Health inspection·April 25, 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, interview, and record review, the facility failed to implement infection control standards of practice when staff did not put on a face shield prior to entering resident rooms when COVID-19 airborne transmission-based (precautions to help stop the spread of germs from one person to another) precautions were in place. Residents Affected - Few This failure had the potential for staff to contract COVID-19 infection and spread to other residents. Findings: During an observation on 4/25/23 at 10:08 A.M., room [ROOM NUMBER] had signs on the door. One sign indicated, Airborne Precaution (preventing infectious bacteria or viruses from being inhaled)/Contact Precaution (preventing the spread of infections by direct or indirect contact) . clean hands when entering and leaving room, doctors and staff must keep door closed, N95 MASK (mask that filters out particles in the air)/FACE SHIELD. CNA 1 and CNA 2 were outside room [ROOM NUMBER]. CNA 1 and CNA 2 used the hand sanitizer from the wall, put on gowns and gloves then entered room [ROOM NUMBER]. CNA 1 and CNA 2 had N-95 masks on but did not put on a face shield. On 4/25/23 at 10:15 A.M., CNA 1 and CNA 2 were observed outside room [ROOM NUMBER]. CNA 1 and CNA 2 put on gowns and gloves, then entered room [ROOM NUMBER]. room [ROOM NUMBER] had 2 signs on the door. One sign indicated, Airborne Precaution/Contact Precaution . clean hands when entering and leaving room, doctors and staff must keep door closed, N95 MASK/FACE SHIELD. CNA 1 and CNA 2 had N-95 masks on but did not put on a face shield prior to entering room [ROOM NUMBER]. On 4/25/23 at 10:36 A.M., an interview and concurrent review were conducted with CNA 1. Concurrent review of the sign in room [ROOM NUMBER] indicated, Airborne Precaution/Contact Precaution . clean hands when entering and leaving room, doctors and staff must keep door closed, N95 MASK/FACE SHIELD. C.N.A. 1 confirmed she did not wear a face shield prior to entering room [ROOM NUMBER]. CNA 1 stated she was not sure if the face shield should have been worn. An interview and concurrent review on 4/26/23 at 10:41 A.M. were conducted with CNA 2. The sign in door 2 was reviewed and it indicated, Airborne Precaution/Contact Precaution . clean hands when entering and leaving room, doctors and staff must keep door closed, N95 MASK/FACE SHIELD. CNA 2 stated she was supposed to wear face shield prior to entering room [ROOM NUMBER] according to the sign on the door. CNA 2 stated she did not wear a face shield. An interview on 4/25/23 at 1:50 P.M., with the Infection Preventionist (IP) was conducted. The IP (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 555158 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 555158 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/25/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE El Centro Post-Acute Care 1700 S. Imperial Ave El Centro, CA 92243 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)