Other·March 10, 2022

72321 (b) Nursing Service- Patients with Infectious Diseases. (b) The facility shall adopt, observe and implement written infection control policies and procedures. These policies and procedures shall be reviewed at least annually and revised 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, a severe respiratory illness caused by a virus and spread from person to person) in accordance with local Public Health guidelines and facility's policy by failing to ensure nine facility staff were fit tested (a test conducted to verify that a respirator is both comfortable and provides the wearer with the expected protection) for N95 respirators (protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles) before initial use of the respirator and at least annually thereafter.  These violations had the potential to result in the spread of COVID-19 placing patients and staff at risk for COVID-19 infection that could lead to severe respiratory illness, hospitalization and/or death. On 1/13/22, an unannounced visit was made to the facility to conduct a complaint investigation regarding infection control. During an observation on 1/13/22 at 11:27 am, the following facility staff were observed wearing various model numbers of N95 respirators: 1. Activity Staff 1 was wearing N95 model number 1. 2. Certified Nursing Assistant 3 (CNA 3) was wearing N95 model number 2. 3. Licensed Vocational Nurse 1 (LVN 1) was wearing N95 model number 3. 4. Physical Therapist Assistant 1 (PTA 1) was wearing N95 model number 3. 5. LVN 2 was wearing N95 model number 1. 6. CNA 4 was wearing N95 model number 3. 7. LVN 3 was wearing N95 model number 3. 8. CNA 1 was wearing N95 model number 3. 9. CNA 2 was wearing N95 model number 1. A review of the facility's undated N95 Fit Testing Log provided by the facility on 1/13/22, indicated the following: 1. Activity Staff 1 was fit tested with N95 model number 3 on 11/23/2020. 2. CNA 3 was fit tested with N95 model number 1 (no date specified). 3. LVN 1 was fit tested with N95 model number 1 (no date specified). 4. PTA 1 was fit tested with N95 model number 3 on 12/7/2020. 5. LVN 2 was no longer employed with the company.  6. CNA 4 was fit tested with N95 model number 3 on 12/4/2020. 7. LVN 3 was fit tested with N95 model number 3 on 12/7/2020. 8. CNA 1 was fit tested with N95 model number 3 (no date specified when it was done).     9. CNA 2 was fit tested with N95 model number 1 on 11/4/2020. During an interview on 1/13/22 at 11:27 am., CNA 3 stated she was wearing N95 model number 2, instead of N95 model number 1 which she was fit tested with at the facility. CNA 3 stated she was fit tested with N95 model number 2 at another facility. During a concurrent observation and interview on 1/13/22 at 11:28 am, LVN 1 stated she was fit tested with N95 model number 3. LVN 1 was observed wearing N95 model number 3. (The N95 Fit Testing Log provided by the facility on 1/13/22, indicated LVN 1 was fit tested with N95 model number 1). During an interview on 1/13/22 at 11:58 am, the Infection Prevention Nurse (IPN) stated facility staff must wear the same model number of N95 respirator they were fit tested with.        During an interview on 1/13/22 at 4:18 pm, the IPN stated the facility was not conducting fit testing with N95 respirators for all staff annually. During a telephone interview on 2/10/22 at 4:53 pm, CNA 2 stated she was fit tested with N95 respirator model number 1 in 2020, but not in 2021 or currently. A review of the facility's updated and undated N95 Fit Testing Log provided on 2/11/22, indicated CNA 3, LVN 1, PTA 1, LVN 2, CNA 4 and CNA 1 were not fit tested in 2021.    During a telephone interview on 3/1/22 at 10:34 am, the DON stated LVN 2 never left the company and was currently employed in the facility. The DON stated the information about LVN 2 from the undated N95 Fit Testing Log provided on 1/13/22 was inaccurate.      A review of the facility's policy and procedures titled, "Coronavirus Disease 2019 [COVID-19] Testing, Vaccination Verification and Personal Protective Equipment for Health Care Personnel [HCP]," dated 12/27/21, indicated all employees working in an area of residence where a suspected or confirmed COVID-19 case is present, must use National Institute for Occupational Safety and Health [NIOSH] approved respirators. An N95 is the minimum protection permitted for these employees. The policy indicated the facility must provide the respirators at no cost, and workers must be instructed how to properly wear the respirator and how to perform seal check according to the manufacturer's instructions, if this has not already occurred. A review of the local Department of Public Health guideline titled "Guidelines for Preventing and Managing COVID-19 in Skilled Nursing Facilities," updated on 1/2/22, indicated initial and annual N95 respiratory fit testing is required for all staff per California Division of Occupational Safety and Health (Cal-OSHA). Retrieved from http://publichealth.lacounty.gov/acd/ncorona2019/healthfacilities/snf/prevention/ The facility failed to implement interventions to prevent and control the spread of COVID-19 in accordance with local Public Health guidelines and facility's policy by failing to ensure nine facility staff were fit tested for N95 respirators before initial use of the respirator and at least annually thereafter.  These violations had the potential to result in the spread of COVID-19 placing patients 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 patients.