Health inspection·November 3, 2022

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure expired food items were not stored in the refrigerator, readily available for use. Residents Affected - Some This failure had the potential to result in foodborne illness to an already vulnerable facility population. Findings: On October 31, 2022, at 9:13 a.m., an initial tour of the kitchen was conducted with the Lead [NAME] (LC). One aluminum steam table deep pan with enchilada sauce, covered with clear plastic wrap, dated 10/26, was observed in the walk-in refrigerator, readily available for use. In a concurrent interview, the LC stated 10/26 was the date it was prepared. The LC stated the enchilada sauce was only good for three days after the preparation date. The LC stated the enchilada sauce was expired and should have been discarded. Additionally, one aluminum steam table deep pan with baked beans, covered with clear plastic wrap, with a label of use by 10/27/22, was observed in the walk-in refrigerator, readily available for use. In a concurrent interview, the LC stated the beans were expired, and should not have been stored in the refrigerator, readily available for use. On October 31, 2022, at 9:17 a.m., the Dietary Services Supervisor (DSS) was interviewed. The DSS confirmed both the enchilada sauce and the baked beans were expired and should not have been stored in the refrigerator, readily available for use. On October 31, 2022, at 9:22 a.m., one aluminum steam table deep pan with gravy, covered with clear plastic wrap, with a date of 10/26 was observed in the reach-in refrigerator, readily available for use. In a concurrent interview, the DSS stated the gravy was prepared on October 26, 2022, and it was good for three days after it was prepared. The DSS stated the gravy was expired and should have been discarded. Additionally, one Ziplock bag containing a previously opened bag of non-dairy whipped cream topping, with a date of 8/9/22, was observed in the same reach-in refrigerator, readily available for use. Page 1 of 6 555390 555390 11/03/2022 Corona Regional Medical Center D/P Snf 730 Magnolia Avenue Corona, CA 92879

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some In a concurrent interview, the DSS stated the whipped cream was expired, and should not have been stored in the refrigerator, readily available for use. On November 2, 2022, at 10:28 a.m., an interview with the Dietary Director (DD) was conducted. The DD stated the expired food items should have been discarded, and not stored in the refrigerator, readily available for use. The DD stated the facility did not have a written policy to address those specific food items, but it was the facility policy and practice to discard food items three days after the preparation date. The facility was not able to provide a policy and procedure related to when the food items should be discarded after the preparation date. 555390 Page 2 of 6 555390 11/03/2022 Corona Regional Medical Center D/P Snf 730 Magnolia Avenue Corona, CA 92879

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, for five of 12 residents reviewed (Residents 90, 10, 30, 25, and 190) the facility failed to maintain and implement infection prevention and control practices when: Residents Affected - Some 1. For Resident 90, the peripherally inserted central catheter (PICC - a catheter inserted to the large vein used to give medications or nutrition) site dressing was not changed after seven days; 2. For Residents 10, 30, and 25, the suction canisters (a container used to collect secretions or fluids from the body) were not changed after seven days; and 3. For Resident 190, the Foley catheter (a flexible tube inserted into the bladder to drain urine) drainage bag was observed on the floor. These failures had the potential to expose the identified vulnerable residents to infections, and to the development and transmission of communicable diseases. Findings: 1. On October 31, 2022, at 10:30 a.m., Resident 90 was observed lying in bed, awake and able to verbalize simple words through her tracheostomy (an opening at the front of the neck so a tube can be inserted into a windpipe for breathing). Resident 90 was observed with a PICC line on her right arm. The PICC line site dressing was dated 10/21/22. On October 31, 2022, at 10:42 a.m., a concurrent observation and interview was conducted with Registered Nurse (RN) 1. RN 1 acknowledged the PICC line site dressing on Resident 90's right arm was dated 10/21/22. He stated Resident 90 was admitted to the facility on [DATE], with a PICC line on her right arm. He stated the PICC line site dressing should have been changed when Resident 90 was admitted . He futher stated the PICC line site dressing needed to be changed every seven days. On November 1, 2022, Resident 90's recod was reviewed. Resident 90 was admitted to the facility on [DATE], with diagnoses which included respiratory failure (a serious condition when the lungs can not get enough oxygen into the blood), pneumonia (lung infection) and septic shock (a widespread infection causing organ failure). The nurse's notes dated October 28, 2022, indicated Resident 90 was admitted to the facility with .Midline (a catheter inserted in the upper arm) right arm with two lumen (openings) dressing intact . The physician's history and physical dated October 29, 2022, indicated Resident 90 had received Intravenous (IV - through a vein) antibiotics (medications for infections) while she was at the acute hospital. The physician's order summary for the month of November 2022, indicated an order to change PICC line site dressing every 7 days. 555390 Page 3 of 6 555390 11/03/2022 Corona Regional Medical Center D/P Snf 730 Magnolia Avenue Corona, CA 92879

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On November 1, 2022, at 3:24 p.m., the Director of Nursing (DON) was interviewed. The DON stated the RN on duty should have changed Resident 90's PICC line site dressing upon admission. The DON further stated it was the facility's practice to change the central line dressing every seven days. The facilty's policy and procedure titled, Central Line Dressing Change/Cap Change, dated April 2021, was reviewed. The policy indicated, .Central line dressings will be changed every seven (7) days and as needed . 2 a. On October 31, 2022, at 10:19 a.m., Resident 10 was observed lying in bed. Resident 10 was observed receiving oxygen at 5 liters per minute through a tracheostomy. The suction tubing was observed with thick yellowish secretions. A suction canister attached to the wall, dated 10/18/22, was observed to contain greenish liquid materials. On October 31, 2022, at 11 a.m., RN 2 was interviewed. RN 2 stated the suction tubing and canister should be changed every seven days and as needed. RN 2 stated the canister should have been changed. RN 2 also stated the suction tubing should have been rinsed with normal saline (NS - a solution used to thin out secretions) to remove the accumulation of secretions. RN 2 stated, There's a potential for growth of bacteria with the accumulation of the secretions. . On October 31, 2022, at 11:10 a.m., the Respiratory Therapist (RT) was interviewed. The RT stated the suction tubing and the suction canister should be changed every week and as needed. The RT stated the suction tubing should have been rinsed with NS to clean out the thick secretions. Resident 10's record was reviewed. Resident 10 was admitted to the facility on [DATE], with diagnoses which included respiratory failure. The physician's order dated, April 2, 2019, indicated, .Suction the tracheostomy as needed to clear airway. May use NS to lavage the secretions . 2 b. On October 31, 2022, at 9:49 a.m., Resident 30 was observed lying in bed. Resident 30 was observed receiving oxygen at 5 liters per minute through a tracheostomy. A suction canister attached to the wall, dated 10/18/22, was observed to contain greenish liquid materials. On October 31, 2022, at 10 a.m., RN 2 was interviewed. RN 2 stated suction canisters should be changed once a week and as needed. RN 2 stated the suction canister should have been changed. On October 31, 2022, at 11:30 a.m., the RT was interviewed. The RT stated the suction canister should be changed once a week on Thursdays, and as needed. On November 1, 2022, at 4:45 p.m., the DON was interviewed. He stated the suction canisters should be changed every week. The DON stated the standard of practice was to change the canister weekly and as needed to prevent infection. 555390 Page 4 of 6 555390 11/03/2022 Corona Regional Medical Center D/P Snf 730 Magnolia Avenue Corona, CA 92879

F 0880 Level of Harm - Minimal harm or potential for actual harm Resident 30's record was reviewed. Resident 30 was admitted to the facility on [DATE], with diagnoses which included respiratory failure. The physician's order dated March 29, 2019, indicated, . Change suction canister .as scheduled every Thursday . Residents Affected - Some 2 c. On October 31, 2022, at 3:45 p.m., Resident 25 was observed lying in bed, receiving oxygen at 2 liters per minute through a tracheostomy. A suction canister attached to the wall was observed containing greenish liquid materials, and was dated 10/21/22. On October 31, 2022, at 3:50 p.m., a concurrent observation and interview was conducted with RN 1. RN 1 acknowledged Resident 25's suction canister was dated 10/21/22. RN 1 stated the suction canister should have bee changed after seven days. On November 1, 2022, Resident 25's record was reviewed. Resident 25 was admitted to the facility on [DATE], with diagnoses which included respiratory failure. The physician's order dated June 10, 2022, indicated .Change suction canister .every day shift every Sunday . On November 1, 2022, at 3:40 p.m., the DON was interviewed. The DON stated Resident 25's suction canister should have been changed every seven days. The facility's policy and procedure titled, Equipment Change Respiratory, dated March 2021, was reviewed. The policy indicated, .Suction Canister once a week on scheduled days and PRN (as needed) . 3. On October 31, 2022, at 9:42 a.m., Resident 190 was observed lying in bed. Resident 190's Foley catheter bag was observed on the floor. On October 31, 2022, at 9:43 a.m., Licensed Vocational Nurse (LVN) 1 was interviewed. LVN 1 stated the Foley catheter bag should not have been on the floor. On November 1, 2022, at 11:59 a.m., RN 3 was interviewed. RN 3 stated Resident 190 was readmitted to the facility with a Foley catheter due to urinary retention. RN 3 stated routine Foley catheter care and maintenance should be observed when caring for a resident with a Foley catheter. RN 3 stated the Foley catheter bag should never be on the floor as a standard of practice and for infection control. On November 3, 2022, at 11:10 a.m., the Staff Development Coordinator (SDC) was interviewed. The SDC stated all nursing staff were given an in-service and have a competency checklist for Foley catheter care and maintenance. The SDC stated the Foley bag should not be on the floor. Resident 190's record was reviewed. Resident 190 was admitted to the facility on [DATE]. 2022, with diagnoses which included respiratory failure, and multiple sites kidney cyst (an abnormal growth). The history and physical dated October 25, 2022, indicated Resident 190 developed recurrent 555390 Page 5 of 6 555390 11/03/2022 Corona Regional Medical Center D/P Snf 730 Magnolia Avenue Corona, CA 92879

F 0880 hematuria (blood in urine) and urinary tract infection. Level of Harm - Minimal harm or potential for actual harm The facility Competency Checklist, titled Foley Catheter Care and Maintenance & Emptying the Foley Catheter Collection System, indicated, .COMPETENCIES .Demonstrates knowledge, skill and understanding .Foley Cather (sic) Maintenance .Keep bag off the floor . Residents Affected - Some 555390 Page 6 of 6