Health inspection·March 3, 2022

§483.80 Infection Control The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. § 72523. Patient Care Policies and Procedures. (a)Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. These deficient practices were identified during a Recertification survey conducted 1/19/2022 through 1/22/2022. The facility failed to implement acceptable infection control practices to prevent the spread and transmission of coronavirus (COVID-19, a potentially severe respiratory illness caused by a coronavirus and characterized by fever, coughing, and shortness of breath) for seven of 13 sampled residents (Residents 1, 6, 9, 17, 20, 31, 48). The facility failed to: A. Ensure a Certified Nurse Assistant (CNA 1) wore gown and gloves while in Residents 1's and Resident 17's room, who were residing in the yellow zone (zone for residents who are mixed quarantine or symptomatic) to prevent transmission of COVID-19 infection. B. Ensure CNA 1, who was designated to work in the red zone, remained in the red zone (zone for residents that are COVID-19 positive) and was not going to a yellow zone after providing care to Resident 6, 9, 20, 31 and 48, in the red zone. C. Ensure the Maintenance Director (MD) was not going from a red zone to a yellow zone while wearing personal protective equipment [(PPE) equipment designed to protect the wearer from the spread of infection or illness]- used to transfer Resident 31 on bed to the red zone. D. Ensure the Administrator (ADM) and Physical Therapy Assistant (PTA 1) wore a face-shield while in the yellow zone to prevent transmission of COVID-19 infection. These failures placed residents 1, 6, 9, 17, 20, 31, 48, staff, visitors, and the community at a high risk for cross contamination and increased spread of COVID-19 infection. On 1/20/2022, at 5:10 p.m., the Immediate Jeopardy ([IJ] a situation in which the provider's non-compliance with one or more requirements of participation had caused or was likely to cause serious injury, harm, impairment, or death to a resident) related to the facility’s failure to implement acceptable infection control practices was called in the presence of the ADM and the Director of Nursing (DON). On 1/21/2022, at 4:16 p.m., the ADM and DON were informed the IJ situation was removed after implementation of an acceptable IJ removal plan ([IJRP] a detailed plan outlining actions needed to reach one or more goals) was verified onsite through observation, interview, and record review. A. During a review of Resident 1's admission record, the record indicated Resident 1 was readmitted to the facility on 5/6/2020 with diagnoses that included quadriplegia (paralysis of all four limbs), hypertension [(HTN) high blood pressure], and kidney failure (a condition in which the kidneys lose the ability to filter waste products from blood). During a review of Resident 1 's Minimum Data Set [(MDS), a standardized assessment and care-screening tool], dated 10/18/2021, the MDS indicated Resident 1 had no impairment in cognitive (ability to learn, remember, understand, and make decision) skills for daily decision making, required extensive assistance with bed mobility, dressing, and personal hygiene, and was totally dependent on staff for transfers, toileting, and bathing. During a review of Resident 17's admission record, the record indicated Resident 17 was readmitted to the facility on 6/1/2016 with diagnoses that included cerebrovascular accident [(CVA) damage to the brain from interruption of its blood supply], Type 2 diabetes mellitus (a condition in which the body fails to metabolize (process) glucose (sugar) correctly), hypertension (high blood pressure), bipolar disorder (a mental condition marked by alternating periods of elation [extreme happiness], and depression). During a review of Resident 17 's MDS, dated 11/29/2021, the MDS indicated Resident 17 had no impairment in cognitive (ability to learn, remember, understand, and make decision) skills for daily decision making, required extensive assistance with bed mobility, dressing, and personal hygiene, and was totally dependent on staff for transfers, toileting, and bathing. During an observation on 1/19/2022, at 12:47 p.m., in the yellow zone, in the east hall adjacent to nursing Station 2, CNA1 was observed entering Resident 1 and Resident 17's room without donning a gown and gloves. CNA1 was observed entering Resident 1 and Resident 17's room with a lunch tray. CNA1 was then observed exiting Resident 1 and Resident 17's room, retrieving another lunch tray from the metal tray cart in the yellow zone, and re-entering Resident 1 and Resident 17's room without donning gown and gloves. During an interview on 1/19/2022, at 12:50 p.m., CNA1 stated when entering the room in the yellow zone she wore a face shield and a N95 (protective device designed to achieve a close facial fit and filters 95% of airborne particles) mask. CNA1 stated she did not put on gown and gloves because she wanted to distribute the lunch trays quickly. CNA1 stated she was aware of the PPE signs posted outside each resident's room indicating the required PPE before entering the room. CNA1 stated it was important to wear required PPE to prevent the spread of COVID-19 infection to residents and staff. During an interview on 1/21/2021, at 1:46 p.m., the Infection Preventionist (IP) 1 stated due the COVID-19 outbreak staff and visitor entering the facility must wear a face shield and N95 mask. IP 1 stated it is the facility's policy that all staff who was entering a residents' room must also wear gown and gloves in both the yellow and red zones. IP 1 stated it is important to wear the required PPE when entering a resident's room to prevent the spread of pathogens (bacteria, virus, or other microorganism that can cause disease) on clothes which can put resident, staff, and the community at risk of developing COVID-19 infection. During an interview on 1/22/2021, at 3:40 p.m., the DON stated staff was required to wear full PPE, including gown, gloves, face shield, and N95 mask when entering a resident's room in both the yellow and red zones. DON stated to prevent the spread of COVID-19 staff should not enter a resident's room without wearing the proper PPE. A review of the facility's Mitigation Plan (MP), dated 1/10/2022 indicated the facility will train staff on selecting, donning, and doffing appropriate PPE. Signage indicating the required PPE will be posted immediately outside the resident's room indicating appropriate infection control and prevention precautions and required PPE in accordance with California Department of Public Health (CDPH) guidance. The MP indicated the facility will implement a staffing plan to limit transmissions during an outbreak and have dedicated consistent staffing team who directly interacts with residents that are Covid-19 positive. During a review of All Facilities Letter (AFL) 20-74.1 CDPH, Healthcare-Associated Infections Program COVID-19 PPE, Resident Placement/Movement, and Staffing Considerations by Resident Category, dated 7/22/2021, the AFL indicated gowns and gloves must be worn upon room entry in the yellow and red zones. According to the website https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html healthcare personnel must use personal protective equipment appropriately, including gloves and gown. Wear a gown and gloves for all interactions that may involve contact with a resident or a resident's environment. Donning PPE upon room entry and properly discarding it before exiting a resident room is done to contain pathogens. B. During a review of Resident 31's admission record, the record indicated the resident was readmitted to the facility on 7/23/2021 with diagnoses that included seizures (disorder in which nerve cell activity in the brain is disturbed, causing seizures, schizophrenia (a serious mental illness that affects how a person thinks, feels, and behaves), Type 2 diabetes mellitus (a condition in which the body fails to metabolize (process) glucose (sugar) correctly), and acquired COVID-19 on 1/17/2022. During a review of Resident 31's MDS, dated 9/9/2021, the MDS indicated the resident had severe impairment in cognitive (ability to learn remember, understand and decisions) skills for daily decision making, required supervision with eating, extensive assistance with bed mobility, transfers, dressing, personal hygiene, and was totally dependent with toileting and bathing. During a review of Resident 48's admission record, the record indicated the resident was admitted to the facility on 7/9/2021 with diagnoses that included chronic obstructive pulmonary disease ([COPD] progressive disease that makes it hard to breath), glaucoma (a group of eye conditions that can cause blindness), hypertension [(HTN) high blood pressure], osteoarthritis (type of arthritis that occurs when flexible tissue at the ends of bones wears down) and acquired COVID-19 on 1/17/2022. During a review of Resident 48's MDS, dated 1/12/2022, the MDS indicated the resident had moderately impaired cognitive skills for daily decision making, required supervision from staff with bed mobility, transfers, walking in room, dressing, eating, and toileting and needed limited assistance from staff with personal hygiene, and required extensive assistance from staff with bathing. During a review of the Resident 6's admission record, the record indicated the resident was admitted to the facility on 5/13/2021 with diagnoses including Type 2 diabetes mellitus (a condition in which the body fails to metabolize (process) glucose (sugar) correctly), essential hypertension (high blood pressure), schizoaffective disorders (mental health condition), and unspecified asthma (condition in which airways become inflamed, narrow and swell, and produce extra mucus, which makes it difficult to breathe). During a review of Resident 6 's MDS, dated 2/5/2021, the MDS indicated the resident had an intact cognitive skill for daily decision making and required staff supervision with bed mobility, transfer, dressing, walk in corridor, toilet use, personal hygiene, and bathing. During a review of the Resident's 9 Admission record, the record indicated the resident was admitted to the facility on 10/6/2021 with diagnoses including sepsis (presence of harmful microorganisms in the blood), chronic obstructive pulmonary disease ([COPD] progressive disease that makes it hard to breath), type 2 diabetes mellitus (a condition in which the body fails to metabolize (process) glucose (sugar) correctly). During a review of Resident 9 's MDS, dated 11/24/2021, the MDS indicated the resident had intact cognitive skills for daily decision making and required extensive assistance from staff with bed mobility, dressing, personal hygiene, and was totally dependent on staff for toilet use and bathing. During a review of Resident 20's admission record, the record indicated Resident 20 was readmitted to the facility on 6/30/2021 with diagnoses that included dementia (a decline in memory, language, problem-solving and other thinking skills that affect a person's ability to perform everyday activities), seizures (disorder in which nerve cell activity in the brain is disturbed, causing seizures, schizophrenia (a serious mental illness that affects how a person thinks, feels, and behaves), and hypertension [(HTN) high blood pressure]. During a review of Resident 20 's MDS), dated 11/29/2021, the MDS indicated the resident had severe impairment in cognitive skills for daily decision making, required extensive assistance from staff with bed mobility, eating, and toileting, and was totally dependent on staff for transfer, dressing, personal hygiene, and bathing. During an interview on 1/19/2022 at 11:00 a.m., IP 2 stated the facility received COVID-19 response testing (twice a week covid testing of residents and staff) results dated, 1/17/2022 and Residents 31, and 48 were tested positive. IP 2 stated Resident 31, and 48 will remain in their rooms and PPE and red zone signage will be posted on their doors. IP 2 stated she will contact the facility's assigned Public Health Nurse (PHN) for guidance on room change. During an observation on 1/19/2022, at 1:23 p.m. in the East hallway, CNA1 was observed entering Resident 9's and Resident 48's room in the red zone wearing a full PPE. At 1:25 p.m. CNA 1 was observed exiting Resident 9's and Resident 48's room in the red zone. CNA1 removed her gown and gloves before exiting the resident's room and went to the nursing station where she washed her hands. On 1/19/2022, at 1:31 p.m. CNA1 was observed entering Resident 20's and Resident 31's room in the red zone wearing full PPE. At 1:35 p.m. CNA1 was observed exiting Resident 20's and Resident 31's room in the red zone. CNA1 removed her gown and gloves before exiting the residents' room and proceeded to the nursing station where she washed her hands. During a concurrent observation and interview on 1/19/2022, at 1:38 p.m. on the East hallway, CNA1 was observed re-entering Resident 20's room wearing full PPE. CNA1 stated she was going to feed Resident 20 and would be in the room for a while. CNA1 was observed entering Resident 20's room with a lunch tray. On 1/19/2022, at 2:30 p.m. in the east hallway, CNA1 was observed exiting a yellow zone room holding a dirty linen after caring for Residents 9, 20, 31, and 48, in the red zone. During an observation on 1/19/2022, at 2:38 p.m. in the East hallway, CNA1 was observed entering Resident 6's room in the yellow zone holding a clean linen after she previously was caring for Residents 9, 20, 31, and 48, in the red zone. During an interview on 1/21/2022, at 1:46 p.m., IP 1 stated when staff assigned to the red zone they are designated to work only in that area and cannot care for the residents in the yellow zone. IP 1 stated staff can start their day in the yellow zone and end their day in the red zone, but after being in the red zone staff cannot return to the yellow zone. Going from the red zone to the yellow zone staff are placing both the residents and other staff at risk of becoming infected with COVID-19. During an interview on 1/22/2022, at 3:40 p.m., DON stated it was the facility's policy for no going back and forth between the red and yellow zones, when staff is designated to work in the red zone they are not allowed to go back into the yellow zone, staff must end their day in the red zone. DON stated, "crossing from the red zone to the yellow zone will affect residents and staff and put everyone at risk of getting COVID-19." According to the website http://publichealth.lacounty.gov/acd/ncorona2019/healthfacilities/snf/prevention/ under special staff considerations, in cohort areas staff assigned to the Red Cohort (area designated for COVID-19 positive residents) should not care for residents in other cohorts if possible. If staff must care for residents in multiple cohorts, they should visit the Red Cohort last and should doff PPE and perform hand hygiene prior to moving between cohorts. C. During an observation on 1/19/2022, at 4:18 p.m., in the red zone, Resident 31 was observed in bed in the hallway awaiting transfer to the room in the red zone. Maintenance Director (MD) was observed pushing Resident 31 on bed to his room in the red zone. MD was observed wearing full PPE including N95 mask, face shield, gown, and gloves. After MD brought Resident 31 into the room MD was observed exiting the red zone room wearing the same PPE, walking down the hall in the red zone, and with gloved hand opened the fire door leading to the yellow zone, and entered the yellow zone. During a concurrent observation and interview on 1/19/2022 at 4:25 p.m., in the red zone, MD was observed re-entering the red zone from the yellow zone through the closed fire door wearing the same PPE used to move Resident 31 to the red zone. MD stated DON informed him that "it was OK to leave the re