Olympia Convalescent Hospital
Inspection Findings
F-Tag F0880
F 0880
Provide and implement an infection prevention and control program.
Level of Harm - Minimal harm or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to follow their infection control policy and procedure (P&P) for two of three sampled residents (Resident 1 and 2), by failing to report the positive COVID cases to the State Agency (SA). This deficient practice had the potential to spread infection to the residents, visitors, and
the community. Findings:During a review of Resident 1's admission Record dated 8/29/25 indicated Resident 1 was admitted to the facility on [DATE REDACTED], with diagnoses including diabetes mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing), hypertension (HTNhigh blood pressure), hyperlipidemia (HLD - a condition characterized by elevated levels of lipids (fats) in
the bloodstream) and major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest). During a review of Resident 1's MDS, dated [DATE REDACTED], indicated Resident 1 had severe cognitive (thinking, reasoning, learning, judgment) impairment and required partial to substantial assistance from staff for toileting, bathing, dressing and personal hygiene. During a review of Resident 2's admission Record dated 8/29/25 indicated Resident 2 was admitted to the facility on [DATE REDACTED] with diagnoses including abnormalities of gait and mobility, HTN, HLD, and anemia (a condition where the body does not have enough healthy red blood cells).During a review of Resident 2's MDS, dated [DATE REDACTED], indicated Resident 2 had moderate cognitive (thinking, reasoning, learning, judgment) impairment and required substantial assistant to dependance on staff for toileting, bathing, dressing and personal hygiene. During an
interview with concurrent record review on 8/28/25 at 4:10 pm with Director of Nursing (DON) the Resident 2's nurses notes dated 8/2/25 were reviewed. The DON verified the resident had had a change of condition, was tested for COVID on that day and was found to be positive. During an interview with concurrent record
review on 8/28/25 at 4:01 pm with DON Resident 1's nurses note for 8/4/25 were reviewed. The note indicated the resident had a change of condition with a fever and had a COVID test at the facility before she was transferred to the hospital which was negative. Further review of nurses noted dated 8/8/25 indicated
the resident was readmitted on that date and tested COVID upon admission. The DON stated the cases were within seven days of each other and should have been reported to the SA. During a review of the facility's policy and procedures titled Infection Prevention and Control Program , reviewed 1/24/25, Duties and Responsibilities. Notify appropriate government agencies of reportable contagious or infectious diseases.
Residents Affected - Few
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
Olympia Convalescent Hospital in LOS ANGELES, CA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in LOS ANGELES, CA, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Olympia Convalescent Hospital or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.