Health inspection·January 29, 2021

F880 §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.

F925 §483.90(i)(4) Maintain an effective pest control program so that the facility is free of pests and rodents. On 12/3/2020, an unannounced visit was conducted at the facility to investigate a complaint regarding pest infestation (the presence of an unusually large number of insects in a place, typically cause damage or disease) in the facility’s kitchen. A review of the facility’s census indicated 177 residents in-house. The facility failed to safely store and prepare food; failed to implement infection control program to prevent the spread infections; and failed to maintain an effective pest control program to be free of pests and rodents, by: 1. Not monitoring the cockroach (small insects that cause spread of bacterial infection) population in the kitchen. 2. Not evaluating and following up the findings from the pest control service reports to verify pests were removed, per the facility's policy. 3. Not keeping clean and in good repair the employee lounge and hallways. 4. Not keeping the kitchen in good repair. 5. Not keeping clean and in good repair the interior of the ice machine, located in the employee lounge, and not keeping clean the ice scooper and its container to prevent the growth of microorganisms and biofilm (a thin, slimy film of bacteria that adheres to a surface). As a result, there was an increased risk for vector-borne diseases (disease that result from an infection transmitted to human by insects including cockroaches) such as diarrhea, vomiting, and fever for the total of 177 residents in the facility. On December 3, 2020, at 2:30 p.m., the Los Angeles County Environmental Health Department Inspector (EHS 1, performs inspections of various licensed health care facilities and properties to determine conformance with applicable State laws and County ordinance code sections) informed the California Department of Public Health (CDPH) about the closure of the facility’s kitchen due to active infestation of live cockroaches in the facility's kitchen. A review of EHS 1 survey report dated December 3, 2020 indicated EHS 1 observed the following: -Two live nymph German cockroaches below the drain board at ware washing corner area; -Eight live adult German cockroaches at the wall ceiling juncture above ware wash unit; -Three dead cockroaches on the shelving below the drain board at same area; -Eight live German cockroaches just below the pass out window (where food is passed through to the adjacent dining room or served to the adjacent dining room), left of the food preparation sink; -Two live nymph cockroaches at same area, left of the food preparation sink; and -Cockroach fecal spotting at the right corner of the pass out window, left of food preparation sink. During an observation of the kitchen on December 3, 2020, at 4:40 p.m., the following was found: -One live nymph cockroach (baby cockroach) on the food preparation sink area (where fruits and vegetables are washed and prepared for residents); -One live nymph cockroach on the floor in the dry storage area; -One dead juvenile cockroach on the floor in the middle of the kitchen; -One live adult cockroach on the wall in the dishwashing area; -One live nymph crawling on the resident food tray in the dishwashing room; -Cracks on the wall and ceiling in the dishwashing area; -Cracks in between the tiles on the floor (the grout was broken); -Dirt accumulated in the spaces between the food preparation sink and the pass out window; and -A big plywood around the hand washing sink that could harborage pests. On December 3, 2020 at 4:40 p.m., during a concurrent interview with the Food Service Director (FSD), she stated that she has been working in the facility since 2019, does quarterly audits including pest control and has never seen any cockroaches in the kitchen. FSD stated if staff see cockroaches, they should let her know but she did not keep a communication log for pests. FSD stated the Pest Control technician (PCT) comes once a month to spray the kitchen. On December 3, 2020, at 4:50 p.m., during an interview, the Dietary Assistant (DA) state seen cockroaches in the kitchen floor and counters in the early mornings. DA said when he sees a cockroach, he kills them and would call the PCT. DA stated he did not remember when he called the pest control technician. On December 3, 2020, at 5 p.m., during an interview, the Dishwasher (DW) stated that he sees cockroaches in the kitchen. When asked if he told the FSD about the cockroaches, DW did not answer. On December 3, 2020 at 5:10 p.m., during an interview, the Administrator stated she did not know there were cockroaches in the kitchen and the PCT is an employee of the corporation and comes once a month. On December 3, 2020 at 5:38 p.m., during a concurrent interview with DON and Infection Control Preventionist (IPN), the IPN stated she makes rounds around the facility, involving the kitchen, to identify infection control issues including pest infestation. Both DON and IPN stated it was important to maintain the kitchen free of pests because of potential for harm to resident food. On December 5, 2020 at 11:57 a.m., during a telephone interview, PCT stated she goes to the facility for about 20 minutes to one hour every month and was aware of the cockroach infestation and planned on making weekly visits but was not able. A review of EHS 1 survey report dated December 5, 2020, after the facility had the PCT fumigate and deep cleaning the kitchen, the following was found: -One live cockroach crawling on top of a stove in the kitchen; -Three live cockroaches harboring between a piece of wood and the side of the hand-washing sink in the kitchen; -Six live cockroaches in the utensil washroom (two located between the automatic dish washing machine drain board back splash and the wall, three located on top of the automatic dish washing machine drain board and one located crawling on the wall above the drain board); -Two egg casings and one nymph cockroach were on top of the dish washing machine drain board. On December 8, 2020, at 2:11 p.m., during an observation of the ice machine located at the employee lounge with the Administrator and concurrent interview, the Administrator stated ice from the ice machine was served to all residents. The interior of ice machine had slime formation and encrusted debris. The Administrator verified that water was dripping on the back side of the ice machine through slime and onto the ice, and there was encrusted debris inside the ice machine. The ice scooper and its container were on top of the ice machine. The Administrator stated maintenance cleaned and sanitized the ice machine and the scooper but there was no record of the cleaning/disinfection. On December 8, 2020, at 2:25 p.m., during an interview, the Maintenance/Housekeeping Supervisor (MHS) stated the ice machine was cleaned and sanitized on a monthly basis and the last time it was cleaned was on 11/28/2020. On December 8, 2020, at 2:03 p.m., during an observation of the employee lounge, with the Administrator, the following was found: -One dead cockroach between a crevice behind a refrigeration unit; -Crevices between wooden boards mounted on the floor; -Trash and debris accumulation under and around equipment; -Encrusted debris on the vending machine and inside a cabinet, and a hole on the wall around an electrical cover plate. The Administrator confirmed observations and stated the area needed cleaning and crevices needed to be sealed. On December 8, 2020, at 2:88 p.m., during a concurrent observation and interview with the Administrator, there was a gap greater than .25 inch between the exterior double doors directing to a hallway that led to a kitchen door. The Administrator stated she will have the door fixed. On December 10, 2020, at 9:30 a.m., during a kitchen observation with EHS 1, the following was found: -One live adult roach in the dishwashing area; -One live nymph on the floor in the dishwashing area; -One live nymph above the ice machine; -One live juvenile cockroach on the walk-in refrigerator; and -One live nymph cockroach in the dry storage area. On December 10, 2020, at 10 a.m., during an interview, Registered Dietitian 1 (RD 1) stated he started working at the facility on December 1, 2020 and during his first audit of the kitchen, on the same date of hire, he did not find any pests. On December 10, 2020, at 10:20 a.m., during an observation of the employee lounge with the Administrator, there was one dead cockroach between a crevice behind a refrigeration unit. During a concurrent interview, the Administrator stated staff will clean the employee lounge after they are done with the kitchen. On December 11, 2020, at 11:27 a.m., during an observation and concurrent interview with the Administrator, there was one dead cockroach on the floor along a hallway that led to a kitchen door. The Administrator confirmed the observation and stated the loose baseboards along the hallway would be replaced. On December 11, 2020, at 11:30 a.m., during an observation of the employee lounge and concurrent interview with the Administrator, there was one live cockroach crawling on the floor and one dead cockroach inside a cabinet. The Administrator confirmed the observation and stated staff would clean the lounge after finishing with the kitchen and would have pest control treat the employee lounge as well. On December 16, 2020, at 11:20 a.m., during an observation of the employee lounge and concurrent interview with the Administrator, there were crevices on the wall shelving, opening on the wooden floor base, missing baseboards, and missing floor tiles. The Administrator confirmed the observations. On December 16, 2020, at 11:30 a.m., during an observation with the Administrator, there were crevices around the baseboards along the hallway leading to a kitchen door. A review of a document completed by an RD (no name), located in the kitchen and titled, "Dietary Quality Control Survey" dated October 2020 indicated, there were dead bugs on the floor near storeroom and all other food storage areas. On December 17, 2020, at 10:30 a.m., during an interview, the Administrator stated on December 16, 2020, during an inspection of the kitchen, EHS 1 found one live roach in the kitchen and the inspector would return on December 17, 2020. A review of the facility's Pest Management Sanitation Report for the past seven months (September was missing) indicated: -On May 6, 2020, pest infestation noted in marked location: Outside- Cockroaches (Large) -On June 16, 2020, pest infestation noted in marked location: Outside- Cockroaches (Large) -On July 7, 2020, pest infestation noted in marked location: Dish washer area- Cockroaches -On August 8, 2020, the invoice indicated: Roaches; initial treatment; inside treatment: kitchen area. -On October 8, 2020, pest infestation noted in marked location: Outside- Cockroaches (Large) -On November 3, 2020, pest infestation noted in marked location: Outside- Cockroaches (Large), Kitchen- Crickets A review of article from the Department of Public Health, County of Los Angeles titled, Effective Management of Cockroach Infestation (retrieved December 4, 2020 at publichealth.lacounty.gov >Vector Management) indicated cockroaches may become pests in any structure that has food preparation or storage areas. They contaminate food and eating utensils, occasionally damage fabric and paper products, leave stains on surfaces, and produce unpleasant odors when present in high enough numbers. When cockroaches that live outdoors encounter human excrement in sewers or with pet droppings, they have the potential to transmit bacteria that cause food poisoning. A review of the job description for Infection Control Preventionist (IPN) dated November 28, 2016 indicated, "Essential Duties and Responsibilities: Perform daily rounds in the facility to assess and identify infection control related issues and problems. Conduct staff in service education/training, when needed, to abate known problems." A review of the facility’s policy and procedure titled, “Housekeeping Pest Control,” revised on September 22, 2020, indicated, “The Administrator arranges for a pest control company to visit and inspect the facility at least once a month” ensuring that the company representative inspects the facility for pest, submits a written report to the Administrator on the findings of his inspection, inspection report is filed and retained for a minimum of one year, “immediate action is taken to rid of the facility or its ground of any environmental pest as noted in the inspection report”, after exterminating or spraying that “the facility is once again inspected by pest control company to ensure that all environmental pests were removed from the premises”, “the company representative issues an additional report to the Administrator, verifying that all environmental pests were removed”, and “All housekeepers should report to the Housekeeping Supervisor any signs of rodents or insects, including ants, in the facility. The Housekeeping Supervisor takes immediate action to remove the pests in the facility. If necessary, he or she calls the extermination company for assistance”. A review of the 2017 U.S. Food and Drug Administration Food Code indicated that the premises (the physical facility, its contents, and surrounding land or property under the control of