Health inspection·December 26, 2024

F921 §483.90(i) Other Environmental Conditions The facility must provide a safe, functional, sanitary, and comfortable environment for residents, staff and the public.

F925 §483.90(i)(4) Maintain an effective pest control program so that the facility is free of pests and rodents 22 CCR §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. On 11/19/2024, the California Department of Public Health (CDPH) conducted an unannounced visit at the facility to investigate two complaints regarding the presence of mice (small rodents [any small gnawing or nibbling animal that belongs to a group of animals with strong sharp front teeth]) in the facility. The facility failed to prevent the presence of mice inside the facility’s residential rooms which were occupied by Residents 1, 2, 3, and 4, by failing the following: 1. Failed to implement an effective pest control program (a set of actions taken to get rid of or contain pests like mice). 2. Failed to provide a safe, sanitary (hygienic and clean), and comfortable homelike environment (is one that feels like home, and is designed to make residents feel comfortable, independent, and in control). 3. Failed to implement the infection prevention policy. As a result, there was an increased risk in creating an unsafe and unsanitary living conditions for Residents 1, 2, 3, and 4. During a review of Resident 1’s Admission Record, the Admission Record indicated the facility admitted the resident on 11/6/2024 with diagnoses including essential (primary) hypertension (high blood pressure), need for assistance with personal care, and anxiety disorder (a condition that causes excessive fear, worry, and feelings of dread or uneasiness that persist over time and can interfere with daily life). During a review of Resident 1’s History and Physical, dated 11/7/2024, the History and Physical indicated the resident had the capacity to understand and make decisions. The History and Physical indicated Resident 1 was able to make decisions for activities for daily living (ADLs – activities such as bathing, dressing and toileting a person performs daily). During a review of Resident 2’s Admission Record, the Admission Record indicated the facility originally admitted the resident on 10/31/2024 and readmitted on 10/10/2024 with diagnoses including anxiety disorder, essential hypertension, and need for assistance with personal care. During a review of Resident 3’s Admission Record, the Admission Record indicated the facility originally admitted the resident on 3/13/2024 and readmitted on 7/10/2024 with diagnoses including essential hypertension and single episode major depressive disorder (a serious mental illness that causes a persistent low mood and loss of interest in activities). During a review of Resident 3’s MDS (a resident assessment tool), dated 9/22/2024, the MDS indicated resident’s cognition (refers to conscious mental activities including thinking, reasoning, understanding, learning, and remembering) was moderately impaired. During a review of Resident 4’s Admission Record, the Admission Record indicated the facility admitted the resident on 9/13/2024 with diagnoses including heart failure, essential hypertension, and abnormalities of gait (manner of walking) and mobility (the ability to move or be moved freely and easily). During a review of the facility-provided census (a complete count of population), dated 11/18/2024, it indicated the facility’s residential room (RM 1) was occupied by Resident 1 and Resident 2, and the residential room 2 (RM 2) was occupied by Resident 3 and Resident 4. During an interview on 11/19/2024 at 4:01 p.m. with Certified Nurse Assistant 1 (CNA 1), CNA 1 stated she was working on 11/17/2024 and approximately around 5:30 p.m., visitors for RM 2 saw mice inside the residential room described as “Two tiny ones.” During a concurrent interview and record review on 11/19/2024 at 4:32 p.m. with the Maintenance Supervisor (MS), the MS stated that on 11/18/2024, one mouse was caught in RM 1 and two mice were caught in RM 2. The MS provided photo evidence of a captured mouse in RM 1 with the date and time stamp of 11/18/2024 at 10:56 a.m., and another photo evidence of a trapped mouse from RM 2 with the date and time stamp of 11/18/2024 at 3:45 p.m. The MS confirmed that RM 2 had a third mouse trapped but did not take a photo. The MS stated there should no mice inside the facility because one does not know what diseases mice can carry. During an interview on 11/19/2024 at 4:50 p.m. with the Infection Control Nurse (IP), the IP stated that pests are not supposed to be inside the facility. The IP stated that mice can bite, carry diseases, and chew and destroy things. The IP stated that the facility is trying to prevent infections or any more disease processes to the residents. During a review of the facility’s undated policy and procedure titled, “Maintenance and Plant Operations,” the policy indicated, “This chapter describes the policies and procedures related to maintenance of the physical plant. Maintenance of a safe and sanitary environment ensures safety, affords protection, and enhances the well-being of the residents, public, and staff. Maintenance activities include: · Providing a functional, sanitary, and comfortable environment · Controlling or eliminating nuisances and pollutants within the immediate environment During a review of the facility’s policy and procedure titled, “Pest Control,” with last revised date of 5/2008, the policy indicated, “Our facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents.” During a review of the facility-provided policy and procedure titled, “Homelike Environment,” with last revised date of 3/2023, the policy indicated, “The facility staff and management maximizes, to the extent possible, the characteristics of the facility that reflect a personalized, homelike setting. These characteristics may include: a. Clean, sanitary, and orderly environment;” During a review of the facility’s policy and procedure titled, "Infection Prevention and Control Program," with last revised date of 4/2023, the policy indicated, “An infection prevention and control program (IPCP) is established and maintained to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. The policy interpretation and implementation include: 1. The infection prevention and control program is developed to address the facility-specific infection control needs and requirements identified in the facility assessment and the infection control risk assessment. The program is reviewed annually and updated as necessary. 2. The program is based on accepted national infection prevention and control standards. 3. The infection prevention and control program is a facility-wide effort involving all disciplines and individuals and is an integral part of the quality assurance and performance improvement program. 4. The elements of the infection prevention and control program consist of coordination/oversight, policies/procedures, surveillance, data analysis, antibiotic stewardship, outbreak management, prevention of infection, employee and resident health and safety. The facility failed to prevent the presence of mice inside the facility’s residential rooms which were occupied by Residents 1, 2, 3, and 4, by failing the following: 1. Failed to implement an effective pest control program. 2. Failed to provide a safe, sanitary, and comfortable homelike environment. 3. Failed to implement the infection prevention policy. As a result, there was an increased risk in creating an unsafe and unsanitary living conditions for Residents 1, 2, 3, and 4. These violations jointly, separately, or in any combination, had a direct relationship to the health, safety, and security of Residents 1, 2, 3, and 4.