Every finding on record at Lifeline Home Health Care of Springfield, LLC

A recertification survey was conducted on 9/18/2023-9/29/2023. An entrance conference was held on 9/18/2023 at 9:15 AM, with the Executive Director. An exit conference was held on 9/29/2023 at 12:00 PM, with the agencies administration.

EP Testing Requirements CFR(s): 484.102(d)(2) §416.54(d)(2), §418.113(d)(2), §441.184(d)(2), §460.84(d)(2), §482.15(d)(2), §483.73(d)(2), §483.475(d)(2), §484.102(d)(2), §485.68(d)(2), §485.542(d)(2), §485.625(d)(2), §485.727(d)(2), §485.920(d)(2), §491.12(d)(2), §494.62(d)(2). *[For ASCs at §416.54, CORFs at §485.68, REHs at §485.542, OPO, "Organizations" under §485.727, CMHCs at §485.920, RHCs/FQHCs at §491.12, and ESRD Facilities at §494.62]: (2) Testing. The [facility] must conduct exercises to test the emergency plan annually. The [facility] must do all of the following: (i) Participate in a full-scale exercise that is community-based every 2 years; or (A) When a community-based exercise is not accessible, conduct a facility-based functional exercise every 2 years; or (B) If the [facility] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required community-based or individual, facility-based functional exercise following the onset of the actual event. (ii) Conduct an additional exercise at least every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [facility's] emergency plan, as needed. *[For Hospices at 418.113(d):] (2) Testing for hospices that provide care in the patient's home. The hospice must conduct exercises to test the emergency plan at least annually. The hospice must do the following: (i) Participate in a full-scale exercise that is community based every 2 years; or (A) When a community based exercise is not accessible, conduct an individual facility based functional exercise every 2 years; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospital is exempt from engaging in its next required full scale community-based exercise or individual facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (3) Testing for hospices that provide inpatient care directly. The hospice must conduct exercises to test the emergency plan twice per year. The hospice must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual facility-based functional exercise; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospice is exempt from engaging in its next required full-scale community based or facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop led by a facilitator that includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the hospice's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the hospice's emergency plan, as needed. *[For PRFTs at §441.184(d), Hospitals at §482.15(d), CAHs at §485.625(d):] (2) Testing. The [PRTF, Hospital, CAH] must conduct exercises to test the emergency plan twice per year. The [PRTF, Hospital, CAH] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the [PRTF, Hospital, CAH] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an [additional] annual exercise or and that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the [facility's] emergency plan, as needed. *[For PACE at §460.84(d):] (2) Testing. The PACE organization must conduct exercises to test the emergency plan at least annually. The PACE organization must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the PACE experiences an actual natural or man-made emergency that requires activation of the emergency plan, the PACE is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the PACE's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the PACE's emergency plan, as needed. *[For LTC Facilities at §483.73(d):] (2) The [LTC facility] must conduct exercises to test the emergency plan at least twice per year, including unannounced staff drills using the emergency procedures. The [LTC facility, ICF/IID] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise. (B) If the [LTC facility] facility experiences an actual natural or man-made emergency that requires activation of the emergency plan, the LTC facility is exempt from engaging its next required a full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [LTC facility] facility's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [LTC facility] facility's emergency plan, as needed. *[For ICF/IIDs at §483.475(d)]: (2) Testing. The ICF/IID must conduct exercises to test the emergency plan at least twice per year. The ICF/IID must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or. (B) If the ICF/IID experiences an actual natural or man-made emergency that requires activation of the emergency plan, the ICF/IID is exempt from engaging in its next required full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the ICF/IID's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the ICF/IID's emergency plan, as needed. *[For HHAs at §484.102] (d)(2) Testing. The HHA must conduct exercises to test the emergency plan at least annually. The HHA must do the following: (i) Participate in a full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise every 2 years; or. (B) If the HHA experiences an actual natural or man-made emergency that requires activation of the emergency plan, the HHA is exempt from engaging in its next required full-scale community-based or individual, facility based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the HHA's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the HHA's emergency plan, as needed. *[For OPOs at §486.360] (d)(2) Testing. The OPO must conduct exercises to test the emergency plan. The OPO must do the following: (i) Conduct a paper-based, tabletop exercise or workshop at least annually. A tabletop exercise is led by a facilitator and includes a group discussion, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. If the OPO experiences an actual natural or man-made emergency that requires activation of the emergency plan, the OPO is exempt from engaging in its next required testing exercise following the onset of the emergency event. (ii) Analyze the OPO's response to and maintain documentation of all tabletop exercises, and emergency events, and revise the [RNHCI's and OPO's] emergency plan, as needed. *[ RNCHIs at §403.748]: (d)(2) Testing. The RNHCI must conduct exercises to test the emergency plan. The RNHCI must do the following: (i) Conduct a paper-based, tabletop exercise at least annually. A tabletop exercise is a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (ii) Analyze the RNHCI's response to and maintain documentation of all tabletop exercises, and emergency events, and revise the RNHCI's emergency plan, as needed. This STANDARD is not met as evidenced by: An Emergency Preparedness recertification and re-licensure survey was conducted on 9/18/2023-9/20/2023. The facility meets all of the requirements for Emergency Preparedness. There were no deficiencies identified.

A recertification survey was conducted on 9/18/2023 - 9/29/2023. An entrance conference was held on 9/18/2023 at 9:15 AM with the Executive Director. An exit conference was held on 9/29/2023 at 12:00 PM with the agencies administration.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on policy review, medical record review, and interview, the agency failed to update the medication profile for 3 of 5 (Patient #1, #2, and #10) patients reviewed. The findings included: Review of the agency's "Monitoring Medications," policy dated 5/1/2019, revealed "...To provide a process to ensure continuous monitoring of medications in the patient's home...A drug regimen review will be performed on all patients in conjunction with all comprehensive assessments. Additionally, all clinicians will participate in medication review and reconciliation throughout the episode...For patients receiving skilled nursing and therapy services, the skilled nurse is responsible for medication review and reconciliation throughout the episode...For patients receiving only therapy services, the therapist is responsible to facilitate drug regimen review and medication reconciliation throughout the episode...Compare medication list obtained from the facility from which the patient was transferred and/or physician orders to actual medications patient is taking...Review all medications including over the counter (OTC) medications, vitamins, herbs and herbal products, creams and topical ointments, and medical marijuana...All clinicians participating in the patient's care are responsible to assist with the maintenance of accurate medication information throughout the episode of care..." Review of the medical record revealed Patient #1 was admitted to the agency on 5/24/2023 with diagnoses of Benign Neoplasm of the Heart, Chronic Obstructive Pulmonary Disease, Panic Disorder, Congestive Heart Failure, Morbid Obesity, and Peripheral Vascular Disease. Review of the Plan of Care dated 7/21/2023, revealed the following: "...5/24/2023...Acetaminophen [Analgesic] Extra Strength 500 mg [milligram]...oral...every 8 hours/prn..." "...6/13/2023...Amiodarone [Antiarrythmic] 200 mg...oral...daily..." "...6/13/2023...Atorvastatin [treats high cholesterol] 80 mg...oral...bedtime..." "...7/23/2023...Baclofen [Muscle Relaxant] 20 mg...oral...2 times daily..." "...5/24/2023...Clopidogrel [[Blood Thinner] 75 mg...oral...daily..." "...5/24/2023...Eliquis [Anticoagulant] 5 mg...oral...2 times daily..." "...5/24/2023...Furosemide [Diuretic] 40 mg...oral...daily..." "...7/11/2023...Gavilax [Stool Softener] 17 gm [gram] oral powder packet...oral...daily..." "...5/24/2023...Imodium Anti-diarrheal] A-D 2 mg...oral...every 6 hours/prn..." "...6/13/2023...Metoprolol [ANtihypertensive]...50 g...oral...2 times daily..." "...5/24/2023...Nitrostat [treats angina] 0.4 mg sublingual...daily/prn..." "...7/23/2023...Pregabalin [treats nerve pain] ...75 mg...oral...2 times daily..." "...6/13/2023...Ropinirole [treats Parkinson's Disease] 1 mg...oral...bedtime..." Observation on 9/18/2023 at 3:10 PM, in Patient #1's home revealed a bubble pack with multiple pills but there is no patient's name or list of medications that are in the pack. There are 8 bottles on a corner shelf that are sitting upside down that Patient #1 states "does not take." There is a bottle dated 8/23/2023 of Hydrocodone/APAP 10/325 mg oral every 6 hours as needed, and dated 8/6/2020 of Sucralfate 1 gm. During an interview on 9/18/2023 at 3:45 PM, the Patient Case Manager (PCM) was asked how she could tell the patient's medications had been reconciled. She stated, "You can't...The bubble pack coming from the pharmacy should have the proper identification on the pack also..." Review of the medical record revealed Patient #2 was admitted to the agency on 10/26/2022 with diagnoses of Neuromuscular Dysfunction of Bladder, Pressure Induced Deep Tissue Damage, Depression, Paraplegia, Hypertensions and Anxiety. Review of the Plan of Care revealed the following: "...10/26/2022...Methenamine [Antibiotic]...1 gm...oral...daily..." "...12/25/2022...Tizanidine [Muscle Relaxant] 4 mg...oral...every 6 hours/prn..." During an interview on 9/18/2023 at 4:35 PM, Patient #2 stated "...Don't know about that one [Methenamine] and don't know where it is...I may have stopped taking it [Tizanidine]..." During an interview with the PCM on 9/18/2023 at 4:50 PM, she confirmed there needed to be some clarification regarding Patient #2' medications. Review of the medical record revealed Patient #10 was admitted to the agency on 4/23/2023 with diagnoses of Open Wound on Left Foot, Diabetes Mellitus, Congestive Heart Failure, Atherosclerotic Heart Disease, and Morbid Obesity. Review of the Plan of Care dated 8/25/2023 revealed the following: "...6/16/2023...Famotidine [Antihistamine and Antacid] 40 mg...oral...daily..." "...4/23/2023...Levothyroxine [treats Hypothyroidism] 100 mcg [micrograms]...oral...daily..." "...4/23/2023...Melatonin [Hormone] 3 mg...oral...bedtime..." "...4/23/2023...Metformin [Antihyperglycemic] 500 mg...oral...two times daily..." Review of Patient #10's home medications revealed the following: "...7/28/2023...Pantoprazole [treats acid reflux] 40 mg...oral...every day..." "...9/13/2023...Vit [Vitamin] D2 [Supplement] 1.25 mg (50,000) unit...oral...every week..." "...7/5/2023...Hydroxyzine [Antihistamine] 25 mg...oral...every day..." "...Amlodipine [Antihypertensive] 5 mg...oral...every day..." "...9/12/2023...Atorvastatin [treats high cholesterol] 40 mg...oral...at bedtime..." During an interview on 9/19/2023 at 2:50 PM, Patient #10's husband stated "...If it isn't in that container, she is not taking..." During an interview with PCM on 9/19/2023 at 3:20 PM, confirmed Patient #10's medications need to be reconciled and would call the patient's physician.

Coordination of Care CFR(s): 484.60(d) Standard: Coordination of care. The HHA must: This STANDARD is not met as evidenced by: Based on medical record review and interview, the facility failed to follow physician's orders related to visit frequency for 2 of 6 (Patient #6 and #7) reviewed. The findings include: Review of the agency's "Physician Orders," policy dated 9/1/2023, revealed "...Services are provided according to the most recent orders updating the patient's Plan of Care... Review of the agency's "Plan of Care," policy dated 12/1/2021, revealed "...PRN [as needed] orders for visits must include parameters to qualify and quantify the visit needed..." Review of the medical record revealed Patient #6 was admitted to the agency on 6/17/2023 with diagnoses of Diffuse Large B-Cell Lymphoma, Anemia in Neoplastic Disease, Paraplegia, Diabetes Mellitus, Hypertension, and Atherosclerotic Heart Disease. Review of the Home Health Certification and Plan of Care dated 6/23/2023, revealed "..SN [Skilled Nurse] 1 WK [week] 1, 10 WK 1, 2 WK 1, 1 WK 7..." Review of the Client Calendar Report revealed Skilled Nursing made 4 visits and 2 prn visits the week of 6/18/2023 thru 6/24/2023. Review of the medical record revealed Patient #6 was admitted to the agency on 6/15/2023 with diagnoses of Atrial Fibrillation, Non-ST Elevation Myocardial Infarction, Liver Cell Carcinoma, Hypertensive Heart Disease with Heart Failure, Diabetes Mellitus, and Osteomyelitis. Review of the Home Health Certification and Plan of Care dated 8/14/2023, revealed "...SN 3 WK 9..." Review of the Client Calendar Report revealed Skilled Nursing made 1 visit the week of 8/13/2023 thru 8/19/2023. During an interview with the Area Administrator on 9/19/2023 at 4:20 PM, she stated "...the new audit process is to add prn visits to the POC [Plan of Correction] to cover any prn added throughout the episode. There seems to be a consistent error that the prn visits are pulling to the POC for the week they are plotted on the calendar frequency to be performed. The order on the POC does not specify that the prn visits are prn in nature instead they are being pulled as part of the weekly frequency. To correct this-prn visits should be left off until needed or find a way to identify on the frequency they are prn..."

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on policy review, medical record review, observation, and interview, the facility failed to ensure practices to prevent the potential spread of infection were maintained when wounds were re-contaminated during cleansing and dressing,no glove changes were made and or no hand hygiene was not practiced between glove changes 1 of 3 (Patient #4) patients reviewed for wounds. The findings include: Review of the agency's "Wound Assessment, Documentation, and Photography," policy dated 8/1/2022, revealed "...Perform wound care according to LHC [Named Home Health Agency] adopted clinical skills guidelines ad physician orders..." Review of the agency's "Infection Control Event Reporting-Patient and Employee," policy dated 9/1/2020, revealed "...The infection control program optimizes the use of resources and assesses the safety and quality of patient care provided by establishing a baseline at each agency, monitoring trends within the agency and using the findings to improve care and decrease infections and other complications...Program Goals...Increase hand hygiene among healthcare workers...Educate staff, patients, caregivers and visitors on infection control and prevention practices...Limit unprotected exposure to pathogens by increasing the rate of hand hygiene...To recommend, and then monitor for compliance, practices oriented towards preventing transmission of infection amongst employees and/or patients...Hand Hygiene Compliance: Prevent transmission of infection through proper adherence of hand hygiene procedure by staff..." Review of the agency's "Wound Care Best Practice Checklist," dated 6/6/2022, revealed "...Perform hand hygiene...Use clean field for wound supplies...Gather supplies for procedure: gloves, PPE [Personal Protective Equipment] if indicated, wound cleanser, clean/sterile scissors (as applicable), waste container, appropriate dressing supplies, measuring device...Open dressings, unwrap equipment, apply protective equipment and/or gloves...Remove dressing and discard...Remove gloves and perform hand hygiene...Apply new gloves...Assess wound size (length, width, depth)...Adequately cleanse wound with either saline or wound spray...Blot dry with gauze...Remove and discard gloves and perform hand hygiene...Apply new gloves...Apply dressing...Remove gloves and perform hand hygiene...Apply new gloves...Label dressing with date/time of application and clinician's initials...Remove gloves and perform hand hygiene..." Review of the medical record revealed Patient #4 was admitted to the agency on 4/21/2022 with diagnoses of Stage 4 Sacral Pressure Ulcer, Stage 4 Left Hip Pressure Ulcer, Stage 2 Other Site Pressure Ulcer, Hypertension, Alzheimer's Disease, Dementia, Cerebrovascular Disease, and Dysphagia. Review of the Plan of Care dated 8/25/2023, revealed "...Wound care to multiple Daily cleanses with wound cleanser, Apply Calcium Alginate. Cover with Foam dressing using clean technique..." Observations on 9/19/2023 at 10:11 AM, in Patient #4's bedroom, revealed Licensed Practical Nurse (LPN) #1 perform hand hygiene and don gloves. LPN #1 repositioned Patient #4 in her bed and removed the old dressings from the left lower scapular wound, sacral wound, right posterior thigh wound, and the left trochanter wound with the same gloves. She removed her gloves and redonned gloves. She failed to sanitize her hands. She then took pictures of Patient #4's wounds with her tablet and removed her gloves and redonned gloves without hand sanitizing. She measured all of the wounds, gathered supplies, and re-gloved. LPN #1 cleaned stool from the patient and removed her gloves and donned new gloves without using hand sanitizer. She cleaned the right shoulder wound with normal saline and 4 x 4's, cleaned the sacral wound with normal saline and 4 x 4's, cleansed the right trochanter wound with normal saline and 4 x 4's, and right calf wound with normal saline and 4 x 4's. She never changed her gloves while cleaning the separate wound. She changed her gloves and donned new gloves with hand sanitizing and cut xeroform gauze with unclean scissors. She applied the xeroform gauze to all 3 wounds and covered all of the wounds with Optifoam Dressing without changing her gloves between the different wounds. She removed her gloves and put on new gloves, applied Dakins soaked 4 x 4's to sacrum and trochanter using the same gloves. During this dressing change, LPN #1 stopped to go through the supply boxes to find a bigger foam dressing, never removing her gloves and then applied the foam dressing to the sacrum. LPN #1 stopped to clean more stool, removed her gloves and donned clean gloves without hand sanitizing, applied Caloseptin Cream to the buttocks. She also handled the Xeroform dressing and Optifoam dressing with her bare hands. Patient #4 is repositioned on her left side. donned gloves. She removed the dressing to the right lateral knee, cleansed with a normal saline soaked 4 x 4, recontaminating the wound while cleansing over the same area with the same 4 x 4. She then applied Xeroform and Alginate. The scissors are never cleaned. She applied the foam dressing and moved on to the right upper arm. She removed the Xeroform and Alginate without changing her gloves or sanitizing her hands and proceeded to cleanse and dress the left upper forearm. LPN #1 removed the dressing to the chest wound and right upper arm with the same gloves. She removed her gloves and took pictures of the two wounds. She sanitized her hands and re-donned new gloves. She cleansed the right upper arm, left arm, and chest with normal saline and 4 x 4's. SHe had to cut the Xerofoam and Alginate dressings with the unclean scissors and applied pieces of the Xerform dressing and Alginate that were pre-cut for other areas to these three wounds. LPN #1 had to get more dressings out of the storage box in the home and proceeded to cut additional pieces to cover the right arm, left arm, and chest wounds. LPN #1 never changed her gloves and sanitized her hands. LPN #1 failed to change her gloves between removing the old dressings from the wounds, cleansing the different wounds, dressing the different wounds, obtaining additional dressings, and when she did change her gloves, failed to sanitize her hands. LPN #1 failed to cleanse the scissors between dressing changes. LPN #1 failed to cleanse her hands after using her tablet to take pictures of the wounds and donning clean gloves to cover the wounds with dressings.