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Complaint Investigation

Garrison Mem Hosp Nsg Fac

Inspection Date: February 27, 2025
Total Violations 1
Facility ID 355115
Location GARRISON, ND
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Inspection Findings

F-Tag F658

F-F658.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 9 of 10 355115 Department of Health & Human Services Printed: 09/07/2025 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 355115 B. Wing 02/27/2025

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

Garrison Mem Hosp Nsg Fac 407 3rd Ave SE Garrison, ND 58540

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 39685 potential for actual harm Based on observation, review of facility policy, and staff interview, the facility failed to follow standards of Residents Affected - Few infection control and prevention for 2 of 8 sampled residents (Resident #5 and #13) and 1 supplemental resident (Resident #6) requiring stand lift transfers. Failure to practice infection control standards related to disinfection of equipment has the potential to spread infection throughout the facility.

Findings include:

Review of the facility policy titled Patient Multi-Use Devices, occurred on 02/27/25. This policy, dated February 2011, stated, . As part of the infection control prevention program, all patient/resident multi-use medical devices must be disinfected between patient/resident uses. These include but are not limited to . Mechanical lift devices .

- Observation on 02/24/25 at 1:40 p.m. showed a certified nurse aide (CNA) (#8) transferred Resident #6 from the toilet to a wheelchair using a stand lift. After completing the transfer, the CNA failed to sanitize the lift. When asked if there was a policy for sanitizing the lifts, the CNA (#8) replied, housekeeping does that.

- Observation on 02/24/25 at 3:58 p.m. showed two CNAs (#7 and #8) transferred Resident #13 from the toilet to a wheelchair using a stand lift. After completing the transfer, the CNAs failed to sanitize the lift and pushed it to another resident's room.

- Observation on 02/24/25 at 4:10 p.m. showed a CNA (#7) and a nurse (#6) transferred Resident #5 from

the toilet to a wheelchair using a stand lift. After completing the transfer, the nurse (#6) failed to sanitize the lift and pushed it to a storage room.

During an interview on the afternoon of 02/25/25, an administrative staff member (#11) provided a Lifts and Stands Maintenance Record showing housekeeping cleans the lifts twice a month and stated, But staff clean them after each use.

During an interview on 02/27/25 at 12:00 p.m., an administrative nurse (#2) stated she expected staff to sanitize the lift between resident use.

45873

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 10 of 10 355115

📋 Inspection Summary

GARRISON MEM HOSP NSG FAC in GARRISON, ND inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in GARRISON, ND, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from GARRISON MEM HOSP NSG FAC or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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