Health inspection·September 22, 2025

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 interview and record review, the facility failed to report a COVID - 19 (a potentially severe illness caused by a coronavirus and characterized by fever, cough, and shortness of breath) outbreak to the California Department of Public Health (CDPH) when three residents (Residents 6, 7, and 8) tested positive for COVID-19 indicative of a facility outbreak.Findings:a. During a review of Resident 6's admission Record (Face Sheet), the Face Sheet indicated Resident 6 was admitted to the facility on [DATE] with diagnoses including arthrogryposis multiplex congenita (a rare, non-progressive condition present at birth, characterized by multiple, stiff, contracted joints (contractures) and muscle weakness).During a review of Resident 6's Minimum Data Set (MDS - a resident assessment tool) dated 7/7/2025, the MDS indicated Resident 6's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) was intact and required substantial/maximal assistance (helper does more than half the effort) from staff to complete her activities of daily living (ADLs- activities such as bathing, dressing and toileting a person performs daily).During a review of Resident 6's COVID- 19 Antigen test result (examines bodily fluids for specific markers of a disease) dated 9/15/2025, the test result indicated Resident 6 tested positive for COVID-19 on 9/15/2025.b. During a review of Resident 7's admission Record (Face Sheet), the Face Sheet indicated Resident 7 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing).During a review of Resident 7's MDS dated [DATE], the MDS indicated Resident 7's cognition was moderately impaired required partial/moderate assistance (helper does less than half the effort) from staff to complete her ADLs.During a review of Resident 7's COVID- 19 Antigen test result dated 9/15/2025, the test result indicated Resident 7 tested positive for COVID-19 on 9/15/2025.c. During a review of Resident 8's admission Record (Face Sheet), the Face Sheet indicated Resident 7 was admitted to the facility on [DATE] with diagnoses including DM.During a review of Resident 8's MDS dated [DATE], the MDS indicated Resident 8's cognition was moderately impaired and required partial/moderate assistance from staff to complete her ADLs.During a review of Resident 8's COVID- 19 Antigen testing results dated 9/15/2025, the testing results indicated Resident 8 tested positive for COVID-19 on 9/15/2025.During an interview on 9/19/2025 at 11:58 a.m., with the Infection Prevention Nurse (IP), the IP Nurse stated she reported the outbreak to the local health department after the residents tested positive on 9/15/2025 but did not report the outbreak to CDPH.During an interview on 9/20/2025 at 2:20 p.m., with the Director of Nursing (DON), the DON stated an outbreak of COVId-19 should be reported to CDPH to ensure proper measures are being done to prevent the virus from spreading within and outside the facility.During a review of the facility's policy and procedure (P&P) titled Unusual Occurrence Reporting, dated 12/2007, the P&P indicted as required by federal or state regulations, the facility reports unusual occurrences or other reportable events which affect the health, safety, or welfare of our residents, employees, or visitors. The P&P Residents Affected - Some Page 1 of 2 055527 055527 09/22/2025 Los Palos Post-Acute Care Center 1430 West 6th Street San Pedro, CA 90732

F 0880 indicated the facility will report the following events to appropriate agencies including an outbreak of any communicable disease. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 055527 Page 2 of 2