Smp Health - St Raphael
Inspection Findings
F-Tag F0812
F 0812
stated their policy is to discard after five days.
Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
09/24/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Smp Health - St Raphael
979 Central Ave N Valley City, ND 58072
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-Tag F0880
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm or potential for actual harm
Based on observation, review of facility policy, and staff interview, the facility failed to follow standards of infection control and prevention for 2 of 7 sampled residents (Resident #16 and #73) observed during cares. Failure to remove gloves and perform hand hygiene during wound care and perineal care has the potential to spread infection throughout the facility.
Residents Affected - Few
Findings include:
Review of the facility policy titled Glove Usage occurred on 09/24/25. This policy, revised November 2018, stated, Purpose: To reduce the risk of exposure, prevent the spread of infection, identify situations where usage of gloves is appropriate and incorporating proper usage of gloves. Procedure: . 2. Once gloves are contaminated, they must be changed before touching clean items or proceeding to perform clean procedure. 7. Hand hygiene must be performed prior to gloving and after removing gloves.
Review of the facility policy titled Hand Hygiene occurred on 09/24/25. This policy, revised September 2023, stated, Purpose: . Hand hygiene . an effective method for preventing the spread of pathogens, such as bacteria and viruses, which cause infections. Condition: Hands are visibly soiled with blood or other body fluids. After handling contaminated objects. Before and after handling clean or soiled dressing. -Observation on 09/23/25 at 9:39 a.m. showed the nurse (#1) performed a dressing change for Resident #73. The nurse applied personal protective equipment (PPE), a gown and gloves and entered the resident's room. The nurse removed a soiled abdominal (ABD) pad from the left hip of Resident #73. Without removing her gloves, the nurse (#1) cleaned the area with wound cleanser, placed a new ABD, and applied tape. The nurse (#1) then removed the gown and gloves and washed her hands.
The nurse failed to remove gloves, perform hand hygiene, and apply new gloves prior to applying the clean dressing. -Observation on the afternoon of 9/23/2025 showed two certified nurse aides (CNAs #2 and #5) applied gowns and gloves and transferred Resident #16 from the wheelchair to the bed using the mechanical lift.
The CNA (#2) wore gloves and completed Resident #16's perineal care after a soft bowel movement. With
the same gloves, the CNA reached into a container of ointment and applied it to the resident's bottom, fastened the new brief, pulled up his pants, opened up a drawer to retrieve a bandana and placed it by the resident's mouth. The CNA (#2) removed her gown, and with same gloves still on plugged in a pump, tied a garbage bag, lowered the bed, turned the television on, took the pillowcase off the resident's neck pillow, tied a garbage bag, and then removed gloves and performed hand hygiene.
The CNA (#2) failed to remove gloves and perform hand hygiene after perineal care and prior to doing other tasks in the resident's room.
During an interview on the afternoon of 09/24/25, an administrative nurse (#4), confirmed staff should remove gloves and performed hand hygiene after removing a soiled dressing and after performing perineal cares.
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
SMP HEALTH - ST RAPHAEL in VALLEY CITY, ND inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
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 VALLEY CITY, 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 SMP HEALTH - ST RAPHAEL or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.