Health inspection·February 6, 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 ensure current infection control practices were followed for two of five residents reviewed for infection control when: Residents Affected - Few 1. Staff wore an N-95 (a fitted filtering mask) mask over a surgical mask, 2. Staff did not use a face shield upon entrance into a room with COVID-19 (a very contagious respiratory virus). This failure resulted in staff being exposed to COVID-19 and had the potential to spread infection to all residents residing in the facility. 1. Resident 1 was admitted to the facility on [DATE] according to the facility's admission Record. The change in condition progress note for Resident 1 dated 2/3/25 at 4:08 P.M. indicated, .Covid tested via rapid test with positive result . An observation of Resident 1's room on 2/6/25 at 9:02 A.M. was conducted. Resident 1's room had a sign on the wall outside which indicated, Special Droplet [spread of germs passed through speaking, sneezing or coughing] Contact [prevention of infection by direct or indirect contact] Precautions .N-95 . A white, plastic cart with drawers were also observed outside Resident 1's room. An observation and interview was conducted on 2/6/25 at 9:10 A.M. with Certified Nurse Assistant (CNA) 1. CNA 1 stated residents who were positive for COVID-19 had a blood pressure cuff and stethoscope inside the room. CNA 1 stated Resident 1 was positive for COVID-19 and will check the room for a blood pressure cuff and stethoscope. CNA 1 put on a gown, an N-95 mask over her surgical mask (a medical face mask) and face shield. On 2/6/25 at 9:41 A.M. CNA 2 was observed prior to entering Resident 1's room. CNA 2 was observed put on a gown then an N-95 mask on top of the surgical mask. An interview on 2/6/25 at 10:03 A.M. was conducted with CNA 1. CNA 1 stated she saw others putting an N-95 on top of a surgical mask and that was what she followed. An interview on 2/6/25 at 9:59 A.M. was conducted with LN 2. LN 2 stated it was her expectation for staff to not put on an N-95 mask on top of the surgical mask. An interview on 2/6/25 at 10:52 A.M. was conducted with LN 3. LN 3 stated staff should remove the surgical mask prior to putting on an N-95 mask for protection. (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: 555290 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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)