Dove Healthcare - Superior
Inspection Findings
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 and interview, the facility did not maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment to help prevent the development and transmission of communicable diseases and infections. This affected 1 out of 3 residents (R) reviewed. (Resident R4) Certified Nurse Assistant (CNA) E did not doff contaminated gloves after emptying urine from catheter into graduate before continuing Resident R4's cares. Findings include: The facility policy, titled Enhanced Barrier Precautions, revised January 2025, states:.4. High contact resident acre activities include:e. Changing linens.f. Changing briefs or assisting with toileting.g. Device care or use. Urinary catheters.Surveyor reviewed Resident R4's record, which indicated Resident R4 is on enhanced barrier precautions (EBP) for history of extended-spectrum beta-lactamase (ESBL) in the urine and Resident R4 has a suprapubic catheter. On 08/26/25 at 3:15 PM, Surveyor followed CNA E into Resident R4's room. Surveyor observed CNA E don Personal Protective Equipment (PPE) before entering Resident R4's room. CNA E pushed Resident R4 into a shared bathroom which is used for Resident R4 and Resident R4's neighbor. Resident R4 stood up and stand pivoted to toilet and sat down. CNA E pulled Resident R4's pants down and proceeded to empty Resident R4's catheter into graduate. CNA E threw used brief onto floor and not
in garbage in the shared bathroom. CNA E opened catheter and emptied in graduate. CNA E closed catheter tubing and placed graduate off to the side on floor. CNA E then used same contaminated gloves to cleanse Resident R4's bottom and pulled Resident R4's pants back up. CNA E opened bathroom door with contaminated gloves and Resident R4 walked out of bathroom. CNA E walked Resident R4 over to wheelchair and then touched wheelchair with contaminated gloves. CNA E wheeled Resident R4 to bed and assisted Resident R4 to bed. CNA E took Resident R4's shoes off with contaminated gloves. CNA E rearranged Resident R4's bedside table that had lunch tray on bedside table. CNA E placed Resident R4's call light within reach with contaminated gloves and then walked to Resident R4's door. CNA E then doffed PPE and contaminated gloves then washed hands. On 08/26/25 at 3:25 PM, Surveyor interviewed CNA E and asked CNA E the process for utilizing PPE in an EBP room. CNA E reported that CNA E should have changed gloves right after emptying graduate with urine before touching other surfaces and CNA E did not. On 08/27/25 at 10:52 AM, Surveyor interviewed Director of Nursing (DON) B and asked expectation of staff utilizing PPE and hand hygiene practices in an EBP room and suprapubic catheter. DON B reported expectation is PPE is to be donned upon entering and frequent glove changes are to be performed.
Surveyor reported to DON B the observation of inappropriate glove use by CNA E. DON B reported that CNA E should have discarded contaminated gloves after emptying Resident R4's urine in graduate, sanitized, and then reapplied new gloves.
Residents Affected - Few
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
DOVE HEALTHCARE - SUPERIOR in SUPERIOR, WI 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 SUPERIOR, WI, (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 DOVE HEALTHCARE - SUPERIOR or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.