Torrance Care Center West, Inc

F-F689

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 35 of 39 055952 Department of Health & Human Services Printed: 09/17/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 055952 B. Wing 07/26/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Torrance Care Center West, Inc 4333 Torrance Blvd Torrance, CA 90503

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 46144 potential for actual harm Based on observation, interview, and record review, the facility failed to maintain and observe infection Residents Affected - Few control practices by failing to:

a. Practice hand hygiene.

b. Disinfect residents smoking aprons after each use.

These deficient practices had the potential to result in cross contamination (physical movement or transfer of harmful bacteria from one person, object, or place to another) and place residents at risk for the spread of infection.

Findings:

a. During an observation on 7/23/2024 at 10:30 a.m. in Building B at nursing station B there was a sink for hand washing. Certified Nursing Assistant (CNA) 2 wiped up a wet substance from the floor next to nursing station B, threw away the paper towel, and failed to wash her hands. CNA 2 preceded to assigned area near Station A and sat in a chair near room [ROOM NUMBER] without washing her hands.

During an interview on 7/23/2024 at 11:00 a.m. with CNA 2, CNA 2 stated, she failed to wash her hands after

she picked up the wet substance off the floor. CNA 2 stated it was important to practice hand hygiene to not spread infection to the residents.

During an interview on 7/26/2024 at 9:32 a.m. with Infection Preventionist Nurse (IP), the IP stated the staff should be washing their hands before and after resident care. The IP stated CNA 2 was to wash her hands right away after wiping up the wet substance. The IP stated it was important to practice good hand hygiene to prevent the spread of germs to the residents and staff.

During a review of the facility's policy and procedure (P&P) titled, Handwashing/Hand Hygiene, date unknown, the P&P indicated, This facility considers hand hygiene the primary means to prevent the spread of infection .Employes must wash their hand after the handling of residents mucous membranes and body fluids or excretions .Employee must wash their hands for at least 15 seconds or using alcohol-based hand rubs.

b. During an observation on 7/25/2024 at 9:45 a.m. in Building B on the smoking patio residents had on aprons while smoking. The residents would remove the aprons and the aprons were not disinfected after each use.

During a concurrent observation and interview on 7/25/24 at 9:54 a.m. with Activity Assistant (AA) 2 near the smoking patio, the smoking residents were removing smoking aprons and other smoking residents were putting on the same smoking aprons without the smoking aprons being disinfected between use. AA 2 stated

the smoking aprons were not being disinfected after each use. AA 2 stated the smoking aprons not being disinfected after each use was placing the residents at risk for infection.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 36 of 39 055952 Department of Health & Human Services Printed: 09/17/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 055952 B. Wing 07/26/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Torrance Care Center West, Inc 4333 Torrance Blvd Torrance, CA 90503

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 During an interview on 7/25/2024 at 1:24 p.m. with the Director of Nursing (DON), the DON stated the staff need to disinfect the smoking aprons after each use. The DON stated it was important to disinfect the Level of Harm - Minimal harm or smoking aprons after each use to prevent the spread of infection from resident to resident. potential for actual harm

During a review of the facility's policy and procedure (P&P) titled, Infection Prevention and Control Program, Residents Affected - Few date unknown, the P&P indicated, This facility has established and maintains an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections .All reusable items and equipment requiring special cleaning, disinfection, or sterilization shall be cleaned.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 37 of 39 055952 Department of Health & Human Services Printed: 09/17/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 055952 B. Wing 07/26/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Torrance Care Center West, Inc 4333 Torrance Blvd Torrance, CA 90503

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0912 Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 47923

Residents Affected - Some Based on observation, interview and record review, the facility failed to provide at least 80 square feet ([sq. ft. ] unit of measurement) per resident in multiple resident bedrooms for 20 out of 78 resident rooms.

This deficient practice had the potential to result in an inadequate provision of safe nursing care, and privacy for the residents.

Findings:

During a facility tour on 7/25/2024 at 8:55 a.m., observed that room [ROOM NUMBER], 18, 19, 20, 21, 23, 24, 25, 27, 29, 30, 31, 32, 33, 34, 35, 37, 38, 39, and 40, residents were able to move in and out of their rooms, and there was space for the beds, side tables, and resident care equipment.

During an interview on 7/25/2024 at 9:10 a.m., with the Administrator (ADM), the ADM confirmed they had rooms less than the required 80 sq. ft per resident.

During a review of the facility's request for waiver of room size letter dated 7/24/2024 submitted by ADM, for 20 resident rooms was reviewed. The waiver request letter indicated there is adequate space for residents to get in and out of wheelchairs and residents have sufficient freedom for movement. The waiver request letter also indicated, the floor area of the affected rooms does not adversely affect the resident's health and safety and is in accordance with the special needs of the residents.

The following room provided less than 80 sq. ft per resident:

Rooms # beds sq. ft.

17 3 228.15

18 3 224.25

19 3 216.6

20 3 214.7

21 3 224.2

23 3 220

24 3 220

25 3 220

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 38 of 39 055952 Department of Health & Human Services Printed: 09/17/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 055952 B. Wing 07/26/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Torrance Care Center West, Inc 4333 Torrance Blvd Torrance, CA 90503

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0912 27 3 220

Level of Harm - Potential for 29 3 220 minimal harm 30 3 220 Residents Affected - Some 31 3 220

32 3 220

33 3 220

34 3 220

35 3 220

37 3 220

38 3 234.6

39 3 234.6

40 3 226.2

The minimum sq. ft. for a three-bedroom room was 240 sq. ft.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 39 of 39 055952