Health inspection·December 28, 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 transmission based infection control measures when Licensed Nurse (LN) 2 entered the room of a resident (Resident 1) who tested positive for COVID-19 (an infectious disease caused by the SARS-CoV-2 virus) without the required personal protective equipment (PPE, equipment worn to minimize exposure to infection and injury in the workplace). Residents Affected - Few This failure had the potential to increase the risk of COVID-19 transmission to all residents, staff, and visitors at the facility. Findings Include: Resident 1 was admitted to the facility on [DATE] with a diagnosis of respiratory failure, per the residents admission record. On 12/5/23 at 11:31 AM an interview was conducted with LN 1 in the hallway outside Resident 1's room. LN 1 stated Resident 1 had tested positive on the routine rapid antigen test for COVID-19 this morning. On 12/5/23 at 11:53 AM an observation and interview were conducted with LN 2 outside of Resident 1's room. LN 2 was observed entering Resident 1's room wearing a gown, gloves, N95 respirator (a respiratory protection device worn over the mouth and nose that filters viruses and particles). LN 2 was not observed wearing a face shield or eye protection upon entering Resident 1's room. LN 2 was observed exiting Resident 1's room at 11:59 AM. LN 2 stated she should have worn eye protection or a face shield in Resident 1's room because Resident 1 tested positive for COVID-19 and had been placed on enhanced droplet precautions (PPE that includes a mask, gown, gloves, eye protection). LN 2 stated not wearing the required PPE while providing care for a COVID-19 positive resident was a problem because it increased the risk of transmission to others. On 12/5/23 at 12:53 PM an interview was conducted with Infection Preventionist (IP) 1 and IP 2. IP 1 stated anyone entering a resident room with COVID-19 was expected to wear goggles, a face shield, gown, gloves and an N95. Stated if staff are observed not wearing the required PPE when entering a COVID-19 positive patient room they increased the risk of COVID-19 transmission to other residents in the facility. On 12/28/23 at 12:57 an interview was conducted with the Director of Nursing (DON). The DON stated staff were expected to wear a gown, gloves, N95 mask, face shield or goggles when caring for COVID-19 positive residents. The DON stated the goal of wear the proper PPE is to prevent COVID-19 positive transmission to other coworkers and susceptible residents. Page 1 of 2 555301 555301 12/28/2023 The Villas at Poway 15615 Pomerado Rd Poway, CA 92064

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of Resident 1's orders, dated 12/5/23 at 11:43 AM, indicated, .Patient Isolation: Enhanced Droplet, Resident is Covid Positive by Antigen Test . A review of the facility document titled, The [NAME] at Poway COVID-19 Surveillance Plan, undated, indicated, I. SUMMARY/INTENT All long term care residents are considered high risk of severe illness, hospitalization and death from COVID-19 infection . C. Care for Residents with Suspected or Confirmed COVID-19 Infection . 4. Staff caring for residents with confirmed or suspected COVID-19 infection should use an N95/PAPR respirator wherever available (if unavailable, a facemask), eye protection (face shield or goggles), gloves, and gown . 555301 Page 2 of 2