Health inspection·June 12, 2023

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 follow their policy and procedure by failing to: Residents Affected - Some 1. Sanitize and disinfect spaces in between visitors, after Coronavirus (COVID-19, a severe infection mainly respiratory disease that could spread from person to person) testing. 2. Properly manage biohazard (a risk to human health or the environment arising from biological work, especially with microorganisms) waste by discarding the used covid testing supply/kits which included a swab, sealed solutions, empty tube and covid 19 test in a regular trash. This deficient practice had the potential for a spread of infection including COVID-19. Findings: During an observation at the facility lobby, in front of the receptionist ' s desk on 6/12/2023 at 10:30 AM, three(3) visitors were observed taking a COVID - 19 test on a table designated by the facility for Covid testing. The 3 visitors were observed disposing the used covid testing suppliesin a regular trash bin, which was in front of the receptionist desk. The facility staff did not disinfect the table used for the Covid 19 testing. There was no biohazard bin and no disinfecting wipes observed on the Covid testing table. During a concurrent observation at the facility lobby, in front of the receptionist ' s desk and interview with Infection Preventionist (IP) Nurse on 6/12/2023 at 11 AM, observed Janitor taking trash from the regular trash bin, which was filled with used COVID testing supplies. The Janitor was observed putting the trash in a housekeeping cart.The IP Nurse stated the used covid testing supplies were considered biohazard and should be in a biohazard bag and not be in a regular trash bin. The IP Nurse stated the Janitors should be treating the waste as a biohazard waste because it can spread COVID. The IP Nurse stated the biohazard waste should be in the locked biohazard room which was only accessible to housekeeping/ janitor and Director of Nursing (DON). During a concurrent observation at the facility lobby, in front of the receptionist ' s desk and interview with IP Nurse on 6/12/2023 at 11:22 AM, two (2) groups of visitors were observed taking the COVID test. The IP Nurse stated that it was not right that the table was not being sanitized before and after every different group of visitors that take the COVID test. IP Nurse stated it is to prevent the spread of infection/COVID. During an interview on 6/12/2023 at 12:10 PM, a visitor for Resident 4 stated they would do the Covid testing on their own and no one would watch them. The visitor stated this was the second time (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: 055760 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 055760 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alhambra Healthcare & Wellness Centre, LP 415 South Garfield Alhambra, CA 91801 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)