Health inspection·January 22, 2024

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on review of facility infection control records, staff interviews, review of staff schedules, review of time punch records, review of electronic mail (e-mail) correspondence, review of facility policies and procedures, review of the Center for Disease Control and Prevention CDC) guidance, and review of Ohio Department of Health's (ODH) guidance for reporting infectious diseases, the facility failed to develop and implement effective infection control practices including written policies and procedures which included when and to who potentially communicable diseases should be reported, and failed to ensure the local health department was notified in a timely manner of a facility gastrointestinal illness outbreak. This affected 29 residents (#5, #6, #10, #17, #22, #23, #28, #36, #38, #39, #42, #48, #57, #58, #59, #60, #61, #63, #66, #69, #71, #74, #75, #77, #79, #82, #90, #91, and #92), two of which (Resident #58 and #60) Norovirus was detected, who experienced symptoms of gastrointestinal illness. This had the potential to affect all residents residing in the facility. The facility census was 86. Residents Affected - Many Findings include: Review of the facility infection control records for the 2024 gastrointestinal outbreak revealed the onset was 12/30/23 and the reporting date was 01/05/24. The facility had 29 residents who experienced gastrointestinal illness including symptoms of vomiting and/or diarrhea (loose stools) from 12/29/23 through 01/13/24. On 12/29/23, Resident #75 experienced both symptoms. On 12/30/23, Resident #48, #74, #79, and #90 experienced both symptoms. On 01/01/24, Resident #71 experienced both symptoms. On 01/02/24, Resident #10 experienced both symptoms, and Resident #36 experienced loose stools. On 01/03/24, Resident #17 experienced both symptoms. On 01/04/24, Resident #22 experienced vomiting, and Resident #42 and #63 experienced loose stools. On 01/05/24, Resident #23 and #28 experienced loose stools, and Resident #77 experienced vomiting. On 01/06/24, Resident #39, #58, and #66 experienced both symptoms, and Resident #6, #69, #82, and #91 experienced vomiting. On 01/07/24, Resident #60 experienced both symptoms, Resident #38 experienced vomiting, and Resident #59 experienced loose stools. On 01/08/24, Resident #5 experienced both symptoms, and Resident #61 experienced vomiting. On 01/12/24, Resident #57 experienced vomiting. On 01/13/24, Resident #92 experienced vomiting. Further review of the infection control records revealed the facility had 29 staff members (Dietary [NAME] #501, Dietary [NAME] #502, Environmental Services Assistant #503, Resident Care Associate (RCA #504, RCA #505, Licensed Practical Nurse (LPN) #506, LPN #507, LPN #508, RCA #509, LPN #510, LPN #511, LPN #512, RCA #513, Guest Relations Staff Member #514, Registered Nurse (RN) #515, Environmental Services Assistant #516, Environmental Services Assistant #517, RCA #518, Business Office Manager #519, Dining Services Assistant #520, RCA #521, Activities Associate #522, LPN #523, Therapy Staff Member #524, RCA #525, RN #526, Therapy Staff Member #527, Therapy Staff Member #528, and the Assistant Director of Health Services) who experienced gastrointestinal illness including symptoms of vomiting and/or diarrhea (loose stools) from 12/29/23 through 01/11/24. Page 1 of 2 365541 365541 01/22/2024 Heritage The 2820 Greenacre Dr Findlay, OH 45840

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Continued review of the facility infection control records for the 2024 gastrointestinal outbreak revealed Dietary [NAME] #501 had an onset date of 01/02/24 and had symptoms of both vomiting and loose stools. The symptom end date for Dietary [NAME] #501 was listed as 01/03/24. Review of the staff schedule and time punch record for Dietary [NAME] #501 revealed the staff member worked on 01/02/24 from approximately 5:30 A.M. to 1:00 P.M., was off on 01/03/24, and returned to work on 01/04/24 from approximately 5:30 A.M. to 6:00 P.M. Interview on 01/22/24 at 10:50 A.M. with Dietary [NAME] #501 revealed the staff member worked all day on 01/02/24 and did not feel ill or have any signs or symptoms of illness. On the early morning of 01/03/24, Dietary [NAME] #501 woke up with symptoms and was not able to go to work. Dietary [NAME] #501 verified he returned to work the next day since symptoms had resolved, although he still did not have an appetite. Dietary [NAME] #501 verified he did not have to wait 48 hours before returning to work. During an interview on 01/22/24 at approximately 3:43 P.M., the Administrator confirmed the local health department was not notified of the gastrointestinal outbreak until 01/05/24, which was approximately seven days after the outbreak began. The Administrator also verified there was no policy which specified when and to who communicable diseases should be reported. Review of the e-mail correspondence from the local health department, dated 01/09/24, revealed after reviewing the line list, the gastrointestinal illness seemed to be Norovirus, so those were the recommendations the health department was following until receiving results from the Ohio Department of Health (ODH) laboratory. The health department inquired about any other interventions implemented such as food handlers being kept from work for at least 48 hours past resolution of symptoms. Review of the facility policy titled Infection Prevention and Control Program (IPCP), revised 11/15/21, revealed the IPCP designee should report communicable diseases that are reportable to local/state public health authorities. The policy did not contain specific information regarding when and to whom potentially communicable diseases would be reported. Review of the CDC guidance titled Guideline for the Prevention and Control of Norovirus Gastroenteritis Outbreaks in Healthcare Settings (2011), revealed as with all outbreaks, notify appropriate local and state health departments, as required by state and local public health regulations, if an outbreak of Norovirus gastroenteritis is suspected. The guidance further stated Personnel who work with, prepare or distribute food must be excluded from duty if they develop symptoms of acute gastroenteritis. Personnel should not return to these activities until a minimum of 48 hours after the resolution of symptoms or longer as required by local health regulations. Review of ODH guidance titled, Know Your ABCs: A Quick Guide to Reportable Infectious Diseases in Ohio, effective 08/01/19 revealed under the section Class C, facilities should report an outbreak, unusual incident or epidemic of other diseases by the end of the next business day. This deficiency represents non-compliance investigated under Complaint Number OH00150095. 365541 Page 2 of 2