DEPARTMENT OF HEALTH AND HUMAN SERVICES PRINTED:05/13/2020

CENTERS FOR MEDICARE & MEDICAID SERVICES FORM APPROVED

OMB NO. 0938-0391
STATEMENT OF (X1) PROVIDER / SUPPLIER (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY
DEFICIENCIES / CLIA A. BUILDING ______ COMPLETED
AND PLAN OF IDENNTIFICATION B. WING _____ 09/24/2019
CORRECTION NUMBER
145208
NAME OF PROVIDER OF SUPPLIER STREET ADDRESS, CITY, STATE, ZIP
BRIDGEVIEW HEALTH CARE CENTER 8100 SOUTH HARLEM AVENUE
BRIDGEVIEW, IL 60455
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.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** >
Level of harm - Minimal Based on observation, interview, and record review the facility failed to follow their policy and procedure regarding
harm or potential for actual scabies by not isolating a resident with a suspicious rash (R9) and failed to follow their Outbreak Management Policy, by
harm not developing a written report of the outbreak for 5 of 5 residents reviewed for infection control in a total sample of 9
residents.
Residents Affected - Some Findings Include:
The facility has had an on going outbreak for scabies in the building since 03/2019. Since 03/22/19, eight residents
contracted a suspicious rash and have been treated for [REDACTED]. The facility has treated 61 different residents on
different floors with anti-scabitic cream from 03/2019 to present whether exhibiting a rash or not.
The Bridgeview Preventative Plan for Rashes, Possible Scabies documents in 05/2019, three residents (R3, R4, and another
resident not in the sample) residing on the fourth floor observed with rashes. The three residents were treated with
anti-scabitic cream. Another resident on the third floor (R7) observed with a rash and had a positive skin scraping for
scabies. This resident treated with the scabies cream and had the room deep cleaned. In 06/2019, another resident on the
fourth floor observed with a rash but had a negative skin scraping. Body checks performed on all residents at this time. In 08/2019,
two of the three residents observed with a rash in 05/2019 had a rash again (R3 and R4). The entire fourth floor
was shut down and all the residents treated [MEDICATION NAME] with the scabies cream.
Per the Physician order [REDACTED]. R7 was the only resident to have a skin scraping come back positive.
On 9/19/19 at 9:55AM, V3 (ADON/Infectious Disease Nurse) stated, The 4th floor has a lot of residents with wandering
behavior so it would be almost impossible to keep track of that. So I can't say who high risk would be. We are using a line list to track
the residents with new rashes. That's the only tracking system we are using right now. I'm wondering where
this is all coming from too. We have tried to find a similarity in people with rashes to staff but we haven't come up with
anything. ID (infectious Disease) tells us to keep doing what we are doing that nothing has to be changed right now. For
residents with new rashes, we isolate them immediately when the rash is found and talk to ID as soon as possible which is
usually within a day.
On 9/19/19 at 4:00PM, V3 stated, I mean I don't know what else we can do for this. We don't use any monitoring before the
rash is observed except a skin check. We keep the isolation on until ID says it can come off. We haven't identified any
risk factors in residents because we don't know where it is coming from. I don't know what else I can do to track this.
It's not something you are always going to be able to prevent. If I can't track where it is coming from or what is causing
this, how can I make a report of who is at risk and what is or isn't working?
On 9/19/19 at 4:19PM, V2 (DON) stated, We don't know what else we can do here. Isn't every resident at risk for getting
scabies here? I mean we consider the residents that have been treated to be at high priority but we haven't specially made
a list of people who would be high risk or have risk factors. The only change we have made to our plan is increasing the
number of rooms we deep clean a day from 1 to 2. I don't think we plan to change anything to our current plan right now.
On 9/20/19 at 12:01PM, R9 observed in the 4th floor parlor room waiting for lunch. R9 noted to be scratching arms and hands
vigorously. Five other residents sitting in the parlor room with R9. R9 sitting alone at a table. A complete body skin
check performed by V12 (LPN) on R9 once R9 was wheeled back to R9's room. R9 with raised, red bumps on neck, chest,
abdomen, back, and bilateral arms, legs, and hands. Fluid filled blisters noted on R9's bilateral arms and legs. R9 stated, I don't know
how long this has been going on but yes it itches like crazy. No isolation noted for R9. V12 interviewed at
this time and stated, I was told the rash R9 has isn't contagious. Well no one told me that there was just nothing in the
chart about R9 needing to be on isolation. I was told it was a skin infection. I wasn't told what kind. Yea, I have seen R9 scratching all
day.
On 9/20/19 at 12:16PM, V3 stated, So R9's nurse called me this past Tuesday to tell me R9 had a new rash. I went to see it,
and I called ID. I told ID it looks like papular [MEDICAL CONDITION]. I told ID it didn't look like scabies to me. ID
started her on antibiotics for a skin infection and then we cultured one of her blisters. ID was in the building to see her yesterday and
looked at R9. The ID nurse practitioner didn't think it looked like scabies so R9 wasn't put on isolation. I
mean R9's rash doesn't look like scabies at all so we didn't isolate R9. I was under the impression we are only isolating
when it looks like scabies. ID told us we didn't need to isolate R9. I don't know who R9 came in contact with. No, we
didn't skin scrape R9. I see where you are coming from, but between myself and the nurse practitioner we didn't think it
was scabies from looking at it.
The Isolation Sheet documents R8 and R8 's roommate on contact isolation from 9/14/19 to 9/16/19 for rash/possible scabies.
R9 never placed on isolation for suspicious rash.
The policy titled, Policy and Procedure Scabies, dated 6/7/16 documents initiate contact precautions upon identification of
the suspicious rash. The policy titled, Outbreak Management Plan, dated 01/2014 documents If control measures are followed
but remain ineffective, re-evaluate and modify as needed. Determine actions that were effective and actions that were
ineffective and possible reasons for the difference. Develop a written report of the outbreak detail including an
epidemiologic curve, attack rates, risk factors identified, actions that were taken, and control measure that were
effective or ineffective.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE

REPRESENTATIVE'S SIGNATURE

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.
FORM CMS-2567(02-99) Event ID: YL1O11 Facility ID: 145208 If continuation sheet
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