Health inspection·July 29, 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:1. Ensure staff wear personal protective equipment (PPE) inside a novel respiratory precaution room for one of nine sample residents (Resident 5).2. Ensure a visitor wear PPE inside a novel respiratory precaution room (Resident 7) for one of seven sample residents.3. Ensure staff wear PPE inside a novel respiratory precaution room for two of nine sample residents (Resident 8 and Resident 9).These deficient practices increased the risk of COVID (highly contagious respiratory disease) transmission to other residents who were not infected. Findings:Findings: A. During a review of Resident 5's admission Record, the admission Record indicated the facility admitted Resident 5 on 12/18/2024 with diagnoses including anxiety (a feeling of worry, nervousness, or unease, typically about an event or something with an uncertain outcome) and anemia (a condition where your blood doesn't have enough healthy red blood cells (RBCs) or hemoglobin to carry enough oxygen to your body's tissues, leading to feelings of fatigue and weakness).During a review of Resident 5's Minimum Data Set (MDS - a resident assessment tool), dated 6/11/2025, the MDS indicated Resident 5 was moderately impaired with thought process and required setup assistance from staff to complete activities of daily living (ADLs - activities such as bathing, dressing, and toileting a person performs daily).During a concurrent observation, interview and record review on 7/28/2025 at 12:34 p.m. with Activity Staff (AS) 1, observed AS 1 inside Resident 5's room not wearing gown and gloves. AS 1 read the postage signed outside Resident 5 and stated Novel Respiratory Precaution. AS 1 stated that Resident 5's room was just a regular room and did not need to wear a gown. AS 1 stated that Resident 5 was looking for her nurse and AS 1 will notify Resident 5 needs. AS 1 stated that if the room was a COVID there must be a red tape on the floor outside the room.During a concurrent interview and record review on 7/28/2025 at 12:39 p.m. with Registered Nurse (RN) 1, RN 1 stated that Novel Respiratory Precaution postage outside the room means the resident inside was either exposed or positive to COVID and staff need to wear gown and glove before entering the room.During an interview on 7/28/2025 at 12:45 p.m. with the Infection Preventionist (IP), the IP stated that staff must wear PPE, do hand washing before and after entering the room to prevent the spread of the infection and to protect themselves. During a concurrent interview on 7/29/2025 at 2:15 p.m. with Assistant Director of Nursing (ADON), the ADON stated that for COVID isolation the staff needed to wear proper PPE upon entering the room to prevent the spread of the virus and must do handwashing before and after entering the room.During a review of the facility policy and procedure titled, COVID-19 Management in LTC California, last review date of 1/2025, the policy and procedure indicated, Gloves and gown are to be donned before entering a room where the resident is isolation and doffed before exiting the room. When there are high rates of COVID-19 transmission in the community, healthcare providers (HCP) are more likely to encounter asymptomatic or pre-symptomatic patient. For this reason, in addition to standard precautions, the CDC recommends that HCP wear eye protection in addition to a facemask for any close contact with Residents Affected - Some Page 1 of 3 555132 555132 07/29/2025 Valley Vista Nursing and Transitional Care LLC 6120 N. Vineland Ave North Hollywood, CA 91606

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some patients. This is particularly important if the patient cannot be reliably source controlled (resident cannot wear a mask) throughout the personal contact. An N-95 respirator instead of a facemask is recommended for any aerosol generating procedures and any other procedures that might pose a higher risk for transmission if the patient were to have COVID-19. B. During a review of Resident 7's admission Record, the admission Record indicated the facility initially admitted Resident 7 on 9/29/2022 and readmitted on [DATE] with a diagnosis of acute kidney failure (a sudden and rapid loss of the kidneys' ability to filter waste and maintain proper fluid and electrolyte balance in the body) and anxiety. During a review of Resident 7's MDS, dated [DATE], the MDS indicated Resident 7 was severely impaired with thought process and required dependent assistance from staff to complete ADLs. During a review of Resident 7's lab and radiology, dated 7/28/2025, the lab and radiology result indicated that Resident 7 was positive for COVID. During a concurrent observation and interview on 7/28/2025 at 12:41 p.m. with RN 1 and Guest Marketer (GM) 1, observed GM 1 enter Resident 7's room. RN 1 stated that GM 1 entered Resident 7's room without a gown and gloves. RN 1 asked GM 1 to wear a gown and gloves before entering the room. RN 1 stated it was important for the staff or visitors to wear gloves, gown and hand washing before entering a novel respiratory precaution room to protect the residents and to protect themselves. GM 1 stated that she did not know that she needed to wear a gown and gloves before entering Resident 7's room.During an interview on 7/28/2025 at 12:45 p.m. with the Infection Preventionist (IP), the IP stated that staff must wear PPE, do hand washing before and after entering the room to prevent the spread of the infection and to protect themselves. During a concurrent interview on 7/29/2025 at 2:15 p.m. with Assistant Director of Nursing (ADON), the ADON stated that for COVID isolation the staff needed to wear proper PPE upon entering the room, to prevent the spread of the virus and must do handwashing before and after entering the room.C. During a review of Resident 8's admission Record, the admission Record indicated the facility admitted Resident 8 on 2/25/2025 with a diagnosis of hypertension (high blood pressure) and anemia. During a review of Resident 8's MDS, dated [DATE], the MDS indicated Resident 8's thought process was intact and required dependent assistance from staff to complete ADLs.During a review of Resident 8's Lab and Radiology, result dated 7/28/2025, the Lab and Radiology indicated that Resident 8 was positive for COVID.During a review of Resident 9's admission Record, the admission Record indicated the facility initially admitted Resident 9 on 8/31/2016 and readmitted on [DATE] with a diagnosis of hypertension and type 2 diabetes (a condition where your body doesn't use insulin properly, a hormone that helps regulate blood sugar). During a review of Resident 9's MDS, dated [DATE], the MDS indicated Resident 9's thought process was intact and independent assistance from staff to complete ADLs.During a concurrent observation and interview on 7/28/2025 at 3:03 p.m. with Certified Nursing Assistant (CNA) 2 and License Vocational Nurse (LVN) 1, observed CNA 2 entered Resident 8 and Resident 9's room without wearing gown and gloves. LVN 1 stated CNA 2 entered Resident 8 and Resident 9's room without wearing gown and gloves. LVN 1 asked CNA 2 to wear gown and gloves before entering a COVID isolation room to prevent the spread of infection. During a concurrent interview on 7/28/2025 at 3:10 p.m. with LVN 2 and CNA 2, CNA 2 stated that she did not know that Resident 8 and Resident 9's room was a COVID isolation because there was no red tape on the floor by the door. LVN 2 give an in service to CNA 2 that she needs to wear a gown, glove and hand washing before entering the COVID isolation room and when leaving the COVID room to wash hands.During an interview on 7/28/2025 at 12:45 p.m. with the Infection Preventionist (IP), the IP stated that staff must wear PPE, hand washing before and after entering the room to prevent the spread of the infection and to protect themselves.During a concurrent interview on 7/29/2025 at 2:15 p.m. with Assistant Director of Nursing (ADON), the ADON stated that for COVID 555132 Page 2 of 3 555132 07/29/2025 Valley Vista Nursing and Transitional Care LLC 6120 N. Vineland Ave North Hollywood, CA 91606

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some isolation the staff need to wear proper PPE upon entering the room, to prevent the spread of the virus and include handwashing before and after entering the room.During a review of the facility policy and procedure titled, COVID-19 Management in LTC California, last review date of 1/2025, the policy and procedure indicated, Gloves and gown are to be donned before entering a room where the resident is isolation and doffed before exiting the room. When there are high rates of COVID-19 transmission in the community, healthcare providers (HCP) are more likely to encounter asymptomatic or pre-symptomatic patient. For this reason, in addition to standard precautions, the CDC recommends that HCP wear eye protection in addition to a facemask for any close contact with patients. This is particularly important if the patient cannot be reliably source controlled (resident cannot wear a mask) throughout the personal contact. An N-95 respirator instead of a facemask is recommended for any aerosol generating procedures and any other procedures that might pose a higher risk for transmission if the patient were to have COVID-19. During an outbreak, the facility will advise visitors of the outbreak, but will allow visitation, if it is still requested, and provide them with the N95 respirator with instructions on how to do a seal check. Visitors will be advised on which personal protective equipment should be donned and instructed on how to don and doff the equipment before the visit. 555132 Page 3 of 3