A COVID-19 Focused Emergency Preparedness Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) Seattle on 12/8/20 to 12/10/20. The facility was found to be in compliance with 42 CFR §483.73 related to E-0024 (b)(6).
Total residents: 37
A COVID-19 Focused Infection Control Survey was conducted by the Centers for Medicare & Medicaid Services (CMS) Seattle on 12/8/20 to 12/10/20.
The survey sample, based on a resident census of 37, 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)
This report reflects the findings of COVID-19 Focused Infection Control revisit survey conducted on 4/13/21. The facility was found to be in substantial compliance with 42 CFR Part 483 Requirements for Long Term Care Facilities.
Total residents: 48
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 HDQC2 cleaning/disinfecting solution used for high-touch items in 1 of 1 resident (R) (R4) rooms observed by Housekeeper (HK)1 . HK1 cleaned all 27 rooms in the facility for residents who were not on transmission-based precautions.
This failure increased the risk for the spread of infection and its associated discomfort and decline in physical condition.
Findings include:
Observation on 12/8/20 at about 11:20 AM showed Housekeeper (HK)1 enter Resident (R)4's room. R4 sat on bed and stated that she was cold. HK1 bagged trash, placed new trash bag, picked up green microfiber cloth towel from bucket of liquid solution, squeezed liquid from cloth and wiped room, bathroom, and closet door knobs and sink. HK then cleaned bathroom toilet. With another green cloth placed in solution, HK1 squeezed cloth of liquid and wiped overbed table, ipad, bedside table, and dresser handles with cloth. HK1 repeated steps with new cloth and wiped walker handles, seat and frame, window sill, tv remote control, bed control, chair arm and back, wall mounted safety bars, call light and infusion pump and pole. Each item was wiped quickly and then HK1 wiped next item. Wall mounted safety bars was touched about 40 seconds after HK1 wiped bars and it was wet. Wall mounted safety bars was touched about 60 seconds after HK1 wiped bars and it was dry.
During an interview on 12/8/20 at about 11:25 AM HK1 stated that the liquid solution that she used to clean items in resident rooms with green cloth was Q2 and items in room are wiped because they kill bacteria. When asked how long items wiped needed to stay wet, HK1 stated "2 minutes."
Observation on 12/8/20 at 11:30 AM in housekeeping closet HK1 showed surveyor Q2 solution. Container showed product label as HDQC2 Clean on the Go cleaner/disinfectant/detergent/fungicide against pathogenic fungi/deodorizer/virucidal activity. The label showed to disinfect inanimate hard non-porous surfaces, add 2 ounces of HDQC2 per gallon of water. Apply solution with a mop, cloth, sponge, hand pump trigger spray to wet all surfaces thoroughly, allow to remain wet for 10 minutes, then remove excess liquid. The EPA registration number shown for HDQC2 was 1839-169.
During an interview on 12/8/20 at 11:54 AM HK1 stated that items wiped with Q2 stayed wet for about 2 to 3 minutes. HK1 stated that items did not remain wet for 10 minutes.
During an interview on 12/8/20 at 1:10 PM Administrator stated that Q2 was the product directed to use and staff should definitely be following manufacturer's instructions on disinfectant's use. Regional support nurse and DON joined the conversation and nodded in agreement that disinfectant's manufacturer's instructions for use should be followed and the facility did not have a policy outlining this but this was general principle followed by the facility. Administrator stated that the rooms for residents who were on transmission-based precautions were taken care of by nursing staff and not housekeeping. Nursing staff cleaned up any large spills and daily room cleaning such as high-touch surfaces, sweeping, and mopping were not routinely done.
During an interview on 12/8/20 at 1: 35 PM Administrator stated that facility will start using Pure product instead of Q2. Pure had a dwell time of 30 seconds.
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."
Record review showed R4 was admitted on 11/13/20 and readmitted on 12/2/20 with diagnosis including COVID-19, diabetes, sepsis with septic shock, and abscess of liver. R4 was receiving antibiotics through a peripherally inserted central catheter (PICC) which is a long thin tube that's inserted through a vein in the arm and passed through to the larger veins near your heart.
Review of facility's COVID19 case log, undated with last entry dated 12/4/20, received by email on 12/8/20 at 10:03 AM and facility daily census, dated 12/9/20 showed facility census of 37 with 10 residents with COVID-19.
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 Multnomah County (the county where the facility was located) had 10.6 percent positivity rate indicating high level of community COVID-19 activity/red zone positivity classification.
"This Plan of Correction is prepared and submitted as required by law. By submitting this plan of correction, Prestige Care of Reedwood does not admit that the deficiency listed on this form exist, nor does the Center admit to any statements, findings, facts, or conclusions that form the basis for the alleged deficiency. The Center reserves the right to challenge in legal and/or regulatory or administrative proceedings the deficiency, statements, facts and conclusions that form the basis for the deficiency" Housekeeping staff were immediately instructed to switch from HDQC2 cleaning product to Pure disinfection product, which has a 30 second dwell time, when cleaning high touch surfaces in resident rooms. All residents and staff have the potential of being affected. Housekeeping staff will be educated on using chemicals according to manufacturers guidelines. Housekeeping and Laundry Supervisor, Maintenance Director, Administrator or designee will perform audits of chemical’s being used to clean resident rooms and make sure they are following the manufacturers guidelines. Audits will be completed once a week for 4 weeks and then monthly for 2 months. Results from the audits will be reviewed monthly at QA meeting and a process improvement plan will be developed if necessary. Laundry and Housekeeping Supervisor, Maintenance Director, and Administrator are responsible for continued compliance.
