Health inspection·February 22, 2024

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 follow infection control practices for the Corona Virus 19 precaution (guidelines recommended by the Centers for Disease Control and Prevention for reducing the risk of the Corona Virus 19 [COVID-19, a respiratory illness that can spread from person to person] infection) for residents and staff when staff did not wear appropriate personal protective equipment (PPE, equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses) for COVID-19 positive confirmed resident and COVID-19 exposed (having contact or close contact to an individual with confirmed or suspected COVID-19) resident (Residents 1 and 2). This failure had the potential to spread COVID-19 throughout the facility. Residents Affected - Few Findings: During an interview on 2/22/2024 at 9:10 a.m. with the Assistant Director of Nursing (ADON), he stated that Resident 1 was confirmed COVID-19 positive this morning, and Resident 2 was exposed to COVID-19 as her roommate. The ADON stated that the facility started COVID-19 precautions for Resident 1 and 2. The ADON further stated that staff and visitors should wear appropriate PPE, which was a N95 mask (a respiratory protective device), gown, gloves, and face shield, before entering the room. A review of Resident 1's physician's order dated 2/22/2024 indicated Isolation with Droplet precautions related to COVID-19 + for 10 days. A review of Resident 2's physician's order dated 2/22/2024 indicated Isolation with Droplet precautions related to Exposure to COVID-19 + for 10 days. During an observation on 2/22/2024 at 10:15 a.m., there was signage for Droplet precautions and PPE and a container with PPE next to Resident 1 and 2's room door. During an observation on 2/22/2024 at 10:18 a.m., CNA A was in Resident 1 and 2's room without appropriate PPE, she was only wearing a surgical mask. During an interview on 2/22/2024 at 10:20 a.m. with CNA A, she confirmed the observation and stated she was assigned to Residents 1 and 2. CNA A stated she was not aware that Resident 1 was confirmed to be COVID-19 positive and on COVID-19 precaution. CNA A stated she saw signage for droplet precautions and PPE, as well as a container with PPE next to the room door, but did not pay attention. CNA A further stated that she forgot to check with her charge nurse. During an observation and interview on 2/22/2022 at 10:22 a.m. with the ADON, he confirmed the above observation. The ADON acknowledged that CNA A should have worn appropriate PPE, which was a N95 mask, gown, gloves, and face shield, while in the resident room on COVID-19 precaution. The ADON Page 1 of 2 555792 555792 02/22/2024 Sunnyvale Post-Acute Center 1291 S Bernardo Avenue Sunnyvale, CA 94087

F 0880 further stated that CNA A should have been informed about Resident 1's COVID-19 positive confirmation. Level of Harm - Minimal harm or potential for actual harm Review of the facility's policy and procedure titled Coronavirus Disease 2019 (COVID-19) Mitigation Plan, updated 1/15/2023, indicated PPE: signs are posted outside of resident rooms indicating appropriate infection control and prevention precautions and required PPE in accordance with CDPH guidance. The facility will ensure confirmed COVID-19 positive residents are placed on quarantine or isolation. The Administrator or DON or Designee is responsible for communication with staff, residents and their family as indicated. Residents Affected - Few 555792 Page 2 of 2