Other·May 24, 2023

F812 Food Procurement, Store/Prepare/Serve - Sanitary §483.60(i)(2) - Store, prepare, distribute and serve food in accordance with professional standards for food service safety. § 72351. Dietetic Service - Staff. (c) Sufficient staff shall be employed, oriented, trained and their working hours scheduled to provide for the nutritional needs of the patients and to maintain the dietetic service areas. If dietetic service employees are assigned duties in other services, those duties shall not interfere with the sanitation, safety or time required for dietetic work assignments. (e) Dietetic service personnel shall be trained in basic food sanitation techniques, wear clean clothing, and a cap or a hair net, and shall be excluded from duty when affected by skin infection or communicable diseases. Beards and mustaches which are not closely cropped and neatly trimmed shall be covered. § 72525. Required Committees. (c) Committee composition and function shall be as follows: (2) Infection control committee. (A) An infection control committee shall be responsible for infection control in the facility. (D) The functions of the infection control committee shall include, but not be limited to: 1. Establishing, reviewing, monitoring and approving policies and procedures for investigating, controlling and preventing infections in the facility. 2. Maintaining, reviewing and reporting statistics of the number, types, sources and locations of infections within the facility. An unannounced visit was conducted by California Department of Public Health on 4/6/23 at 9:50 AM to investigate a facility reported incident regarding patient safety. The facility failed to implement their policy and procedure for infection control and to follow safe food handling practices for Patient 1 and Patient 2 to prevent an unknown gastrointestinal (GI) outbreak (a sudden rise in the number of cases of an infectious disease) by: 1. Failing to ensure Kitchen Staff 1 (KS 1) did not work in the facility kitchen and prepare food for the patients on 3/27/2023 and from 3/30/2023 to 4/3/2023 while KS 1 was experiencing diarrhea (the passage of three or more loose or liquid stools per day) abdominal pain, vomiting, nausea, fever, and loss of appetite. 2. Failing to recognize an unknown gastrointestinal (GI, stomach, and intestines) outbreak, identify organism/ source of infection, monitor, and control the spread of infectious disease when Patient 1 and Patient 2 had symptoms of diarrhea and vomiting on 4/2/2023 in accordance with the facility’s policy and procedure. 3. Failing to ensure three (3) staff (Certified Nurse Assistant [CNA] 6, Treatment Nurse [TN, licensed nurse in charge of performing wound care] and CNA 5) were wearing Personal Protective Equipment (PPE) when working with patients on contact isolation (used when a patient has an infectious disease that may be spread by touching either the patient or other objects the patient has handled) precautions. 4. Failing to ensure supplies (gloves) necessary for the care of patients on contact precautions are accessible and available for staff and visitors use. 5. Failing to store refrigerated food items in accordance with professional standards for food service. Facility kept food items with unclear expiration dates and past used by dates in the refrigerator on 4/6/2023. These deficient practices placed the patients, facility staff and visitors at risk for contracting gastrointestinal (GI) infection and resulted to 21 patients (Patients 1,2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 and 21) and 5 facility staff (KS 2, Certified Nurse Assistant (CNA) 1, CNA 2, CNA 3, and CNA 4) to experience diarrhea, abdominal pain, vomiting, nausea, fever, and/ or loss of appetite. Patient 3, who experienced nausea, vomiting and diarrhea, was sent to the general acute care hospital (GACH) on 4/7/2023. Patient 4, who also experienced nausea, vomiting and diarrhea, was sent to the GACH on 4/5/2023. 1. During an interview on 4/14/2023 at 2:45 PM, KS 1 stated, she first experienced symptoms of abdominal pain, diarrhea, vomiting, nausea, fever, and loss of appetite on 3/27/2023. KS 1 stated she worked at the facility as a dishwasher on 3/27/2023 and did not report her symptoms to DSS. KS 1 stated from 3/30/2023 to 4/3/2023 she was still having the same symptoms of abdominal pain, diarrhea, vomiting, nausea, fever, and loss of appetite. KS 1 stated she worked as a kitchen cook at the facility and prepared meals for the patients from 3/30/2023 to 4/3/2023 and she did not report to DSS or any of the facility staff that she was experiencing GI symptoms. A review of KS 1’s Time and Attendance – Employee Punch History (timecard) dated 3/27/2023 to 4/14/2023, indicated KS 1 worked at the facility on 3/27/2023 from 9:38 AM to 6:14 PM. The timecard also indicated, KS 1 worked at the facility on 3/30/2023 to 4/3/2023 on different shifts (morning between 5 AM to 2:30 PM] or afternoon shift [between 2 PM to 7 PM]). During an interview on 4/14/2023 at 2:49 PM, Dietary Service Supervisor (DSS) stated that KS 1 did not report feeling sick on 3/27/2023 or on 3/30/2023 to 4/2/2023. The DSS stated, on 4/3/2023 after KS 1 finished working her entire shift KS 1 told DSS that she felt sick experiencing diarrhea. During an interview on 4/14/2023 at 3:50 PM, the DON stated, the staff identified to have first experienced the GI symptoms was KS 1. The DON stated, KS 1 had GI symptoms of abdominal pain, diarrhea, vomiting, nausea, fever, and loss of appetite which started on 3/27/2023 but KS 1 did not report being sick until 4/3/2023 at the end of her shift. The DON stated KS 1 was supposed to report her symptoms to DSS before coming to work on 3/27/2023. The DON stated it is important to report feeling sick if staff work in the kitchen to prevent the food from being contaminated, the patients from getting sick and from unknown GI outbreak to occur. A review of the facility’s Acute Gastroenteritis (inflammation of the stomach and intestines resulting from bacterial toxins or viral infection and causing symptoms such as diarrhea, abdominal cramps, nausea, vomiting and fever) Surveillance Line List dated 4/5/2023 indicated on 3/28/2023, KS 1 experienced abdominal pain, diarrhea, nausea, vomiting, fever, and loss of appetite. A review of the facility’s Policy and Procedure (P&P) titled Norovirus Prevention and Control, revised August 2011, indicated the facility personnel who work with, prepare, or distribute food will be excluded from work if they develop symptoms of acute gastroenteritis and personnel will not return to work until 48 hours after the resolution of symptoms or longer as required by local health regulations. 2. A review of Patient 1's Admission Record (AR) indicated the Patient 1 is a 61- year- old- make who was admitted to the facility on 3/22/23, with diagnoses that included type 2 diabetes (a disease in which a person’s blood glucose, or blood sugar, levels are too high). A review of Patient 1's Minimum Data Set (MDS - a comprehensive assessment and care-screening tool) dated 4/4/23, indicated Patient 1’s cognition (mental processes, ability to understand and make decision) was intact. A review of Patient 1’s Situation Background Assessment Recommendation (SBAR - written communication tool) dated 4/2/2023, indicated, Patient 1 had three (3) episodes of yellow- colored loose bowel movement (LBM). A review of Patient 1’s physician telephone order dated 4/3/2023 indicated an order for stool culture to rule out (R/O) Clostridium difficile (C. diff - a germ [bacteria] that causes life-threatening diarrhea). A review of Patient 1’s Order Summary Report dated 4/6/2023, indicated, on 4/6/2023 (4 days from GI symptoms onset) patient was to be placed on contact isolation (the creation of barriers and other protection such as gloves, masks, or gowns to prevent the spread of an infection). A review of Patient 2's AR indicated the patient is a 70- year- old- female who was admitted to the facility on 4/10/15, with diagnoses that included convulsions (a condition in which muscles contract and relax quickly and cause uncontrolled shaking of the body). A review of Patient 2's MDS dated 3/17/23, indicated Patient 2’s cognition was severely impaired. A review of Patient 2’s SBAR dated 4/4/2023, indicated, Patient 2 had episodes of nausea, vomiting and LBM. A review of Patient 2’s physician telephone order dated 4/4/2023 indicated an order for stool culture. A review of Patient 3's AR indicated the patient is a 82- year- old- female who was initially admitted to the facility on 7/29/2020, with diagnoses that included type 2 diabetes (a disease in which a person’s blood glucose, or blood sugar, levels are too high). A review of Patient 3's MDS dated 1/26/2023, indicated Patient 3’s cognition (ability to understand and make decision) was intact. A review of Patient 3’s SBAR dated 4/4/2023 timed at 4:02 PM, indicated Patient 3 noted to have loose bowel movement (LBM/ diarrhea) with nausea and vomiting (not indicated how many times). A review of Patient 3’s Nurses Progress Note (NPN) dated 4/4/2023 timed at 4 PM indicated Patient 3 had LBM (diarrhea) with nausea and vomiting. A review of Patient 3’s NPN dated 4/4/2023 timed at 9:37 PM indicated Patient 3 had 1 episode of LBM (diarrhea) in moderate amount. A review of Patient 3’s Acute Gastroenteritis Surveillance Line List dated 4/5/2023, indicated, on 4/3/2023 Patient 3 experienced diarrhea, nausea, and vomiting. A review of Patient 3’s NPN dated 4/6/2023 times at 2:31 PM, indicated “LBM (diarrhea) was noted at this time.” A review of Patient 3’s physician’s order dated from 4/4/2023 to 4/6/2023, did not indicate patient was to be placed on contact isolation. A review of Patient 3’s physician order dated 4/7/2023 indicated an order to transfer Patient 3 to GACH. A review of Patient 3’s NPN dated 4/7/2023 times at 8:20 AM, indicated patient sent to GACH via 911 (Emergency Services) at 2:35 AM. A review of Patient 4's AR indicated the patient is a 65- year- old- female who was initially admitted to the facility on 9/13/2022, with diagnoses that included anemia (a condition in which the number of red blood cells within body is lower than normal). A review of Patient 4's MDS dated 3/13/2023, indicated Patient 4’s cognition was intact. A review of Patient 4’s SBAR dated 4/4/2023, indicated, Patient 4 was experiencing nausea, vomiting and LBM (diarrhea). A review of Patient 4’s SBAR dated 4/5/2023, indicated, Patient 4 was transferred to GACH. A review of the facility’s Acute Gastroenteritis Surveillance Line List dated 4/5/23 indicated as follows for patients: a. On 4/2/2023, Patient1 and 2 experienced diarrhea, nausea, and vomiting. b. On 4/3/2023, Patient 3 and 13 experienced diarrhea, nausea, and vomiting. c. On 4/4/2023, Patient 4, 5, 6, 7, 8, 9, 10, 11, and 12 experienced diarrhea, nausea, and vomiting. d. On 4/5/2023, Patient 14 experienced diarrhea, nausea, and vomiting, and Patient 15 experienced diarrhea and nausea. e. On 4/6/2023, Patient 16 experienced vomiting and loss of appetite, Patient 17 experience diarrhea, nausea, and vomiting, and Patient 18 and 19 experienced nausea and vomiting. f. On 4/7/2023, Patient 20 experienced nausea, vomiting, and loss of appetite. g. On 4/8/2023, Patient 21 experienced diarrhea. A review of the facility’s Acute Gastroenteritis Surveillance Line List dated 4/5/23 indicated as follows for staff: a. On 4/6/2023, KS 2 experienced diarrhea and vomiting. b. On 4/8/2023, CNA 1 experienced abdominal pain and nausea. c. On 4/9/2023, CNA 2 experienced abdominal pain, diarrhea, nausea and vomiting, CNA 3 experienced diarrhea and CNA 4 experienced nausea and vomiting. During an interview on 4/14/2023 at 4 PM, DON stated she cannot explain the reason as to why the contact isolation precautions were not done for Patient 1 and Patient 2 from 4/2/2023 to 4/5/2023. The DON stated the order should have been obtained from the patient’s attending physician and implemented on 4/2/2023. The DON stated it was important to place patients (Patient 1 and 2) on contact isolation to stop the spread of the infection. During a concurrent interview and record review on 4/14/2023 at 4:10 PM, ADM stated per facility’s policy and procedure for outbreak investigation when two (2) or more patients are experiencing GI symptoms (diarrhea, vomiting, nausea, abdominal pain and/ or fever), outbreak control measures should be implemented. The ADM stated the facility’s unknown GI outbreak which started on 4/2/2023 was reported to CDPH (via electronic notification) late on 4/5/2023. The electronic notification sent by the facility to CDPH, indicated the report of 14 cases (13 patients and 1 staff) with GI symptoms was sent on 4/5/2023. During an interview on 4/14/23 at 4:20 PM, DON stated the unknown GI outbreak was reported via electronic notification to CDPH on 4/5/2023 when a total of 14 cases: 1 Staff (KS 1) and 13 patients (Patients 1 to 13) were experiencing symptoms. The DON stated only a few symptomatic patients (Patient 1, 2, 3, 7, 10, 12, 13, 16,17, 20 and 21) were tested for stool culture that were experiencing GI symptoms (diarrhea and/ or nausea and vomiting). The DON stated she only got 4 stool culture test result from the 11 patients. The DON stated the 10 patients (Patients 4, 5, 6, 8, 9, 11, 14, 15, 18 and 19) have not been tested and the DON was unable to explain as to why the remaining 10 patient stool culture was not done. The DON stated, it was important to ensure correct laboratory test was done to ensure facility have recognized the source of infection and/ or type of bacteria or virus the facility need treat and prevent the spread. During the same interview on 4/14/2023 at 4:20 PM, DON stated outbreak was reported to PHN and CDPH (via electronic notification) on 4/5/2023 (3 days after the first 2 symptomatic patients). The DON stated, the IPN did not communicate with her why the GI outbreak was not reported until 4/5/2023 when it should have been reported on 4/2/2023. The DON stated it was important to ensure the facility report thei