Health inspection·August 30, 2023

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On August 30, 2023, at 9:45 a.m., an interview was conducted with LVN 2. She stated she worked as a treatment nurse and cared for residents who were COVID-19 positive prior to and after August 23, 2023. She stated she had not been tested yet for COVID-19 since her shift started this morning. On August 30, 2023, at 10:31 a.m., an interview was conducted with Certified Nursing Assistant (CNA) 1. He stated he worked and cared for residents on August 23 to 25, of 2023. He stated he was off for several days after August 25, 2023, and returned to work today. He stated he had not been tested for COVID-19 when he worked on August 23 to 25, 2023, and since he started his shift this morning. On August 30, 2023,at 10:45 a.m., the Infection Preventionist (IP) was interviewed. She stated the facility had COVID-19 outbreak started on August 23, 2023. She stated a line listing of residents and staff who were exposed to the COVID-19 positive residents and staff should have been initiated to prioritize testing for COVID-19. She stated there was no documentation a line listing of exposed staff was initiated after the onset of COVID-19 on August 23, 2023. She stated the facility's current COVID-19 testing plan for staff and residents was to be done twice weekly which started on August 28, 2023. The current CDC guidance for testing of staff after an outbreak was identified was reviewed with the IP. In a concurrent interview witht the IP, she stated the staff should have been tested for COVID-19 24 hours after exposure to a COVID-19 positive case, 3rd day post exposure and another one on the 5th day post exposure. On August 30, 2023, at 11 a.m., an interview was conducted with CNA 2. She stated she worked and cared for residents who were COVID-19 positive prior and after August 23, 2023. She stated she got tested for COVID -19 on August 28, 2023. On August 30, 2023, a review of the undated document titled COVID-19 Testing Information, was conducted. The documented indicated the following: · Residents A, B, C, D, and E tested positive for COVID-19 on August 23, 2023. · Resident F tested COVID-19 positive on August 24, 2023. There was no documented evidence testing for healthcare personnel was conducted after August 23 or 24, of 2023. On August 30, 2023, an interview was conducted with the Director of Nursing (DON) and the Infection Preventionist (IP). The DON and the IP stated the HK tested positive for COVID-19 on August 23, 2023 and worked several days prior to testing positive. The DON stated one or more confirmed positive case of COVID-19 either for residents or staff must be reported to the California Department of Public Health (CDPH) within 24 hours from the time the outbreak in the facility was identified. The DON stated this was not done according to the facility's policy and or according to the state requirement for reporting of an outbreak in the facility. The DON and IP stated testing for healthcare personnel was not done until August 28, 2023 (five days after initial outbreak in the facility on August 23, 2023). The DON and IP stated testing of healthcare personnel (HCP) should have been started immediately and 24 hours from the time outbreak in the facility was identified. The DON and IP stated this was not done according to the facility's policy of adhering to the current CDC's guideline for testing requirements for HCP during COVID-19 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555613 If continuation sheet Page 2 of 3 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 555613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/30/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Grove Care and Wellness 3401 Lemon Street Riverside, CA 92501 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)

F 0880 outbreak. Level of Harm - Minimal harm or potential for actual harm The facility's policy and procedure titled, Infection Prevention and Control Program, dated May 2023, indicated, .Reporting: When and to whom possible incident of communicable disease or infections should be reported. It is the policy that the facility will follow state reporting requirements on which communicable disease will be reported to the local/state authorities . Residents Affected - Some The facility's policy and procedure titled, COVID-19 Testing, dated October 2022, was reviewed. The document indicated, .It is the policy of this facility to provide or obtain laboratory testing services for residents and staff to assist in the identification and management of SARS-CoV-2 (COVID-19) infections and/or outbreaks. This testing will be performed according to current to current local/state health departments and Centers for Disease Control and Prevention guidelines . According to the Center of Disease Control (CDC) guideline titled, Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, dated May 8, 2023, indicated, .Responding to a newly identified SARS-CoV-2-infected HCP or resident .A single new case of SARS-CoV-2 infection in any HCP or resident should be evaluated to determine if others in the facility have been exposed .Perform testing for all residents and HCP identified as close contacts or on the affected unit(s) if using a broad approach, regardless of vaccination status. Testing is recommended immediately (but not earlier than 24 hours after exposure) and, if negative, again 48 hours after first negative test and, if negative again, again in 48 hours after the second negative test. This will typically be at day 1 (where day of exposure is day 0), day 3, and day 5. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555613 If continuation sheet Page 3 of 3