Health inspection·December 5, 2023

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, staff interviews, facility policy review and review of the Centers for Disease Control (CDC) Considerations for Preventing Spread of COVID-19, the facility failed to maintain proper infection control procedures to prevent the spread of infection. This affected one resident (#21) and had the potential to affect fifteen residents (#5, #9, #17, #18, #19, #22, #23, #26, #29, #32, #33, #35, #40, #42, #44) who resided on the Sycamore Unit (rooms 202 through 213). The facility census was 57. Residents Affected - Few Findings include: Review of the medical record for Resident #21 revealed an admission date of 06/17/21 with diagnoses including type II diabetes, hemiplegia and hemiparesis following cerebral infarction, and chronic obstructive pulmonary disease. Review of the quarterly Minimum Date Set (MDS) assessment dated [DATE] revealed Resident #21 was alert and oriented to person, place, and time. Review of the care plan dated 10/31/23 revealed Resident #21 had signs and symptoms of coronavirus (COVID-19) positive coronavirus testing positive. Interventions included preventing the spread of infection to others, placing in isolation, and staff to wear personal protective equipment (PPE) during all care. Review of the current immunization record revealed Resident #21 was up to date for all COVID-19 related immunizations. Review of the physician orders dated 12/01/23 revealed Resident #21 had an order in place for droplet isolation precautions, gown, gloves, N95 mask, and face shield required every shift for COVID-19 positive. Review of the progress note dated 12/01/23 at 12:33 P.M. revealed a COVID-19 test was performed on Resident #21 with positive results. Resident #21 had no symptoms and was in bed resting comfortably with a call light in reach. Resident #21 was placed on isolation precautions. Interview on 12/04/23 at 8:43 A.M. with Assistant Director of Nursing (ADON) #825 revealed Resident #21 tested positive for COVID-19. Observation on 12/04/23 at 8:43 A.M. revealed a PPE bin outside of Residents #21 room that included masks, gloves, and gowns. Page 1 of 2 365594 365594 12/05/2023 Gardens of Euclid Beach 16101 Euclid Beach Blvd Cleveland, OH 44110

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Observation and interview on 12/04/23 at 8:46 A.M. revealed Licensed Practical Nurse (LPN) #831 exiting Resident #21 room and standing at the medication cart outside of the room. LPN #831 was observed to be wearing an N95 mask and no other PPE. LPN #831 revealed Resident #21 was positive for COVID-19 and staff were to wear a mask, gown, and gloves. LPN #831 revealed staff were to don PPE prior to entering and doff upon exiting the room. LPN #831 revealed she changed her face mask once or twice a shift when she went on her lunch break. LPN #831 confirmed and verified she was not wearing a gown, gloves, face shield and/or goggles or a surgical mask over her N95 mask as she entered an exited Resident #21 room. LPN #831 was not observed entering any other resident's rooms after exiting Resident #21's room. Observation and interview on 12/04/23 at 8:59 A.M. revealed ADON #825 and State Tested Nurse Assistant (STNA) #833 donning PPE to enter Resident #21 room. ADON #825 revealed any staff entering COVID-19 positive rooms, should wear full PPE including mask, gloves, and gowns. Review of the Centers for Disease Control and Prevention document related to droplet precautions revealed everyone must clean their hands, including before entering and when leaving the room, make sure their eyes, nose and mouth were fully covered before room entry and remove face protection before room exit. Further review revealed staff must don proper PPE when entering a COVID-19 positive room that included a gown, N95 mask, face shield and/or goggles, and gloves. Review of the documents revealed the facility did not implement the protocol. Review of the facility document titled Isolation- Categories of Transmission-Based Precautions, revised October 2018, revealed the facility had a policy in place that transmission-based precautions would be initiated when a resident develops signs and symptoms and at risk of transmitting the infection to other residents. Review of the document revealed appropriate notification would be placed on the room entrance door, front of the chart to alert staff and visitors, and gown, gloves and goggles would be worn. Review of the document revealed the facility did not implement the policy. This deficiency represents non-compliance investigated under Complaint Number OH00148779. 365594 Page 2 of 2