Health inspection·January 25, 2024

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 its Infection policy and procedure (P&P) by failing to report a Coronavirus disease ([Covid-19] a highly contagious illness caused by a virus that could easily spread from person to person) outbreak to the California Department of Public Health District Office (CDPH DO). Residents Affected - Few This failure had the potential to result in the spread of Covid-19 cases in the facility and placed residents, staff and the community at risk for contracting the Covid 19 virus. Findings During a review of Resident 3's admission Record (Face Sheet), the admission Record indicated Resident 3 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including muscle weakness, and diabetes mellitus (high blood sugar). During a review of Resident 3's History and Physical (H&P) dated 8/24/2023, the H&P indicated Resident 3 did not have the capacity to understand and make decisions. During a review of Resident 3's Minimum Data Set ([MDS], a standardized assessment and care planning tool), dated 10/10/2023, the MDS indicated Resident 3 was dependent on staff for Activities of Daily Living (ADL's) such as toileting, showering and dressing. During a review of Resident 3's Change of Condition (COC) Evaluation, dated 1/18/2024, the COC indicated Resident 3 had symptoms of cough and runny nose. The COC also indicated Resident 3 tested positive for Covid-19 when a rapid test (testing method that provide result in 20 minutes or less) was conducted. During a review of Resident 3 COVID-19 PCR ([polymerase chain reaction] laboratory [lab] test) results dated 1/19/2024 at 6:35 a.m., the PCR indicated Covid-19 was detected for Resident 3. During an interview with the Infection Prevention Nurse (IP) on 1/25/2024 at 1:10 p.m., the IP stated the Covid-19 outbreak started on 1/19/2024 and was not aware she needed to report the Covid-19 outbreak to CDPH DO therefore was not done. During an interview with the Director of Nursing (DON) on 1/25/2024 at 2:00 p.m., the DON stated, Covid -19 outbreak needed to be reported to CDPH DO. DON also stated, reporting the cases of Covid-19 to CDPH DO, would help the facility to follow guidelines to control and stop the spread of the disease. Page 1 of 2 056019 056019 01/25/2024 Gardena Convalescent Center 14819 S. Vermont Gardena, CA 90247

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview with the Administrator (ADM), ADM stated, the facility's Covid -19 outbreak should have been reported to CDPH DO. ADM stated it was important to report to the CDPH DO so the facility could follow up with the guidelines and keep residents safe. During a review of the facility's P&P titled, infection Prevention and Control Program dated 10/2022, the P&P indicated to ensure the facility establishes and maintains and Infection Control Program to provide a safe environment and to help prevent the development and transmission of disease and infection in accordance with Federal and State requirements. The P&P also indicated to notify appropriate government agencies of reportable contagious or infectious diseases. During a review of the facility's P&P titled, Unusual Occurrence, dated 11/2017 and revised 10/2022, the P&P indicated As required by Federal or State regulations, our facility reports unusual occurrences or other reportable events which affect the health, safely, or welfare of our residents. The P&P indicated the facility would report an outbreak of any communicable disease to the appropriate agency within 24 hours of the incident or as otherwise required by federal and state regulations. 056019 Page 2 of 2