Health inspection·October 5, 2023

F 0727 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis. Based on interview and record review, the facility failed to provide a Registered Nurse (RN) who was on duty, eight hours out of every day, seven days a week. This failure had the potential for RN assessment skills and supervision to not be available every day for residents and staff. Findings: Record review of the staffing schedules for the months of August and September 2023 showed there was no RN working on the following dates: 8/5, 8/6, 8/19, and 8/20; 9/2, 9/3, 9/9, 9/10, 9/16, 9/17, 9/23, 9/24, and 9/30. During an interview, on 10/3/23, at 9:18 am, the Administrative Assistant stated they did not have a full-time RN on the weekends during the months of August and September 2023. During an interview, on 10/4/23, at 10:23 am, the Director of Nursing stated they didn't have any policy about nurse staffing or RN staffing. During an interview, on 10/4/23, at 10:42 am, Licensed Nurse (LN) A stated RNs on the floor were sporadic, they came and went. During an interview, on 10/4/23, at 11:41 am, the Nurse Manager stated that for the last month they didn't have an RN working on the weekends. Page 1 of 2 555420 555420 10/05/2023 Modoc Medical Center D/P Snf 228 W MC Dowell Ave Alturas, CA 96101

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 interview and record review, the facility failed to report a COVID-19 (a contagious virus that caused respiratory illness) outbreak which affected four residents (Residents 5, 19, 43, and 45) and four staff members to the California Department of Public Health (CDPH). This failure had the potential to expose further residents to illness, which could have threatened their health and well-being. Residents Affected - Some Findings: A facility policy, titled, Outbreak Investigation, revised 1/1/12, was reviewed. An outbreak was defined as an excess level of endemic (constantly present in a specific location) disease or statistically (by the numbers) significant increase in endemic level. The time period would have varied according to the infection. The facility's threshold (required number of cases for an outbreak) was defined as greater than five percent of the resident population. If an outbreak was confirmed, it should have been reported to the local county Public Health Department and also to CDPH within 24 hours of the initial identification. A review of Resident 5's record indicated they were admitted to the facility on [DATE]. Resident 5's diagnoses included chronic obstructive pulmonary disease (COPD--a lung disorder) and pneumonia (a lung infection). Resident 5 tested positive for the COVID-19 virus on 9/23/23. A review of Resident 19's record indicated they were admitted to the facility on [DATE]. Resident 19's diagnoses included COPD and heart failure (inability of the heart to pump adequately). Resident 19 tested positive for the COVID-19 virus on 9/21/23. A review of Resident 43's record indicated they were admitted to the facility on [DATE]. Resident 43's diagnoses included COPD and heart failure. Resident 43 tested positive for the COVID-19 virus on 9/23/23. A review of Resident 45's record indicated they were admitted to the facility on [DATE]. Resident 45's diagnoses included dementia (a mental disorder that caused confusion and memory loss) and high blood pressure. Resident 45 tested positive for the COVID-19 virus on 9/28/23. Record review of the facility's census (number of residents) showed that from 9/21/23 to 9/28/23, there were 48 to 49 residents. The number of positive COVID-19 cases (four), would have been approximately eight percent of the facility's resident population at that time. During an interview, on 10/3/23, at 1:42 pm, the Infection Preventionist (IP) stated the facility had four residents who had tested positive for COVID-19 in September of 2023, and IP reported it to their county's Public Health Department. Their county's Health Officer was also the facility's Medical Director. IP stated they did not report it to CDPH. IP had been reporting outbreaks to CDPH and also via another network reporting system, until recent changes in the reporting procedure were implemented. IP stated, We absolutely did have an outbreak in September [2023]. 555420 Page 2 of 2