Health inspection·June 30, 2025

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 infection control practices were implemented for two of three sampled residents (Residents 1 and 2) when Licensed Vocational Nurses (LVN 1 and 2) did not wear personal protective equipment (PPE- equipment, such as gloves and gown, used to protect against infection or illness) while administering medications via G-tube (a feeding tube inserted through the abdominal wall directly into the stomach) to residents on Enhanced Barrier Protection (EBP-an infection control intervention to reduce transmission of multidrug-resistant organisms [MDRObacteria that have become resistant to multiple antibiotics).This failure had the potential to expose vulnerable residents to cross-contamination and increase the risk of developing infections.Findings:1. A review of Resident 1's medical record was conducted. Resident 1 was admitted to the facility on [DATE], with diagnosis which included gastrostomy status (an opening into the stomach for food). A review of Resident 1's Order Summary, dated June 9, 2025, indicated, .Enhanced Barrier Precautions-Staff to utilize gowns and gloves for high-contact resident care activities due to Indwelling catheter [flexible tube that is inserted into the bladder to drain urine] and feeding tube [a medical device used to deliver nutrition, fluid, and medications directly into the person's stomach], and wound every shift. A review of Resident 1's care plan dated June 8, 2025, indicated .The resident requires tube feeding .Interventions .Enhanced Barrier Precautions-Staff to utilize gowns and gloves for high-contact resident care activities such as dressing, bathing/showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use .On June 30, 2025, 4:35 p.m., during an observation in Resident 1's room with LVN 1, LVN 1 was seen entering Resident 1's room without wearing an isolation gown while providing contact care and administering medication via Resident 1's G-tube.On June 30, 2025, at 4:55 p.m., during an interview with LVN 1, LVN 1 stated she forgot to wear the isolation gown. LVN 1 further stated she should have worn the isolation gown to protect the residents and prevent the spread of germs.2. A review of Resident 2's medical record was conducted. Resident 2 was admitted to the facility on [DATE], with diagnoses which included cerebral infarction (stroke), and gastrostomy status (an opening into the stomach for food).A review of Resident 2's care plan dated June 14, 2025, indicated .Resident requires enhanced barrier precautions to prevent the spread of multidrug- resistant organisms (MDROs).Interventions.Enhanced Barrier Precautions-Staff to utilize gowns and gloves for high-contact resident care activities such. device care or use (e.g . feeding tube.) .A review of Resident 2's Order Summary, dated June 16, 2025, indicated, .Enhanced Barrier Precautions-Staff to utilize gowns and gloves for high-contact resident care activities due to indwelling catheter and feeding tube, and wound every shift.On June 30, 2025, 5:10 p.m., during an observation in Resident 2's room with LVN 2, LVN 2 was seen entering Resident 2's room without wearing an isolation gown while providing contact care and administering medication via Resident 2's G-tube.On June 30, 2025, at 5:30 p.m., during an interview with LVN 2, LVN 2 stated she was supposed to Residents Affected - Few (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: 555566 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 555566 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corona Post Acute Center 2600 South Main Street Corona, CA 92882 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)