A COVID-19 Focused Infection Control Survey was conducted by the Oregon State Survey Agency on 10/19/20 to 10/22/20.
A deficiency was cited.
Total residents: 40
Abbreviations possibly used in this document:
ADL: activities of daily living
bid: twice a day
BIMS: Brief Interview for Mental Status
CAA: Care Area Assessment
CBG: capillary blood glucose or
blood sugar
cm: centimeter
CMA: Certified Medication Aide
CNA: Certified Nursing Assistant
CPR: Cardiopulmonary Resuscitation
DNS: Director of Nursing Services
F: Fahrenheit
FRI: Facility Reported Incident
HS or hs: hour of sleep
LPN: Licensed Practical Nurse
MAR: Medication Administration
Record
mcg: microgram
MDS: Minimum Data Set
mg: milligram
ml: milliliters
O2 sats: oxygen saturation in the
blood
OT: Occupational Therapist
PCP: Primary Care Physician
PO: by mouth, orally
PRN: as needed
PT: Physical Therapist
RA: Restorative Aide
RAI: Resident Assessment
Instrument
RD: Registered Dietician
ROM: range of motion
RN: Registered Nurse
RNCM: Registered Nurse Care
Manager
SLP: Speech Language
Pathologist
TAR: Treatment Administration
Record
tid: three times a day
UA: Urinary Analysis
UTI: urinary tract infection
A COVID-19 Focused Infection Control Revisit Survey was conducted by the Oregon State Survey Agency on 12/31/20 to 1/4/21.
The facility was found to be in compliance with 42 CFR §483.80.
Total residents: 18
2. Centers for Disease Control and Prevention, Preparing for COVID-19 in Nursing Homes, revised 6/25/20, Evaluate and Manage Residents with Symptoms of COVID-19. Facilities should complete the following: ... "Ask residents to report if they feel feverish or have symptoms consistent with COVID-19
... Actively monitor all residents upon admission and at least daily for fever and symptoms consistent with COVID-19. Ideally, include an assessment of oxygen saturation via pulse oximetry. If residents have fever or symptoms consistent with COVID-19, implement Transmission-Based Precautions. Older adults with COVID-19 may not show common symptoms such as fever or respiratory symptoms. Less common symptoms can include new or worsening malaise, headache, or new dizziness, nausea, vomiting, diarrhea, loss of taste or smell. Additionally, more than two temperatures" above 99 degrees" "might also be a sign of fever in this population. Identification of these symptoms should prompt isolation and further evaluation for COVID-19."
Review of the facility Infection Control Policy and Procedure, Coronavirus Disease (COVID-19) - Infection Prevention and Control Measures, revised 7/2020, instructed the staff were to screen residents daily for fever and signs/symptoms of COVID-19.
Resident 4 admitted to the facility on 10/17/20 with diagnoses including after surgical care and depression.
On 10/20/20 at 1:38 PM, Staff 2 (Interim DNS) stated the facility monitors residents for signs and symptoms on the MAR in the residents' EHR (Electronic Health Record).
During record review on 10/21/20, Resident 4 had no evidence of monitoring for COVID-19 signs or symptoms. No alert charting was found in her/his EHR.
In an interview on 10/20/20 at 11:11 AM, Staff 2 stated she would expect Resident 4 to have monitoring of COVID signs and symptoms in her/his EHR. Staff 2 and Staff 1 (Executive Director) stated they would provide addition information if Resident 4 had COVID monitoring in place.
On 10/23/20 at 4:30 PM, no further documentation was provided
3. Centers for Disease Control (CDC), updated 6/19/20, refers to the facility to implement Universal Source Control which refers to facemasks to cover a person's mouth and nose to prevent spread of respiratory secretions when they are talking, sneezing or coughing. Because of the potential for asymptomatic and pre-symptomatic transmission, source control measures are recommended for everyone in a healthcare facility, even if they do not have symptoms of COVID-19. Staff should wear a facemask at all times while they are in the healthcare facility, including spaces where they might encounter co-workers. Staff should be aware about the importance of performing hand hygiene immediately before and after any contact with their facemask or cloth face covering. Do not wear respirator/facemask under [the] chin or store in scrubs pocket between patients.
Review of the facility Infection Control Policy and Procedure, Coronavirus Disease (COVID-19) - Infection Prevention and Control Measures, revised 7/2020, instructed the staff "while in the building, personnel were required to strictly adhere to established infection prevention and control practices which included social distancing when applicable, universal source control (use of facemask's)... Staff should wear a facemask at all times when in the facility. Physical distance of 6 feet enforced among residents and staff were required to practice social distancing with other staff and residents."
On 9/24/20 Staff 1 (Executive Director) was observed at the front door of the facility with his mask under his chin and not socially distanced from an unmasked male. Staff 1 was provided TA (technical assistance) by surveyor to wear his mask and wear eye protection. Staff 1 was provided further TA by surveyors on several other occasions from 9/24/20 to 10/19/20 about staff wearing masks and face shields while in the facility.
On 10/19/20 at 3:06 PM, Staff 1 was observed sitting at his desk without a mask or eye protection, in his office. Staff 3 (Care Manager) was standing and leaning on his desk, while wearing full PPE including a gown, she had worn into multiple residents' rooms to complete COVID testing. Staff 1 and Staff 3 were observed not social distanced..
On 10/22/20 at 11:11 AM, Staff 1 confirmed he expected staff to wear face masks and face shields while in the facility. Staff 1 acknowledged he was not wearing a face mask or face shield on Monday, 10/19/20 at 3:06 PM.
Based on observation, interview and record review, it was determined the facility failed to implement appropriate infection control practices including social distancing and Personal Protective Equipment (PPE) for 2 of 2 units observed and monitor resident(s) for signs/symptoms of COVID-19 for 1 of 4 sampled residents reviewed (#4) for infection control. This placed residents at increased risk for potential exposure and contracting the highly communicable COVID-19 disease. Findings include:
1. The 7/15/20 Centers for Disease Control and Prevention (CDC) Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic guidance revealed for "healthcare professionals (HCP) the potential for exposure to COVID-19 is not limited to direct patient care interactions. Transmission can also occur through unprotected exposures to asymptomatic or pre-symptomatic co-workers in breakrooms or co-workers or visitors in other common areas. Examples of how physical distancing in non-patient care areas, providing implemented for HCP include: emphasizing the importance of source control and physical distancing in non-patient care areas, providing family meeting areas where all individuals (e.g., visitors, HCP) can remain at least 6 feet apart from each other, designating areas for HCP to take breaks, eat, and drink that allow them to remain at least six feet apart from each other, especially when they must be unmasked."
Review of the facility Infection Control Policy and Procedure, Coronavirus Disease (COVID-19) - Infection Prevention and Control Measures, revised 7/2020, revealed staff were required to strictly adhere to established infection prevention and control practices, which included social distancing. The physical distance of six feet was to be enforced among residents and staff. Staff were required to practice social distancing with other staff and residents while in the facility.
On 10/19/20 at 12:58 PM, Resident 1 was observed on the street corner to talk with a person from the town/local community who was walking their dog, neither had a mask on and were closer than six feet apart.
On 10/19/20 at 1:36 PM, two staff were observed not social distanced on Hall B at the computer kiosk.
On 10/19/20 at 1:49 PM, three staff were observed not social distanced on Hall C (observation/isolation hall), were closer than six feet apart.
On 10/19/20 at 1:57 PM, four staff were observed not social distanced on Hall B at the computer kiosk.
On 10/19/20 at 1:57 PM, five staff and one resident were observed not social distanced at the nurse's station during change of shift. The charge nurse attempted to redirect staff, only one staff member stepped back to observe social distancing guidelines.
On 10/19/20 at 2:01 PM, three staff were observed not social distanced on Hall C.
On 10/19/20 at 2:05 PM, two staff were observed on the Hall A to walk shoulder-to-shoulder in the middle of the hall and congregated at the computer kiosk.
On 10/19/20 at 2:10 PM, two staff were observed not social distanced on Hall B at the computer kiosk.
On 10/19/20 at 2:16 PM, Staff 3 (LPN/Care Coordinator) was observed in Staff 1's (Executive Director) office leaning on the corner of his desk with her dirty gown touching the desk. Staff 1 and Staff 3 were observed not social distanced.
On 10/19/20 at 3:06 PM, Staff 3 and Staff 1 were observed not social distanced at Staff 1's desk. Staff 1 was observed to not wear a face mask or eye protection.
During an interview on 10/19/20 at 2:24 PM, Staff 10 (LPN) stated she tried to get staff to social distance, but they don't always listen. She stated this happened all the time.
In an interview on 10/19/20 at 2:50 PM, Staff 1 and Staff 2 (Interim DNS) confirmed they expect staff to social distance when in the facility, with exception for resident care needs.
This plan of correction constitutes the facility’s written allegation of compliance for the deficiencies cited. The submission of this plan of correction is not an admission of, or agreement with, the deficiencies or conclusions contained in the department’s inspection report.Deficiencies related to F- tag 8801. Correction/s as it relates to the resident/s: No negative impact noted from this deficient practice on any residents. Residents #1,2,3,4 were last tested 10/19, with negative results. No other suspected or positive result residents in the Facility.2. Action/s taken to protect residents in similar situations: Other residents are at potential risk for contacting this Virus, due to improper infection control practice can lead to exposure and contraction of communicable disease such as COVID- 19 . Current residents are being monitored daily, any resident noted with signs/symptoms consistent with COVID-19 are tested to rule out COVID. No positive or suspected COVID-19 residents or staff in the facility at this time..3. Measures taken or systems altered to ensure that solutions are sustained: Re- education will be provided to the staff on CDC guidelines by DNS regarding Social distancing (maintain a distance of 6 feet), Proper use of Personal Protective Equipment (PPE) , monitoring process for signs/symptoms of communicable disease such as COVID- 19. Capacity in facility has been altered , by reducing shared rooms to private rooms on Observation unit for new admissions, readmissions and suspected COVID residents . Residents are monitored times 14 days, any resident noted with s/s consistent with COVID -19 , are provided testing.Education will be provided to residents that smoke on the importance of wearing masks per OHA guidelines on mask wearing in public. A box of masks will be placed in residents rooms and encourage to wear mask when they are out to smoking.4. Plans to monitor performance to ensure solutions are sustained and person responsible: DNS, ED and/or designee will conduct random observation of the staff and resident to ensure practice of Social distancing, proper use of PPE, good hand washing and respiratory hygiene. Any concerns identified will be corrected immediately. Audit will be done 5X /week for 3weeks, then for 2 weeks. Ongoing observation during rounds. Results of the audit will be reviewed in monthly QAPI, until compliance is met and sustained or per recommendation of the Committee.5. Who will be responsible for ensuring compliance: DNS and ED are responsible for compliance
A COVID-19 Infection Control Survey and a COVID-19 Confirmed Facility Review were conducted by the Oregon State Survey Agency on 10/19/20 to 10/22/20.
Total residents: 40
A deficiency was cited.
Abbreviations possibly used in this document:
ADL: activities of daily living
bid: twice a day
BIMS: Brief Interview for Mental Status
CAA: Care Area Assessment
CBG: capillary blood glucose or
blood sugar
cm: centimeter
CMA: Certified Medication Aide
CNA: Certified Nursing Assistant
CPR: Cardiopulmonary Resuscitation
DNS: Director of Nursing Services
F: Fahrenheit
FRI: Facility Reported Incident
HS or hs: hour of sleep
LPN: Licensed Practical Nurse
MAR: Medication Administration
Record
mcg: microgram
MDS: Minimum Data Set
mg: milligram
ml: milliliters
O2 sats: oxygen saturation in the
blood
OT: Occupational Therapist
PCP: Primary Care Physician
PO: by mouth, orally
PRN: as needed
PT: Physical Therapist
RA: Restorative Aide
RAI: Resident Assessment
Instrument
RD: Registered Dietician
ROM: range of motion
RN: Registered Nurse
RNCM: Registered Nurse Care
Manager
SLP: Speech Language
Pathologist
TAR: Treatment Administration
Record
tid: three times a day
UA: Urinary Analysis
UTI: urinary tract infection
A COVID-19 Confirmed Facility Review was conducted by the Oregon State Survey Agency on 12/31/20 to 1/4/21.
Total residents: 18
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OAR 411-086-0330 Infection Control and Universal Precautions
Refer to F880
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Based on observation, interview and record review it was determined the facility failed to implement quarantine measures for 6 of 9 (#3, 6, 7, 9, 10 and 11) newly admitted or readmitted sampled residents for a period of 14 days. Quarantine measures should include placement of resident in a private room. This placed residents at increased risk for potential exposure and contracting the highly communicable COVID-19 disease. Findings include:
Surveyors provided technical assistance on multiple occasions during previous State Review visits in 10/2020 for cohorting residents who had been admitted in the past 14 days.
The 10/20/20 census sheet revealed Resident 6 and Resident 9 shared a room, Resident 7 and Resident 10 shared a room and Resident 3 and Resident 11 shared a room.
On 10/20/20 at 10:58 AM, Rooms 28 and 29 on the C Hall for isolations was observed to have two residents residing in each. Staff 8 (CNA) confirmed two residents resided in room 33 with one resident out of facility at an appointment.
On 10/20/20 at 1:38 PM, Staff 1 (Executive Director) confirmed the facility did not quarantine newly admitted residents in a private room for a 14 days quarantine.
Deficiencies related to T010 – OAR 4111. Correction/s as it relates to the resident/s: Facility has created and implemented quarantine ( Observation ) Unit for newly admitted and/or readmitted residents.2. Action/s taken to protect residents in similar situations: Newly admitted and readmitted residents are monitored twice a day for 14days. Residents noted with signs/ symptoms consistent with COVID -19 . Suspected COVID -19 residents are placed in the quarantine Unit and tested to rule out infection. Admission Coordinator conducts risk based COVID -19 screening, test result provided to the facility, before admission is accepted in compliance with OHA guidance. No suspected or positive COVID -19 residents currently in the facility.3. Measures taken or systems altered to ensure that solutions are sustained: System change- Facility capacity has been altered to reduce shared rooms to private rooms. Required Personal protective equipment (PPE) storage located on the unit.4. Plans to monitor performance to ensure solutions are sustained and person responsible: Admissions person, ED and DNS will assign new admissions and returns from hospital to private rooms and validate on routine rounds.5. Who will be responsible for ensuring compliance: DNS, ED are responsible for compliance.
