complaint·October 27, 2023

10/03/23 if there were any more residents being treated for scabies and both Karan Bassi, the DRS and Carlin Robertson, the Campus Business Office Manager (CBOM), replied, “No.” On 10/18/23, this LPA visited the facility and during the course of this investigation found that 29 additional residents had been treated for scabies symptoms without CCL or the Stanislaus County Public Health Department (SCPHD) being notified. The standard for the preponderance of evidence has been met and the department finds this allegation SUBSTANTIATED. Regarding: Staff did not follow protocol when dealing with an infectious outbreak. On 7/28/23 CCL received notification from SCPHD that El Rio Memory Care had a resident with a suspected case of scabies on 07/27/23. The resident had a rash, scabs, and blood on their clothing. The resident was prescribed a medication for scabies by their primary care doctor. SCPHD sent an email to El Rio Memory Care with guidance for control, treatment, and disinfection. They also included a Scabies Line List that the facility was instructed to complete with resident and or staff information. On 08/08/23, an unannounced collaborative visit was made to El Rio Memory Care by Licensing Program Analyst, (LPA) Kimberly Viarella, and representatives from Stanislaus County Public Health Department, Zaurina Jones, Public Health Nurse, and Gorlia Xiong, Medical Investigator. The LPA identified herself and her colleagues and asked to speak with the Executive Director. The group explained the purpose of their visit was to provide technical support in addressing the recent scabies outbreak. This visit was informational and educational. The team met with Kent Mulkey, Executive Director, Karan Bassi, Director of Resident Services, and Carlin Robertson, the Campus Business Office Manager. The DRS shared the current practices and procedures that were being implemented to address and prevent the spread of scabies. The SCPHD representatives shared strategies for improving these procedures and offered additional suggestions to assist with eradicating scabies from the facility. These strategies included but were not limited to the following: Separate those who have never been treated / shown symptoms from those who have been treated /shown symptoms as much as possible. On 08/08/23, during the collaborative visit with SCPHD, the DRS Karan Bassi, at the time, informed the group that they were practicing social distancing throughout the community in order to prevent more residents from contracting scabies. This LPA observed an activity taking place in the dining room where more than 12 residents were sitting in a circle shoulder to shoulder less than On 10/018/23 LPA visited the facility and observed a resident (R5) in the main dining room sitting with 3 other residents. R5 was itching and scratching non-stop. LPA brought this to the attention of Kayleen August, the Regional Nurse for Koelsch. LPA suggested checking the resident for scabies. The Regional Nurse confirmed that they had just received a prescription for scabies medication for that R5. R5 was suspected of having scabies and was observed eating in the main dining room with 3 other residents at the table. Vacuum and deep clean. SCPHD recommended that vacuuming all flooring, bedding, and furniture, particularly the furniture in common areas like the dining rooms, would assist in limiting the spread of scabies. On 10/18/23 during an interview with the Physical Plant Director (PPD), Jay Duarte, this LPA learned that furniture and bedding had not been vacuumed and that this information had not been passed along to the PPD. Enhance environmental cleaning procedures. During the interview with the PPD (also in charge of Housekeeping), on 10/18/23, the PPD shared that they had switched to disposable mop and dust heads based on recommendations from public health. This LPA also learned that he had not been informed of the additional 31 residents who had been treated for scabies symptoms (as of 10/18/23) and whose rooms required a deep cleaning. The Physical Plant Director thought the most recent cases had been treated in August of 2023. The PPD had not been instructed to deep clean the rooms of any of the residents who had been treated for scabies since August. 6 inches apart. Communication It was encouraged by the team that signage be posted in the lobby regarding potential exposure to scabies upon entering the community. SCPHD also offered to share a template of a letter that could be utilized to share this information with the family members and responsible parties for all the residents in care. The facility did not request this information, and letters were not sent out to responsible parties for residents in care. SCPHD also suggested developing questionnaires to assist in gathering information from those who have visited or who intend to visit the facility. This LPA visited the facility on: 08/08/23, 10/03/23 and 10/18/23 and did not observe any signage regarding the outbreak. Based on interviews with 5 out of 6 responsible parties, El Rio Memory Care did not notify them of their family members’ change of condition re quiring scabies treatment. The facility also did not develop or send out any questionnaires. 6 inches apart. On 8/21/23, Stephen Sarine, Regional Director of Operations (RDO) sent a letter to CCL acknowledging that they had a total of 8 cases, the last dated 8/2/23. According to the LIC 9282 that was submitted to CCL by El Rio Memory Care, their own Emergency Infection Control Plan states the following on page 4. Under section C: 1: Enhanced environmental cleaning and disinfection. Effective environmental cleaning strategies, and the locations where deep cleaning was needed, were not communicated to the PPD There shall be separation and/or cohorting of residents as needed. LPA did not witness any separation / social distancing or cohorting during multiple visits on: 08/03/23, 10/3/23 and 10/18/23. 2: Isolate residents / use contact precautions until treated. None of the residents were isolated . Treat residents and staff and monitor post treatment for effectiveness. During this investigation, this LPA found multiple instances where residents had to be treated for scabies more than once. One individual was treated more than 3 times since March. Identification of contacts of symptomatic case(s) . Questionnaires were never utilized, and visitors and families were not contacted. El Rio Memory Care was not adhering to its own infection control plan as evidenced by the information provided above. The standard for the preponderance of evidence has been met and the department finds this allegation SUBSTANTIATED. Regarding: Staff did not meet resident's hygiene needs. Through interviews conducted during the course of this investigation, this LPA learned that scheduled showers are sometimes not completed due to call-outs. 5 out of 5 responsible p a rties for individuals treated for scabies stated that they noticed their loved ones scratching at a rash and/or scabs and alerted carestaff. During a facility visit on 10/03/23 this LPA inspected the bedding and mattresses in 5 resident bedrooms. 1 had reddish stains on the sheets as well as on the box spring. Pictures were taken for reference. Also related to hygiene, 4 out of 7 r esponsible parties interviewed stated that they had observed their loved ones in soiled or wet briefs for ext ended periods of time. Interviews with staff revealed that if there were call -outs it could take 3 to 3 and a ½ hours for one caregiver to complete their rounds. This already exceeds the incontinence check required at the 2-hour mark. The LPA also learned during interviews that if there were callouts, that fewer or sometimes none of the scheduled showers might take place that day. The standard for the preponderance of evidence has been met and the department finds this allegation SUBSTANTIATED. Regarding: Facility did not report rash to licensing. During the course of this investigation, this LPA reviewed the Medication Records for R5 for July and August. There was a handwritten prescription for Permethrin, a drug used to treat scabies, that was administered on 07/14/23 . Community Care Licensing was not informed that this resident was treated as early as 7/14/23. The report we received said that the first 2 cases were noted on 7/27/23. El Rio Memory Care failed to meet reporting requirements when they failed to notify Licensing of the change in residents’ conditions and the resulting need for scabies medication. They did not submit LIC 624s alerting CCL to the continued presence of scabies at the facility. By 08/21/23 there were a total of 29 additional residents that had been treated for scabies symptoms. The standard for the preponderance of evidence has been met and the department finds this allegation SUBSTANTIATED. Regarding: Facility did not report rash to families. Based on 5 out of 5 interviews with responsible parties, the facility did not notify them of scabies being present in the facility. In 4 out of 5 cases, the responsible parties informed the facility of the rash and suspected presence of scabies. Some residents have been treated more than once. Families were not notified of additional treatments. R5 was treated for scabies in March of 2023. This LPA reviewed the Medication Record and found additional prescriptions for treatment for R5. A handwritten prescription for Ivermectin was in the MAR and given on 07/31/23. LPA found a third handwritten prescription for Permethrin that was given on 09/22/23 and there was a box on the 28 th that appeared to indicate that another dose should have been given at that time, exactly 7 days later. This LPA spoke with the new Director of Resident Services and was informed that R5 had received another Permethrin treatment on 10/21/23. This LPA spoke with R5’s responsible party and they were only aware of the treatment in March and thought R5 might need another as they noticed R5 scratching during their latest visit. The standard for the preponderance of evidence has been met and the department finds this allegation SUBSTANTIATED. Deficiencies for the above substantiated allegations were cited on the LIC 9099D page. A copy of this report was provided along with Appeal Rights. Exit Interview shower logs were completed appropriately. The caregivers would document rashes and bruises. It was up to the nurse performing the actual skin assessments to determine if the rash might be scabies. The standard for the preponderance of evidence has not been met and the department finds this allegation UNSUBSTANTIATED. A property of this report was provided. Exit interview.