Health inspection·August 6, 2024

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, for one of (Resident A) five residents, residents with a multidrug- resistant organism (MDRO-bacteria and other microorganisms that have developed a resistance to one or more classes of antimicrobial drugs) was placed in a single room or cohorted with other residents with the same MDRO infection, according to the facility's policy and procedure. Residents Affected - Few This failure had the potential to exposed Resident A's two susceptible roommates to acquiring an infection. Findings: On August 5, 2024, at 9 a.m., an unannounced visit was conducted at the facility for the investigations of three complaints. On August 5, 2024, at 10 a.m., two Certified Nursing Assistants (CNAs) were observed caring for a resident in bed one, wearing gloves. A sign outside the room, indicated, Contact Isolation (a set of precautions used in healthcare facilities to prevent the spread of germs from patients with illnesses that can be transmitted through direct or indirect contact). A cart was observed outside of the room, next to the doorway, containing personal protective equipments (PPE - equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses). On August 5, 2024, at 10:05 a.m., an interview was conducted with the CNA. The CNA stated she did not know why the contact isolation sign was on the door. The CNA stated a contact isolation sign means we are to put on gloves, a gown, and sometimes a mask or shield before caring for a patient. The CNA stated the other staff member said she only needed to wear gloves. The CNA stated only bed three (Resident A) required contact isolation, the residents in bed one and two bed were okay. The CNA stated she did not know why bed three was placed on contact isolation. On August 5, 2024, at 10:10 a.m., an interview was conductedwith the Licensed Vocational Nurse (LVN). The LVN stated she was the charge nurse for Resident A, and Resident A had ESBL(extended spectrum beta-lactamase: a bacteria that is difficult to kill, because it is resistant to many antibiotics) in her urine. The LVN stated it was okay if Resident A stays in the room, Resident A did not need a private room, the ESBL was contained, and Resident A had a catheter (flexible tube inserted into the body) for draining her urine. The LVN stated she did not know when Resident A tested positive for ESBL and did not know if it was an active infection. A review of Resident A's record indicated Resident A was admitted to the facility on [DATE], with (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: 555353 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 555353 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Health Care Center 8965 Magnolia Avenue Riverside, CA 92503 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)