Health inspection·May 5, 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. An unannounced visit was made to the facility on 3/26/21 to conduct a complaint investigation regarding infection control. 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) in accordance with local Public Health guidelines, facility's policy and procedures and Mitigation Plan (MP, a plan to reduce loss of life and impact of COVID-19 in the facility) for Residents 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12 by failing to: 1. Ensure the Screening Staff 1 (SS 1) was not wearing but a surgical mask while inside the facility. 2. Ensure Certified Nursing Assistants 1, 2, 3 and 4 (CNAs 1, 2, 3 and 4) wore the required Personal Protective Equipment (PPE- gowns, gloves, N95 masks, and face shields worn to minimize exposure to hazards that cause serious workplace injuries and illnesses) 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) while providing care to Residents 1, 2, 3, and 4. 3. Ensure CNAs 1, 3 and 4 performed hand hygiene after contact with Residents 1, 8 and 9. 4. Ensure Housekeeper 1 (HK 1) cleaned and disinfected high touch areas (the bedrails, doorknobs, drawer/closet handles and call lights) inside 2 of 2 rooms in the Yellow Zone. 5. Ensure Licensed Vocational Nurse 1 (LVN 1), wore a fit tested 3M 1860 small size face mask while in the Yellow Zone. As a result, the facility placed all residents and staff not infected with COVID-19, at high risk to become positive for COVID-19 infection which could lead to severe respiratory illness, hospitalization and/or death During an observation of the facility on 3/26/21 at 11:30 a.m. to 7:00 p.m. there were 26 residents in the Yellow Zone and 43 residents in the Green Zone. 1. During an observation in the lobby area on 3/26/21 at 11:30 a.m., SS 1 was wearing a cloth face mask while screening people who entered the facility for COVID-19 symptoms. During an interview with SS 1 on 3/26/21 at 11:39 a.m., she stated she forgot to switch her mask from cloth to surgical mask. SS 1 stated she needed to wear a surgical mask while inside the facility and not a cloth mask. During an interview with the Director of Staff Development (DSD) on 3/26/21 at 11:39 a.m., DSD stated staff should not wear cloth mask when inside the facility. A review of the local health guideline, titled" Guidelines for Preventing and Managing COVID-19 in Skilled Nursing Facilities" updated on 2/22/21, indicated all healthcare personnel (HCP) should wear a medical-grade surgical/procedure mask or respirator for universal source control at all times while they are in the facility. 2a. During an observation in the Yellow Zone with the DSD on 3/26/21 at 12:14 p.m., CNA 1 was inside the resident's room in the Yellow Zone, CNA 1 was not wearing an isolation gown and gloves while feeding Resident 1. CNA 1's one hand was touching the bed rails, and another hand was feeding Resident 1. CNA 1's pants were touching the bed. During an interview with CNA 1 in the Yellow Zone on 3/26/21 at 12:18 p.m., CNA 1 did not reply when asked what PPE should be worn when inside a resident's room in the Yellow Zone and while providing care to a resident in the Yellow Zone. During an interview with the Director of Staff Development (DSD) on 3/26/21 at 12:19 p.m., DSD stated CNA 1 needed to wear appropriate PPE (which included gown and gloves) when providing care in the Yellow Zone. 2b. During an observation in the Yellow Zone on 3/26/21 at 2:27 p.m., CNA 2 was inside Resident 2 and Resident 3's room without an isolation gown and gloves, CNA 2 was collecting pitchers from Bed A then Bed B. CNA 2's work clothes were touching the table while reaching for the pitcher on the side table. During an observation in the Yellow Zone on 3/26/21 at 2:28 p.m., CNA 2 went through the shared bathroom and entered Resident 4's and Resident 5's room and CNA 2 collected pitchers from Bed B then Bed A. During an observation in the Yellow Zone on 3/26/21 at 2:30 p.m., CNA 2 entered Resident 6's and Resident 7's room without wearing an isolation gown and gloves. CNA 2 collected water pitchers from Bed A then Bed B. CNA 2's clothes were touching the curtain while moving from Bed A to Bed B. During an interview with the DSD on 3/26/21 at 2:40 p.m., DSD stated all staff should wear complete PPE when entering the resident's room in the Yellow Zone. The DSD stated complete PPE included isolation gown, gloves, N95 mask and face shield. The DSD stated CNA 2 needed to wear an isolation gown and gloves to prevent contamination of his work clothes and cross contamination of the resident's environment. 2c. During an observation in the Yellow Zone on 3/26/21 at 3:18 p.m., CNA 3 was not wearing an isolation gown and face shield while inside Resident 8's room. CNA 3 was standing in front of Resident 8's bedside table within 6 feet of Resident 8, talking, and assisting Resident 8 with a coloring activity. During a concurrent interview with Resident 8 and CNA 3 in the Yellow Zone on 3/26/21 at 3:20 p.m., CNA 3 stated she did not touch the resident, so she did not wear an isolation gown. Resident 8 stated CNA 3 needed to wear a face shield when in close contact with a resident. 2d. During an observation in the Yellow Zone on 3/26/21 at 4:40 p.m., CNA 4 entered Resident 9's room with the dinner tray without wearing an isolation gown. CNA 4 proceeded to reposition Resident 9 by using the bed control to raise up the head of the bed. CNA 4 placed a pillow behind Resident 9. CNA 4's work clothes were touching the bed as he was repositioning Resident 9. During an interview with CNA 4 on 3/26/21 at 4:43 p.m., he stated he did not wear PPE when entering the rooms in the Yellow Zone because he was alone. CNA 4 stated he needed to wear an isolation gown, gloves, N95 mask and face shield when providing care to residents in the Yellow Zone. During an observation in the Yellow Zone on 3/26/21 from 12:01 p.m. to 4:45 p.m., signs were posted outside all the rooms in the Yellow Zone. The signs indicated for the staff to follow contact and droplet precautions and the PPE to be used included an isolation gown, gloves, N95 mask and face shield/goggles. A review of the facility's updated Mitigation Plan indicated signs are posted immediately outside of resident rooms indicating appropriate infection control and prevention precautions and required PPE in accordance with CDPH guidance. A review of the local guideline titled" Guidelines for Preventing and Managing COVID-19 in Skilled Nursing Facilities" updated on 2/22/21, indicated healthcare personnel (HCP) should follow transmission- based precautions for each cohort. HCP should wear gowns, gloves, N95 respirators, and eye protection, which is defined as a face shield or goggles, is recommended for close contact with patients (within 6ft), especially if the patient cannot reliably wear a face covering. 3a. During an observation in the Yellow Zone with the DSD on 3/26/21 at 12:14 p.m., CNA 1 was inside the resident's room in the Yellow Zone, CNA1 was not wearing an isolation gown and gloves while feeding Resident 1. CNA 1's one hand was touching the bed rails, and another hand was feeding Resident 1. CNA 1's pants were touching the bed. During an interview with the Director of Staff Development (DSD On 3/26/21 at 12:20 p.m., DSD stated CNA 1 left the room without performing hand hygiene. The DSD stated CNA 1 needed to do hand hygiene before and after each resident contact. DSD stated CNA 1 did not perform hand hygiene. 3b. During an observation in the Yellow Zone on 3/26/21 at 3:18 p.m., CNA 3 was not wearing an isolation gown and face shield while inside Resident 8's room, CNA 3 was standing in front of Resident 8's bedside table within 6 feet of Resident 8, talking and assisting Resident 8 with a coloring activity. CNA 3 did not perform hand hygiene upon exiting Resident 8's room. During an interview with CNA 3 on 3/26/21 at 3:20 p.m. in the Yellow Zone, she stated she forgot to do hand hygiene upon exiting Resident 8's room. 3c. During an observation in the Yellow Zone on 3/26/21 at 4:40 p.m., CNA 4 entered Resident 9's room with the dinner tray without wearing an isolation gown. CNA 4 proceeded to reposition Resident 9 by using the bed control to raise up the head of the bed. CNA 4 placed a pillow behind Resident 9. CNA 4's work clothes were touching the bed as he was repositioning Resident 9. CNA 4 did not perform hand hygiene after removing his gloves and upon exiting Resident 9's room. During an interview with the DSD on 3/26/21 at 4: 50 p.m., DSD stated all staff needed to do hand hygiene before and after contact with the resident. A review of the local guideline titled, "Guidelines for Preventing and Managing COVID-19 in Skilled Nursing Facilities" updated on 2/22/21, indicated healthcare personnel (HCP) and other staff members should perform hand hygiene (HH) before and after all patient encounters and should also use HH at the beginning of their shifts, before and after eating, after using the restroom, and at other times throughout the day. Hand hygiene should be performed before donning and after doffing gloves. 4. During an observation in the Yellow Zone on 3/26/21 at 1:15 p.m., HK 1 entered Resident 10's and 11's room wearing complete PPE. HK 1 cleaned the toilet bowl, sink, bedside tables and swept and mopped the floor. HK 1 did not clean high touch areas such as the bedrails, doorknobs, drawer/closet handles and call lights. During an observation in the Yellow Zone with the DSD on 3/26/21 at 1:53 p.m., HK 1 entered Resident 8's and Resident 12's room wearing complete PPE. HK 1 cleaned the toilet bowl, sink, bedside tables, and swept and mopped the floor. HK 1 did not clean high touch areas such as the bedrails, doorknobs, drawer/closet handles, and call lights. During an interview with HK 1 on 3/26/21 at 2:00 p.m., she stated door handles were to be cleaned by the Housekeeping Supervisor. HK 1 stated she did not clean the bedrails and closet handles. The DSD stated HK 1 needed to clean and disinfect high touch areas inside the room. The DSD stated high touch areas were bedrails, drawer/closet handles, and call lights. A review of the local guideline titled, "Guidelines for Preventing and Managing COVID-19 in Skilled Nursing Facilities" updated on 2/22/21, indicated enhanced environmental disinfection with EPA-approved healthcare disinfectants should be performed on high touch surfaces (e.g., bed rails, doorknobs, handrails, etc.). 5. During an observation in the Yellow Zone on 3/26/21 at 12:01 p.m., LVN 1 was wearing a Direct Supply N95 mask (DSN95). LVN 1's mask was observed not properly fitted. A review of LVN 1's Mask Fit Testing with the DSD, dated 11/10/20, indicated LVN 1 was fit tested for 3M 1860 small size face mask. During an interview with the DSD on 3/26/21 at 2:42 p.m., DSD stated LVN 1 needed to wear the correct fit tested face mask to ensure proper fit and to prevent leakage of air particles or the virus into the wearer and/or to residents in close contact to LVN 1. A review of the local DPH's Guideline, titled, "Guidelines for Preventing and Managing COVID-19," dated 11/24/20 and updated 2/22/21, indicated an initial and annual N95 fit testing were required for all staff per California Division of Occupational Safety and Health (Cal-OSHA). A review of the Cal/OSHA Interim Guidance on COVID-19 for Healthcare Facilities-Severe Respirator Supply Shortages, dated 8/6/20, indicated initial fitted tests and re-fitted tests for N95 masks were required before using N95 masks when changing in the masks' model, make, or size. The Cal/OSHA guidance indicated an annual fit testing for N95 masks was also required. The facility failed to implement interventions to prevent and control the spread of COVID-19 in accordance with local Public Health guidelines, facility's policy and procedure and Mitigation Plan for Residents 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12 by failing to: 1. Ensure the SS 1 was not wearing a cloth mask but a surgical mask when in the facility. 2. Ensure CNAs 1, 2, 3 and 4 wore proper PPE in the Yellow Zone while providing care to Residents 1, 2, 3, and 4. 3. Ensure CNAs 1, 3 and 4 performed hand hygiene after contact with Residents 1, 8 and 9. 4. Ensure HK 1 cleaned and disinfected high touch areas inside 2 of 2 rooms in the Yellow Zone. 5. Ensure LVN 1 wore a fit tested 3M 1860 small size face mask in the Yellow Zone. As a result, the facility placed all residents and staff not infected with COVID-19, at high risk to become positive for COVID-19 infection which 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 all residents and staff not infected with COVID-19.