Health inspection·August 13, 2024

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 practices by failing to ensure one of nine sampled staff (Licensed Vocational Nurse 1 [LVN 1]) wore an isolation gown (protective apparel, used to protect the wearer from the spread of infection or illness if the wearer comes in contact with potentially infectious liquid and solid material) and a face shield (a protective covering for all or part of the face that is commonly made of clear plastic and is worn especially to reduce the spread of transmissible disease) before entering Resident 2's room which was placed on novel respiratory precautions (NRP - precautions should be used for residents known or suspected to be infected with {Coronavirus Disease 2019 [COVID-19 - a highly contagious respiratory illness in humans capable of producing severe symptoms]}). Residents Affected - Few These deficient practices had the potential to result in the spread of infection placing residents, staff, and visitors at risk to be infected with COVID-19. Findings: During a review of Resident 2's admission Record, indicated the facility admitted Resident 2 on 5/9/2024 with diagnoses that included hemiplegia (a medical condition that causes a person to lose strength or experience paralysis [loss of muscle function] on one side of their body) and hemiparesis (weakness or the inability to move on one side of the body) following cerebral infarction (a type of stroke that occurs when blood flow to the brain is blocked, causing brain tissue to die) affecting left dominant (powerful) side and atrial fibrillation (an irregular and often very rapid heart rhythm). During a review of Resident 2's Minimum Data Set (MDS - a standardized resident assessment and care screening tool) dated 5/16/2024, indicated Resident 2's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) was moderately impaired. The MDS further indicated that Resident 2 required moderate assistance with eating, oral hygiene, toileting hygiene, shower/bathing, personal hygiene, and bed mobility (movement). During a review of Resident 2's Physician's Order dated 8/9/2024, indicated, to place Resident 2 on contact isolation (an infection prevention method that involves healthcare staff and visitors following precautions to prevent the spread of germs from residents to others; used for residents who have germs that can spread through touching the resident or objects in their room) and droplet isolation (a set of steps that healthcare staff and visitors take to prevent the spread of germs from residents who have infections that can be spread through coughing, sneezing, or talking) every shift for ten days. During a review of Resident 2's Care Plan (untitled) initiated date 8/9/2024, indicated that (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: 056137 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 056137 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/13/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Meadows Post Acute 14857 Roscoe Boulevard Panorama City, CA 91402 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)