Health inspection·August 27, 2025

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 ensure proper infection control precautions were implemented for one of two residents (Resident 1), when a staff member was observed returning an unused dinner tray from a COVID (Corona virus - a contagious respiratory disease) positive residents isolation room (A room that separates residents from others, while receiving specialized medical treatment) to the meal cart which stored trays that were being served to other residents.This failure had the potential to cross contaminate clean resident dinner trays and spread COVID infection to uninfected residents. Findings:On August 26 and 27, 2025, unannounced visits were made to the facility to investigate infection control, safety, and quality of care issues.On August 26, 2025, at 2:10 p.m., an interview was conducted with the Infection Prevention (IP) Nurse, who stated the facility had two COVID positive residents sharing an isolation room. The IP stated an in-service was recently provided to staff on COVID which reviewed the topics of proper hand washing, Personal Protective Equipment (PPE-equipment worn by staff to protect against exposure to COVID positive residents), and the proper use of isolation/airborne precautions (specific infection control measures implemented to help prevent the spread of airborne diseases, such as COVID). The IP stated before staff enter a COVID isolation room they are to don (put on) PPE, including a mask, gown, gloves, and eye shields. When staff have completed caring for a COVID resident, they are to doff (take off) the PPE and dispose of the equipment in the rooms trash. A review of the facility in-service titled, COVID-19 & Droplet Isolation Precautions Management, dated, August 17, 2025, indicated, . At the conclusion of the presentation, (staff) will be able to .Demonstrate correct donning and doffing of PPE including gown, gloves, mask/N95, and face shield .Apply proper hand hygiene techniques according to facility policy .Safely manage meal tray removal for residents on droplet/COVID isolation using . reusable trays .On August 26, 2025, at 2:55 p.m., an observation of Resident 1's COVID isolation room was conducted. The room had a sign outside of the resident's door indicating airborne/droplet precautions, instructing staff to don the PPE of a mask, gown, gloves and eye shield before entering the room. A cart containing PPE equipment for staff to use was also outside of the room.On August 26, 2025, at 5:10 p.m., an observation of dinner service was conducted. Dinner trays from the kitchen on a main cart were rolled onto the unit. Two staff members were observed taking the unused dinner trays to assigned resident rooms.On August 26, 2025, at 5:20 p.m., an observation of Certified Nursing Assistant (CNA) 1 delivering Resident 1's dinner tray to resident's COVID isolation room was conducted. CNA 1 was observed wearing an N95 mask (respiratory protective mask that filters out bacteria and viruses), cleaning his hands with alcohol-based hand rub, then donning PPE of a gown, eye shield and gloves, prior to entering Resident 1's room. After donning PPE, an additional staff member was observed handing Resident 1's plastic dinner tray to CNA 1. CNA 1 then entered the resident's room with the dinner tray and partially closed the room door.On August 26, 2025, at 5:38 p.m., an observation of the Activity Director (AD) at Resident 1's bedroom Residents Affected - Few (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: 056428 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 056428 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE California Nursing & Rehabilitation Center 2299 North Indian Canyon Drive Palm Springs, CA 92262 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)