Health inspection·September 10, 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 observation, interview, and record review, the facility failed to implement infection control practices during a Coronavirus Disease 2019 (COVID-19 - a highly contagious respiratory illness in humans capable of producing severe symptoms caused by the SARS-CoV-2 virus) outbreak (OB - when more people than usual get sick with a particular disease in a specific area over a certain time period) by:1. Failing to ensure two of 13 sampled staff (Activity Assistant 1 [AA 1] and Certified Occupational Therapy Assistant 1 [COTA 1]) wore masks properly, covering both nose and mouth while in resident care areas2. Failing to ensure two of 13 sampled staff (Physical Therapist 1 [PT 1] and Housekeeping 1 [HK 1] performed hand hygiene (HH cleaning hands by either washing with soap and water, or by using a hand sanitizing [removing germs] gel) when:a. PT 1 failed to perform HH after Resident 6's physical therapy session and before touching the resident's body, wheelchair, and other objects.b. HK 1 failed to perform HH after handling trash in Restroom [ROOM NUMBER]. 3. Failing to ensure one of 13 sampled staff (HK 1) observed proper trash handling, as four trash bags touched HK 1's body during transport to the outside bin.These deficient practices had the potential to result in the spread of infection placing residents, staff, and visitors at risk of being infected with COVID-19. Findings:During an observation on 9/10/2025 at 7:55 a.m. observed a sign posted at the facility entrance indicating COVID-19 Exposure, dated 8/29/2025 and timed at 10:30 a.m.During an interview on 9/10/2025 at 2 p.m., with the Infection Prevention Nurse (IPN), the IPN stated that as of 9/10/2025, there are a total of 15 residents and eight staff with confirmed COVID-19 cases, since the initial exposure on 8/28/2025, and the outbreak (OB) is still ongoing.1.a. During a concurrent observation and interview on 9/10/2025 at 8:20 a.m., with AA 1, observed AA 1 sitting in the facility entrance area, wearing a surgical mask, positioned below the nose, covering only the mouth. AA 1 stated that he was assigned as a companion for residents who go out to medical appointments and was waiting for a resident. When AA 1 was asked if he was aware there is an ongoing COVID-19 OB in the facility, AA 1 responded that he has received training on proper mask use and that he should have covered both his mouth and nose with the surgical mask.1.b. During a record review of Resident 5's admission Record, the admission Record indicated that the facility admitted Resident 5 on 8/25/2025 with diagnoses including malignant (harmful or cancerous) neoplasm (an abnormal growth of cells that can form a mass or tumor) of tongue.During a review of Resident 5's Minimum Data Set (MDS - a comprehensive assessment and screening tool) dated 8/30/2025, the MDS indicated that Resident 5's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) was intact. The MDS further indicated that Resident 5 required moderate assistance with toileting hygiene, dressing, and bed mobility (movement).During a review of Resident 5's Care Plan (CP) Report on COVID-19 Infection initiated on 9/4/2025, the CP indicated that Resident 5 required care and isolation precautions specifically related to COVID-19 infection and was exposed to the COVID-19 positive roommate on 9/3/2025. The intervention indicated to follow Residents Affected - Some Page 1 of 3 056124 056124 09/10/2025 Tarzana Health and Rehabilitation Center 5650 Reseda Blvd Tarzana, CA 91356

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some current policy and procedures for management of COVID-19.During a concurrent observation and interview on 9/10/2025 at 9:10 a.m., with COTA 1 observed a novel respiratory precaution (NRP - precautions should be used for residents known or suspected of being infected with COVID-19) sign posted outside Resident 5's room. Observed COTA 1 standing in Resident 5's doorway, talking to Resident 5. COTA 1 was wearing a surgical mask positioned below the nose, covering only the mouth. COTA 1 stated that he was aware of the ongoing COVID-19 OB and did not notice that his (COTA 1) surgical mask slid down and was covering only his mouthDuring an interview on 9/10/2025 at 1:45 p.m. with the DON, the DON stated that during a COVID-19 OB, all staff should wear well-fitted surgical mask covering both their mouths and noses in the resident care areas to protect residents and staff. During a review of the facility policy and procedure (P&P) titled Infection Outbreak Response and Investigation revised 4/24/2025, the P&P indicated, The facility promptly responds to outbreaks of infectious diseases within the facility to stop transmission of pathogens (any organism that causes disease) and prevent additional infections. Staff will be educated on the mode of transmission of the organism, symptoms of infection, and isolation or other special procedures. This includes special environmental infection control measures that are warranted based on the organism and the current Centers for Disease Control and Prevention (CDC) guidelines,During a review of the facility P&P titled Transmission-Based (Isolation) Precautions revised 4/24/2025, the P&P indicated, Initiation of Transmission-Based (Isolation) Precautions. Signage that includes instructions for use of specific PPE will be placed in a conspicuous location outside the resident's room, wing, or facility wide. or instructions to see the nurse before entering will be included in the signage,During a review of the CDC Guidelines titled Infection Control Guidance: SARS-CoV-2 dated 6/24/2024, it indicated that This guidance applies to all United States settings where healthcare is delivered, including nursing homes and home health. The recommendations in this guidance continue to apply after the expiration of the federal COVID-19 Public Health Emergency (PHE - a crisis that threatens the health of many people, like a new disease outbreak) . Source control options for Health care personnel included a well-fitting facemask,2.a. During a record review of Resident 6's admission Record, the admission Record indicated that the facility admitted Resident 6 on 8/29/2019 with diagnoses including hemiplegia (total paralysis [loss or impairment of muscle function, resulting in an inability to move or control certain parts of the body] of the arm, leg, and trunk on the same side of the body) and hemiparesis (paralysis or weakness on one side of the body) following cerebral infarction (CI - a serious medical condition that occurs when blood flow to the brain is blocked, leading to brain cell death).During a review of Resident 6's MDS dated [DATE], the MDS indicated that Resident 6's cognition was severely impaired. The MDS further indicated that Resident 6 required maximal assistance with eating and dependent on staff with oral/toileting/personal hygiene, shower/bathing, dressing, bed mobility (movement), and transfer.During an observation on 9/10/2025 at 8:33 a.m., observed PT 1 wearing N-95 (a disposable face mask that covers the user's nose and mouth which offers protection from small solid or liquid droplets found in the air) and gloves while providing physical therapy to Resident 6 inside the rehabilitation room. Observed PT 1 assisting Resident 6 with putting on a shoe and disinfected the gait belt at the end of the therapy. PT 1 did not perform hand hygiene after removing gloves and did not perform hand hygiene before touching the resident and the wheelchair. PT 1 then took Resident 6 to the hallway outside of Resident 6's room. PT 1 stated she (PT 1) should have performed hand hygiene after she (PT1) removed the gloves and before she touched any part of the resident's body and the wheelchair to prevent the spread of germs.During an interview on 9/10/2025 at 8:39 a.m., with the IPN, the IPN stated that PT 1 should have performed hand hygiene after she removed her (PT 1) gloves and before she 056124 Page 2 of 3 056124 09/10/2025 Tarzana Health and Rehabilitation Center 5650 Reseda Blvd Tarzana, CA 91356

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some touched Resident 6 to prevent the spread of germs2.b. During an observation on 9/10/2025 at 12:35 p.m., observed HK 1 handling trash from Restroom [ROOM NUMBER] without using gloves. During an interview on 9/10/2025 at 12:50 p.m., with HK 1 and CNA 1, who provided translation, HK 1 stated that she should have performed HH after handling trash and before touching the janitor cart for infection control purposes. During an interview on 9/10/2025 at 1:29 p.m. with the DON, the DON stated that HK 1 should have performed HH after handling trash and before touching other objects.During a review of the facility P&P titled Hand Hygiene revised 4/4/2025, the P&P indicated, All staff will perform hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors. This applies to all staff working in all locations within the facility. The use of gloves does not replace hand hygiene. If your task requires gloves, perform hand hygiene prior donning (to put on) gloves, and immediately after removing gloves.3. During an observation on 9/10/2025 at 12:45 p.m., observed HK 1 transported four trash bags with bare hands, and the bags were in contact with her clothing from Hallway 1 to outside trash bin. During an interview on 9/10/2025 at 12:55 p.m., with HK 1 and CNA 1, who provided translation, HK 1 stated the trash bags were heavy, making it difficult for her (HK 1) to hold the trash bags away from her (HK 1) body and prevent them (trash bags) from touching her (HK 1) clothing. During an interview on 9/10/2025 at 1:29 p.m. with the DON, the DON stated that HK 1 should have used a cart to transport the trash to prevent cross contamination (the transfer of bacteria or other microorganisms from one substance to another). During a review of the facility P&P titled Infection and Control Program revised 4/24/2025, the P&P indicated, This facility has established and maintains an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable disease and infection as per accepted national standards and guidelines, 056124 Page 3 of 3