Health inspection·October 2, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure one of one sampled resident (Resident 8) was treated with dignity by failing to provide privacy while accessing Resident 8's PEG tube (G-tube, a tube inserted through the belly to bring nutrition and/or medications directly to the stomach) during medication administration. This deficient practice resulted in exposure of Resident 8's portion of the abdomen (belly) and had the potential to result in Resident 8's value as human being not respected. Findings: During a review of Resident 8's History and Physical (H&P), dated 12/8/2023, the H&P indicated, Resident 8 had a medical history including +trach (tracheostomy, a surgically created hole [stoma] in your windpipe [trachea] that provides an alternative airway for breathing) to Tbar (a device used in respiratory therapy for weaning a patient from a ventilator) and PEG. During a review of Resident 8's admission Record (AR), the AR indicated, Resident 8 was admitted on [DATE] with chief complaint of pneumonia (a lung infection [refers to an invasion of the body by harmful microorganisms]), UTI (urinary tract infection), and sepsis (serious condition in which the body responds improperly to an infection). During a review of Resident 8's Minimum Data Set (MDS, a federally mandated resident assessment tool), dated 10/2/2024, the MDS indicated, Resident 8's cognitive (ability to think and process information) skills were severely impaired (never/rarely made decisions). The MDS indicated, Resident 8 was dependent (helper does all the effort, resident does none of the effort to complete the activity, or the assistance of 2 or more helpers is required for the resident to complete the activity) for all activities of daily living. The MDS indicated, Resident 8 had a feeding. During a concurrent observation and interview on 10/2/2024 at 9:07 a.m. with Registered Nurse (RN) 1, during medication administration, Resident 8 was in a semi-private room with a roommate. RN 1 drew the privacy curtain between Resident 8's bed and the roommate's bed, RN 1 did not draw the curtain completely and around Resident 8's bed. RN 1 lifted Resident 8's gown and exposed a portion of Resident 8's abdomen. RN 1 accessed Resident 8's G-tube to administer Resident 8's medications. RN 1 stated, RN 1 exposed Resident 8's tummy, stomach, and RN 1 should have pulled the curtain all the way for privacy and to protect Resident 8. During an interview on 10/2/2024 at 11:57 a.m. with the Director of Nursing (DON), the DON stated, Page 1 of 12 555634 555634 10/02/2024 Greater El Monte Community Hos 1701 Santa Anita Avenue El Monte, CA 91733

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few when [staff] accessed a resident's (in general) G-tube, staff had to make sure residents were provided with privacy by pulling the curtain all around the resident and closing the window blinds. The DON stated, residents had a right to privacy and to be provided with dignity. During a review of the facility's policy and procedure (P&P) titled, Gastrostomy & Jejunostomy Site Care, last revised 9/2024, the P&P indicated tube site care would be given daily .the procedures included to provide privacy. During a review of the facility's undated P&P titled, Patient Rights and Responsibilities, included in the facility's admission packet titled Patient Guide, the P&P indicated, patient rights included considerate and respectful care, and to be made comfortable. The P&P indicated residents had the right to respect for their personal values and beliefs. The P&P indicated, having personal privacy respected, case discussion, consultation, examination, and treatment were confidential and should be conducted discreetly. The P&P indicated privacy curtains would be used in semi-private room. 555634 Page 2 of 12 555634 10/02/2024 Greater El Monte Community Hos 1701 Santa Anita Avenue El Monte, CA 91733

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility staff failed to notify the physician for one of three sampled residents (Resident 3) when Resident 3's Gastrostomy-Tube (G-Tube, a tube that is inserted through the abdominal wall and into the stomach to provide nutrition and medication) leaked. This deficient practice resulted in delayed provision of necessary care and services to Resident 3. Findings: During a review of Resident 3's admission Record (AR), the AR indicated the facility admitted Resident 3 on 7/1/2024, with diagnosis including, chronic respiratory failure (long standing condition that occurs when the lungs cannot get enough oxygen into the blood or eliminate enough carbon dioxide [a colorless, odorless gas that's naturally present in the air, essentially a waste product that we breathe out when we exhale] from the body), anoxic brain damage (a complete lack of oxygen to the brain, which results in the death of brain cells after prolonged oxygen deprivation), and ventilator dependent (a serious medical condition that occurs when a patient requires a ventilator [a machine that helps people breathe when they can't breathe on their own] to breathe for all or part of the day and is unable to wean [gradually reduce] off it). During a review of Resident 3's RD [Registered Dietician]-Nutritional assessment dated [DATE], timed 11:23 AM, the assessment indicated Resident 3 had experienced, Wt. [weight] loss in the last month possibly due to leaky GTF [G-tube feeding]. During a review of Resident 3's Minimum Data Set (MDS, a federally mandated resident assessment tool), dated 10/2/2024, the MDS indicated Resident 3's cognition (ability to understand and process information) was severely impaired and Resident 3 was dependent with activities of daily living (ADL, term used in healthcare that refers to self-care activities) and was unable to ambulate (to walk or move without any kind of assistance) due to illness. During an interview and concurrent record review on 10/1/2024 at 3:34 PM, with the Registered Dietician (RD), Resident 3's Patient Progress Notes (PPN) dated 9/3/2024 and amended on 9/7/2024, timed 12:07 PM were reviewed. The RD stated Resident 3's progress notes, dated 9/3/2024 did not indicate the physician was notified about Resident 3's G-tube leakage. The RD stated the expectation was for staff to always report imperative information to the physician accurately and in a timely manner. The RD stated staff should notify the physician when weight loss was related or associated to possible G-tube leakage. Resident 3's Monthly Interdisciplinary Team Conference report was reviewed with the RD, date of review 9/18/2024. The RD stated Resident 3's weight loss was a result of a G-tube leakage and Resident 3's G-tube was changed to a bigger size and the leakage improved. During an interview and concurrent record review on 10/2/2024 at 12:14 PM, with the Director of Staff Development (DSD), Resident 3's PPNs dated 9/3/2024 and amended on 9/7/2024, timed 12:07 PM were reviewed. The DSD stated the DSD's expectation was for staff to report [resident] change in conditions with as much detail as possible to give an accurate report to the physician to avoid serious outcomes and complications to the residents (in general). The DSD stated based on the licensed nurse progress notes the physician was not notified of Resident 3's G-tube leakage when significant weight loss was reported to the physician. The DSD stated the importance of reporting G-tube leakage in a 555634 Page 3 of 12 555634 10/02/2024 Greater El Monte Community Hos 1701 Santa Anita Avenue El Monte, CA 91733

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few timely manner was to prevent loss of nutrients and resident decline, especially when there was significant weight loss. During a review of the facility's P&P titled, Change in Resident Condition/Notification of Changes, approved date 9/2022, the P&P indicated any sudden or serious change in a resident's condition manifested by a marked change in physical, mental, or psychosocial status. a. The licensed nurse in charge will notify the Physician at once with a request for physician visit, recommendations, and/or evaluation. b. If unable to contact the attending physician or alternate physician timely, notify medical director for follow-up to change in resident condition. c. All nursing actions will be documented in the licensed progress notes as soon as possible, including assessment, notifications, actions taken and resident's response. 555634 Page 4 of 12 555634 10/02/2024 Greater El Monte Community Hos 1701 Santa Anita Avenue El Monte, CA 91733

F 0584 Level of Harm - Minimal harm or potential for actual harm Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview, and record review, the facility failed to maintain a clean, sanitary, and homelike environment for six of six sampled residents' (Resident 3, 4, 5, 7, 8, and 9) rooms. Residents Affected - Some This deficient practice had the potential for residents to be exposed to dirt, mold, and drywall dust, which can lead to a decline in the resident's health and result in irritation of the eyes, skin, nose, throat, and lungs. Additionally, prolonged exposure can cause serious problems such as acute (sudden) respiratory illness, persistent coughing, and asthma (narrowed airways in the lungs that make it difficult to breath). Findings: During an observation on 10/2/2024 at 8:41 a.m. in Resident 4 and Resident 8's bathroom, a cracked floor where the floor meets the wall near the toilet and a right-side wall was observed with scraped and chipped paint. During an observation on 10/2/2024 at 8:55 a.m. in Resident 3 and Resident 5's bathroom, behind a round light above the mirror, the wall had missing plaster and paint where a previous light fixture had been removed. Resident 3 and Resident 5's bathroom had chipped paint and scratch marks on adjacent walls and on the door frame casings. During an observation on 10/2/2024 at 8:57 a.m. in Resident 9's bathroom, three walls were observed with multiple peeling paint spots and one wall was observed with a horizontal scratch mark line (over 18 inches in length) near the light switch. During an observation on 10/2/2024 at 8:58 a.m. in Resident 7's bathroom, the following were present: a) a cracked floor near the corner of the wall and to the left side of the bathroom sink. b) underneath the bathroom sink and, on the floor, there was a brown/reddish rust stain. c) above on the ceiling, there was missing plaster and paint where a previous larger light fixture had been removed and a smaller light fixture had been installed. During a concurrent observation and interview on 10/2/2024 at 9:17 a.m., with Certified Nursing Assistant 3 (CNA 3), in Resident 3, 5, 7 and 9's bathroom, CNA 3 stated CNA 3 would report to the charge nurse (unidentified) and the Director of Nursing (DON) any maintenance issues. CNA 3 stated the charge nurse or DON would place an order in the computer to notify the engineering department, responsible for [facility] repairs, plaster, and painting. CNA 3 stated CNA 3 did not know if the repairs needed in bathrooms of Residents 3, 5, 7 and 9, were reported by housekeeping or any other staff. CNA 3 stated CNA 3 did not report any maintenance issues for Residents 3, 5, 7 and 9. During a concurrent observation and interview on 10/2/2024 at 9:34 a.m., with Housekeeping (HK), in Resident 7's bathroom, the HK stated cracked floors and overhead light repairs were done by engineering [department]. The HK stated another housekeeper who worked at night, waxed the floor last week. 555634 Page 5 of 12 555634 10/02/2024 Greater El Monte Community Hos 1701 Santa Anita Avenue El Monte, CA 91733

F 0584 Level of Harm - Minimal harm or potential for actual harm The HK stated the HK did not know when someone reported maintenance issues, but any staff member could report maintenance issues. The HK stated the HK did not report the cracked floor or overhead light repair maintenance issue. The HK stated when a resident's (in general) bathroom had floor cracks, chipped paint, or wall damage, it should be repaired because it could gather dirt or debris and it was not safe for residents. Residents Affected - Some During a concurrent observation and interview on 10/2/2024 at 10:02 a.m., with Environmental Services Manager (EM), in Resident 3, 5, 7 and 9's bathroom, the EM stated the EM rounded daily and asked the manager or charge nurse for any issues in the unit that needed to be addressed. The EM stated the EM did not keep a log or track daily rounds; the EM let Engineering know right away so it could be corrected on the spot. The EM stated in Resident 7's bathroom there was a brown/reddish rust stain on the floor underneath the sink. The EM stated the rust stain on the floor was darker and the EM cleaned it in March of this year, but the stain only faded to light brown/reddish. The EM stated the bathroom floor needed to be redone because it was not clean. The EM stated the EM was unsure if the floor crack was reported to Engineering, and the crack should be fixed because it would accumulate a lot of dirt in the crack and was a safety risk to the residents. During a concurrent interview and record review on 10/2/2024 at 10:38 a.m., with the Facilities Manager (FM), the Engineering Department's Work Order Submission, dated June to September 2024 was reviewed. The FM stated subacute staff was usually good at reporting all issues that needed to be addressed by Engineering. The FM stated there were no work order requests for repair work in Residents 3, 4, 5, 7, 8, and 9's bathrooms. The FM stated maintenance issues such as cracked flooring, patching, and painting were issues that should be addressed because a cracked floor could cause a resident to slip and fall. The FM stated chipped or peeling paint on the walls could cause breathing problems for the residents. During a review of the facility's policy and procedure (P&P) titled, Work Orders -ENG 1.01, dated May 2022, the P&P indicated, Scope: It is the policy of [the facility] to maintain the [facility] in a safe operating condition. The P&P further indicated, It is the responsibility of the Engineering Department to keep the [facility] in a safe and efficient operating condition at all times . During a review of the facility's undated Mission Statement (included in the admission packet given to the resident/family members), the statement indicated, Our mission is to provide quality healthcare in a safe environment that is sensitive and supportive to the physical, emotional, spiritual, and diverse multicultural needs of our patients and their loved ones. The statement indicated [the facility] would advocate the preservation of human dignity in the delivery of services and programs. 555634 Page 6 of 12 555634 10/02/2024 Greater El Monte Community Hos 1701 Santa Anita Avenue El Monte, CA 91733

F 0695 Provide safe and appropriate respiratory care for a resident when needed. 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 one of ten sampled residents (Resident 9), received proper respiratory (relating to breathing) care such as oxygen (02 [a colorless, odorless, tasteless gas essential for living]) therapy to meet Resident 9's needs in accordance with the physician's order and the facility's policy and procedure (P&P) titled, Oxygen Therapy,. Residents Affected - Few This failure resulted in a lower level of 02 therapy delivered to Resident 9 and had the potential to result in hypoxia (low levels of 02 in your body) and the potential to compromise Resident 9's respiratory status and result in respiratory distress. Findings: During a review of Resident 9's History and Physical (H&P), dated 12/8/2023, the H&P indicated, Resident 9's assessment included respiratory failure on trach (tracheostomy, a surgically created hole [stoma] in your windpipe [trachea] that provides an alternative airway for breathing) to vent (ventilator, a machine that helps you breathe or breathes for you). The H&P indicated Resident 9 was alert and able to communicate by nodding/shaking head. During a review of Resident 9's admission Record (AR), the AR indicated, Resident 9 was admitted to the facility on [DATE] with chief complaints that included chronic (persisting for a long time) respiratory failure and severe cervical myelophathy (the spinal cord in the neck is compressed). During a review of Resident 9's Physician's Nursing Orders (PNO), dated 9/30/2024, the PNO indicated, an order to wean (gradual process of decreasing) per protocol c/o RT as tolerated. During a review of Resident 9's Cardiopulmonary Patient Progress Notes, (PNC, Respiratory Therapist's [RT] notes), dated 9/30/2024 timed at 3:41 p.m., the PNC indicated, Resident 9 was placed on a t-bar (a device used in respiratory therapy for weaning a patient from a ventilator) on 8L/min (liters per minute, 02 flow rate) and 35% Fi02 (fraction of inspired oxygen, 02 percentage, an estimation of the oxygen content a person inhales). During a review of Resident 9's PNC dated 10/1/2024 timed at 3:23 a.m., the PNC indicated, Resident 9 was on 35% Fi02. The note did not indicate how many L/min. During a review of Resident 9's PNC dated 10/1/2024 timed at 7:38 a.m., the PNC indicated, Resident 9 was on 35% Fi02 and did not indicate how many L/min. The PNC indicated, Resident 9 stated it was too much air from the cool aerosol and the RT wanted to increase the liters to 8L but Resident 9 stated, no. During a review of Resident 9's Minimum Data Set (MDS, a federally mandated resident assessment tool), dated 10/2/2024, the MDS indicated, Resident 9's cognitive (ability to think and process information) status was moderately impaired. The MDS indicated, Resident 9 was dependent (helper does all the effort, resident does none of the effort to complete the activity, or the assistance of 2 or more helpers is required for the resident to complete the activity) for all activities of daily living. The MDS indicated, Resident 9 was received oxygen while a resident at the facility. During a review of Resident 9's PNO, dated 10/2/2024, the PNO indicated, an order, T-Bar 28% at 555634 Page 7 of 12 555634 10/02/2024 Greater El Monte Community Hos 1701 Santa Anita Avenue El Monte, CA 91733

F 0695 night. Level of Harm - Minimal harm or potential for actual harm During a concurrent observation, interview, and record review on 10/1/2024 at 8:17 a.m. with Registered Nurse (RN) 1, Resident 9 was asleep with Resident 9's t-bar was connected to Aquapak (brand name) nebulizer (small machine that turns liquid medicine into a mist that can be easily inhaled) with the adaptor set at 35% Fi02 oxygen concentration and the flowmeter set at 5L/min. The adaptor set indicated the different 02 flow rate with the corresponding 02 percentage. The adapter set indicated 8 LPM for 35 (%). RN 1 stated, RN 1 did not know why the flowmeter was set at 5 and stated the flowmeter should be set at 8. RN 1 stated RN 1 thought the RT (unnamed) titrated (adjusted the amount of 02 a patient receives) the 02. Residents Affected - Few During a concurrent observation and interview on 10/1/2024 at 8:30 a.m. with the RT, Resident 9 was asleep with Resident 9's t-bar connected to the Aquapak nebulizer with the adaptor set at 35% Fi02 and the flowmeter set at 5L. The RT stated the 02 flowmeter was at 5L and the flowmeter was supposed to be set at 8L. The RT stated, the RT who worked last night (unnamed) decreased the 02 flowmeter from 8L to 5L because Resident 9 said it was too much. The RT stated the RT knew the [physician's] order was for 35% (Fi02). The RT stated it was important to have the right oxygen liter flow rate for Resident 9 to get the full 35% (Fi02) and the RT would get a doctor's order to titrate the O2 flowmeter to 28% (Fi02). During a review of the nebulizer adaptor instruction sheet IS, manufacture date 4/4/2024, and the nebulizer adaptor enclosed in the packet, the IS indicated, instructions included setting to the desired oxygen concentration and turning flowmeter on to desired setting. The nebulizer adaptor indicated arrow set to 35 with 8 LPM. During a review of the facility's P&P titled, Oxygen Therapy, revised 3/2009, the P&P indicated, it was the policy of the facility for oxygen therapy to be administered as ordered by the physician. The P&P indicated to set oxygen flow rate as ordered or oxygen percentage (if trach) as ordered. 555634 Page 8 of 12 555634 10/02/2024 Greater El Monte Community Hos 1701 Santa Anita Avenue El Monte, CA 91733

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** b.During a review of Resident 9's History and Physical (H&P), dated 12/8/2023, the H&P indicated, Resident 9's assessment included respiratory failure on trach (tracheostomy, a surgically created hole [stoma] in your windpipe [trachea] that provides an alternative airway for breathing) to vent (ventilator, a machine that helps you breathe or breathes for you). The H&P indicated Resident 9 was alert and able to communicate by nodding/shaking head. Residents Affected - Some During a review of Resident 9's admission Record (AR), the AR indicated, Resident 9 was admitted to the facility on [DATE] with chief complaints that included chronic (persisting for a long time) respiratory failure and severe cervical myelophathy (the spinal cord in the neck is compressed). During a review of Resident 9's Minimum Data Set (MDS, a federally mandated resident assessment tool), dated 10/2/2024, the MDS indicated, Resident 9's cognitive (ability to think and process information) status was moderately impaired. The MDS indicated, Resident 9 was dependent (helper does all the effort, resident does none of the effort to complete the activity, or the assistance of 2 or more helpers is required for the resident to complete the activity) for all activities of daily living. The MDS indicated, Resident 9 was received oxygen while a resident at the facility. During a review of Resident 10's H&P, dated 3/16/2024, the H&P indicated, Resident 10 had a medical history including asthma, COPD and ventilator (a machine that helps you breathe or breathes for you) dependency. The H&P indicated, Resident 10 had developmental delay and did not follow commands. During a review of Resident 10's AR, the AR indicated Resident 10 was admitted to the facility on [DATE] with chief complaint that included respiratory failure, COPD (chronic obstructive pulmonary disease, a group of lung diseases that block airflow and make it difficult to breathe), asthma (a condition in which a person's airways become inflamed, narrow and swell, and produce extra mucus, which makes it difficult to breathe), seizure (a sudden, uncontrolled burst of electrical activity in the brain) and septic shock (a widespread infection causing organ failure and dangerously low blood pressure). During a review of Resident 10's MDS, dated 10/2/2024, the MDS indicated, Resident 10's cognitive (ability to think and process information) skills for daily decision making were severely impaired (never/rarely made decisions.) The MDS indicated, Resident 10 was dependent for all activities of daily living. c. During a review of Resident 1's H&P, dated 12/7/2023, the H&P indicated, Resident 1's assessment included chronic (long standing) respiratory failure, leukocytosis (a high level of white blood cells in the blood), rule out sepsis (serious condition in which the body responds improperly to an infection), and multiple pneumonias. During a review of Resident 1's AR, the AR indicated, Resident 1 was admitted to the facility on [DATE] with chief complaints of respiratory failure, cerebral palsy (a congenital disorder of movement, muscle tone, or posture caused by damage that occurs to the developing brain), HTN (hypertension, high blood pressure) and GERD (gastroesophageal reflux disease, acid reflux, digestive disorder that occurs when acidic stomach juices, or food and fluids back up from the stomach into the esophagus [muscular tube through which food passes from the throat to the stomach]). 555634 Page 9 of 12 555634 10/02/2024 Greater El Monte Community Hos 1701 Santa Anita Avenue El Monte, CA 91733

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a review of Resident 1's MDS, dated 10/2/2024, the MDS indicated, Resident 1's cognitive (ability to think and process information) skills for daily decision making were severely impaired. The MDS indicated, Resident 10 was dependent for all activities of daily living. During a review of Resident 2's H&P, dated 12/8/2023, the H&P indicated, Resident 2's assessment included sepsis, multiple pneumonias and tracheostomy status. During a review of Resident 2's AR, the AR indicated, Resident 2 was admitted to the facility on [DATE] with chief complaints of anoxic encephalopathy (brain damage from a lack of oxygen to the brain). During a review of Resident 2's MDS, dated 10/2/2024, the MDS indicated, Resident 1's cognitive (ability to think and process information) status was not completed. The MDS indicated, Resident 2 was dependent for all activities of daily living. During an observation on 9/30/2024 at 9:03 a.m. in Resident 9's room, an IV pole was stored inside Resident 9's restroom. During a concurrent observation and interview on 9/30/2024 at 9:12 a.m. with the Registered Nurse Supervisor (RNS), Resident 1 and 2's restroom had a red trash can with a label that indicated Biohazard kept inside. The trash can was full, and the lid not closed. The RNS stated, the trash can was full. The RNS stated, the trash can was used for dirty canisters, Foley (a tube that helps drain urine from the bladder into a collection bag), you don't know what kind of virus (infectious agent), germs [are] inside and stated this was a safety issue. The RNS stated, the trash can should be kept closed for the safety of the staff and the RNS would call housekeeping right away to change the trash can. During a concurrent observation and interview on 9/30/2024 at 9:36 a.m. with the RNS, there were two IV poles stored inside Resident 10's restroom. The RNS stated, IV poles should not be stored inside the restroom and should be kept in the storage room inside the nursing station for infection control [purposes]. During an interview on 9/30/2024 at 12:10 p.m. with the Housekeeping (HK), the HK stated, the red biohazard trash cans were kept in the restroom's and should always be closed because it (red trash biohazard can) was a dirty thing, sometimes there's blood, canisters and should be changed when full. The HK stated, IV poles were supposed to be clean and placed in the utility room and it was not okay to leave it (IV pole) inside the resident's restroom when they not in used, for infection control. During an interview on 10/2/2024 at 3:02 p.m. with the Infection Preventionist (IP), the IP stated, all medical equipment device including IV poles were stored in the facility's central medical device storage and it was not okay to store them in the resident's restroom for infection control. The IP stated, the biohazard trash cans had potential contagious or infectious materials and should always be closed for infection control and safety [purposes]. During a review of the facility's policy and procedure (P&P) titled, Equipment Supplies and Space, last reviewed 9/2022, the P&P indicated, a storage space for equipment and supplies where they can be maintained in a secured, clean, and orderly fashion were essential to maintaining the goal of improving the quality of life for each resident. 555634 Page 10 of 12 555634 10/02/2024 Greater El Monte Community Hos 1701 Santa Anita Avenue El Monte, CA 91733

F 0880 Level of Harm - Minimal harm or potential for actual harm During a review of the facility's P&P titled, Biohazard Waste Removal, revised 9/2022, the P&P indicated, to keep the interior of the hospital as free of this material as possible, thereby minimizing the potential for cross contamination. The P&P indicated, biohazard waste collection vehicles shall be labeled as such, be rigid containers with tight fitting lids and full biohazard waste collection vehicles are removed and transported to an approved storage area and a clean empty container is replaced. Residents Affected - Some During a review of the facility's P&P titled, Infection Prevention & Control, latest revised date 7/2024, the P&P indicated, some of the goals were limiting unprotected exposure to pathogens throughout the hospital, minimizing the risk of transmitting infections with the use of procedures, medical equipment and medical devices and maintaining a sanitary environment to avoid sources and transmission of infections and communicable diseases. Based on observation, interview, and record review, the facility failed to implement infection control protocols for 8 of eleven sampled residents (Resident 1, 2, 3, 5, 7, 9, 10, and 11) by failing to: a. Ensure that Enhanced Barrier Precautions (EBP, gown and glove use during high-contact resident care activities for residents known to be colonized or infected with a MDRO [a germ resistant to many antibiotics] as well as those at increased risk of MDRO acquisition, e.g., residents with wounds or indwelling [inside your body] medical devices) were implemented and applied for Residents (2, 3, 5, 7, and 11) who had indwelling medical devices (a medical device that remains inside the body and provides a direct path for pathogens [any organism that causes disease] to enter the body and cause infection) and who were at risk for acquiring Multi-Drug Resistant Organisms (MDRO, bacteria that have become resistant to certain antibiotics). b. Resident 9 and Resident 10's restroom had IV (intravenous, within a vein) poles (devices that keep IV bags full of medicine or fluid in place) stored inside Resident 10's restroom. c. Resident 1 and Resident 2's shared restroom had a red trash can with a label that indicated Biohazard (substance that poses a threat [or is a hazard] to the health of living organisms, primarily humans) that was full, and the lid was not closed. These failures had the potential to spread pathogens (any organism that causes disease) and result in cross contamination (process by which bacteria can be transferred from one area to another) among healthcare workers and residents and compromise Residents 1, 2, 3, 5, 7, 9, 10, and 11's well-being. Findings: a. During an observation on 10/2/2024 at 8 AM, Licensed Vocational Nurse 2 (LVN 2) administered medications for Resident 3 via Gastrostomy-Tube (G-tube, a tube that is inserted through the abdominal wall and into the stomach to provide nutrition and medication) without donning a gown. During an observation on 10/2/2024 at 08:35 AM, LVN 2 administered medications for Resident 7 via G-tube without donning a gown. During an observation on 10/2/2024 at 08:49 AM, LVN 2 administered medications for Resident 5 medications via G-tube without donning gown. 555634 Page 11 of 12 555634 10/02/2024 Greater El Monte Community Hos 1701 Santa Anita Avenue El Monte, CA 91733

F 0880 Level of Harm - Minimal harm or potential for actual harm During an observation on 10/2/2024 at 09:04 AM, LVN 2 administered medications for Resident 11 via G-tube without donning a gown. During an observation on 10/22/2024 at 09:15 AM, LVN 2 administered medications for Resident 2 via G-tube without donning a gown. Residents Affected - Some During an observation on 10/22/2024 at 10:30 AM, the facility had no EBP signs posted on resident's room doors or the perimeter. During an interview on 10/2/2024 at 11:10 AM, the Infection Preventionist (IP) Nurse stated the IP's expectation was for all staff to wear proper PPE, such as a gown, during medication administration via G-tube due to the high potential risk of bodily fluid exposure. The IP Nurse stated all residents on the unit have indwelling medical devices. The IP Nurse stated the facility should have implemented EBP standards across the unit. The IP Nurse stated EBP ensures staff reduce the risk of MDRO transmission. The IP nurse stated visitors and family members should follow EBP when participating in high-contact care activities for residents on EBP. The IP Nurse stated the facility should have ensured that all staff members have a clear knowledge of EBP practices and are in accordance with the Center for Disease Control and Prevention (CDC) EBP guidelines. The IP nurse stated the facility tries to keep up with CDC guidelines and always seek guidance from the Los Angeles County Department of Public Health regarding changes in Infection Prevention and Control practices and guidelines. During a review of Centers for Disease Control and Prevention (CDC, national public health agency of the United States), guidelines titled, Implementation of Personal Protective Equipment (PPE, protective clothing or equipment, designed to protect the wearer from injury or the spread of infection or illness) Use in Nursing Homes to Prevent Spread of Multidrug-resistant Organisms (MDROs),dated 4/2/2024, the guideline's key points indicated, multidrug-resistant organism transmission is common in skilled nursing facilities, contributing to substantial resident morbidity and mortality, EBP may be indicated (when Contact Precautions do not otherwise apply) for residents with any of the following: wounds or indwelling medical devices, regardless of MDRO colonization status, and effective implementation of EBP requires staff training on the proper use of personal protective equipment (PPE) and the availability of PPE. The guideline indicated expand the use of PPE and refer to the use of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDROs to staff hands and clothing. 555634 Page 12 of 12