Health inspection·January 18, 2024

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. Based on interviews, record review, and document review, the facility failed to notify the state designated authority when a significant change in status assessment was completed for 1 (Resident #7) of 2 sampled residents reviewed for preadmission screening and resident review (PASARR). Findings included: A review of Resident #7's Face Sheet, revealed the facility admitted the resident on 06/01/2009, with diagnoses of malignant neoplasm of colon, anxiety, psychotic disorder with hallucinations, and major depressive disorder. A review of a document addressed to Resident #7 from the State of California - Health and Human Services Agency Department of Health Care Services, dated 01/28/2019, revealed Resident #7's Level II PASARR evaluation suggested the resident was best served in a skilled nursing facility bed with access to services. A review of Resident #7's medical record revealed a significant change in status Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 12/19/2023, was signed as being completed on 12/26/2023. A review of Resident #7's medical record revealed no evidence to the state designated authority was notified when the resident had a significant change in status assessment completed. During an interview on 01/18/2024 at 1:40 PM, the Director of Nursing stated she would expect a rescreen to be completed if a resident who received Level II services had a significant change in status assessment completed. During an interview on 01/18/2024 at 1:54 PM, the Acting Administrator stated she would expect Resident #7 to have a rescreen PASARR submitted when the significant change in status assessment was completed. Page 1 of 2 056189 056189 01/18/2024 San Luis Post Acute Center 3033 Augusta Street San Luis Obispo, CA 93401

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on interviews, facility policy review, and review of facility documents, the facility failed to ensure all potential sources of water-borne illness were identified and monitored. This deficient practice affected all 65 residents who currently reside in the facility. Residents Affected - Many Findings included: A review of the facility's undated policy titled, Legionella Water Management and Risk Reduction and Prevention Program, revealed, Our facility is committed to the prevention, detections and control of water-borne contaminants, including Legionella. The policy specified, 3. The purposes of the water management program are to identify areas in the water system where Legionella bacteria could grow and spread, and to reduce the risks of Legionnaire's disease [a type of pneumonia caused by Legionella bacteria]. A review of the facility Legionella Prevention Program Maintenance Log, revealed no evidence to indicate the facility monitored the bathtubs in the facility, the water fountains, the laundry area, or the kitchen dishwasher. During an interview on 01/18/2024 at 11:01 AM, the Maintenance Consultant stated the facility did not have a water flow map. On 01/18/2024 at 12:40 PM, the Acting Administrator and Chief Nursing Officer provided the surveyor with a copy of the facility diagram which illustrated the flow of water throughout the building and the location of the facility's water heaters. A review of the diagram revealed no evidence to indicate the facility monitored the flow of water in the water fountains, showerheads, bathtubs, two ice machines, the laundry room, and the saltwater fish tank. During an interview on 01/18/2024 at 2:23 PM, the Director of Nursing stated the areas in the facility that were at an elevated risk of creating water-borne illness included the facility's water supply, water fountains, and the drinking fountains. During an interview on 01/18/2024 at 2:29 PM, the Acting Administrator stated she expected the facility to maintain a water system consistent with the facility's policies and procedures. The Acting Administrator stated she expected maintenance to follow all protocols and check and maintain all the various aspects of mitigation strategies for water-borne illness. According to the Acting Administrator, the facility diagram used to illustrate the flow of water throughout the building was not updated until 01/18/2024. The Acting Administrator acknowledged the importance of ensuring the facility diagram was updated as part of the facility's overall water management program. 056189 Page 2 of 2