Other·February 25, 2021

§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. §483.80(f) Annual review. The facility will conduct an annual review of its IPCP and update their program, as necessary. 72523(c)(3) Patient Care Policies and Procedures (c) Each facility shall establish and implement policies and procedures, including but not limited to: (3) Infection control policies and procedures. The facility failed to implement interventions to prevent and control the spread of COVID-19 (Coronavirus disease, a severe respiratory illness caused by virus and spread from person to person) for five residents (Residents 1,2,3,4 and 5) in accordance with local Public Health guidelines and the facility's Mitigation Plan (MP, a plan to reduce loss of life and impact of COVID 19 in the facility) by failing to: a. Ensure dedicated staffing in the Red Zone (area for residents who tested positive for COVID-19) b. Ensure accurate and complete screening for signs and symptoms of COVID-19 c. Ensure staff enter and exit the Red Zone only through the designated area. These deficient practices had the potential to result in the spread of COVID-19 that could lead to respiratory illness to the residents and staff in the facility. A review of Resident 1's Admission Record indicated the resident, a 97 year old female, was admitted to the facility on 8/27/18 with diagnoses that included COVID-19 and diabetes (a disease in which the body's ability to produce or respond to the hormone insulin is impaired, resulting in elevated levels of glucose/sugar in the blood and urine). A review of Resident 2's Admission Record indicated the resident, an 89 year old female, was readmitted to the facility on 9/8/16 with diagnoses that included COVID-19 and heart failure (condition when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs). A review of Resident 3's Admission Record indicated the resident, a 61 year old male, was admitted to the facility on 11/12/20 with diagnoses that included epilepsy (a term used for a brain disorder that may cause violent muscle spasms or lose consciousness) and heart failure. A review of Resident 4's Admission Record indicated the resident, a 93 year old male, was admitted to the facility on 10/30/20 with diagnoses that included heart failure and acute kidney failure (condition when the kidneys [organ that filter wastes and excess fluids from the blood] suddenly fail to function). A review of Resident 5's Admission Record indicated the resident, a 75 year old female, was admitted to the facility on 11/2/2020, with diagnoses that included generalized muscle weakness and pressure ulcer (lesion/wound caused by unrelieved pressure that results in damage of underlying tissue). During an observation of the facility on 11/29/20 at 10:30 a.m., there were 43 residents in the Yellow Zone (area for residents who have been in close contact with known cases of COVID-19, newly admitted or re-admitted residents, those who have symptoms of possible COVID-19 pending test results and for residents with indeterminate tests) and 28 residents were in the Red Zone. There was no Green Zone (area for residents who tested negative for COVID-19) in the facility at the time of investigation. During an interview on 11/29/20 at 10:32 a.m., Registered Nurse Supervisor 1 (RN Sup 1) stated he was the only Registered Nurse (RN) in the facility so he had to enter both Red and Yellow Zones. RN Sup 1 stated he started his work shift at 6:15 a.m. and stated he went to the Red Zone at 6:20 a.m. to check the residents who needed intravenous (IV) fluid or medication. RN Sup 1 stated he would enter the Red Zone because he had one resident with scheduled antibiotics and two residents with ongoing IV hydration for the day. During an observation on 11/29/20 at 10:50 a.m., RN Sup 1 left the Yellow Zone and entered the Red Zone. During an observation on 11/29/20 at 11:12 a.m., RN Sup 1 was back in the Yellow Zone. During a concurrent observation and interview on 11/29/20 at 1:15 p.m., RN Sup 1 had IV dressings on top of his cart and stated he would change a PICC (a peripherally inserted central catheter [PICC] is a flexible catheter that is inserted in a peripheral vein in the arm which is guided to a larger vein that eventually leads to the heart) line dressing for Resident 4 who was in the Yellow Zone. During an interview on 11/29/20 at 3:15 p.m., the Director of Nursing (DON) stated there could be a risk of cross contamination when staff would move back and forth the Red and the Yellow Zone. During a phone interview on 11/29/20 at 3:30 p.m., the facility Administrator stated the facility attempted to get an RN from the facility's contracted registry but there was no RN available. The Administrator stated there was no documentation of this communication with the contracted registry. A review of Resident 1's Medication Administration Record (MAR) for November 2020 indicated the resident had Zosyn (antibiotics) scheduled to be given intravenous (IV) at 12:00 noon and at 6:00pm. Resident 1 was in the Red Zone. A review of Resident 2's MAR for November 2020 indicated the resident had IV Dextrose - Sodium Chloride Solution (hydration) ordered to run at 75 millimeter per hour (ml/hr). Resident 2 was in the Red Zone. A review of Resident 3's MAR for November 2020 indicated daptomycin (antibiotics) scheduled to be given intravenous (IV) at 9:00 am. Resident 3 was in the Yellow Zone. A review of Resident 4's MAR for November 2020 indicated ceftriaxone (antibiotics) scheduled to be given IV at 9:00 am and 9:00 pm., penicillin to be given at 10:00am. Resident 4 was in the Yellow Zone A review of Resident 5's MAR for November 2020 indicated ceftriaxone (antibiotics) IV scheduled at 2:00 pm, levofloxacin (antibiotics) IV scheduled at 9:00 am, and vancomycin (antibiotics) IV scheduled at 9:00 am. Resident 5 was in the Yellow Zone. A review of the facility's Line Listing (data collection and active monitoring of both residents and staff during a suspected illness or outbreak) indicated 4 residents were confirmed positive from the COVID-19 testing conducted on 11/10/20, there were 16 residents who were confirmed positive from the COVID-19 testing on 11/16/20 and there were 9 residents who were confirmed positive from the COVID-19 testing conducted on 11/23/20. A review of the facility's Mitigation Plan dated 6/25/2020 indicated the facility has implemented a staffing plan to limit transmission including; - Dedicated, consistent staffing team who directly interact with residents that are COVID-19 positive. - Limiting clinical and other staff who have direct resident contact to specific floors or wings. There should be no rotation of staff between floors or wings during the period they are working each day. The facility's Mitigation Plan indicated the facility has policies in place for dedicated spaces within the facility to ensure separation of infected patients and for eliminating movement of healthcare personnel among those spaces to minimize transmission risk. b. During an observation on 11/29/20, at 10:35 a.m., Housekeeper 1 (HK1) came to work. The receptionist took HK1's temperature with a digital thermometer but did not screen HK1 for other signs and symptoms for Covid 19. HK1 recorded his body temperature and answered the questions on the screen log on his own. During an interview on 11/29/20 at 1:10 p.m., HK 1 stated, he recorded his name, then wrote down his temperature and answered the questions on the screening log on his own. During an observation on 11/29/20 at 1:25 p.m., upon entering into the Red Zone, Licensed Vocational Nurse 1 (LVN) 1 took the body temperatures of the two surveyors. LVN1 informed the surveyors of their temperatures but did not record the temperatures on the screening log. LVN1 did not screen the surveyors for other signs and symptoms of Covid 19. The two surveyors completed the screening questionnaire on their own. During an interview on 11/29/20 at 2:50 p.m., the DON stated when staff or authorized visitors enter the facility, including the Red Zone, a facility staff would screen the staff or visitors by taking the temperatures, asking the screening questions and record the information on the screening log. A review of the facility's Mitigation Plan indicated the facility screens and documents every individual entering the facility (including staff) for COVID-19 symptoms. During a telephone interview on 11/29/20, at 3:40 p.m., the Administrator and the DON stated the facility staff did not follow the screening process by asking the individuals the questions and recording the answers on the screening log. The DON stated all persons should be screened for signs and symptoms of COVID-19. c. During an observation on 11/29/20 at 1:10 p.m., Maintenance Supervisor (MS) entered the Red Zone through the plastic barrier. The MS did not enter the Red Zone using the designated entrance. During an interview on 11/29/20 at 2:45 p.m., MS stated he entered the Red Zone to bring the trash bins out. The MS stated he was not supposed to use the plastic barrier as an entrance to the Red Zone. A review of the facility's Mitigation Plan indicated cohorting will be done in 3 separate cohorts, the cohorting areas are physically separate from other patient care areas within the facility. Temporary physical barriers (screen/plastic sheeting) with clear signage posted will be used to separate the COVID from the non COVID areas. The facility failed to implement interventions to prevent and control the spread of COVID-19 (Coronavirus disease, a severe respiratory illness caused by virus and spread from person to person) for five residents (Residents 1,2,3,4 and 5) in accordance with local Public Health guidelines and the facility's Mitigation Plan (MP, a plan to reduce loss of life and impact of COVID 19 in the facility) by failing to; a. Ensure dedicated staffing in the Red Zone (area for residents who tested positive for COVID-19) b. Ensure accurate and complete screening for signs and symptoms of COVID-19 c. Ensure staff enter and exit the Red Zone only through the designated area. As a result, these deficient practices had the potential to spread COVID-19 and put residents and staff at risk for COVID 19 infection that could lead to severe respiratory illness, hospitalization and/or death. These violations, jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of Residents 1,2,3,4 and 5.