Health inspection·February 11, 2026

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 the facility's infection prevention and control program (IPCP) for four of four sampled residents (Residents 1, 2, 3, and 4) by failing to: 1.Initiate and monitor a Line List (a tool used for data collection and systemic case tracking and surveillance during outbreaks) for residents and staff suspected of having scabies on 2/4/26 2. Maintain an updated infection surveillance log to track and monitor infections among residents and staff to detect a potential scabies (a contagious skin infestation by mites causing intense itching and rash) outbreak on 10/21/25 when Resident 1 was suspected of having scabies and treated with Permethrin cream (Elimite - a medicated cream used to treat scabies), and again on 2/5/26 when Residents 1, 2, 3, and 4 were suspected of having scabies and treated with Permethrin cream in accordance with the facility's P&P for IPCP). 3. Perform a skin scrape test to rule out scabies prior to prophylactically (done as a preventative measure to stop a disease or condition before it occurs) treating Resident 1 with Permethrin cream on 10/21/26 and on 2/5/26. 4. Recognize and report a suspected outbreak of scabies to the Department of Public Health when Residents 1, 2, 3, and 4 were placed on contact precautions for a suspicious rash and tested for scabies on 2/4/26. The facility reported a possible scabies outbreak to the LA DPH on 2/12/26, eight (8) days later. This failure to follow LA DPH guidelines for scabies management and reporting delayed outbreak control measures, potentially facilitating transmission of scabies among vulnerable residents and staff, and had the potential to cause increased discomfort from itching and secondary complications such as skin infections for residents and staff.A. During a review of Resident 1's admission Record, the record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including neuropathy (disease or dysfunction of one or more nerves, typically causing numbness or weakness in the hands and feet) and diabetes mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing). During a review of Resident 1's Minimum Data Set (MDS- a resident assessment tool) dated 1/2/26, the MDs indicated Resident 1 had intact cognition (the resident had good orientation, memory recall, and attention) and was fully dependent on staff for bathing, lower body dressing, and putting on/taking off footwear. During a review of Resident 1's Progress notes on 10/21/25 at 1:07 PM signed by the Infection Preventionist (IP), the notes indicated, [Resident] verbalizes complaints of ‘mild itchiness' associated with rashes on the left arm and left lateral torso. Assessment of skin reveals localized, non-vesicular rashes on the left arm and left lateral torso. No fluid-filled blisters, discharge, or scaling noted. Rashes appear contained to the initial areas. MD has assessed the [resident] and new orders have been received. [Resident] presents with a rash of unknown etiology, posing a potential risk for transmission. The prescribed treatment with Permethrin cream suggests a possible differential diagnosis of scabies. Due to the unknown nature and potential for contagion, infection control measures are warranted to prevent potential cross-contamination to roommates and healthcare staff. [Resident] and current roommates have Residents Affected - Some Page 1 of 8 055899 055899 02/11/2026 Royal Palms Post Acute 630 W. Broadway Glendale, CA 91204

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some been placed on contact isolation for a planned duration of [seven] days. Signage has been posted on the door. This measure is implemented to prevent the potential spread of the undiagnosed condition. Will administer medications as per [medical doctor, MD] orders: Permethrin cream, Hydroxyzine HCL 25 mg (milligrams- a unit of measurement) [by mouth] for pruritic, and Hydrocortisone cream 1% for inflammation. During a review of Resident 1's Medication Administration Review (MAR) for the month of 10/2026, the MAR indicated Resident 1 was administered Permethrin External Cream 5% on 10/28/26. During a review of Resident 1's untitled care plan (CP) initiated on 2/5/26, the CP indicated Resident 1 had impaired skin integrity related to generalized rash of unknown etiology and a risk for infection transmission related to potential parasitic or fungal infestation. The CP further indicated nursing interventions to maintain Resident 1 in an isolation room with Contact Precaution signage clearly posted; ensure the availability of PPE at the room entrances for all staff and visitors; perform skin assessments every shift to monitor for changes in the rash, signs of excoriation, or secondary infection; monitor for skin scrape results and notify the physician immediately upon receipt to adjust the treatment plan; and to continue staff in-servicing on scabies/fungal protocols and the importance of hand hygiene and environmental cleaning. During a review of Resident 1's Order Recap Report dated 2/11/2026, the report indicated the following physician's orders:1. Contact Precautions: Staff and visitors to don gloves and gown prior to entering room and remove before exiting room, in room use dedicated equipment. Dietary service shall provide meals using single-use disposable trays and utensils. All disposable meal ware must be bagged within the patient's room and discarded in the designated waste receptacle every shift, ordered by Medical Doctor 2 on 2/5/262. Elimite External Cream 5% (Premethrin) apply from neck to toe topically at bedtime every seven days for prophylaxis (empiric) for seven days (ensure coverage under fingernails, skin folds, and between toes), ordered by MD 2 on 2/5/26. 3. May do skin scrape upon kit arrival. May do three to four sites, ordered by MD 2 on 2/7/26. During a review of Resident 1's MAR for the month of 2/2026, the MAR indicated Resident 1 was administered Permethrin on 2/5/26. During a review of Resident 1's Progress Notes for the month of 2/2026, the notes indicated the following: 1. On 2/7/26 timed at 3:33 PM, and signed by the IP, the notes indicated that on 2/4/26 a dermatology consultation was conducted by MD 1 regarding a generalized body rash. Following the assessment, Resident 1 was transferred to an isolation room and contact precautions were initiated as a prophylactic measure. To mitigate environmental transmission risks, deep cleaning was completed and privacy curtains were replaced in the transition from the unoccupied to the occupied room. A skin scrape was performed to rule out parasitic infestations, fungal infections, or yeast. The procedure was successfully performed on 2/6/26 upon the arrival of the necessary kits. Results pending.2. On 2/7/26 timed at 3:53 PM and signed by the IP, the notes indicated skin scrape number one completed and packaged for lab pick up, remainder of the skin scrapes to be completed when kits arrive.3. On 2/8/26 timed at 10:41 AM and signed by the IP, the notes indicated Resident 1's skin scrape test was left at the front desk since Friday (2/6/26) and the IP communicated with lab dispatch. The notes further indicated Resident 1's skin scrape test performed on 2/6/26 was picked up from the facility on 2/8/26 at 10:30 AM. B. During a review of Resident 2's admission Record, the record indicated Resident 2 was originally admitted to the facility on [DATE] with diagnoses including chronic obstructive pulmonary disease (COPD- a chronic lung disease causing difficulty in breathing) and congestive heart failure (CHF- a heart disorder which causes the heart to not pump the blood efficiently, sometimes resulting in leg swelling). During a review of Resident 2's MDS dated [DATE], the MDS indicated Resident 2 had moderate cognitive impairment (the resident may commonly experience forgetfulness, difficulty recalling information, or occasional confusion). The MDS also 055899 Page 2 of 8 055899 02/11/2026 Royal Palms Post Acute 630 W. Broadway Glendale, CA 91204

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some indicated that Resident 2 was dependent on staff for toileting hygiene, bathing, lower body dressing, and putting on/taking off footwear. During a review of Resident 2's Change in Condition Evaluation (CIC) dated 2/7/26 at 1:19 PM and signed by Licensed Nurse (LN) 2, the CIC indicated, Upon being changed by CNA [certified nursing assistant], noticed generalized rash. Charge nurse notified and upon assessment noted with rash and spoke with IP about generalized rash. Reported to dermatologist and given skin cream orders. Orders noted and carried out During a review of Resident 2's Progress Notes for the month of 2/2026, the notes indicated the following:1. On 2/7/26 at 3:17 PM and signed by the IP, the note indicated a dermatology consultation was completed on 2/4/26 regarding Resident 2's generalized body rash. All new clinical orders were noted and implemented. To mitigate the risk of potential transmission, Resident 2 was placed on contact precaution pending a definitive diagnosis. Environmental interventions were initiated immediately, including deep cleaning of Resident 2's room and replacement of privacy curtains. A skin scrape test was performed on 2/6/26 following the arrival of collection kits to evaluate for parasitic infestations such as scabies, fungal, or yeast infections.2. On 2/7/26 at 3:52 PM and signed by the IP, the note indicated Resident 2's skin scrape was completed and packaged for pick up.3. On 2/8/26 at 10:44 AM and signed by the IP, the note indicated Resident 2's skin scrape test was done on three sites: the left arm, right arm, and abdomen on 2/6/26 and picked up by lab dispatch from the facility on 2/8/26. During a review of Resident 2's untitled CP initiated on 2/7/26, the CP indicated Resident 2 had impaired skin integrity related to generalized body rash as evidenced by skin lesions and dermatology consult, and a risk for infection transmission related to unidentified skin etiology and potential for parasitic or fungal spread. The CP further indicated nursing interventions to maintain contact precautions strictly and to ensure PPE was available and to perform skin assessments every shift to monitor for changes in the rash distribution or signs of secondary bacterial infection. During a review of Resident 2's Order Recap Report dated 2/11/26, the report indicated the following physician's orders:1. May do skin scraping upon kit arrival. May do three to four sites, ordered by MD 3 on 2/5/26.2. Elimite External Cream 5% (Permethrin) Apply to neck to feet prophylaxis topically one time only for prophylactic-empiric until 2/6/26 4:59 PM ordered by MD 3 on 2/6/26.3. Ivermectin (an antiparasitic medication) oral tablet 3 mg, give 15 mg by mouth in the evening every Friday for empiric for rashes for four weeks, ordered by MD 3 on 2/6/264. Hibiclens (an antiseptic skin cleanser) External Solution 4% (Chlorhexidine Gluconate) apply to rashes topically one time a day for rashes for three weeks, ordered by MD 3 on 2/7/26 During a review of Resident 2's MAR for the month of 2/2026, the MAR indicated Resident 2 was administered the following medications:1. Elimite external cream 5% (Permethrin) topically for prophylactic-empiric on 2/6/26 at 4:14 PM.2. Ivermectin oral tablet 15 mg by mouth in the evening every Friday for empiric for rashes for four weeks on 2/6/26 C. During a review of Resident 3's admission Record, the record indicated Resident 3 was originally admitted to the facility on [DATE] with diagnoses including Parkinson's disease (a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise movements), cerebrovascular accident (CVA-stroke, loss of blood flow to a part of the brain), and hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body). During a review of Resident 3's MDS dated [DATE], the MDS indicated Resident 3 had had intact cognition (the resident had good orientation, memory recall, and attention) and was dependent on staff for bathing, upper body/lower body dressing, and toileting. During a review of Resident 3's CIC Evaluation dated 2/1/26 at 6:52 PM and signed by LVN 3, the CIC indicated, Upon being changed by CNA, CNA noticed [Resident 3] with having scattered rashes on the rear side of he left shoulder. Doctor recommended oral and topical medications During a review of Resident 3's untitled CP 055899 Page 3 of 8 055899 02/11/2026 Royal Palms Post Acute 630 W. Broadway Glendale, CA 91204

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some initiated on 2/5/26, the CP indicated Resident 3 had impaired skin integrity related to generalized body rash and potential parasitic or fungal infection with a risk for infection transmission related to unknown etiology of generalized rash. The CP further indicated nursing interventions to maintain strict contact precaution protocols, ensuring PPE (gowns and gloves) were available at the room entrance and disposed of within the room; monitor skin scraping site and generalized rash areas for signs of secondary bacterial infection as per constitutional criteria for infection; and provide ongoing education to the family and staff regarding the importance of hand hygiene and the specific rationale for isolation while awaiting lab results. The CP further indicated nursing goals that indicated the resident remained in contact precautions until skin scrape results returned or the rash was cleared by dermatology. During a review of Resident 3's Physician Order Report for the month of 2/2026, the report indicated the following orders:1. As a precaution, while waiting for all lab results, all of resident's belongings labeled and bagged and placed outside under the sun. Housekeeping deep cleaned room and curtains changed, ordered by MD 3 on 2/4/26 at 1:18 PM and confirmed by IP.2. Perform skin scraping upon kit arrival. May do three to four site, ordered by MD 3 on 2/5/26 at 3:39 PM and confirmed by IP.3. Elimite External Cream 5% (Permethrin) Apply to neck to feet prophylaxis topically one time only for prophylactic-empiric until 2/6/26 11:59 PM. Ordered by MD 3 at 2/5/26 at 5:45 PM and confirmed by IP.4. Contact Precautions: Staff and visitors to don gloves and gown prior to entering room and remove before exiting room, in room use dedicated equipment. Dietary services shall provide meals using single-use disposable trays and utensils. All disposable mealware must be bagged within the resident's room and discarded in the designated waste receptacle every shift. Ordered by MD 3 on 2/5/26 at 5:48 PM and confirmed by IP. During a review of Resident 3's Progress Notes for the month of 2/2026, the notes indicated the following:1. On 2/6/26 at 3:49 PM, signed by the IP, the notes indicated that skin scrape number one was completed and packaged for lab pick up and the IP will complete the remainder of the skin scrape as soon as kits arrive.2. On 2/7/26 at 2:46 PM, signed by the IP, the notes indicated that a dermatology consultation was completed by MD 1 on 2/4/26 regarding a generalized body rash. In accordance with CDC, Title 22, and CMS F880 guidelines for unexplained rashes, the resident was prophylactically transitioned to contact precautions. Terminal cleaning and deep disinfection of both the prior room and the new room were performed, including change of all privacy curtains. Diagnostic skin scraping was performed on 2/6/26 following the arrive of the collection kits to rule out parasitic infestations (scabies per McGreer Criteria), fungal, or yeast infections. Laboratory results were pending. Infection control measures implemented included use of disposable meal service with appropriate bedside bagging and disposal. All resident belongings bagged and placed in direct sunlight for 24 to 48 hours prior to processing. Contaminated linens were transported in biohazard red bags. Treatment was focused on topical interventions and diagnostic identification of parasitic or fungal etiology rather than systemic bacterial infection.3. On 2/8/26 at 10:45 AM, signed by the IP, the notes indicated that Resident 3's skin scrape package was left at the front desk since 2/6/26 and picked up on 2/8/26 at 10:30 AM. The notes further indicated the skin scrape was done on the left shoulder, neck, and upper back. D. During a review of Resident 4's admission Record, the record indicated Resident 4 originally admitted to the facility on [DATE] with diagnoses including DM, adult failure to thrive (a decline caused by chronic diseases and functional impairments), and kidney calculus (kidney stones- hard mineral deposits often causing severe, intermittent pain in the back, side, or groin). During a review of Resident 4's MDS, dated [DATE], the MDS indicated Resident 4 had moderate cognitive impairment (the resident has some difficulties with memory, orientation, and short term recall) and was dependent on staff for bathing and lower body 055899 Page 4 of 8 055899 02/11/2026 Royal Palms Post Acute 630 W. Broadway Glendale, CA 91204

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some dressing. During a review of Resident 4's untitled CP initiated on 2/5/26, the CP indicated Resident 4 had impaired skin integrity related to generalized body rash and potential infection process and risk for infection transmission related to contagious skin condition and potential cross-contamination. The CP further indicated nursing interventions to maintain strict contact precautions, ensuring all staff and visitors don gloves and gown upon entry; monitor skin integrity every shift for changes in the distribution, color, or texture of the rash; apply topical treatments as ordered by the wound care nurse or dermatologist; implement sunlight decontamination for non-washable belongings for a minimum of 24-48 hours as ordered; conduct ongoing staff education regarding hand hygiene and the appropriate sequence for donning and doffing PPE. During a review of Resident 4's Order Summary Report for the month of 2/2026, the report indicated the following orders:1. Contact Precautions: Staff and visitors to don gloves and gown prior to entering room and remove before exiting room, in room use dedicated equipment. Dietary services shall provide meals using single-use disposable trays and utensils. All disposable mealware must be bagged within [Resident 4's] room and discarded in the designated waste receptacle, ordered on 2/5/26 by MD 3 and verified by the IP.2. Elimite External Cream 5% (Permethrin) apply to neck to feet prophylaxis topically one time only for prophylactic-empiric rashes, ordered on 2/6/26 by MD 3 and verified by the IP.3. Ivermectin Oral Tablet three mg, give 15 mg by mouth one time a day every seven days for empiric-prophylactic rashes for four weeks. Ordered by MD 3 on 2/6/26 and verified by the IP.4. Hibiclens External Solution 4% (Chlorhexidine Gluconate) apply to rashes topically one time a day for rashes for five days, ordered by MD 3 on 2/7/26 and verified by the IP.5. May do skin scraping as soon as kit arrives. May do three to four sites. Ordered on 2/7/26 by MD 3 and verified by IP.6. As a precaution, while waiting for all lab results, all of [Resident 4's] belongings labeled and bagged and placed outside under the sun for 24 hours then brought to the laundry room in red bags. Housekeeping deep cleaned room and curtains changed. Laundry services instructed on how to handle contaminated laundry and linens, ordered by MD 3 on 2/7/26 and verified by the IP. During a review of Resident 4's MAR dated 2/2026, the MAR indicated Resident for was administered the following medications:1. Elimite External Cream 5% (Permethrin) for prophylactic-empiric rashes on 2/5/2026 at 8:58 PM2. Elimite External Cream 5% (Permethrin) for prophylactic-empiric rashes on 2/6/2026 at 4:05 PM.3. Ivermectin oral tablet 3 mg for empiric-prophylactic rashes on 2/7/26 During a review of Resident 4's Progress Notes for the month of 2/2026, the notes indicated the following:1. On 2/6/26 at 3:53 PM signed by the IP, the note indicated Resident 4's skin scrape test was completed and packaged for lab pick up.2. On 2/7/26 at 3:01 PM signed by the IP, the note indicated, Generalized body rash noted with dermatology consultation completed by [MD 1] on 2/4/26. [Resident 4] remains on contact precautions with signage posted and PPE available. Environmental controls establishes: deep cleaning of the room was performed, and privacy curtains were replaced. Skin scrape for parasitic, fungal, and yeast pathogens was performed 2/9/26; results are currently pending. Dietary staff transitioned to disposable meal service. Nursing staff instructed on the proper bagging and disposal of waste within the room. [Resident 4's] belongings bagged and placed in direct sunlight for 24-48 hours prior to laundering in biohazard/red bags. Laundry services notified of contaminated linens. Informed consent for treatment and isolation obtained from [Resident 4]. Wound care nurse performing ongoing skin treatments. Staff in-service regarding isolation protocols and PPE compliance initiated and ongoing. 3. On 2/8/26 at 10:31 AM and signed by the IP, the note indicated Resident 4's skin scrape test was performed on Resident 4's left arm, right arm, and abdomen and was picked up from the facility by lab on 2/8/26 at 10:30 AM. During a review of the facility's fax sheet to the LAC DPH dated 2/12/26 and timed 3 PM, the fax sheet indicated a report of a possible 055899 Page 5 of 8 055899 02/11/2026 Royal Palms Post Acute 630 W. Broadway Glendale, CA 91204

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some scabies outbreak rash in the facility. The fax was signed by the IP. During an observation on 2/11/26 at 12:05 PM, Residents 1, 2, and 4 were observed to be in the same room with a contact precaution sign posted at the door. Personal protective equipment (PPE protective clothing, helmets, gloves, face shields, goggles, masks, and other gear designed to protect the wearer's body from injury, infection, or hazardous materials) was observed to be in front of the room with instructions for staff to don (put on) PPE prior to entering the room and doff (take off) PPE prior to exiting the room. Resident 3 was observed to be in a private room with a contact precaution sign posted at the door. PPE was also observed to be in front of Resident 3's room with instructions for staff to don PPE prior to entering the room and doff prior to exiting the room. During an interview with the IP on 2/11/26 at 12:37 PM, the IP stated Residents 1, 2, 3, and 4 were placed on contact precautions for a suspicious rash and were tested for scabies with a skin scrape test (a procedure that collects superficial skin cells to detect mites, eggs, or fungi under a microscope). The IP further stated that Residents 1, 2, 3, and 4 were prophylactically treated with Permethrin cream for suspected scabies. The IP stated Residents 2 and 4 were also given oral Ivermectin to prophylactically treat scabies. The IP stated Residents 1, 2, 3, and 4 should have been tested with a skin scrape prior to being treated with Permethrin cream. During the same interview with the IP on 2/11/26 at 12:37 PM, the IP stated he had not created a line list of residents to track how many residents were potentially affected by scabies. The IP also stated that some facility staff reported developing a rash and were concerned for having scabies, but the IP did not create a line list of employees potentially affected by scabies. The IP stated he was not sure of how many staff officially reported experiencing a rash because he did not have a list to track it. During a concurrent interview and record review with the IP on 2/11/26 at 12:45 PM, the IP's list of skin scrape results dated 2/11/26 was reviewed. The IP stated he did not report a potential scabies outbreak to the Public Health Department because the skin scrape tests results of Residents 1, 2, 3, and 4 were still pending. The IP stated he decided to wait to report the potential outbreak to LAC DPH only after one skin scrape test came back positive but had started in-servicing the facility's staff on scabies and risks for transmission. During a concurrent interview and record review with the IP on 2/11/26 at 1:50 PM, the IP's infection surveillance logs from 10/2025 to 1/2026 was reviewed. The logs did not contain tracking of residents with rashes treated with Permethrin. Specifically, the log did not include Resident 1, who was suspected to have scabies and treated with Permethrin cream on 10/21/25. The IP stated he did not include Resident 1 in the surveillance log because the MD did not order a skin scrape test to rule out scabies. The IP then stated that he should have made a recommendation to the MD from an infection prevention standpoint to rule out scabies prior to administering Permethrin cream. The IP stated it was important to test residents with rashes for scabies prior to administering Permethrin cream in order to properly report and prevent outbreaks. During the same concurrent interview and record review with the IP on 2/11/26 at 1:50 PM, the IP's infection surveillance logs from 10/2025 to 1/2026 were reviewed. The logs also did not include tracking of Residents 1, 2, 3, and 4 for the month of 2/2026 after they were placed on isolation for a suspicious rash and treated with Permethrin cream. The IP stated he did not have a current surveillance log for 2/2026 because he had been busy with other tasks. The IP further stated he did not include suspicious rashes that were treated with Permethrin in the surveillance log because he did not consider rashes a potential infection that required monitoring. The IP explained that he only tracked residents with infections that required antibiotics. The IP stated he should have been tracking the residents suspected of having scabies in order to properly report and control potential scabies outbreaks. During a concurrent interview and record review with LN 1 on 2/11/26 at 055899 Page 6 of 8 055899 02/11/2026 Royal Palms Post Acute 630 W. Broadway Glendale, CA 91204

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 2:43 PM, Resident 1's Lab results, Progress Notes, and Treatment Administration Record (TAR) were reviewed. LN 1 stated that Resident 1 had a rash that was treated with Permethrin on 10/28/26 but was not tested with a skin scrape test to rule out scabies. LN 1 also stated that Resident 1's rash resolved after treatment with topical steroid cream and Permethrin cream, but the rash returned again in February. During the same interview with LN 1 on 2/11/26 at 2:43 PM, LN 1 stated Resident 1 was treated with Permethrin cream on 2/5/26 and a skin scrape was done on 2/6/26 after Resident 1 was treated with Permethrin cream. During a concurrent interview and record review with the IP on 2/11/26 at 4:06 PM, the LAC DPH guidance provided by the facility titled, Scabies Prevention and Control Guidelines for Healthcare Settings dated 7/2019 was reviewed. The guidance indicated the definition of an outbreak in a long-term care facility was two or more clinically suspected or confirmed cases of scabies in residents, healthcare workers, volunteers and/or visitors during a six-week time period. The IP stated, based on this guideline, he should have reported a potential outbreak to LAC DPH. During a telephone interview on 2/12/26 at 10:30 AM with the Director of Nursing-Consult (DON-C), the DON-C stated it was important for the IP to follow the proper infection control and outbreak guidelines in order to mitigate any potential outbreak of communicable diseases. The DON-C explained that not tracking the residents suspected of having scabies with a line list or in the surveillance log had the potential to spread the scabies infection and be uncontrolled in the facility. During a review of the facility's P&P titled Infection Prevention and control Program revised on 10/2018, the P&P indicated the infection prevention and control program was coordinated and overseen by an infection preventionist. The P&P also indicated surveillance tools were used for recognizing the occurrence of infections, recording their number and frequency, detecting outbreaks and epidemics, monitoring employee infection, monitoring adhered to infection prevention and control practices, and detecting unusual pathogens with infection control implications. The P&P also indicated that Outbreak Management was a process that consisted of:Determining the presence of an outbreakManaging the affected residentsPreventing the spread to other residentsDocumenting information about the outbreakReporting the information to appropriate public health authorities such as LAC DPHEducating the staff and the public[DC1] Monitoring for recurrencesReviewing the care after the outbreak has subsidedThe medical staff will help comply with pertinent state and local regulations concerning the reporting and management of those with reportable communicable diseases. During a review of the facility's P&P titled Surveillance for Infections revised 9/2017, the P&P indicated the infection preventionist would conduct ongoing surveillance for healthcare-associated infections (HAIs- an infection that a person acquires while receiving medical treatment in a healthcare setting) and other epidemiologically significant infections that have substantial impact on potential resident outcome and that may require transmission-based precautions (TBPadditional infection control measures to prevent the spread of contagious pathogens) and other preventative interventions. Infections that were included in routine surveillance include those with pathogens associated with serious outbreaks such as scabies. During a review of the LAC DPH guidance provided by the facility titled, Scabies Prevention and Control Guidelines for Healthcare Settings dated 7/2019, the guidance indicated the following:1. Evaluate residents on affected units and immediately place residents with suspected scabies in contact precautions.2. Immediately remove from work any healthcare worker (HCW) with signs and symptoms of scabies and refer to employee health, other healthcare consultant or clinician experienced in the diagnosis of scabies.3. Meet with key staff to coordinate control measures and give adequate resources to accomplish the objective in a timely manner. Representatives from the following departments should be included: administration, employee health, environmental services, infection prevention, pharmacy, medicine and 055899 Page 7 of 8 055899 02/11/2026 Royal Palms Post Acute 630 W. Broadway Glendale, CA 91204

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some nursing.4. Search for a possible source case. If two or more employees working in the same unit/area are diagnosed with scabies, it is likely that the source case was a resident with atypical or crusted scabies infestation.5. Confirm the presence of scabies by microscopic identification of the mite or its products (skin scraping) in one or more symptomatic residents or HCW. The absence of mites does not rule out scabies infestation.6. Report healthcare-associated scabies outbreaks to LAC Department of Public Health.7. Prepare a line listing of symptomatic residents and HCW with a separate line list of their contacts. Evaluate contacts for scabies.8. Treat symptomatic residents and HCW with an approved scabicide, provide prophylactic scabicide to all contacts of symptomatic cases, and perform environmental cleaning of affected units. Ideally, these steps (treatment, prophylaxis, and environmental cleaning) should all be accomplished within the same 24-hour period to prevent re-infestation of treated or prophylaxed individuals.9. Provide training to all staff on scabies signs and symptoms. Emphasize that people can be infested and contagious for up to 6 weeks before symptoms begin.10. Perform environmental cleaning of affected units.11. Arrange for follow-up evaluation and prophylactic treatment of discharged patients/residents who were scabies contacts.12. Communicate with the affected patient's/resident's family members and provide scabies education. During a review of the facility's Job Description titled, Infection Preventionist - LVN/LPN updated on 11/1/24, the job description indicated the IP was responsible for overseeing and managing the facility's Infection Prevention and Control Program. This role was crucial in ensuring a safe, sanitary, and comfortable environment by preventing the development and transmission of communicable diseases and infections. The job description stated that the IP develops, implements, and evaluates infection control strategies in accordance with company policies and regulatory standards including Centers for Disease Control (CDC), Occupation Safety and Health Administration (OSHA), and local guidelines. The job description further indicated the IP reported all reportable diseases to federal and state health departments according to Corporate Compliance programs. 055899 Page 8 of 8