Health inspection·October 21, 2023

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure Licensed Vocational Nurse (LVN) 1 transcribed (write down) and carried out the physician order for Augmentin (antibiotic [medicine that fight infection]) and Loratadine (medication to treat allergy symptom) immediately after receiving the order on 10/21/2023 at 7:35 a.m. for one of three sampled resident (Resident 8). The deficient practice resulted in a more than six-hour delay of care, treatment, and relief of symptoms (headache and right cheek pain) for Resident 8. Findings: During a review of Resident 8's admission Record (Face Sheet), the Face Sheet indicated Resident 8 was admitted to the facility on [DATE] with diagnoses including COVID 19 (a highly contagious infection, caused by a virus [germ]that can easily spread from person to person), atrial fibrillation (irregular heart beat), and essential hypertension (high blood pressure [a measure of how forceful the blood pumps in the body]) During a review of Resident 1's Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 9/22/2023, the MDS indicated Resident 8's had intact cognitive (ability to learn, reason, remember, understand, and make decisions) skills for daily decision making. During a record review of Resident 8's Change in Condition (COC) evaluation, dated 10/21/2023 and timed at 6 a.m., the COC indicated Resident 8 complained of headache and right cheek pain. The COC indicated Resident 8 was concerned it may be a sinus (bones of the face) infection. During a concurrent interview and record review on 10/21/2023 at 1:20 pm with LVN 1, Resident 8's COC for 10/21/2023 at 6 a.m. and Resident 8's order sheet was reviewed. The COC indicated the resident complained of headache and cheek pain. The physician order sheet indicated there were no orders for Resident 8 at 10/21/2023 at 7:35 a.m. LVN 1 stated Resident 8 complained of headache and right cheek pain at 6 am. LVN 1 stated she called Resident 8's physician and the physician, through text messaging, ordered Augmentin, 875 milligram (mg-unit of measurement) two times a day for seven days and Loratadine 10 mg, daily for seven days. LVN 1 stated she has not entered the medication order in Resident 8 physician order sheet as of 1:50 p.m. indicating a six-hour delay of order transcription and implementation. LVN 1 stated the delay in entry of physician order led to a delay in resident care, treatment, and relief of Resident 8's symptoms. During an interview on 10/21/2023 at 1:32 pm with the of Director of Staff Development (DSD), the Page 1 of 10 055123 055123 10/21/2023 Beachside Post Acute 3294 Santa Fe Avenue Long Beach, CA 90810

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few DSD stated LVN 1 should have immediately transcribed Resident 8's order once received. The DSD stated the delay in transcription delayed the treatment needed by Resident 8. During a review of facility's policies and procedure (P&P) titled Change of Condition, revised 9/16, the P&P indicated any changes in a resident's condition needed to be thoroughly assessed and evaluated with physician notification for early clinical management to avoid unnecessary readmissions to acute hospitals. During a review of facility's P&P titled Physician Services, revised 1/2018, the P&P indicated drug and biological [class of drug] orders must be recorded on the physician 's order sheet in the resident's clinical record. 055123 Page 2 of 10 055123 10/21/2023 Beachside Post Acute 3294 Santa Fe Avenue Long Beach, CA 90810

F 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. Based on interview and record review the facility failed to document a completed facility wide assessment for 86 of 90 residents by: a. Failing to ensure Infection Preventionist Nurse (IPN) involvement in completing the assessment and failing to include the need for an IPN in the facility. b. Failing to describe the resident population profile by not indicating the average daily resident census (number of residents in the facility), the residents' acuity (allocation of clinical expertise and caregiver resources needed to provide care) levels. c. Failing to describe ethnic, cultural, and religious factors that affect the type of care needed for the facility's resident population. These deficient practices had a potential to result in the provision of incompetent care and services to the facility's resident population. Findings: During a record review of the Facility assessment tool, revised 10/19/2022, the tool indicated the following: a. The IPN did not participate in completing the tool on from 10/13/ 2022 to 10/18/2022. b. The average daily resident census and the residents' acuity levels were blank. c. The ethnic, cultural, and religious factors that affect the type of care for the residents were not indicated in the tool. During a concurrent interview on 10/21/2023 at 1:05 p.m., with the Administrator (ADMIN) and record review of the facility's assessment tool, dated 10/19/2022, the facility assessment tool was reviewed. The tool indicated no documented evidence of the IPN involvement in completing the assessment tool. The ADMIN stated that it would have been good if the IPN was involved in the completion of the facility assessment since infection prevention and control (practical evidenced based approach preventing residents' health workers from being harmed by avoidable infections) facility practices was always changing. During an interview on 10/21/2023 at 1:24 p.m. with the ADMIN and record review of the facility assessment tool, the tool was reviewed. The tool indicated the IPN and Director of staff Development (DSD), will use infection control surveillance data (the number of infections in the facility) to create an action plan (steps to take to meet goals) summary and submitted it to the QAPI (Quality Assurance and Performance Improvement) committee (group responsible for performance improvement activities in the facility) via Director of Nursing (DON) and ADMIN. The ADMIN stated IPN nurse has assigned tasks in the facility and should have been involved in the completion of the facility assessment tool. 055123 Page 3 of 10 055123 10/21/2023 Beachside Post Acute 3294 Santa Fe Avenue Long Beach, CA 90810

F 0838 Level of Harm - Minimal harm or potential for actual harm During an interview with the ADMIN and record review of the facility assessment tool, on 10/21/2023 at 2:10 p.m., the tool was reviewed. The tool did not indicate the average daily resident census, the residents' acuity levels, and the ethnic, cultural, and religious factors that affect the type of care needed for the resident population. The ADMIN confirmed the information missing in the tool would be addressed. Residents Affected - Many 055123 Page 4 of 10 055123 10/21/2023 Beachside Post Acute 3294 Santa Fe Avenue Long Beach, CA 90810

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to implement Coronavirus disease ([COVID-19] a potentially severe respiratory illness caused by a corona virus and characterized by fever, coughing, and shortness of breath) outbreak response measures (acts and procedures to minimize the spread of a disease) as evidenced by the facility failure to: Residents Affected - Many a.Ensure two of two Certified Nursing Assistants (CNA 3 and 4) doffed (took off) the N95 mask (a respiratory protective device designed to achieve a very close facial fit for effective filtration of airborne particles) they wore inside the isolation (rooms designated to keep residents, who have certain medical conditions, such as infections, separate from other people while they receive medical care) rooms of Covid-19 positive residents (Resident 4 and 5) prior to exiting the resident's room and donned (put on) a clean N95 mask after exiting residents' isolation rooms and walking in the hallway of the resident care areas. b.Screen one of one symptomatic Covid-19 positive resident (Resident 4) for eligibility to receive anti-viral (a substance that fights against viruses and inhibits their growth) Covid-19 treatment. c.Provide an in-services (training) to staff (License Nurses and Certified Nursing Assistant) regarding Covid-19 updates on the guidelines and how many residents tested positive for Covid-19 in the facility. d.Ensure one of three CNAs (CNA 4) was fit tested (test conducted to verify the respirator was both comfortable and correctly fits the user) for the BYD (type of N95) mask, the mask she (CNA 4) was wearing while working with Covid-19 positive residents. These failures had the potential to result in the continued spread of Covid-19 in the facility and Covid 19 can cause respiratory failure (a condition in which the blood does not have enough oxygen or has too much carbon dioxide [a colorless, odorless gas]), pneumonia (an infection that inflames the air sacs in one or both lungs making it difficult to breath), acute liver injury, a secondary infection (an infection that occurs during or after treatment for another infection), and septic shock (a condition sometimes occurring in severe sepsis [an extreme reaction to an infection], in which the blood pressure falls and the organs of the body fail to receive sufficient oxygen) leading to hospitalization, intubation (insertion of a tube into a patient's body to assist with breathing), and possible death. Findings: a.During a review of Resident 4's admission Record (Face Sheet), the Face Sheet indicated Resident 4 was admitted to the facility on [DATE] and during stay, on 10/14/2023, the resident got diagnosed with Covid-19. During a review of Resident 4's MDS, dated [DATE], the MDS indicated Resident 4 was rarely/never understood and the resident's cognitive (thought process) skills for daily decision making was severely impaired. During a review of Resident 4's Change of Condition (COC) Situation Background, Assessment, and Request/Responsible Party notification/ Response (SBAR) Covid-19 form, dated 10/14/2023 the COC SBAR 055123 Page 5 of 10 055123 10/21/2023 Beachside Post Acute 3294 Santa Fe Avenue Long Beach, CA 90810

F 0880 form indicated the resident was transferred to an isolation room. Level of Harm - Minimal harm or potential for actual harm During a review of Resident 5's face sheet, the face sheet indicated Resident 5 was admitted to the facility on [DATE] diagnosed with sepsis (infection in the blood) and systemic inflammatory response syndrome (an exaggerated defense response of the body to a noxious stressor [infection, trauma, surgery]). Residents Affected - Many During a review of Resident 5's MDS, dated [DATE], the MDS indicated Resident 5 was rarely/never understood and the resident's cognitive skills for daily decision making was severely impaired. During a review of Resident 5's COC SBAR Covid-19 form, dated 10/20/2023 the COC SBAR form indicated the resident was positive for Covid-19. During concurrent observation in the residents hallway in front of isolation rooms [ROOM NUMBER] and interview with Licensed Vocational Nurse LVN (1) on 10/21/2023 at 9:50 a.m., the personal protective equipment ([PPE] equipment used to prevent or minimize exposure to hazards) carts in front of the isolation rooms were not stocked with N95 mask. LVN 1 stated there were no N95 masks stocked in the isolation carts. During an observation in the isolation area and interview with CNA 3 on 10/21/2023 at 10:05 a.m., CNA 3 was observed exiting Resident 2's isolation room with a used N95; and CNA 3 did not replace the used N95 with a clean one. CNA 3 was observed walking in the hallway of the isolation area with a used N95 mask. CNA 3 stated we use the same N95 throughout the shift (7:00 a.m.- 3:00p.m.). During an interview on 10/21/2023 at 10:42 a.m. with CNA 4, CNA 4 stated all PPEs including the N95 must be removed upon exiting the room of Resident 5. CNA 4 stated it was important to remove all PPE upon exit to prevent cross contamination (process by which germs are spread unintentionally), and risk of spreading Covid-19 to other residents, staff, and visitors. During an observation on 10/21/2023 at11:20 a.m., in one of the facility's isolation area, (designated area in the facility with positive Covid 19 residents), CNA 4 was observed exiting Resident 5's isolation room wearing a used N95 mask. CNA 4 did not don a new and clean N95 then she proceeded to hallway of a resident care area. During a review of the isolation sign titled Transmission based Precautions (additional measures focused on the mode of transmission of the infection), undated, published by the Long Beach Health and Human Services, on the door of Resident 2's room, and interview with CNA 3 on 10/21/2023 at 10:05 a.m., the isolation sign was reviewed. The isolation sign indicated to change to clean N95 when exiting the room. CNA 3 stated she did not change her N95 after exiting the isolation room because we use the same N95 throughout the shift. CNA 3 stated she did not know she was supposed to change her N95 after exiting the isolation room. During a review of the facility's policy and procedure (P&P), titled Infection Control- Enhanced Standard Precautions (revised 3/2016), the P&P indicated the facility will follow instructions for contact precautions. During a review of Centers for Disease Control and Prevention (CDC) Interim Infection Prevention and Control Recommendations for healthcare Personnel 055123 Page 6 of 10 055123 10/21/2023 Beachside Post Acute 3294 Santa Fe Avenue Long Beach, CA 90810

F 0880 Level of Harm - Minimal harm or potential for actual harm During the Coronavirus Disease 2019 (Covid-19) Pandemic (updated 5/8/2023), the article indicated the recommendations in this guidance continue to apply after the expiration of the federal COVID-19 Public Health Emergency. The article indicated if the N95 was used during the care of a patient with Covid-19 infection, the mask should be removed and discarded after the patient care encounter and a new one should be donned. Residents Affected - Many b.During an interview and record review of Resident 4's COC SBAR form, dated 10/14/2023 at 5:45 p.m., with the Director of Staff development (DSD), on 10/21/2023 at 10:15 a.m., the form was reviewed. The form indicated the resident had a fever (elevated body temperature) of 101.8 degrees Fahrenheit (unit of measure) and tested positive for Covid-19. The DSD stated Resident 4 was symptomatic with Covid-19. The COC indicated no documented evidence Resident 4 was evaluated for consideration of Covid-19 anti-viral treatment. The DSD confirmed the resident was not evaluated for consideration for Covid-19 treatment and she didn't know Resident 4 was eligible to receive treatment for mild to moderate covid 19 and should evaluated by a physician for consideration. During an interview and record review of Resident 4's nurse progress notes for 10/14/2023 to 10/21/2023 with the DSD on 10/21/2023 at 10:15 a.m.,. The notes indicated no documented evidence Resident 4 was evaluated for consideration of Covid-19 treatment. The DSD stated the resident was not evaluated for consideration for Covid-19 treatment and she did not know Resident 4 was eligible to receive treatment for mild to moderate covid 19 and should evaluated by a physician for consideration. During a record review of the facility's P&P titled Infection Control Program System, dated 01/2023, the P&P indicated the facility infection control program includes a system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors and other individuals providing services. c. During a concurrent observation and interview on 10/21/2023 at 9:05 a.m. with LVN 3, LVN 3 stated that she's been assigned to the Covid area for the past couple days. LVN 3 stated, since the outbreak started, she has not attended facility given in-services regarding Covid-19 on guidelines to follow. LVN 3 stated that she found out about the outbreak when she walked in the facility, and she received her assignment to the Covid positive area. LVN 3 stated she should have been updated by the facility on the new guidelines for Covid- 19 since changes to guidelines occur quickly. LVN 3 stated it was important to be informed on the numbers of Covid positive residents and staff in the facility. During a concurrent interview and record review of the binder for infection control in-services with the Director of Staff Development (DSD) on 10/21/2023 at 2:00p.m., the in-services binder was reviewed. The binder indicated no documented evidence of any in-services since the outbreak on 10/12/2023. The DSD stated there was no documented evidence of any in-services after the outbreak started was noted. During an interview with the ADMIN on 10/21/2023 at 2:10 p.m., The ADMIN stated no documented evidence of any covid-19 in-services was noted. The ADMIN stated Covid-19 education was important so the staff would be updated with the new regulations and the implementation of the infection control practices can be reviewed. The ADMIN stated the responsible person making sure implementing all the policies and procedure was the IPN. During a review of the Facility assessment tool, (reviewed 10/19/2022), the tool indicated the director of nursing (DON), supervisors and the DSD provides the required staff education/in-service 055123 Page 7 of 10 055123 10/21/2023 Beachside Post Acute 3294 Santa Fe Avenue Long Beach, CA 90810

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many including infection control prevention topics on a monthly and as needed bases when areas of concern were identified. During a record review of the facility's P&P titled Infection Control Program System dated 01/2023, the P&P indicated the IPN was responsible for educating residents, staff and visitors on good infection control of infection. d.During a review of CNA 4's N95 fit testing form, the form indicated CNA 4 was fit tested on [DATE] with the Honeywell mask (type of N95 mask). During a concurrent observation and interview on 10/21/2023 at 10:40 a.m. with CNA 4, outside Resident 5's room, CNA 4 was observed wearing a BYD N95. CNA 4 stated she was wearing the BYD N95 mask. During a concurrent interview and record review on 10/21/2023 at 1:32 p.m. with the DSD, CNA 4's N95 fit testing form, 7/27/2023, was reviewed. The form indicated CNA 4 was fit tested with the Honeywell N95. The DSD stated based on the N95 fit testing form, CNA 4 was fit tested with Honeywell and not BYD N95 mask. The DSD stated it was important to wear the correct N95 mask you were fit tested for to ensure a correct fit and seal was attained, to protect CNA 4 against airborne particles which can cause respiratory illnesses, ensure compliance with Occupational Safety and Health Administration (OSHA) regulation, and to prevent the spread of Covid-19 infection to residents, staff, and visitors. During a review of facility's P&P, titled Fit Test and Respirator Seal Check Policy, revised 11/2020, the P&P indicated The fit test must be conducted using the same make, model, and size of mask that the worker will use on the job. Fit testing with a different type of mask than the one that will be used does not assure proper protection. 055123 Page 8 of 10 055123 10/21/2023 Beachside Post Acute 3294 Santa Fe Avenue Long Beach, CA 90810

F 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review facility failed to ensure one out of five residents (Resident 11) received the pneumococcal vaccine (medication to protect against pneumonia [infection of the lungs]) after consent was obtained on 11/28/2022; and the facility failed to ensure two of five sampled residents (Resident 12, and 13) were offered pneumococcal vaccination yearly after refusal. Residents Affected - Some These deficient practices placed three residents at a higher risk of acquiring and transmitting pneumonia to other residents in the facility. Findings: a. During a record review of Resident's 11 admission record, the admission record indicated Resident 11 was admitted to the facility on [DATE] and re- admitted on [DATE] with diagnoses that included diabetes mellitus (disease that causes human immunodeficiency virus (HIV- virus [germ] that attacks the body's immune system[way the body protects against outside invaders]), and hypertensive heart disease ( problems with the heart that can cause high blood pressure [measure of how much force it takes for blood to pump in the body]) with heart failure (heart does not function normally). During a review of the Resident 11's Minimum Data Set (MDS), a standardized assessment and care screening tool, dated 10/6/2023, the MDS indicated, Resident 11 was understood and able to understand others and had intact cognition (thought process). During a record review of the Resident 11 's Pneumococcal Immunization informed consent, dated 11/28/2022, Resident 11 consented to receive the pneumococcal vaccination and risk and benefits were explained to the resident. During a record review of Resident 11's immunization record, dated 11/28/2022, the record indicated no pneumococcal vaccine was administered. During an interview 10/21/2023 at 11:01 a.m. with Licensed Vocational Nurse (LVN 4), LVN 4 stated when Resident 11 gave a consent the pneumococcal vaccine should have been administered. b. During a record review of the admission record, the admission record indicated Resident 12's was admitted to the facility on [DATE] and re-admitted on [DATE] with diagnoses that include hyperlipidemia (high level of lipids(fats) in your blood, diabetes mellitus, and atrial fibrillation (irregular heartbeat). During a review of the Resident 12's MDS, dated [DATE], the MDS indicated Resident 12 had clear speech, was understandable, and can understand others. During a record review of Resident 12's immunization records, the records indicated the pneumococcal vaccine was last offered on 3/3/2021 and the resident refused the vaccination. During a review of the admission record, the admission record indicated Resident 13 was admitted to the facility on [DATE] with diagnoses that included, Coronavirus disease ([COVID-19] a potentially severe respiratory illness caused by a corona virus and characterized by fever, coughing, and shortness of breath), hypertension and atrial fibrillation. 055123 Page 9 of 10 055123 10/21/2023 Beachside Post Acute 3294 Santa Fe Avenue Long Beach, CA 90810

F 0883 Level of Harm - Minimal harm or potential for actual harm During a review of the Resident 13's MDS, dated [DATE], the MDS indicated the Resident 13 had clear speech, was able to make self-understood, and can understand others. During a record review of Resident 13 immunization records, the records indicated Resident 13 refused on 7/30/2021 and no pneumococcal vaccine was administered. Residents Affected - Some During an interview on 10/21/2023 at 11:30 a.m. with Licensed Vocational Nurse (LVN 4) and record review of the immunization records for Resident 12, and 13, the records were reviewed. The records indicated after the residents refused their vaccinations no other attempt to acquire consent for pneumococcal vaccine administration annually was noted. LVN 4 stated that Infection Preventionist Nurse (IPN) was the responsible person overseeing the pneumococcal vaccine administration in the facility. LVN 4 stated the IPN was the one who obtains the consent from the resident or responsible party during the residents' admission. LVN 4 stated it was important to get the elderly vaccinated because it protects the residents from getting pneumonia or it lessens the symptoms if the disease was acquired. LVN 4 stated the pneumonia vaccine should have been offered yearly even if the resident or responsible party initially refused because the resident might change their mind and the resident might understand the importance of getting immunized. During an interview on 10/21/2023 at 2:25 p.m. with the Administrator (Admin), the Admin stated it was the IPN's responsibility to ensure the pneumococcal vaccine was being offered to all the residents. The Admin stated the pneumococcal vaccines should have been offered because the elderly was the one who gets infected. The residents need to get vaccinated to be protected. During a record review of the facility's policy and procedure(P&P) titled Pneumonia Vaccine dated 12/2018, the P&P indicated all residents were offered pneumococcal vaccines according to the newest recommendations. On admission, all residents will be evaluated for pneumococcal vaccination needs. The resident's clinical record should include documentation that the resident or their representative was provided education regarding the benefits and potential side effects of pneumococcal immunization and that the resident whether received the immunization or did not receive the immunization due to medical contraindications or refusal. 055123 Page 10 of 10