Health inspection·January 17, 2025

California Code of Regulations, Title 22, 72311. Nursing Service – General. (a) Nursing service shall include, but not be limited to, the following: (1) Planning of patient care, which shall include at least the following: (A)Identification of care needs based upon an initial written and continuing assessment of the patient’s needs with input, as necessary, from health professionals involved in the care of the patient. Initial assessments shall commence at the time of admission of the patient and be completed within seven days after admission. (2) Implementing of each patient’s care plan according to the methods indicated. Each patient’s care shall be based on this plan. (3) Notifying the attending licensed healthcare practitioner acting within the scope of his or her professional licensure promptly of: (B)Any sudden and/or marked adverse change in signs, symptoms or behavior exhibited by a patient. 72523. Patient Care Policies and Procedures. (b) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. (b) All policies and procedures required of these regulations shall be in writing, made available upon request to physician and other involved health professionals, patients or their representatives, employees and the public shall be carried out as written. Policies and procedures shall be reviewed at least annually, revised as needed and approved in written by the patient care policy committee. 72525. Required Committees (a) Each facility shall have at least the following committees: patient care policy, infection control and pharmaceutical service (2) Infection control committee. (A) An infection control committee shall be responsible for infection control in the facility. (B) The committee shall be composed of representatives from the following services: physician, nursing, administration, dietetic, pharmaceutical, activities, housekeeping, laundry and maintenance. (C) The committee shall meet at least quarterly. (D) The functions of the infection control committee shall include, but not be limited to: 1. Establishing, reviewing, monitoring and approving policies and procedures for investigating, controlling and preventing infections in the facility. 2. Maintaining, reviewing and reporting statistics of the number, types, sources and locations of infections within the facility. An infection control committee shall be responsible for infection control in the facility. The committee shall be composed of representatives from the following services: physician, nursing, administration, dietetic, pharmaceutical, activities, housekeeping, laundry and maintenance. The committee shall meet at least quarterly. The functions of the infection control committee shall include, but not be limited to: Establishing, reviewing, monitoring and approving policies and procedures for investigating, controlling and preventing infections in the facility. Code of Federal Regulations, Title 42 F880 (Rev. 211; Issued: 02-03-23; Effective: 10-21-22; Implementation: 10-24-22) §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. §483.80(a) Infection prevention and control program. The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements: §483.80(a)(1) A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to §483.70(e) and following accepted national standards; §483.80(a)(2) Written standards, policies, and procedures for the program, which must include, but are not limited to: (i) A system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility; (ii) When and to whom possible incidents of communicable disease or infections should be reported; (iii) Standard and transmission-based precautions to be followed to prevent spread of infections; (iv) When and how isolation should be used for a resident; including but not limited to: (A) The type and duration of the isolation, depending upon the infectious agent or organism involved, and (B) A requirement that the isolation should be the least restrictive possible for the resident under the circumstances. (v) The circumstances under which the facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease; and (vi) The hand hygiene procedures to be followed by staff involved in direct resident contact. §483.80(a)(4) A system for recording incidents identified under the facility’s IPCP and the corrective actions taken by the facility. On 12/16/2024 at 12:04 PM, an unannounced visit was made to the facility to investigate a complaint regarding infection control. The facility failed to implement an ongoing infection prevention and control program (IPCP) to prevent, control the onset and spread of gastrointestinal (GI, the organs of the body that play a part in food digestion) infection, for 26 of 106 sampled Patients (Patients 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ,11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, and 26),and 16 of 150 facility staff (CNAs 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, LVNs 1, 3, 4, and Ancillary Staff 1, who presented with GI illness (conditions affecting the digestive system) from 12/5/2024 to 12/18/2024 (14 days) by failing to: 1. Implement preventative measures to address the outbreak (a greater number of disease cases than expected in a specific area or group of people over a given time) of GI illness among Patients and staff in the facility that included but not limited to placing affected Patients on transmission based precautions, prohibiting staff from working and not come back to work at the facility until symptom free for at least 48 hours, collect stool specimens of affected patients. 2. Ensure the facility placed 26 patients (Patients 1 to 26) on transmission-based precautions (precautions used to stop the spread of germs in a healthcare setting) when these Patients had signs and symptoms of vomiting and diarrhea (loose, watery, stools [bowel movement]), from 12/5/24 to 12/18/24. 3. Ensure facility staff that included CNA 1 and CNA 2 who had active diarrhea and vomiting were prohibited from providing care to the Patients to control further spread of infection and made aware of the current surveillance (the analysis of health information to look for problems that may be occurring in the workplace that require targeted prevention) of Patients having GI illness. 4. Investigate an outbreak of GI illness (nausea, emesis and/or diarrhea) among patients and staff to address and identify both individual cases and trends (changes in direction) to provide appropriate preventative interventions. 5. Ensure the Infection Preventionist (IP) nurse started the facility’s surveillance tracking tool to monitor Patients and staff with GI illness after the occurrence of three or more cases of the same GI infection over a specified period of time and included accurate information, necessary to identify infections and trends among facility staff and Patients, in accordance with the facility’s policy and procedure (P&P) on Outbreaks of Communicable Diseases. 6. Notify the local health department between 12/5/24 to 12/15/24, of the possible outbreak of GI illness among patients and staff, after the occurrence of three or more patients with GI symptoms in accordance with the facility’s P&P on Outbreak of Communicable Diseases. 7. Ensure the facility staff follow hand hygiene procedures consistent with accepted standards of practice and infection control procedure which had the potential to cross contaminate the ice served for the patients and cause food borne illness in patients, staff and visitors who consume the ice in the facility, when: a. There was no properly installed handwashing sink near the Ice dispensing room, located in the facility’s dirty utility room. b. One CNA did not wash hands after entering the utility room and before putting ice in the water pitcher that belongs to a Patient. As a result of these deficient practices, the facility placed 26 patients (Patients 1 to 26) and 16 staff (CNAs, LVNs and Ancillary Staff) at risk for complications from vomiting and diarrhea included dehydration (a condition that occurs when the body loses more fluids than it takes in) that could lead to hospitalization, and possible death. The facility also placed 80 remaining Patients and 134 remaining staff at risk for GI infection. Patients 1 and 25’s Laboratory (Lab) Results Report for Norovirus 2 [a contagious virus that causes severe vomiting, diarrhea by Polymerase Chain Reaction (PCR, a test that checks for material in a specimen sample to diagnose certain infectious diseases)] came back positive for Norovirus 2 upon collection/testing on 12/18/24. Findings: 1. A review of Patient 1’s Admission Record (AR), the AR indicated a 67-year-old, male patient, admitted to the facility on 1/26/2024, with a primary diagnosis of chronic pancreatitis [a progressive disorder associated with destruction of the pancreas (an organ in the abdomen that aids in digestion)], osteoarthritis (a joint disease that affects the joints causing pain). A review of Patient 1’s History and Physical Examination (H&P) dated 1/31/2024, the H&P indicated the Patient had the capacity to understand and make decisions. A review of Patient 1’s Change in Condition (COC, a medical document used to record any significant alterations in a patient's health status) Evaluation dated 12/16/2024 timed at 3:35 PM, the COC indicated Patient 1 noted (on 12/16/24) with loose bowel movement for two times. Medication (did not indicate the name of the medication) given/offered. The COC indicated MD 1 was made aware on 12/16/2024 at 3:00 PM. The COC indicated there were no new orders received. A review of Patient 1’s untiled care plan, initiated on 12/16/2024, the care plan indicated Patient 1 has diarrhea. The care plan interventions included educate Patient 1 on the causes of diarrhea and steps to take in avoiding diarrhea and its complications, monitor intake, output (a medical procedure that measures the amount of fluids that enter and leave the body), and laboratory test as ordered by the physician, administer medications as ordered by the physician, report to the physician as needed for sign and symptoms of dehydration, dry skin, and mucous membranes (the moist, inner lining of some organs and body cavities), poor skin turgor (elasticity of the skin), weight loss, anorexia (a disorder characterized by restriction of food intake), malaise (a general feeling of being unwell or discomfort), hypotension (abnormally low blood pressure), increased heart rate, fever, abnormal electrolyte (are minerals in the blood and other body fluids that carry an electric charge and affect how the body functions) levels. A review of Patient 1’s Order Summary Report with active orders date of 12/17/2024, the Report indicated on 12/17/2024, MD 1 ordered for Patient 1 to be on “Contact Isolation Precaution [Contact precautions are required when interacting with people known or suspected to have infections or diseases that can be transmitted through either direct or indirect contact with people, objects or environmental surfaces that have infectious matter on them. Contact precautions are used when Standard Precautions (the basic level of infection control that should be used in the care of all patients all of the time) might not be enough to stop the spread of infection and to prevent the spread of germs that are transmitted by touching a person or an object they have touched] at all times (due to diarrhea episodes).” A review of Patient 1’s Laboratory (Lab) Results Report for Norovirus 2 [a contagious virus that causes severe vomiting, diarrhea by PCR with collection date of 12/18/24 and report date of 12/26/24, the Lab Report indicated Norovirus 2 was detected (found). 2. A review of Patient 2’s AR, the AR indicated the facility re-admitted 63-year old male Patient on 12/12/2024, with a primary diagnosis of pressure ulcer (localized damage to the skin and/or underlying tissue that usually occurs over a bony prominence of sacral region (region located at the base of spine just above the buttocks), and Type 2 Diabetes mellitus (a condition that results from insufficient production of insulin, causing high blood sugar). A review of Patient 2’s untitled care plan initiated on 12/13/2024 with a revision date of 12/16/2024, the care plan indicated Patient 2 has Clostridium Difficile (C-Diff., a bacterium known for causing serous diarrheal infections) with active symptoms. The care plan interventions included for Patient 2 to receive diet as ordered by the physician, and Registered Dietician consult as needed. The interventions also included for staff to educate the Patients, family members, visitors, and caregivers regarding C-Difficile and how C-Difficile spread, monitor the labs diagnostic testing as ordered by physician, and administer medications as ordered by the physician. A review of Patient 2’s COC Evaluation dated 12/14/2024 timed at 6:54 AM, the COC indicated Patient 2 was noted (on 12/14/24) with episodes of vomiting and diarrhea before shift change (time was not indicated). A review of a facility document titled, “Gastrointestinal illness/Norovirus (a highly contagious viral disease that causes vomiting, diarrhea and stomach pain) Outbreak Line List for Healthcare Facilities-Patient/Patients,” dated 12/16/2024, provided by the facility’s IP nurse on 12/16/2024 at 5:11 PM and a concurrent review of the Patient’s records, the List included the 20 Patients (Patients 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, and 21) with their corresponding illness descriptions that included symptoms such as vomiting or diarrhea and onset dates. During the concurrent Patient’s (Patients 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, and 21) record reviews, the following Line List indicated 13 Patients had vomiting, six Patients had diarrhea, and one Patient had vomiting and diarrhea. The Line List indicated 10 of the 20 Patients had unresolved vomiting and diarrhea as indicated below: Patient 2 (vomiting=Yes) (diarrhea=Yes) with onset date of 12/14/24 and resolved date indicated blank. Patient 3 (vomiting=Yes) (diarrhea =No) with onset date of 12/12/24 and resolved date indicated blank. Patient 4 (vomiting = Yes) (diarrhea = No) with onset date 12/13/24 and resolved date indicated blank. Patient 5 (vomiting = No) (diarrhea = Yes) with onset date 12/13/24 and resolved date indicated blank. Patient 6 (vomiting = No) (diarrhea = Yes) with onset date 12/14/24 and resolved date indicated blank Patient 7 (vomiting = No) (diarrhea = Yes) with onset date 12/13/24 and resolved date indicated blank Patient 8 (vomiting = Yes) (diarrhea = No) with onset date 12/15/24 and resolved date indicated blank Patient 9 (vomiting = No) (diarrhea = Yes) with onset date 12/15/24 and resolved date indicated blank Patient 10 (vomiting = No) (diarrhea = Yes) with onset date 12/15/24 and resolved date indicated blank Patient 11 (vomiting = Yes) (diarrhea = No) with onset date 12/08/24 and resolved date indicated blank Patient 12 (vomiting = No) (diarrhea = Yes) with onset date of 12/8/24 and resolved date of 12/16/24. Patient 13 (vomiting = Yes) (diarrhea =No) with onset date of 12/12/24 and resolved date of 12/15/24. Patient 14 (vomiting = Yes) (diarrhea = No) with onset date 12/12/24 and resolved date of 12/15/24. Patient 15 (vomiting = Yes) (diarrhea = No) with onset date 12/12/24 and resolved date of 12/1