Inspection visit
Health inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm
or potential for actual harm
Based on observation, interview and record review, the facility failed to implement infection control
measures by failing to:
Residents Affected - Some
1. Ensure Certified Nurse Assistant (CNA) 2 washed and /or sanitized (make clean and hygienic; disinfect)
hands before and after entering the residents ' room to provide care.
2. Ensure CNA 3 washed and/or sanitize hands after disposal of soiled linens before touching clean linen
storage to get supplies for the resident.
These failures had the potential to result in compromised infection control measures to prevent the potential
spread of Covid-19 and other infectious disease among residents, staff, and visitors.
Findings:
During an observation on 6/27/2023, at 1:40 p.m., in a hallway near room A (RM A), CNA 2 entered room A
to get the lunch tray, without washing hands. Upon exiting RM A with the tray, CNA 2 did not wash his
hands and pushed the tray cart to another hallway.
During an observation on 6/27/2023, at 1:45 p.m., in a hallway near room B (RM B), CNA 2 entered RM B
to answer the call light without washing his hands and covered the resident with blanket as requested by
the resident. CNA 2 did not wash his hands when he exited the room.
During an observation on 6/27/2023, at 1:48 p.m., in a hallway near room C (RM C), CNA 2 entered RM C
to answer the call light without washing his hands and handed a cup of water to the resident. CNA 2 did not
wash his hands after exiting the room.
During an observation on 6/27/2023, at 1:50 p.m., in a hallway near room D (RM D), CNA 2 entered RM D
to assist CNA 3 to reposition the resident without washing his hands upon entering the room.
During an interview on 6/27/2023, at 1:55 p.m., in a hallway near RM D, with CNA 2, CNA 2 stated, he did
not wash his hands before and after entering residents ' room to provide care to the residents in RMs A, B,
C, and D. CNA 2 stated, it was important to maintain hand hygiene to protect residents from getting
infectious disease and he should have washed his hands before and after providing care to the residents.
CNA 2 stated, he was focusing on answering the call lights and did not realize he was cross- contaminating
(the transfer of harmful bacteria from one person, object, or place to another) among the residents by not
washing his hands before and after entering the rooms.
During an observation on 6/27/2023, at 2:05 p.m., in a hallway near RM D, CNA 3 came out from RM D
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 2
Event ID:
055744
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055744
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/27/2023
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Atlantic Memorial Healthcare Center
2750 Atlantic Avenue
Long Beach, CA 90806
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0880
Level of Harm - Minimal harm
or potential for actual harm
with soiled linen in plastic bags and held the plastic bags with soiled linen in them without wearing gloves.
CNA 3 lifted hamper top up and discarded the soiled linen. CNA 3 did not wash or sanitize her hands and
touched the door knob of the clean linen storage room. CNA 3 opened and entered the clean linen storage
room to get clean linen and an adult brief. CNA 3 entered RM D without washing hands to apply clean linen
and the adult brief to the resident.
Residents Affected - Some
During an interview on 6/27/2023, at 2:08 p.m., in a hallway near RM D, with CNA 3, CNA 3 stated, she
should have brought the hamper close to RM D to discard the bags of dirty linen. CNA 3 stated, she did not
want to walk out of RM D with soiled linen, but she forgot to bring the hamper near room D. CNA 3 stated,
she should have washed her hands after discarding soiled linen in the hamper before entering the clean
linen storage room. CNA 3 stated, practicing hand hygiene was important to prevent spreading infections to
the residents and staff.
During an interview on 6/27/2023, at 3:50 p.m., with Infection Preventionist (IP), IP stated, good hand
hygiene practice was the best way to prevent the spread of infectious disease such as covid 19 and
Clostridiodies difficile ([C-diff]-a germ that causes diarrhea and inflammation of the colon) infection. IP
stated that hand hygiene was important, and she provided education to staff frequently. IP stated, CNAs
should wash their hands before entering the room because they might have to provide direct care to the
residents thereby touching the residents ' body when providing assistance. IP stated, CNAs should wash
their hands after they are done providing care to prevent possible cross-contamination. IP stated, clean the
hands with alcohol-based hand sanitizer if not visibly soiled. IP stated, clean the hands with soap and water
when they were visibly soiled.
During an interview on 6/28/2023, at 1:33 p.m., with the Director of Nursing (DON), DON stated, all staff
should follow the hand hygiene policy and procedure. DON stated, keeping good hand hygiene would
prevent spreading infectious disease and it was the first defense line to prevent infection to protect the
residents and staff.
During a review of the facility ' s policy and procedure (P&P) titled, Hand Hygiene, revised 10/2022, the
P&P indicated, Purpose: Hand hygiene is one of the most effective measures to prevent the spread of
infection. Studies show that effective hand decontamination can significantly reduce the rate of healthcare
associated infection. All personnel shall follow the handwashing/hand hygiene procedure to help prevent
the spread of infections to other personnel, residents, and visitors. Procedure:2. Use an alcohol-based hand
rub containing at least 62% alcohol; or, alternatively, soap and water for the following situations: b.Before
and after direct contact with residents .h. Before moving from a contaminated body site to a clean body site
during resident care; i. After contact with a resident's intact skin; j.After contact with blood or bodily fluids; k.
After handling used dressings, contaminated equipment, etc.; m. After removing gloves; .o. Before and after
eating or handling food . and q. After personal use of the toilet or conducting your personal hygiene.
During a review of the facility ' s policy and procedure (P&P) titled, Infection Control and Prevention Policy,
revised 6/8/2021, the P&P indicated, Policy: It is the policy of this facility to include preparatory plans and
actions to respond to the threat of the Covid-19, including but not limited to infection prevention and control
practices in order to prevent transmission. Procedure .2. Adhere to Standard and Transmission-Based
Precautions .Hand Hygiene- Healthcare personnel should perform hand hygiene before and after all patient
contact, contact with potentially infectious material, and before putting on and after removing PPE,
including gloves. Hand hygiene after removing PPE is particularly important to remove any pathogens that
might have been transferred to bare hands during the removal process.
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055744
If continuation sheet
Page 2 of 2
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Back to topCitations
1 citation recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F880 - Infection Control
Provide and implement an infection prevention and control program.
FAQ · About this visit
Common questions about this visit
What happened during the June 27, 2023 survey of ATLANTIC MEMORIAL HEALTHCARE CENTER?
This was a inspection survey of ATLANTIC MEMORIAL HEALTHCARE CENTER on June 27, 2023. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at ATLANTIC MEMORIAL HEALTHCARE CENTER on June 27, 2023?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Provide and implement an infection prevention and control program."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.