Disease outbreak check·September 11, 2023

On 09/11/2023, an unannounced collaborative visit was made to Belmare Senior Living by Licensing Program Analyst, (LPA) Kimberly Viarella, and representatives from Stanislaus County Public Health Department, Zaurina Jones, Pubic Health Nurse, and Jose Contreras, 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 treatment of 2 residents and 2 staff for scabies. This visit was informational and educational. The team met with Cindy Lichtenhan, Executive Director, and Terri Ford, the Director of Wellness. The group made a brief tour of the Memory Care area and met afterward to review resident files. Public Health representatives had previously participated in a Microsoft Teams meeting to discuss some of the best practices for containing and eradicating scabies from a facility. The following is a partial list of best practices that the team has developed over time working in a number of facilities. A complete report will be delivered at a future date by these public health officials. Some of these suggestions are already being implemented to a certain degree. It is hoped that the staff at Belmare Senior Living would include them as they update and enhance their current infection control plan. Again, these are best practices for any facility. The report from Public Health will be tailored to Belmare Senior Living specifically. Separate those who have never been treated / shown symptoms from those who have been treated /shown symptoms as much as possible. Utilize a different dining / activity room for each group. This would assist in preventing new cases. Another option would be to stagger the times for dining and activities, but this would require a thorough deep cleaning and vacuuming between each session which may/may not be possible. Enhance environmental cleaning procedures. Utilize disposable mop and dust heads. Color code laundry bags to indicate which laundry / bedding belongs to a resident who is being treated for scabies. Only launder exposed items with other exposed items. PPE Staff assisting with the showering, changing, and / or toileting needs of residents, would wear PPE (gowns and gloves). Staff assisting with walking a resident somewhere or helping with an activity would wear gloves to prevent skin to skin contact. If appropriate, bilingual signs explaining donning/doffing would be posted for staff to review as needed. PPE would be kept outside of resident’s rooms with some type of child lock to prevent residents from disturbing or taking items. Another option would be to keep PPE at the Nurse’s station of some other designated area that would be centrally located and easy for staff to access. Communication It was encouraged by the team that signage be posted in the lobby regarding potential exposure to scabies upon entering the community. Additional Recommendations: Although not covered in today's meeting, this LPA encouraged the Executive Director to contact Public Health to request a template of a letter informing family members and other visitors of the potential exposure to scabies. In the past at other facilities, Public Health also suggested developing questionnaires to assist in gathering information from those who have visited or who intend to visit the facility. LPA conducted an exit interview with the Belmare Senior Living representatives and a copy of this was provided. No citations cited during this visit.