Health inspection·October 6, 2023

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to provide prompt efforts to resolve the grievances the residents voiced to the facility through the grievance reporting form and resident council (organized group of residents who meet regularly to discuss and address concerns about their rights, and care in the facility) meetings for three of seven residents (Resident 14, Resident 39, Resident 105) who attended the resident council meeting during the recertification survey. Residents Affected - Some This failure has violated the residents' right to have grievances filed by residents in the facility during the resident council meeting was addressed and resolved. Findings: During a review of Resident 14's admission record (face sheet) the face sheet indicated Resident 14 was admitted to the facility on [DATE] with diagnoses including Parkinson's disease (a progressive disorder of the nervous system that affects movement), diabetes mellitus (a group of diseases that affect how the body uses blood sugar) and pneumonia (respiratory infection) During a review of Resident 14's Minimum Data Set (MDS), a standardized assessment and care-screening tool, dated 7/24/2023, the MDS indicated, Resident 14 had the ability to make self-understood and can understand others, and intact cognitive (ability to learn, remember, understand, and make decision) ability. Resident 14 required extensive assistance from two staff for bed mobility, transfers, toilet use, personal hygiene and dressing. During a review of Resident 39's admission record (face sheet), the face sheet indicated Resident 39 was admitted to the facility on [DATE] with diagnoses including polyneuropathy (multiple peripheral nerves become damaged), dependence on supplemental oxygen, and history of falling. During a record review of Resident 39 MDS, dated [DATE], the MDS indicated, Resident 39 had the ability to make self-understood and can understand others, and has intact cognitive ability. Resident 39 required limited assistance from one staff for bed mobility, transfers, and extensive assistance for toilet use, personal hygiene and dressing. During a record review of Resident 105's admission record (face sheet), the face sheet indicated Resident 105 was admitted to the facility on [DATE] with diagnoses including metabolic encephalopathy (problem in the brain caused by a chemical imbalance in the blood), chronic pancreatitis (pancreas becomes damaged by long-standing inflammation, hypertensive heart disease (heart problems that occur because of high blood pressure that is present over a long time). Page 1 of 14 056446 056446 10/06/2023 Paramount Convalescent Hosp. 8558 East Rosecrans Avenue Paramount, CA 90723

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a record review of Resident 105's MDS dated [DATE], the MDS indicated, Resident 39 had the ability to make self-understood and can understand others, and has intact cognitive ability, Resident 105 required limited assistance from one staff for bed mobility, transfers, toilet use, personal hygiene and dressing. During a review of the facility's Grievance Reporting Form dated 9/27/2023, indicated the concerns that call lights were not being answered during the 9:00 p.m. to 12 midnight. During a review of the Grievance Reporting Form dated 10/1/2023, indicated the concerns that call lights were not being answered promptly. During a review of the Grievance Reporting Form dated 10/5/2023, indicated the concerns that call lights were not being answered promptly. During an interview on 10/4/2023 2:59 pm. with the Assistant to Director of Staff Development (ADSD), stated call light should be answered immediately to attend to resident needs and if there was an emergency it can be addressed in a timely manner. The ADSD states it was the responsibility of all staff to answer call light immediately. During an interview on 10/5/2023 at 10:02 a.m. with the Director of Social Services (DSS), stated all concerns in the resident's grievance form should be addressed promptly and appropriate action taken to resolve the issues listed in the form. During the resident council meeting held on 10/5/2023 at 1:30 pm Resident 14,39 and 105 all stated the facility was notified of their grievances to the head nurse about call lights not being answered promptly but the issues kept coming back. The residents complained of delayed in response in answering call lights. Resident 39 stated he had to wait for 30 minutes in wet incontinence brief (diaper) with urine after pressing the call light. During an interview on 10/6/2023 at 10:38 a.m., with the Director of Nursing (DON) the DON stated call light should be answered immediately to attend to resident needs. DON stated if call lights were not answered promptly when resident needed to go to the bathroom, they can have accidents and can cause frustration to the residents. During a review of the facility's policies and procedures (P&P) titled Call Lights: Accessibility and Timely Response, revised 12/19/20222, indicated that the staff members who see or hear an activated call light are responsible for responding. If the staff member cannot provide what the resident desires, the appropriate personnel should be notified. During a review of the facility's P &P titled Resident and Family Grievance, revised 2/22/2023 indicated the facility supports the residents' right to voice grievances with respect to care and treatment. The P&P indicated facility will take any immediate action needed to prevent further potential violation of any resident rights. During a review of the facility's P &P titled Resident Council, revised 2/19/2023, indicated facility supports the rights of residents to organize and participate in resident groups, including a Resident Council. The policy indicates the facility will act upon concerns and recommendations of the council, make attempts to accommodate recommendation to the extent practicable and communicate decisions to the council. 056446 Page 2 of 14 056446 10/06/2023 Paramount Convalescent Hosp. 8558 East Rosecrans Avenue Paramount, CA 90723

F 0558 Level of Harm - Minimal harm or potential for actual harm During a review of the facility's P&P titled Promoting /maintaining resident dignity, revised 12/19/2022, indicated the facility will promote and treat each resident with respect and dignity as well as care for each resident in a manner and in an environment, that maintains or enhances resident's quality of life. The policy indicated to respond to requests for assistance in a timely manner. Residents Affected - Some 056446 Page 3 of 14 056446 10/06/2023 Paramount Convalescent Hosp. 8558 East Rosecrans Avenue Paramount, CA 90723

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on interview and record review the facility failed to ensure one of four Residents (Resident 17) with limited mobility received assistance to improve, maintain and prevent avoidable decline in range of motion and mobility by failing to implement Physical Therapy ([PT] the treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery) recommendations to start Restorative Nursing Assistive Services ([RNAS] nursing interventions that promote the residents ability to adapt and adjust to living) ordered on 9/18/2023 for Passive Range of Motion (PROM) for the bilateral (both) lower legs for joint integrity (inspection, palpation, active and passive range of motion, and the assessment of supporting structures and special testing). This failure had the potential to limit Resident 17's range of motion to all extremities, gradual loss of strength and development of pressure injury ( damaged to the skin due to prolonged pressure on the skin) due to immobility ( inability to move). Findings: During a review of Resident 17's admission record (AR) dated 5/23/2023, the AR indicated Resident 17 with a diagnoses of diabetes mellitus ( body's ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine), Parkinson's disease (a progressive disease of the nervous system marked by tremors and muscular rigidity) and end stage renal disease (the gradual loss of kidney function). During a review or Resident 17's Minimum Data Set [MDS- a comprehensive assessment and screening tool], dated 8/21/2023, the MDS indicated Resident 17 had severe cognitive impairment (when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life). During a review of Resident 17's Physical Therapy Evaluation (PTE) dated 8/26/2023, the PTE indicated that Resident 17 needed skilled physical therapy to increase lower leg strength, increase functional activity tolerance and perform functional mobility with reduced risk of falls. During interview on 10/5/2023 at 11:03 a.m. with Resident 17's Responsible Party (RP1), the RP1 stated he had a concern about his father receiving physical therapy treatments to get stronger. RP1 stated he felt Resident 17 was getting weaker recently and was able to walk and get out of bed previously. During an interview on 10/06/23 11:15 a.m. with the DOR, the DOR stated Resident 17 was not walking and dependent (needing total assistance) for bed mobility. The DOR stated there was a recommendation from PT therapy to start Resident on RNA services on 9/18/2023 for Passive Range of Motion (PROM [someone physically moves or stretches a part of your body]). During an interview on 10/6/2023 at 12:39 p.m. with the Director of Nurses (DON), the DON stated that if a resident needed RNA orders, they are assessed by the Physical Therapy (PT) department. The DON stated that if the PT department recommended RNA services for a resident, they will inform the nursing staff to get an order for RNA services from the physician. The DON stated if the PT department does not inform the nursing to get an order for RNA services, the resident could have an overall 056446 Page 4 of 14 056446 10/06/2023 Paramount Convalescent Hosp. 8558 East Rosecrans Avenue Paramount, CA 90723

F 0688 decline (gradual loss of strength). Level of Harm - Minimal harm or potential for actual harm During an interview and record review on 10/6/2023 at 1:23 p.m. with the Restorative Nurse Aide (RNA) 1, the RNA 1 stated RNA services are provided to the resident to maintain their functional ability, failure to initiate RNA services had the potential for resident to develop wounds if they don't have mobility and always in bed. The RNA 1 stated Resident 17 was not being treated by RNA services and was not aware that Resident 17 should be treated with RNA services. The RNA stated the Director of Rehabilitation (DOR) should informed the RNA that Resident 17 will need RNA services. During a record review of all the resident being seen by RNA services on 10/6/2023 at 1:35 p.m., Resident 17 was not on the facility list to be seen for RNA services. The RNA 1 stated Resident 17 has declined with is functional status recently and developed an open wounds to his knees. Residents Affected - Few During a review of the Restorative Nursing Assistant (RNAJD) job description dated 2003, the RNAJD indicated the RNA should provide Range of Motion (ROM) exercises and record data as instructed. During a review of the DOR job description (DORJD) dated 3/23/2016, the DORJD indicated the DOR is responsible for the overall delivery of therapeutic services including active participation in patients' treatments. The DORJD indicated the DOR participates in the development of quality interdisciplinary treatment programs that meet the needs of the residents. During a review of the facility policy and procedure (P&P) dated revised 11/2017, titled Restorative Nursing Program, the P&P indicated the RNA program nursing interventions are used to promote the resident's ability to adapt and adjust to living as independently and safely as possible. The P&P indicated the RNA program is to assist each resident to achieve and maintain optimal physical, mental, and psychosocial well-being. The P&P indicated RNA care is provided for every resident with physician order for the RNA program and according to the resident's care plan. During a review of the facility P&P dated revised 11/2017, titled Contracture Management, the P&P indicated the physical therapist will provide caregiver training to the RNA. During a review of the facility P&P dated revised 11/2017, titles Joint Mobility, the P&P indicated when there is a change in status for a resident assessment, the rehabilitation staff will discuss the findings with the physician and develop and treatment plan. 056446 Page 5 of 14 056446 10/06/2023 Paramount Convalescent Hosp. 8558 East Rosecrans Avenue Paramount, CA 90723

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to ensure necessary care and services needed were provided to one of two sample residents (Resident 5). Facility failed to: Residents Affected - Few 1.Ensure Resident 5 oxygen tubing was connected to oxygen machine and the nasal cannula (a device used to deliver supplemental oxygen or increased airflow to a patient or person in need of respiratory help) was on Resident 5 nostril. This failure had the potential for complications associated with lack of proper oxygen therapy for Resident 5. Findings: During a review of Resident 5's admission Record (face sheet) indicated Resident 5 was admitted to the facility on [DATE] with diagnoses including aphasia (a language disorder that affects a person's ability to communicate), type 2 diabetes mellitus (a condition in which the body fails to metabolize (process) glucose (sugar) correctly ), chronic obstructive pulmonary disease ([COPD-progressive disease that makes it hard to breath). During a review of Resident 5's Minimum Data Sheet (MDS- a standardized assessment and care screening tool) dated 08/23/23 indicated Resident 5 had severe cognitive (ability to learn, understand, and make decisions) impairment and required total assistance for bed mobility, dressing, toilet use and personal hygiene. During a review of Resident 5's Care Plan (CP) dated 08/23/23, Resident 5 had shortness of breath and was on continuous use of oxygen via nasal cannula at two liters per minute. During an observation on 10/04/23 at 10:32 a.m., Resident 5's nasal cannula was not on Resident 5's nostril and oxygen tubing was not connected to the oxygen machine. During an interview on 10/05/23 at 09:35 a.m., with the Director of Nursing (DON), the DON stated that all licensed nurses should checked residents on oxygen therapy to ensure nasal cannula was on Resident 5's nostrils and oxygen tubing connected to oxygen concentrator. DON stated Resident 5 can have de-saturation (low oxygen level in the blood) and shortness of breath if oxygen therapy was not administered correctly. During an interview on 10/05/2023 at 10:17 a.m., with the Licensed Vocational nurse (LVN) 1 stated Resident 5 who was on oxygen therapy should be assessed prior to start of shift to ensure Resident 5 was receiving oxygen therapy as ordered by physician. During a review of facility's policy and procedure (P&P) titled Oxygen Administration revised 6/5/2023 indicated Oxygen was administered to residents who need it, consistent with professional standards of practice, the comprehensive person centered care plans, and the resident's goals and preferences. 056446 Page 6 of 14 056446 10/06/2023 Paramount Convalescent Hosp. 8558 East Rosecrans Avenue Paramount, CA 90723

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure correct dosage of medications were administered per physician order to two of two sampled residents (Resident 50 and 32). This failure had the potential for harm to Resident 50 and Resident 32 receiving a medication dosage not ordered by the physician. Findings: A. During an observation and record review on 10/5/2023 at 8:57 a.m. of Resident 50's morning medication administration (med pass) observed Licensed Vocational Nurse (LVN) 1 dispensed Vitamin B12 (vitamin supplement) 500 micrograms (mcg-strength in microgram unit) to Resident 50. LVN 1 stated the order for Resident 50's was Vitamin B12 50 mcg by mouth daily. LVN 1 stated he gave the 500-mcg dose because Vitamin B12 does not come in 50 mcg. LVN 1 stated the licensed nurses just give Resident 50 the 500mcg dose because Vitamin B12 50 mcg was not available. LVN 1 stated Resident 50 should not receive the Vitamin B 12 500 mcg dose because it was not ordered by the physician. During a review of Resident 50's admission Record (face sheet), the face sheet indicated Resident 50 was admitted to the facility on [DATE], with diagnoses including chronic kidney disease (gradual loss of kidney function), anemia (low red blood count) and metabolic encephalopathy (problem in the brain that is caused by a chemical imbalance in the blood). During a review of Resident 50's Minimum Data Set [MDS- a standardized assessment and care screening tool] dated 8/10/2023, the MDS indicated Resident 50 had moderate cognitive (ability to learn, remember, understand, and make decision) impairment (decline in memory and thinking) relating to activities of daily living (ADL's). During a review of Resident 50's Physician Order dated 9/10/2023, indicated Resident 50 had an order for Vitamin B12 50 mcg by mouth once a day. B. During an observation and record review on 10/5/2023 at 9:51 a.m. of Resident 32's morning med pass observed LVN 2 administered Vitamin C 500 mg by mouth to Resident 32. LVN 2 stated the MAR indicated to give Vitamin C one tablet by mouth daily. During a record review of Resident 32's admission Record (face sheet) dated 6/2/2022 indicated Resident 32 was admitted [DATE] to the facility with diagnoses including metabolic encephalopathy, diabetes mellitus (a condition in which the body fails to metabolize (process) glucose (sugar) correctly) and peptic ulcer disease (a sore on the lining of your stomach, small intestine, or esophagus). During a review of Resident 32's MDS dated [DATE], the MDS indicated Resident 32 had moderate cognitive impairment relating to activities of daily living (ADL's). During a record review of Resident 32's physician order dated 6/17/2023, indicated Resident 32 had a physician order for Vitamin C one tablet by mouth once daily. During a concurrent interview, and record review on 10/5/2023 at 9:55 a.m. with LVN 2, LVN 2 stated 056446 Page 7 of 14 056446 10/06/2023 Paramount Convalescent Hosp. 8558 East Rosecrans Avenue Paramount, CA 90723

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some he administered Vitamin C 500 mg to Resident 32 because the physician order did not state what dose to give and Vitamin C usually comes in 500 mg. LVN 2 stated, Resident 32 has been receiving Vitamin C 500 mg by mouth daily. LVN2 stated, the nurses should have clarified the order with the physician. LVN 2 confirmed on the MAR that the order for Vitamin C did not have a specified dose. During an interview on 10/6/2023 at 12:39 p.m. with the Director of Nursing (DON), the DON stated, licensed nurse should follow the physician orders for medications and give the correct dosage as ordered. The DON stated if the resident was given an incorrect dose of medication, it could have a negative impact on Resident 50. The DON stated resident (Resident 50) could have an adverse reaction to the medication because of wrong dosage given. The DON stated licensed nurse should clarify the order for Resident 32's dosage of Vitamin C prior to administration. During a review of the facility job description for LVN dated 2003, indicated the LVN should review the resident's chart for medication orders, maintain nursing standards and to prepare and administer medications as ordered by the physician. During a review of the facility's policy and procedure (P&P) dated 12/19/2022, titled Medication Administration the P&P indicated to correct any discrepancies and report to the nurse manager. The P&P indicated medications are administered by licensed nurses as ordered by the physician and in accordance with professional standards of practice. The P&P indicated to verify the medication name, dose, and route. 056446 Page 8 of 14 056446 10/06/2023 Paramount Convalescent Hosp. 8558 East Rosecrans Avenue Paramount, CA 90723

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure one of 17 sampled resident (Resident 205) medication was not left unattended at bedside without a physician order for self-administration. This failure had the potential for Resident 205 at risk for medication errors and had the potential for unsafe medication administration to an incorrect resident. Findings: During an observation on 10/4/2023 at 10:48 a.m. during the initial tour of a recertification survey with the Registered Nurse (RN) 1, Oral B throat lozenges (medication used for sore throat) was found on Resident 205's bedside table without a physician order for self -administration (able to take medications on their own without the nurse being present). During a review of Resident 205's admission Record (face sheet) the face sheet indicated Resident 205 was admitted to the facility on [DATE], with diagnoses including spinal stenosis (narrowing of the spine), sepsis (infection in the blood) and acute respiratory failure (a condition where you don't have enough oxygen in the tissues in your body). During a review of Resident 205's Minimum Data Set (MDS- a standardized assessment and care screening tool] dated 7/14/2023, the MDS indicated Resident 205 was alert and oriented and able to make independent decisions about his activities of daily living. During a review of Resident 205's Physician Order dated 10/2023, there was no current physician order for Oral B throat lozenges, and order for Resident 205's to self-administered or left at bedside. During an interview on 10/5/2023 at 3:25 p.m. with RN 2, RN 2 stated medications can only be left at the bedside if there was a doctor's order, and the resident was assessed to be able to take their own medications. RN 2 stated she was informed by RN 1 that the Oral B throat lozenges were left at the bedside unattended. RN 2 stated it was important not to leave medications at the bedside because the resident can overdose that could lead to death. RN 2 stated she was not aware medication was left at the bedside of Resident 205. During a review of the facility's policy and procedure (P&P) revised 12/19/2022, titled Medication Storage, the P&P indicated, the facility will ensure all medications housed on their premises will be stored in the pharmacy or medication rooms. The P&P indicated that all drugs will be stored in locked compartments. The P&P indicated during a medication pass, medications must be under the direct observation of the person administering medications or locked in the medication cart. During a review of the facility's P&P dated 12/19/2022, titled Medication Administration, the P&P indicated that medications are administered as ordered by the physician and in accordance with professional standards of practice. 056446 Page 9 of 14 056446 10/06/2023 Paramount Convalescent Hosp. 8558 East Rosecrans Avenue Paramount, CA 90723

F 0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure Residents Affected - Many food was stored and distributed under food safety requirements by failing to: 1. Ensure ice machine was maintained in a clean and sanitary way. 2. Ensure canned food stored in dry storage pantry had a received date label. These failures had the potential to cause food borne illness (food poisoning) for 49 out of the 49 residents in the facility. Findings: During an initial kitchen tour on 10/05/2023 at 8:00 a.m. with the Dietary Manager (DM), observed ice machine with brown reddish spots inside the border of the ice machine when wiped with a white paper towel and the inside of the ice machine sliding door was observed with rusty dark spots. During a concurrent observation and interview with DM on 10/5/2023 at 8:00 am., the DM stated the ice machine was cleaned once a month by the maintenance staff but should be cleaned daily. During an observation on 10/05/2023 at 8:15 a.m. in the presence of DM in the dry food storage pantry, observed Campbells soup can was not labelled with the date and time it was delivered and received by the facility staff. During a concurrent observation and interview on 10/5/2023 at 8:15 am with DM, stated it should be labelled on the day it was delivered and received by facility staff for tracking, to ensure it will be used prior to expiration date for resident safety. During an interview on 10/6/2023 at 12:15 pm., with the maintenance staff the maintenance staff stated the ice machine was cleaned once a month. During an interview with the dietary aid (DA) on 10/6/2023 at 12:24 pm., the DA stated the external of the ice machine was cleaned every morning and every day. During an interview on 10/6/2023 at 12:30 pm. with the Director of Nursing (DON) the DON stated, it was the responsibility of the dietary aid to clean the ice machine daily in the kitchen. During a review of the facility's policy and procedure (P&P) titled Ice machine cleaning procedure, indicated the ice machine needs to be cleaned and sanitized monthly. During a review of the facility's titled Ice machine, indicated to follow manufacturers guidelines for type of detergent and sanitizer (product that is used to reduce or eliminate pathogenic agents 056446 Page 10 of 14 056446 10/06/2023 Paramount Convalescent Hosp. 8558 East Rosecrans Avenue Paramount, CA 90723

F 0812 Level of Harm - Minimal harm or potential for actual harm (bacteria) on surfaces) to use on cleaning ice machine. Sanitation of equipment with frequency daily included to wash exterior of the machine with hot water and detergent, rinse with clean water and cloth. In addition, the policy indicated dietary staff cannot do the actual cleaning of the internal components but are responsible to see that it was completed per manufacturer guidelines which will specify the appropriate cleaner and sanitizer. Residents Affected - Many During a review of the facility's policy titled Storage of food and supplies, indicated dry food items and liquid food items must be labelled and dated. The policy included all food items will be dated - month, day year. All food products will be used per the time specified in the dry food storage guidelines. 056446 Page 11 of 14 056446 10/06/2023 Paramount Convalescent Hosp. 8558 East Rosecrans Avenue Paramount, CA 90723

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 infection control practices to prevent the development and transmission of communicable diseases and infections. The facility failed to: Residents Affected - Many 1.Ensure visitors wore Personal Protective Equipment (PPE: equipment to protect self and others from spreading infectious bacteria and virus) when entering Resident 26's room who were on contact isolation (when a patient has an infectious disease that may be spread by touching either the patient or objects the patient has handled), took a chair and brought it inside Resident 105's room and failed to do hand hygiene (cleaning one's hands that substantially reduces potential pathogens (harmful microorganisms) on the hands). 2. Ensure certified nurse assistant (CNA) 9 donned (put on )PPE inside the room of a resident who was on contact isolation while rendering care. 3. Ensure CNA 8, donned PPE prior to entering resident room on contact isolation. This failure had the potential for cross contamination (the physical movement or transfer of harmful bacteria from one person, object or place to another) and spread of infectious microorganism (organism that cause infection) from person to person or objects and equipment throughout the facility. Findings: 1. During a review of Resident 26's admission Record (face sheet) indicated Resident 26's was initially admitted to the facility on [DATE] and re-admitted on [DATE] with a diagnoses including of clostridium difficile (is a germ that causes diarrhea and colitis -an inflammation of the colon), type 2 diabetes mellitus (a condition in which the body fails to metabolize (process) glucose (sugar) correctly ), and malignant neoplasm of the prostate (cancer of the prostate [male gland]) During a review of Resident 26's Minimum Data Sheet (MDS- a standardized assessment and care screening tool) dated 08/31/2023 indicated Resident 26 had intact cognitive (ability to learn, understand, and make decisions) ability and requires extensive assistance for bed mobility, dressing, toilet use and personal hygiene. During a review of Resident 26 Care Plan dated 09/19/2023 indicated to follow contact isolation and the required PPE needed to provide care and when entering the residents' room to prevent the spread of infection. During an observation on 10/04/2023 at 12:23 p.m., observed Resident 105's visitor entered Resident 26's room who was on contact isolation removed a chair inside the room and brought it inside Resident 105's room (not on contact isolation). Resident 105's visitor failed to do hand hygiene after exiting the room. During an interview on 10/04/2023 at 12:55 p.m., with the Infection Preventionist (IP), the IP stated it was facility's staff responsibility to inform visitors regarding facility's infection control policies. IP stated facility staff including visitors should wear PPE prior to entering a room on contact isolation to prevent cross contamination. 056446 Page 12 of 14 056446 10/06/2023 Paramount Convalescent Hosp. 8558 East Rosecrans Avenue Paramount, CA 90723

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During an interview on 10/04/2023 at 02:13 p.m., with the Director of Nursing (DON), stated all facility staff including visitor should wear the required PPE before entering Resident 26's room who was on contact isolation. The DON stated it was facility's staff responsibility to remind visitors regarding acceptable infection control practices to prevent the spread of infection to residents, staff, and visitors. During a record review of Resident 1's admission Record (face sheet), indicated Resident 1 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including inflammatory disorders of scrotum (general reactions in the body due to infection) severe protein calorie malnutrition, diabetes mellitus (a group of diseases that affect how the body uses blood sugar), hemiplegia (paralysis of one side of the body) and hemiparesis (weakness of one side of the body), hypertensive heart disease (heart problems that occur because of high blood pressure that is present over a long time), Stage 4 pressure ulcer of sacral region (severely damaged and a large wound up to bone) and Candida auris (C. auris- type of yeast infection that can cause severe illness and spreads easily among patients in healthcare facilities. During a record review of Resident 1's Minimum Data Set (MDS- a standardized assessment and care-screening tool) dated 7/17/2023, the MDS indicated, Resident 1 had intact cognition. Resident 1 required extensive assistance from one staff for bed mobility, toilet use, personal hygiene and total dependance for transfers. During an interview on 10/6/2023 at 10:38 a.m. with the Director of Nursing (DON), stated prior to entering any isolation room staff must don PPE and before exiting the room they should doff the PPE inside the room. During an interview on 10/6/2023 11:42a.m. with certified nurse assistant (CNA 8), CNA 8 stated went inside the room to answer call light without realizing it was a contact isolation room. Stated if he provides care without the PPE, he can carry infection to self to other residents and family. During an interview on 10/6/2023 11:50 a.m. with licensed vocational nurse (LVN 2), LVN 2 stated if we don't follow proper infection control practices, we are putting everyone at risk for what the isolation patient is having, spreading infection to other residents' staff and family. During a review of the facility CNA job description dated 2003, the CNA job description indicated the CNA will perform all assigned task in accordance with our established policies and procedures, and as instructed by your supervisors. The CNA job description indicated the CNA will follow established policies concerning blood or body fluids and will follow established isolation precautions and procedures. During a review of the facility P&P dated 12/19/2022, titled Infection Prevention and Control Program, indicated the facility will be established and maintains an infection prevention and control program to provide a safe and sanitary environment to help prevent the development and transmission of diseases and infections per accepted national standards and guidelines. The P&P indicated all staff are responsible for following all policies and procedures related to the infection control program. The P&P indicated all staff shall assume that all residents are potentially infection when providing resident care services and all staff shall use PPE according to established facility policy governing the use of PPE. 2. During an observation on 10/4/2023 at 12:40 pm by nursing station 1, observed CNA 9 inside a 056446 Page 13 of 14 056446 10/06/2023 Paramount Convalescent Hosp. 8558 East Rosecrans Avenue Paramount, CA 90723

F 0880 resident's room on contact isolation without a PPE. Level of Harm - Minimal harm or potential for actual harm During an interview on 10/04/23 at 12:46 p.m. with CNA 9, CNA 9 stated she did not need to wear an isolation gown inside the room because she was only going to feed the resident and did not need an isolation gown on in the room. Residents Affected - Many During an interview on 10/04/23 2:30 p.m. with CNA 9, CNA 9 stated she forgot don isolation gown inside the room. CNA 9 stated it was important to wear PPE in a contact isolation room to prevent the spread of infection to the rest of the residents and staff. During an interview on 10/5/2023 at 2:21 p.m. with the Infection Preventionist ([IP] professionals who make sure healthcare workers and patients are doing all the things they should to prevent infections) stated that anyone entering a contact isolation room should wear PPE to prevent the spread of infection, even if they are going to feed a resident. During an interview on 10/5/2023 with the Registered Nurse (RN) 1, RN1 stated if there was contact isolation sign on a resident's door, all staff entering the room should wear PPE when entering the room to prevent the spread of infection, regardless of the task they will perform. RN 1 stated, CNA 9 should have donned PPE in a contact isolation room even if she was feeding a resident. 056446 Page 14 of 14