Inspection·May 16, 2024

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 transmission-based infection control measures when personal protective equipment (PPE, protective garments worn to prevent exposure to infection hazards) was not readily available for staff when entering the room of a resident (2) on transmission-based precautions (TBP, control measures put in place to prevent the spread of disease). Residents Affected - Few This failure increased the risk of MRSA transmission to all susceptible residents, staff, and visitors at the facility. Findings: Resident 2 was admitted to the facility on [DATE] with a diagnosis of a sacral pressure ulcer (injury to the skin and tissue at the base of the spine), per the facility's admission Record. A review of Client 2's physician orders, dated 4/18/24, indicated Resident 2 was on enhanced barrier precautions (EBP, intervention to decrease risk of disease transmission during resident contact that requires use of a gown and gloves) for a history of Methicillin-resistant Staphylococcus aureus (MRSA, a bacteria that is resistant to many antibiotics). On 4/18/24 at 12:16 PM, an observation outside of Resident 2's room was conducted. An orange dot was located next to Resident 2's name outside the door to Resident 2's room. There was a sign hanging next to Resident 2's name panel indicating EBP, and gloves and a gown should be worn for high contact activities. There was no PPE available for immediate use outside or inside Resident 2's room. On 4/18/24 at 12:49 PM, a concurrent observation and interview was conducted with licensed nurse (LN) 2 outside of Resident 2's room. LN 2 stated the orange dot and the sign outside Resident 2's room indicated Resident 2 was on EBP and gloves and a gown should be worn if having physical contact with Resident 2. LN 2 stated she did not know why Resident 2 was on EBP and there were no gloves or gowns available outside the room, and that there should be. LN 2 stated not having EBP PPE outside Resident 2's room was an infection control problem. On 4/18/24 at 12:58 PM, a concurrent observation and interview was conducted with medical doctor (MD) outside Resident 2's room. The MD stated she was going to enter Resident 2's room but could not enter because the EBP PPE was not available outside the room. The MD stated Resident 2 was on EBP for a history of MRSA and a lack of PPE for protection at the door of a resident on EBP increased the risk of spreading infection to others. On 4/18/24 at 1:02 PM, an interview was conducted with the infection prevention (IP) nurse. The IP (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: 056330 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 056330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reo Vista Healthcare Center 6061 Banbury St. San Diego, CA 92139 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)