Health inspection·December 15, 2023

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 ensure infection control practices were implemented when the facility did not have oxygen tubing labeled for 2 of 6 residents (Residents 10 and 12) receiving oxygen. The facility did not have tubing or nasal cannula (pronged tubing that sits in nostrils to deliver oxygen) stored in a plastic bag when not in use for one of six residents (Resident 10) receiving oxygen, and the nasal cannula and tubing were on the floor. Residents Affected - Few These failures placed Residents 10 and 12 at risk for healthcare-associated infections. Findings: During a review of Resident 10 ' s admission Record dated 12/15/23, the admission Record indicated Resident 10 was admitted to the facility in October 2023. During a review of Resident 10 ' s Order Summary Report dated 12/15/23, the Order Summary Report indicated an order, dated 10/24/23, for oxygen at 2 liters per minute via nasal cannula as needed. During a review of Resident 12 ' s admission Record dated 12/15/23, the admission Record indicated Resident 12 was admitted to the facility in May 2023. During a review of Resident 12 ' s Order Summary Report dated 12/15/23, the Order Summary Report indicated an order, dated 9/01/22, for oxygen at 2 liters per minute via nasal cannula if oxygen saturation (amount of oxygen in blood) below 90% then titrate to 1 liter per minute as needed for shortness of breath. During an observation on 12/15/23 at 11:11 a.m. a red sign with Oxygen in Use was attached to the doorframe of Resident 12 ' s room. Resident 12 had a nasal cannula laying on her chest while being dressed. The oxygen tubing was not labeled. During an interview on 12/15/23 at 11:38 a.m., Licensed Vocational Nurse (LVN) 1, LVN 1 stated oxygen tubing changes occurred every week on Tuesdays on the night shift. LVN 1 stated the tubing should be labeled with date changed, date due to be changed, and nurse ' s initials. During an observation on 12/15/23 at 11:39 a.m. a red sign with Oxygen in Use was attached to the doorframe of Resident 10 ' s room. During a concurrent observation and interview on 12/15/23 at 11:39 a.m. with Resident 10 in Page 1 of 3 056381 056381 12/15/2023 Delta View Post Acute 1210 A Street Antioch, CA 94509

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident 10 ' s room, oxygen tubing and a nasal cannula were uncovered and coiled on the floor in front of the bedside table. The oxygen tubing was not labeled. Resident 10 stated the oxygen is used at night for sleeping. During a concurrent observation and interview on 12/15/23 at 11:54 a.m. with Certified Nurse Assistant (CNA) 1, in Resident 10 ' s room, Residnt 10 ' s oxygen tubing and nasal cannula were unlabeled and laying on the floor uncovered. CNA 1 stated oxygen tubing is changed weekly. During a concurrent observation and interview on 12/15/23 at 12:17 p.m. with Licensed Vocational Nurse (LVN) 2 in Resident 10 ' s room, LVN 2 stated Resident 10 ' s tubing and nasal cannula on the floor were a respiratory infection risk because the floor was dirty. LVN 2 stated he did not know how the oxygen tubing and nasal cannula should be stored when not in use. LVN 2 removed and discarded the oxygen tubing and nasal cannula. During an interview on 12/15/23 at 12:29 p.m. with Infection Preventionist (IP), IP stated oxygen tubing was changed every week on Tuesdays by night shift. IP stated oxygen tubing and masks or nasal cannula should be placed in a plastic back when not in use or staff should use new tubing. IP stated dirty tubing or nasal cannulae on the floor could introduce bacterial infection. During a review of the facility ' s policy and procedure (P&P) titled, Departmental (Respiratory Therapy) Prevention of Infection, dated November 2011, the P&P indicated, Change the oxygen cannulae and tubing every seven (7) days, or as needed. Keep the oxygen cannulae and tubing used PRN (as needed) in a plastic bag when not in use. Based on observation, interview and record review, the facility failed to ensure infection control practices were implemented when the facility did not have oxygen tubing labeled for 2 of 6 residents (Residents 10 and 12) receiving oxygen. The facility did not have tubing or nasal cannula (pronged tubing that sits in nostrils to deliver oxygen) stored in a plastic bag when not in use for 1 of 6 residents (Resident 10) receiving oxygen, and the nasal cannula and tubing were on the floor. These failures placed Residents 10 and 12 at risk for healthcare-associated infections. Findings: During a review of Resident 10's admission Record dated 12/15/23, the admission Record indicated Resident 10 was admitted to the facility in October 2023. During a review of Resident 10's Order Summary Report dated 12/15/23, the Order Summary Report indicated an order, dated 10/24/23, for oxygen at 2 liters per minute via nasal cannula as needed. During a review of Resident 12's admission Record dated 12/15/23, the admission Record indicated Resident 12 was admitted to the facility in May 2023. During a review of Resident 12's Order Summary Report dated 12/15/23, the Order Summary Report indicated an order, dated 9/01/22, for oxygen at 2 liters per minute via nasal cannula if oxygen saturation (amount of oxygen in blood) below 90% then titrate to 1 liter per minute as needed for shortness of breath. During an observation on 12/15/23 at 11:11 a.m. a red sign with Oxygen in Use was attached to the 056381 Page 2 of 3 056381 12/15/2023 Delta View Post Acute 1210 A Street Antioch, CA 94509

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few doorframe of Resident 12's room. Resident 12 had a nasal cannula laying on her chest while being dressed. The oxygen tubing was not labeled. During an interview on 12/15/23 at 11:38 a.m., Licensed Vocational Nurse (LVN) 1, LVN 1 stated oxygen tubing changes occurred every week on Tuesdays on the night shift. LVN 1 stated the tubing should be labeled with date changed, date due to be changed, and nurse's initials. During an observation on 12/15/23 at 11:39 a.m. a red sign with Oxygen in Use was attached to the doorframe of Resident 10's room. During a concurrent observation and interview on 12/15/23 at 11:39 a.m. with Resident 10 in Resident 10's room, oxygen tubing and a nasal cannula were uncovered and coiled on the floor in front of the bedside table. The oxygen tubing was not labeled. Resident 10 stated the oxygen is used at night for sleeping. During a concurrent observation and interview on 12/15/23 at 11:54 a.m. with Certified Nurse Assistant (CNA) 1, in Resident 10's room, Residnt 10's oxygen tubing and nasal cannula were unlabeled and laying on the floor uncovered. CNA 1 stated oxygen tubing is changed weekly. During a concurrent observation and interview on 12/15/23 at 12:17 p.m. with Licensed Vocational Nurse (LVN) 2 in Resident 10's room, LVN 2 stated Resident 10's tubing and nasal cannula on the floor were a respiratory infection risk because the floor was dirty. LVN 2 stated he did not know how the oxygen tubing and nasal cannula should be stored when not in use. LVN 2 removed and discarded the oxygen tubing and nasal cannula. During an interview on 12/15/23 at 12:29 p.m. with Infection Preventionist (IP), IP stated oxygen tubing was changed every week on Tuesdays by night shift. IP stated oxygen tubing and masks or nasal cannula should be placed in a plastic back when not in use or staff should use new tubing. IP stated dirty tubing or nasal cannulae on the floor could introduce bacterial infection. During a review of the facility's policy and procedure (P&P) titled, Departmental (Respiratory Therapy) – Prevention of Infection, dated November 2011, the P&P indicated, Change the oxygen cannulae and tubing every seven (7) days, or as needed. Keep the oxygen cannulae and tubing used PRN (as needed) in a plastic bag when not in use. 056381 Page 3 of 3