Mountain Vista Health Park

grooming and dressing but did not think she had to perform hand hygiene or apply a face mask for tray

on precautions and PPE but could not recall the dates. NA #1 reported she became confused about the

Resident #45, who was not on droplet precautions, and said she was nervous because she was being observed. NA #2 reported she knew Resident #52 was on droplet precautions but, due to nervousness, did not think to perform hand hygiene or apply a face mask before delivering a meal tray.

Both NAs stated they were told during morning report on 4/27/26 that Resident #52 tested negative for COVID, influenza, and RSV, and they thought the droplet precautions sign was going to be removed; they also said they did not recall touching anything in the room that would have required hand hygiene.

The DON stated both NAs had infection control education in the past and should have performed hand hygiene and worn a face mask before entering a room with droplet precautions, and she acknowledged that Resident #52 had a negative PCR test but remained on droplet precautions, adding that she expected staff to read and follow posted precaution signs and apply required PPE before entering the room.An interview was conducted with the Infection Control Preventionist (IP) on 4/29/26 at 9:03 AM.

The IP reported Resident #52 had signs and symptoms of respiratory infection and special droplet precautions were implemented.

The IP explained Resident #52 was tested for COVID, influenza, and RSV.

The IP explained the rapid test was negative for COVID, and the PCR was negative for COVID, influenza, and RSV, but because Resident #52 had a cough, the facility kept her on droplet precautions and discontinued the special droplet precautions.

The IP explained that if one resident was on droplet precautions in a room, the roommate was considered exposed and on droplet precautions.

The IP explained that this meant the facility staff should wear a surgical mask when entering the room to provide care, as well as perform hand hygiene before and after care, including delivering meal trays to the resident under droplet precautions and their roommate.The Administrator was interviewed on 4/29/26 at 2:08 PM.

The Administrator reported she and the DON discussed the incident and determined because NA #1 and NA #2 had been told in morning report on 4/27/26 that Resident #52 was negative for COVID, influenza, and RSV, they thought Resident #52 was going to be taken off droplet precautions, and it was okay to deliver the meal tray without performing hand hygiene or applying a face mask.

The Administrator reported she expected all staff to follow the instructions on precaution signs posted on a resident's door.The facility Physician was interviewed on 4/29/26 at 2:46 PM.

The Physician reported he had ordered loratadine (used to treat allergy symptoms) for Resident #52 based on her symptoms and medical history, but he had not examined her on 4/26/26.

The Physician reported that the rapid and PCR test for COVID, influenza, and RSV were negative and Resident #52 remained on droplet precautions due to a cough, which he felt the allergy medication would help.

The Physician reported he was concerned about the potential for infectious disease spread when he learned NA #1 and NA #2 did not follow the droplet precaution sign instructions by not performing hand hygiene or applying a face mask prior to delivering a meal tray to Resident #45 and Resident #52.