Health inspection·November 28, 2023

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to implement interventions to prevent and control the spread of COVID-19 (Coronavirus disease, a severe respiratory illness caused by virus and spread from person to person) in accordance with the facility ' s COVID-19 Mitigation Plan (facility ' s plan to minimize the effect of COVID-19 and to reduce loss of life) guidelines by failing to ensure: Residents Affected - Few Licensed Vocational Nurse 1 (LVN 1) wore a fitted (fit test - a test to determine how effectively a mask or respirator will protect the wearer) N95 mask or respirator (a respiratory protective device designed to achieve a very close facial fit and efficient filtration of airborne particles) in the facility during a COVID-19 outbreak. This deficient practice had the potential to result in the spread of COVID-19 to other residents and staff in the facility. Findings: During a concurrent observation and interview on 11/28/23 at 3:10 PM LVN 1 was observed wearing a Direct Supply 84A-7638 model (a specific model of N95 mask) N95 mask. LVN 1 stated, she had been working in the facility for one month and was not fit tested for the Direct Supply 84A-7638 model N95 mask. LVN 1 stated, the Direct Supply N95 mask was given to her to wear because it was the only N95 mask the facility had. During a concurrent interview and record review on 11/28/23 at 3:20 PM the Infection Prevention Nurse (IPN, nurse who helps prevent and identify the spread of infectious agents like bacteria and viruses in a healthcare environment) stated, there was a COVID-19 outbreak in the facility which started on11/9/2023. During a reviewed of facility ' s document titled, Respiratory Fit Test Record, for the month of September, October and November 2023, did not indicate LVN 1 was fit tested for any N95 mask. The IPN stated, the facility staff should be fit tested for N95 mask upon hired and annually. IPN stated, I missed it, and did not do N95 fit test for LVN 1. IPN stated, it was important for the staff to wear a fitted N95 mask to prevent the spread of airborne particles which can lead to infection and possible death. During a review of the facility ' s COVID-19 Mitigation Plan, revised on 8/25/23, indicated, Initial and annual N95 respiratory fit testing is required for all staff per California Division of Occupational Safety and Health (Cal-OSHA). During a review of the Los Angeles County Department of Public Health's guideline titled, Guidelines for Preventing and Managing COVID-19, updated 8/11/23, indicated N95 respirators should be worn in Page 1 of 2 555503 555503 11/28/2023 Royal Oaks Manor-Bradbury Oaks 1763 Royal Oaks Drive Duarte, CA 91010

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few the COVID-19 free area, in quarantine areas, and in isolation areas if the facility has an active outbreak. The Guideline indicated, Initial and annual N95 respiratory fit testing is required for all staff per California Division of Occupational Safety and Health (Cal-OSHA). During a review of Cal/OSHA ' s, Respiratory Protection in the Workplace – A Guide for Employers, revised April 2021, indicated, fit testing is required before the initial use of a respirator, whenever a different respirator is used, at least annually, and whenever the employee reports changes or whenever the employer observes changes in the employee ' s physical condition that could affect the respirator fit. 555503 Page 2 of 2