A COVID-19 Focused Emergency Preparedness Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) Seattle on 12/9/20 to 12/11/20. The facility was found to be in compliance with 42 CFR §483.73 related to E-0024 (b)(6).
Total residents: 61
A COVID-19 Focused Infection Control Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) Seattle on 12/9/20 to 12/11/20.
The survey sample, based on a resident census of 61, included 5 sampled residents.
CMS Seattle federal surveyors can be reached at:
US Department of Health and Human Services
Centers for Medicare and Medicaid Services
701 Fifth Avenue Suite 1600
Region 10, mailstop 400
Seattle, WA 98104
206.615.2313
206.615.2088 (Fax)
A COVID-19 Focused Infection Control Revisit Survey was conducted by the Oregon State Survey Agency on 4/2/21.
The facility was found to be in compliance with 42 CFR §483.80.
Total residents: 69
Based on observation, interview and record review, the facility failed to establish and maintain an infection prevention and control program designed to provide a safe and sanitary environment to help prevent the transmission of communicable diseases, including COVID-19 and infections. COVID-19 is an infectious disease by a new virus causing respiratory illness with symptoms including cough, fever, new or worsening malaise, headache, or new dizziness, nausea, vomiting, diarrhea, loss of taste or smell, and in severe cases difficulty breathing that could result in severe impairment or death.
The facility failed to follow manufacturer's instructions for cleaning/disinfecting Virex II 256 solution used for high-touch items in 1 of 1 resident (R) (R1) rooms observed. Housekeepers (HK)1, HK2 and HK3 stated that Virex II was used to clean all resident rooms in the facility.
This failure increased the risk for the spread of infection and its associated discomfort and decline in physical condition.
Findings include:
During a concurrent observation and interview on 12/9/20 at 8:26 AM HK3 was in housekeeping closet near Cedar Lane filling up buckets on housekeeping cart with solutions from closet. HK3 filled bucket with Virex II 256 solution, EPA registration number 70627-24, and stated that Virex was used to wipe down table, and other items in the resident rooms that are touched. The label on Virex container showed solution was a one-step cleaner and disinfectant for hard non-porous environmental surfaces. All surfaces must remain wet for 10 minutes. Wipe surfaces and let air dry.
Observation on 12/9/20 at about 10:40 AM showed Housekeeper (HK)1 and HK2 enter Resident (R)1's room. Sign on R1's door showed Admission temporary precautions. Use hand hygiene in and out of room, gown, mask with eye protection and gloves. An isolation cart with gowns and gloves was outside the room. HK1 and HK2 wore gown, gloves, surgical face masks and face shields. HK2 placed microfiber towel in bucket that was on housekeeping cart and squeezed towel of liquid. HK2 then wiped drawers, tv shelf, foot board of bed, air conditioner, window sill, handle for blinds, head board of bed, light above bed, chair, wall-mounted hand sanitizer, bathroom and closet door handles. Each item was wiped quickly and then HK2 wiped next item. HK2 then got new cloth and placed in bucket on housekeeping cart, squeeze cloth of liquid and wiped resident's overbed table after removing phone, tissue box, incentive spirometer, water cup and other items off overbed table. After wiping overbed table, R1 asked if he should let it dry for a minute or could he put back items removed from overbed table. HK1 stated, "It shouldn't hurt you" and resident immediately placed items back on overbed table, less than a minute lapsed from the time HK1 wiped overbed table to when items were placed on overbed table. HK1 and HK2 continued cleaning room.
During an interview on 12/9/20 at about 10:42 AM HK1 and HK2 stated that Virex solution was in bucket for cloth used to wipe overbed table and other items in resident's room. When asked if surfaces wiped with Virex solution needed to stay wet for a certain period of time, HK1 stated, "I wring the cloth as much as I can, so it's damp." When asked how long the items wiped remained wet, HK1 stated, "maybe 5 to 10 seconds". HK1 and HK2 reviewed Virex label showing dwell time of 10 minutes. HK1 stated he worked in the facility for about a month and wasn't taught to keep items wiped with Virex wet for a certain period of time or at least 10 minutes. HK2 stated that he worked in the facility for the past year and wasn't taught to keep items wiped with Virex wet for a certain period of time or at least 10 minutes
During an interview on 12/9/20 at 1:02 PM Maintenance and Housekeeping Supervisor (HKS) stated that he worked at the facility for a little over a year and all housekeepers have been trained by fellow housekeepers. HK2 is employed staff and HK1 and HK3 are agency contracted staff. HKS stated that Diversey (cleaning product company) had a new training that demonstrates proper way to disinfect and sanitize areas and agency staff have gone through training but employed staff have not. HKS also stated that he has observed HK staff clean rooms without concerns. When asked what expectations were for cleaning high-touch items in resident's rooms, HKS stated that high-touch items should be cleaned daily with Virex II. When asked to outline steps for use of Virex II, HKS stated that solution should be wringed out as much as possible, wipe down surfaces and allow to air dry. When asked if items wiped with Virex solution should remain wet for a certain period of time, HKS stated "4 to 5 minutes ....that's what I usually see." When Virex label was shown, HKS stated that items wiped with Virex should remain wet for 10 minutes as the manufacturer's label should be followed. When asked how HK should assess or determine how the items wiped remain wet for 10 minutes, HKS said, "you tell me." When asked HKS instructions or directions he provided his HK staff for ensuring dwell time of 10 minutes when using Virex, HKS did not answer. HKS then stated Virex has been in use since February 2020 and was not brought in because of COVID.
During an interview on 12/9/20 at 3:19 PM HK3 stated that he cleaned all the rooms on Cedar Lane today and used Virex solution that he mixed earlier in the day that he showed surveyor. HK3 stated that he wiped everything down with it, such as door knobs, overbed table, because it was a germ killer. HK3 stated that Virex dries on its own and the cloth dries pretty quickly. When asked after wiping with Virex how long the items stays wet, HK3 stated "close to a minute, or less than that. If the air conditioner in the room is on, it dries faster." When asked about his training, HK3 stated that another HK taught him and he watched HK2. HK3 stated that he tries to squeeze cloth (in Virex) as tightly as possible so it doesn't leave any water stains.
During an interview on 12/9/20 at 3:48 PM Director of Nursing, who also stated that she would respond for the Infection Preventionist (IP) as she did most of the IP role, stated that manufacturer's instructions cleaning/disinfectant should be followed.
Review of R1's records showed facility admitted resident on 12/5/20 with diagnosis including fracture leg, chronic respiratory failure with hypoxia, emphysema and dependence on oxygen. Resident was admitted from the hospital with orders for droplet and contact transmission based precautions for first 14 days of admission.
During Exit Conference on 12/11/20 at 4:10 PM Administrator stated that we have been so focused on contact (dwell) time for clinical staff but we overlooked housekeeping staff.
Review of CDC Preparing for COVID-19 in Nursing Homes, https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html, dated 6/25/20, accessed 11/17/20, under Environmental Cleaning and Disinfection showed "Develop a schedule for regular cleaning and disinfection of shared equipment, frequently touched surfaces in resident rooms and common areas; Ensure EPA-registered, hospital-grade disinfectants are available to allow for frequent cleaning of high-touch surfaces and shared resident care equipment ....Ensure HCP (healthcare personnel) are appropriately trained on its use."
Review of facility Daily Cleaning Inspection Form, undated, showed several items such as telephone hand set, remote control, chair arm rests, counter tops, cabinet handles were to be clean but did not detail disinfectant manufacturer's instructions of 10 minute dwell time or how dwell time should be assessed or determined. HKS provided form when asked for facility policy and procedure for resident daily room cleaning.
Review of Centers of Disease Control and Prevention (CDC) cases and deaths by county, https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/county-map.html, dated 12/2/20, accessed 12/7/20, showed Marion County (the county where the facility was located) had 11.9 percent positivity rate indicating high level of community COVID-19 activity/red zone positivity classification.
The current product has been labeled with the contact time. We have ordered a replacement product that has a contact time of 1 minute. Until it arrives, we will encourage staff to use Oxivir wipes and Clorox Fuzion spray, both of which have contact times of 1 minute, and are already available to staff. The housekeeping staff have been inserviced on the meaning of and importance of contact time and specifically the contact time for the products we use.Audits of room cleaning will be done on 10% of rooms monthly. This audit will include observation of contact time.
