Personal protective Equipment) used for these situations during high contact patient cared activities: device care or use .tracheostomy, wound care; any skin opening requiring a dressing, and PPE required, Gown, gloves prior to high contact care activity and Face protection may also be needed if performing activity with risk of splash or spray.

Facilities procedure for Tracheostomy Care and Tracheostomy Suctioning instructs nursing to Put on PPE including eye protection and face mask, as indicated

Facilities procedure for wound Dressings: Aseptic instructs nursing to apply personal protective equipment as indicated, Apply clean gloves . Discard soiled dressing and gloves .preform hand hygiene. Apply gloves. Cleanse or irrigate wound and periwound gently .

1. Review of Resident #48's medical record had Special Instructions: MDRO: MRSA [Methicillin-resistant Staphylococcus aureus], PSEUDOMONAS AERUGINOSA (Enhanced Barrier Precaution). Outside the entrance to Resident #48's bedroom was a stop sign stating, Enhanced Barrier Precaution instructing nursing to wear gown and gloves prior to . wound care: any opening requiring a dressing and face protection may also be needed if preforming activity with risk of splash or spray. A cart with PPE was available outside of the room which contained gowns, masks and eye protection.

On 9/23/24 at 9:10 a.m., the surveyor observed Resident #48's tracheostomy care with the Licensed Practical Nurse (LPN). The LPN entered the room, preformed hand hygiene and applied sterile gloves. She completed the tracheostomy care which included suctioning the tracheostomy cannula, removing the soiled split sponge, cleaning around the stoma, removing the inner cannula and replacing with a new cannula and applying a new splint sponge around the stoma all without the use of the appropriate Personal Protective Equipment (PPE) of a gown and face/eye protection. At this time, surveyor asked the LPN if she is to wear a gown, face/eye protection while preforming tracheostomy care. LPN stated, she does not wear a gown and or face/eye protection, only gloves when she performs the trach care.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 16 of 17 205068 Department of Health & Human Services Printed: 09/17/2025 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 205068 B. Wing 07/19/2024

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

Springbrook Center 300 Spring St Westbrook, ME 04092

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 2. Review of Resident #79's medical record had Special instructions: MDRO risk- due to wounds (Enhanced barrier precaution). Outside the entrance to resident #79's bedroom was a stop sign stating, Enhanced Level of Harm - Minimal harm or Barrier Precaution instructing nursing to wear gown and gloves prior to . wound care: any opening requiring a potential for actual harm dressing and face protection may also be needed if preforming activity with risk of splash or spray. A cart with PPE was available outside of the room which contained gowns, masks and eye protection. Residents Affected - Some

On 9/23/24 at 9:20 a.m., the surveyor observed Resident #79's wound care with the LPN. The LPN prepared

the wound care supplies, spraying the gauze with the wound wash. She then applied clean gloves and removed the soiled dressing, then cleansed the wound with the wet gauze. She then obtained the wound wash spray and sprayed the wound bed and patted it dry with another gauze pad. With the same gloved had

she then applied the primary dressing of xeroform and then the secondary foam dressing. At this time, the surveyor discussed the lack of PPE and the lack of hand hygiene preformed between removing old dressing and cleansing/applying new dressing. The LPN stated, she should have washed wash her hands and applied new gloves before cleansing and applying the new dressing.

On 9/23/24 at 9:42 a.m., during an interview with the Director of Nursing, the above was discussed.

On 9/23/24 at 11:27 a.m., during an interview, the Infection Preventionist confirmed the nurses are expected and educated on the use Enhanced Barrier Precautions and should wear a gown, glove and whole face covering and/or mask/goggles when preforming tracheostomy or wound care due to risk of splashes or sprays.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 17 of 17 205068