C M Tucker Nursing Care Center / Roddey

F-F880.

On 04/18/25 at approximately 11:45 AM, the survey team presented the Administrator with a copy of the CMS Immediate Jeopardy (IJ) Template and informed the facility that IJ existed as of 02/17/25. The IJ was related to 42 CFR 483.80 - Infection Control.

On 04/18/25, the facility provided an acceptable IJ Removal Plan. On 04/18/25 at 3:00 PM, the survey team validated the facility's corrective actions and removed the IJ. The facility remained out of compliance at a lower scope and severity of F.

Findings include:

Review of the facility policy titled, Infection Control for Laundry-Personal/Unit Based, with a review date of February 2025, documented, It is the policy of Laundry Service to adhere to standards of infection control practice while providing services to prevent the spread of infection and disease . Soiled laundry shall neither be sorted nor rinsed prior to placing in the washer. Further review of the policy revealed, 1. Unit Washer: . b. Laundry detergent is released in pre-measured amounts from an automatic dispensing system . Unit Laundry Room: . d. Clean and soiled clothing will remain separated at all times to avoid contamination.

Review of the facility's QAPI Action Plan, with a Date of Implementation 02/17/25 and a Completion Date of 12/31/25, revealed an Action Plan which documented, There is a need for re-education on the proper use of chemicals, adhering to cleaning schedules to ensure facility cleanliness, and laundering process. Further

review of the QAPI Action Plan revealed inservice sign in sheets dated: 02/17/25, 03/18/25, and 04/09/25. Additionally, documentation titled Audit to Ensure ALL EVS Policies and Processes are Followed, revealed audits were being conducted for the months of 02/25, 03/25, and 04/25. Results of documentation reviewed for this QAPI, did not confirm or solidify these processes were in place at the time of the survey, evidenced by multiple surveyor observations throughout the survey.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 4 of 6 425360 Department of Health & Human Services Printed: 08/28/2025 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 425360 B. Wing 04/18/2025

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

C M Tucker Jr Nursing Care Center Roddey Pavilion 2200 Harden Street Columbia, SC 29203

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 observation and interview on 04/16/25 at approximately 8:38 AM, the laundry rooms on Unit 140, Unit 130, and Unit 138, were observed with no designation or separation indicating which side was clean and Level of Harm - Immediate and which side was dirty/soiled linens. Further observation revealed a bag of dirty linens were observed in a jeopardy to resident health or thin, clear plastic bag on the floor. Clean linens were sitting strewn and unfolded on top of the dryer and safety throughout the laundry room. Folded and clean hospital gowns were observed in the left corner of the room.

An interview with Laundry Service Worker and the Housekeeping Manager verified that residents' dirty and Residents Affected - Many clean clothes are laundered together in the same space.

During an observation and interview on 04/16/25 at approximately 8:38 AM, a container of Oxy Suds Premium Laundry Detergent was observed on a stand next to the washer. The detergent was connected to

an automatic dispensing system. The Label instructions read: Instructions Usage: 2 to 4 oz [ounces] for home-type washer, Use 4 to 8 oz per 100lbs [pounds] on commercial machines. Use for HE [High Efficiency] washers; High efficiency - use 2 oz per load. The Laundry Service Worker stated that the automatic dispenser only releases a small amount of detergent. He further explained that he manually adds more detergent to the washer to compensate, without measuring the amount. The Laundry Service Worker further stated he picks up the Oxy Suds container and pours it directly into the washer.

During an interview on 04/16/25 at approximately 8:38 AM, the Housekeeping Manager stated that Certified Nursing Assistants (CNA)s manually remove excessive amounts of feces from personal clothing items into residents' toilets, sinks, or shower rooms.

During an interview on 04/17/25 at approximately 1:45 PM, the Infection Preventionist (IP) stated that he expects dirty/soiled linens and personal items to be separate in the laundry.

During a follow-up interview on 04/17/25 at approximately 2:54 PM, both the Environmental Services (EVS) Supervisor and Housekeeping Manager confirmed that staff rinse fecal matter in the resident sinks before washing personal clothing items.

Multiple interviews were conducted on 04/18/25 between approximately 9:12 AM and 9:45 AM, with Registered Nurse (RN)1, CNA1, CNA3, CNA4, CNA5, CNA6, and CNA7, all confirmed the practice of removing feces from the residents' clothing and rinsing the soiled items out into the residents' sinks, toilets, and the shower.

At approximately 10:15 AM on 04/18/25, the facility provided an acceptable IJ Removal Plan, which included

the following:

Facility failed to follow proper infection control standards regarding laundry services in 3 of 3 laundry rooms, to include: 1. Laundry Room not separated into a clean area and dirty/soiled area. 2. Laundry aids were not following manufacturer recommendations regarding detergent/sanitizer use in washing machines. 3. Certified Nursing Assistant were rinsing off heavily soiled clothing items in the resident's personal toilets (CNA) were rinsing off heavily soiled clothing items in the resident's personal toilets (located in their room) before processing them for laundry services.

The facility's failure to follow infection control standards in the laundry process has the potential for transmission of pathogens and cross contamination.

It places all residents at risk of contracting infections, such as bacterial, viral, fungal, or parasitic infections.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 5 of 6 425360 Department of Health & Human Services Printed: 08/28/2025 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 425360 B. Wing 04/18/2025

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

C M Tucker Jr Nursing Care Center Roddey Pavilion 2200 Harden Street Columbia, SC 29203

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 Facility previously identified these issues in February 2025 and had placed a QAPI Action Plan in place, with

an alleged date of total compliance of 12/31/25. Level of Harm - Immediate jeopardy to resident health or Laundry Staff and CNAs were educated on the Facility's Infection Control for Laundry-Personal Unit Based safety Policy and process.

Residents Affected - Many USA Vendor is currently in facility working to secure laundry detergent for staff not to be able to add additional chemicals.

Facility placed signs in the laundry rooms, in order to identify the Clean vs Dirty Side of the laundry room.

The EVS Management staff will be utilizing the audit tool created to monitor the deficiencies twice a week until 12/31/202. Results from this audit will be brought forth to the QAPI Committee.

Facility has previously put this issue into our QAPI plan. Therefore, will continue to monitor for compliance.

The following compliance issues were noted:

-Improper use of chemicals, detergent, and sanitizing agents

-Failing to adhere to deep cleaning schedules

-Failing to keep separate the clean and dirty side of laundry room

-Proper disposal of soiled linen. Do not trash without getting approval from resident's RP and/or resident

-Failing to measure chemicals when mixing

AOC Date 04/18/25

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 6 of 6 425360