Other·January 19, 2022

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. T22 72523. Patient Care Policies and Procedures. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. The facility failed to: 1. Ensure to have an effective infection prevention and control program, led by the Infection Preventionist Nurse (IP, nurse who helps prevent and identify the spread of infectious agents like bacteria and viruses in a healthcare environment), to provide a safe and sanitary environment. 2. Maintain the kitchen in a clean, safe, and sanitary condition by not ensuring food was stored, prepared, and served in accordance with professional standards of food service safety. 3. Remain free of pests by not having an effective pest control. For 42 residents in the facility, who received food, fluids, and used tableware from the kitchen, the facility failed to: 4. Eradicate (destroy/kill) cockroach (small insects that carry and spread infectious diseases) infestation (presence of an unusually large number of cockroach population) in the kitchen. 5. Eliminate harborage conditions (locations and conditions where pests can live, thrive [grow strong], reproduce, and feed) such as holes, gaps, cracks, crevices (narrow openings) in the walls, floors, and different surfaces in the kitchen. As a result, the facility placed 42 residents (Residents 1-42) at risk of vector-borne diseases (illnesses that result from infections transmitted to humans by insects, such as cockroaches) from ingesting (drinking/eating) contaminated food and unsanitary food preparation and storage that could lead to life-threatening complications and death. On 12/7/2021, at 9:28 am, during a kitchen observation respectively, the surveyor and the Registered Environmental Health Specialist (REHS, a health inspector who inspects various facilities and properties to determine conformance with applicable State laws and County Ordinance Code sections), observed one live cockroach in the facility's kitchen, specifically in the janitor’s closet. A review of the REHS's Official Inspection Report, dated 12/7/2021 indicated there were five to six live cockroaches harboring (hiding) in a gap between the interior mop sink room door jam/base tile coving and the wall in the facility’s kitchen. The inspection report also indicated there were two dead cockroaches on the floor, under the automatic dish washing machine drainboard, next to the wall.  A review of the facility's census report, dated 12/6/2021, indicated there were 42 residents residing in the facility. On 12/7/2021, at 9:10 am, the surveyor conducted a kitchen observation with the REHS. At 9:28 am, the surveyor observed one live German cockroach (are known to carry disease-producing organisms, such as bacteria, protozoans, and viruses. These cockroaches also spread different forms of gastroenteritis [food poisoning, dysentery, diarrhea, and other illnesses], plus they carry a number of allergens which may cause people to exhibit skin rashes, watery eyes, sneezing, congestion of nasal passages, and asthma), walking on the kitchen floor, inside the janitor’s closet. On 12/7/2021, at 9:30 am, during an interview, the Dietary Supervisor (DS) stated the pest control company came to the facility once a month and applied treatment (pesticides used to kill, repel or control pests). On 12/7/2021, at 10:05 am, during an interview, the REHS stated he arrived at the facility, on 12/7/2021 at 7 am, and proceeded to conduct a routine inspection of the kitchen. At 7:10 am, the REHS stated he saw five live German cockroaches inside the janitor’s closet, next to the door. The REHS stated he saw two dead German cockroaches on the kitchen floor, under the dishwashing drainboard. On 12/7/2021, at 10:58 am, during an observation, the REHS posted a county food closure sign on the kitchen door and informed the administrator the sign should not be remove until the Environmental Health department reopened the kitchen. On 12/7/2021, at 1:30 pm, a review of the pest control service reports, dated 9/30/2021, 10/11/2021, and 11/24/2021, was conducted. All three service reports indicated that a pest control technician applied treatment, and there were no signs or presence of cockroach activities. A review of the IP’s email dated 12/17/2021, timed at 1:31 pm, indicated the facility did not provide pests in-services because there was no activity of cockroaches. A review of the facility’s pest control policy, dated May 2008, was conducted. This policy indicated that the facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents and shall maintain an effective pest control program. A review of the facility’s kitchen sanitation and infection control policy, regarding pest control, dated 2018, was conducted. This policy indicated that the facility would ensure a pest control program provides monthly inspection, treatment and prevention of vermin and insect infestation. The pest control is designed to maintain a sanitary environment, which prevents contamination, transmission or spread of disease, by insects or rodents. A review of the undated article from the County of Los Angeles, Department of Public Health, Effective Management of Cockroach Infestation, at http://publichealth.lacounty.gov/eh/docs/specialized/vector_management/cockroachmgmt.pdf indicated that cockroaches may become pests in any structure that has food preparation or storage areas. The article indicated cockroaches contaminate food and kitchen utensils, occasionally damage fabric and paper products, leave stains on surfaces, and produce unpleasant odors when present in high numbers. Cockroaches that live outdoors could come into contact with human excrement (waste matter/feces) in sewers or with animal fecal matter and had the potential to transmit bacteria that cause food poisoning when they entered the facility's kitchen. A review of the Centers for Disease Control and Prevention, Guidelines for Environmental Infection Control in Health Care Facilities, updated July 1, 2019 https://www.cdc.gov/infectioncontrol/guidelines/environmental/index.html, indicated the guidelines were recommendations for the prevention and control of infectious diseases that are associated with healthcare environments. The guidelines indicated pest included cockroaches from inside the health care facilities that can serve as agents for the mechanical transmission of microorganisms (small living thing/cell), or as active participants in the disease transmissions process by serving as a vector (a live carrier that transfers infectious pathogens/germs) to animal and or human. The facility failed to: 1. Ensure to have an effective infection prevention and control program, led by the Infection Preventionist Nurse (IP, nurse who helps prevent and identify the spread of infectious agents like bacteria and viruses in a healthcare environment), to provide a safe and sanitary environment. 2. Maintain the kitchen in a clean, safe, and sanitary condition by not ensuring food was stored, prepared, and served in accordance with professional standards of food service safety 3. Remain free of pests by not having an effective pest control. For 42 of 42 residents in the facility, who received food, fluids, and used tableware from the kitchen, the facility failed to: 4. Eradicate (destroy/kill) cockroach (small insects that carry and spread infectious diseases) infestation (presence of an unusually large number of cockroach population) in the kitchen. 5. Eliminate harborage conditions (locations and conditions where pests can live, thrive [grow strong], reproduce, and feed) such as holes, gaps, cracks, crevices (narrow openings) in the walls, floors, and different surfaces in the kitchen. As a result, the facility placed 42 residents (Residents 1-42) at risk of vector-borne diseases (illnesses that result from infections transmitted to humans by insects, such as cockroaches) from ingesting (drinking/eating) contaminated food and unsanitary food preparation and storage that could lead to life-threatening complications and death. The above violation had a direct or immediate relationship to the health, safety, or security of Residents 1-42.