Inspection·August 2, 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, record review and facility policy review, the facility failed to implement enhanced barrier precautions (EBP) during wound care for 1 (Resident #64) of 1 sampled resident reviewed for pressure ulcer/injury. Residents Affected - Few Findings included: A facility policy titled, IPC303 Enhanced Barrier Precautions, revised 07/05/2024, revealed, 2. For residents for whom EBP are indicated, EBP is employed when performing the following high-contact resident care activities for those at risk of transmission or acquisition of MDROs [multi-drug resistant organisms]: a. Dressing b. Bathing/showering c. Transferring within the resident room d. Providing hygiene e. Changing linens f. Changing briefs or assisting with toileting g. Device care or use: central line, urinary catheter, feeding tube, tracheostomy/ventilator i. CDC [Centers for Disease Control and Prevention] does not currently consider peripheral I.V. [intravenous], continuous glucose monitors, and insulin pumps as indications for Enhanced Barrier Precautions. h. Wound care: any skin opening requiring a dressing i. Per the CDC, this generally includes residents with chronic wounds, and not those with only shorter-lasting wounds, such as skin breaks, abrasions, or skin tears covered with a Band-aid or similar dressing. Per the policy, 6. Gown and gloves would not be required for patient care activities other than those listed, unless otherwise necessary for adherence to Standard Precautions. An admission Record revealed the facility admitted Resident #64 on 01/25/2024. According to the admission Record, the resident had a medical history that included a diagnosis of pressure ulcer of sacral region, Stage 2. An admission Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 01/30/2024, revealed Resident #64 had a Brief Interview for Mental Status (BIMS) score of 6, which indicated the resident had severe cognitive impairment. The MDS revealed the resident was at risk of developing pressure ulcers/injuries and had one Stage 2 pressure ulcer, two unstageable pressure ulcers, and two unstageable deep tissue injuries that were all present on admission. Resident #64's care plan included a focus area revised 06/04/2024, that indicated the resident had a Stage 2 pressure ulcer on their sacrum. Interventions directed staff to administer treatments as ordered and monitor for effectiveness (initiated 02/02/2024). During wound care observation on 07/30/2024 at2:22 PM, Licensed Vocational Nurse (LVN) #2 performed wound care for Resident #64's pressure ulcer on their sacrum. LVN #2 did not wear a gown during wound care. During an interview on 07/30/2024 at 3:12 PM, LVN #2 stated she was educated on EBP approximately one month ago by the infection control nurse. LVN #2 stated a resident would be required to be on EBP for a wound with exudate (fluid that had leaked out of blood vessels into or on nearby tissues). LVN #2 stated Resident #64 did not require EBP because their wound did not have much exudate. During an interview on 07/30/2024 at 3:15 PM, Registered Nurse (RN) #3 stated she was educated about EBP approximately two months ago, and again the previous week. RN #3 stated if a resident had wounds, they should be on EBP. RN #3 stated Resident #64 should have been on EBP for wound care. RN #3 stated the personal protective equipment for EBP would be a gown and gloves for wound care. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056300 If continuation sheet Page 2 of 3 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 056300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Granada Rehabilitation & Wellness Center, LP 2885 Harris Street Eureka, CA 95503 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on 07/30/2024 at 3:55 PM, Infection Control Preventionist (ICP) #4 stated Resident #64 did not require EBP because the wound was not draining. During an interview on 08/01/2024 at 11:40 AM, ICP #5 stated Resident #64 did not require EBP because their wound was healing, and it had a dry wound bed. ICP #5 stated when she educated the staff regarding EBP, she instructed them that if a wound had a lot of drainage, then the resident should be on EBP. During an interview on 08/02/2024 at 9:28 AM, the Director of Nursing stated residents with any wound should be put on EBP, and the facility would do that in the future. During an interview on 08/02/2024 at 10:51 AM, the Administrator stated the facility would place a resident on EBP who had a wound that was a longer lasting (chronic) wound. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056300 If continuation sheet Page 3 of 3