Inspection·August 17, 2023

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview, on 8/16/23, at 1:00 P.M., with PTA, he stated he does not have the time to answer some questions because he was going to see his patients. During an interview, on 8/17/23, at 10:32 A.M., with IP, she stated that cleaning or disinfecting of medical equipment like walker are done before and after each use by residents. She also stated that gloves are used for direct patient care and changed in between tasks. She further stated that use and wearing of gloves in the hallway are never permitted or allowed. During an interview, on 8/17/23, at 1:44 P.M., with Occupational Therapist Assistant (OTA), she stated that per protocol, equipment like walker was disinfected before and after each use by a resident using bleach wipes or CaviWipes depending on the condition of the resident. Must perform hand washing before putting gloves and after removal. She also stated that gloves are never worn in the hallway. Review of facility's Cleaning and Disinfection of Resident-Care Items and Equipment policy, revised 9/2022, indicated Durable medical equipment is cleaned and disinfected before reuse by another resident. Review of facility's Hand Hygiene Policy and Procedure, dated 1/1/2019, indicated Remove gloves promptly after use, before touching non-contaminated items and environmental surfaces, and before caring for another resident. 3. During an observation, on 8/17/23, at 1:40 P.M., the door of the Covid-19 isolation room was open. Resident 3 was admitted on [DATE] with a diagnosis of Covid-19 and muscle weakness. Tested positive for Covid-19 on 8/8/23. During an interview, on 8/17/23, at 1:43 P.M., with Certified Nursing Assistant (CNA B), she stated that hand hygiene and personal protective equipment must be worn before entering the isolation room. She also stated that the door must be always closed. During an interview, on 8/17/23, at 1:45 P.M., with CNA C, she stated that the door of the isolation room for Covid-19 should be closed. During an interview, on 8/17/23, at 2:18 P.M., with Registered Nurse (RN D), she stated that the door of the Covid-19 isolation room should be closed always. During an interview, on 8/17/23, at 2:30 P.M., with IP, she stated that in Covid-19 isolation room, personal protective equipment was provided and placed by the door. Hand hygiene are performed. Donning and gloving are performed outside. Waste receptacles are provided. She also stated that the door of the room must be closed. Review of facility's Policy and Procedure for Preventing Spread of Covid-19, indicated The isolation room will be separated from the other rooms with door closed. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056178 If continuation sheet Page 2 of 4 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 056178 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manresa Healthcare Center 919 Freedom Blvd Watsonville, CA 95076 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)

F 0883 Develop and implement policies and procedures for flu and pneumonia vaccinations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to offer and administer pneumococcal vaccine (PV, immunization against bacteria that causes pneumonia [a lung infection]) for one of five sampled residents (Resident 2) in accordance with the current Centers for Disease Control and Prevention (CDC) recommendations. This failure had the potential to compromise the resident's health. Residents Affected - Few Findings: Review Resident 2's clinical record indicated Resident 2 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus type 2 (a chronic condition that affects the way the body processes blood sugar), acute respiratory failure with hypoxia, secondary hypertension (high blood pressure), bradycardia (abnormally slow heart rate). Review of Resident 2' Minimum Data Set (MDS, functional and clinical assessment tool), dated 10/10/22, indicated the resident had a brief interview for mental status (BIMS) score of 13 (a score of 13 indicated the resident was cognitively intact). Review of Resident 2's immunization report indicated Resident 2 received pneumococcal polysaccharide vaccine 23 (PPSV23, used to protect adults against 23 types of pneumonia bacteria) on 12/21/2012 and 10/06/2018, but was not offered an additional pneumococcal dose at least 1 year after receiving these. There was no indication that Resident 2 received pneumococcal conjugate vaccine 20 (PCV 20, protects against 20 types of pneumococcal bacteria) or pneumococcal conjugate vaccine 15 (PCV 15, protects against 15 types of pneumococcal bacteria that commonly cause serious infection in adults), which should be administered at least 1 year after as recommended by CDC. The CDC's guidance titled Vaccines and Preventable Diseases (https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timings.pdf), last reviewed 3/15/23, indicated for adults 65 years or older who have only received PPSV23, the CDC recommends to give 1 dose of PCV 15 or PVC20. The PCV15 or PCV20 dose should be administered at least 1 year after the most recent PPSV23 vaccination. Review of the CDC's Pneumococcal Vaccination: Summary of Who and When to Vaccinate indicated increased risk of exposure to pneumococcal infections among people 65 years or older, who are living in nursing homes or other long-term care facilities and have chronic medical conditions such as diabetes. During an interview with the Infection Preventionist (IP) on 8/17/23 at 10:35 a.m., she stated upon admission, she would screen the residents to see if they were vaccinated or not. She stated the residents would have to sign a form for consent or refusal of vaccination. The IP further stated she would keep offering the vaccine if the resident continued to refuse and would have family involved. During a concurrent interview and record review with facility's IP on 8/17/2023 at 1:40 p.m., the IP stated she used the CDC's recommendations for PPSV23, dated [DATE]. During a concurrent interview and record review with the IP on 8/17/2023 at 2:30 p.m., she stated she was not aware of the CDC's recommendations to offer and administer PCV 15 or PVC20. The PCV15 or PCV20 dose should be administered at least 1 year after the most recent PPSV23 vaccination. Review of the facility's policy and procedure (P&P) titled, Immunization plan and protocol, date (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056178 If continuation sheet Page 3 of 4 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 056178 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Manresa Healthcare Center 919 Freedom Blvd Watsonville, CA 95076 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)

F 0883 revised 3/31/2023, the P&P indicated, Each patient will be offered the Pneumococcal immunization unless medically contraindicated, refused or already immunized during this time frame. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056178 If continuation sheet Page 4 of 4