Inspection·October 26, 2023

F 0880 infection. Level of Harm - Minimal harm or potential for actual harm During an interview on 10/26/2023 at 10 a.m. with the infection preventionist (IP), IP stated staff should not have long fingernails in the resident's care area because long fingernails could harbor dirt and bacteria which could contribute to the transmission of infection to the residents. Residents Affected - Some c.During a review of Resident 6's admission Record (Face Sheet), the Face Sheet indicated Resident 6 was initially admitted on [DATE] and readmitted on [DATE] with diagnoses including covid-19, chronic obstructive pulmonary disease ([COPD] lung disease that block airflow and made it difficult to breathe) and diabetes (high blood sugar). During a review of Resident 6's Minimum Data Set ([MDS], a standardized assessment and care planning tool) dated 8/21/2023, the MDS indicated Resident 6 had severely impaired cognition (ability to think and reason). The MDS also indicated Resident 6 required limited (resident involved in activity, staff provide weight-bearing support) to extensive (resident involved in activity, staff provide weight-bearing support) assistance for Activities of Daily Living (ADL's) including bed mobility, transfer, walking, dressing, eating, toilet use and personal hygiene. During a review of Resident 6's Lab Results Report dated 10/22/2023, the Report indicated Resident 6 tested positive for covid-19. During an interview on 10/26/2023 at 10 a.m. with IP, IP stated there were 18 residents positive for Covid-19 in the facility. During an interview on 10/26/2023 at 11 a.m. with the Administrator (ADM), the ADM stated that the facility COVID-19 outbreak was not reported to state licensing district office because he was not aware that it needed to be reported. During a review of the facility's P&P titled, Infection Control 1/1/2012, the P&P indicated the facility would maintain a safe, sanitary, and comfortable environment and help prevent and manage transmission of diseases and infections. During a review of the facility's P&P titled, Personal Protective Equipment Infection Control Manual dated 1/1/2012, the PPE indicated, when gowns were used, they were used only once and discarded into appropriate receptacles located in the room. During a review of the facility's undated P&P titled, Standard Operating Procedure: COVID-19 Enhanced Droplet & Contact Precautions, the P&P indicated doffing procedure as follows: ensure all doffing materials were available and in place (i.e. hand sanitizer, waste supplies), doff gloves, doff gown by gently removing gown forward and placing into appropriate container, sanitize hands, doff face shield, sanitize hands and exit resident's room. During a review of the facility's P&P titled, Covid 19 (coronavirus disease 2019) Infection Control Manual dated 9/16/2020, the P&P indicated the purpose was to identify and report immediately to the required agencies any case of diagnosed Covid-19 or Person Under Investigation (PUI) for Covid-19 infection. The P&P also indicated to immediately report any residents or staff members suspected of or diagnosed with covid-19 to the local health department (LHD) and the CDPH. During a review of Centers for Disease Control and Prevention (CDC) guidelines titled, Hand hygiene (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555130 If continuation sheet Page 2 of 3 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 555130 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/26/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Maywood Skilled Nursing & Wellness Centre 6025 Pine Ave Maywood, CA 90270 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)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete in Healthcare Settings, dated 1/8/2021, the guidelines indicated healthcare workers should keep natural nail tips less than 1/4 inch long. During a review of the CDC's Recommendation titled Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the (COVID-19) Pandemic, dated 5/8/2023, the recommendation indicated healthcare facilities responding to COVID-19 transmission within the facility should always notify and follow the recommendations of public health authorities. Event ID: Facility ID: 555130 If continuation sheet Page 3 of 3