Based on interview and record review, it was determined that the facility failed to follow the return to work guidelines for health care personnel who were positive for COVID-19 illness from working in the facility. 1 of 13 staff reviewed for COVID-19 infection returned to work the day after they tested positive for COVID-19. 12 of 13 staff reviewed for COVID-19 infection returned to work on day 4 or later. This failure increased the likelihood of exposure to pathogens for the facility's census of 87 residents, staff, and visitors (Staff identifiers are A, M, N, O, P, W, Q, R, S, G, T, U, and V). Findings include: Review on 4/10/23 of the facility COVID-19 line list of positive staff and the March 2023 and April 2023 nursing schedules revealed the following: Staff A (Registered Nurse (RN)) tested positive for COVID-19 on 3/14/23 and returned to work on 3/20/23 (Day 6); Staff M (RN) tested positive for COVID-19 on 3/17/23 and returned to work on 3/24/23 (Day 7); Staff N (Licensed Nursing Assistant (LNA)) tested positive for COVID-19 on 3/28/23 and returned to work on 4/2/23 (Day 5); Staff O (LNA) tested positive for COVID-19 on 3/28/23 and returned to work on 4/4/23 (Day 7); Staff P (LNA) tested positive for COVID-19 on 3/28/23 and returned to work on 4/5/23 (Day 8); Staff W (Activities Aide) tested positive for COVID-19 on 3/28/23 and returned to work on 4/3/23 (Day 6); Staff Q (Licensed Practical Nurse (LPN)) tested positive for COVID-19 on 3/29/23 and returned to work on 4/5/23 (Day 7); Staff R (Medication Nursing Assistant (MNA)) tested positive for COVID-19 on 3/29/23 and returned to work on 4/4/23 (Day 6); Staff S (LPN) tested positive for COVID-19 on 3/29/23 and returned to work on 4/4/23 (Day 6); Staff G (LNA) tested positive for COVID-19 on 3/30/23 and returned to work on 4/5/23 (Day 6); Staff T (LNA) tested positive for COVID-19 on 3/30/23 and returned to work on 3/31/23 (Day 1); Staff U (LNA) tested positive for COVID-19 on 4/1/23 and returned to work on 4/5/23 (Day 4); Staff V (LNA/Activities Aide) tested positive for COVID-19 on 4/1/23 and returned to work on 4/6/23 (Day 5). Interview on 4/7/23 at approximately 10:00 a.m. with Staff A (RN) revealed that he/she had COVID-19 on 3/12/23 and had returned to work on 3/20/23. Staff A also revealed that he/she tested negative either on 4/3/23 or 4/5/23. Interview on 4/7/23 at approximately 12:30 p.m. with Staff B (Infection Preventionist) confirmed that Staff A returned to work on Day 6 after they tested positive for COVID-19. Staff B stated the facility was using contingency staffing guidance at that time. Staff B stated they were following the return to work criteria for contingency staffing during the recent COVID-19 outbreak due to staff being out sick. Interview on 4/10/23 at approximately 11:30 a.m. with Staff B confirmed that Staff T tested positive for COVID-19 on 3/30/23 and was working on the 11 p.m. to 7 a.m. shift performing direct resident care on 3/31/23, 4/1/23, 4/2/23, 4/3/23, 4/5/23, 4/6/23 and 4/7/23. Staff B stated that at the time the facility was following the crisis staffing guidelines. Interview on 4/10/23 at approximately 1:30 p.m. with Staff X (Administrator) revealed that the process for changing to contingency or crisis staffing is done between the Infection Preventionist, Director of Nursing and the Administrator. Staff X stated that they were aware that Staff T was positive for COVID-19 and working while positive as they were informed that they had no other options due to low staffing and no one to replace Staff T. Staff X stated that if the facility cannot cover an open shift and staffing is needed they would utilize the MDS [Minimum Data Set] Nurse, Infection Preventionist and then the Director of Nursing to cover the shift as a last resort. Further interview with Staff X confirmed that no nurse managers were scheduled for the 6 days above that Staff T worked while COVID-19 positive and confirmed that 5 of those days they had more than minimal staffing to allow for Staff T to have the time off. Interview on 4/10/23 via phone call at approximately 2:30 p.m. with Staff Y (Director of Nursing) revealed that he/she did not realize that Staff T worked all 5 days after testing positive for COVID-19. Staff Y also revealed that the process for changing to contingency or crisis staffing is done by the Infection Preventionist, but should be completed by all of the management team. Review on 4/10/23 of the Centers for Disease Control (CDC) Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 [Severe acute respiratory syndrome coronavirus 2] Infection or Exposed to SARS-CoV-2, updated September 23, 2022, revealed, . Return to Work Criteria for HCP [Health Care Personnel] with SARS-CoV-2 Infection. The following are criteria to determine when HCP with SARS-CoV-2 infection could return to work and are influenced by severity of symptoms and presence of immunocompromising conditions. After returning to work, HCP should self-monitor for symptoms and seek re-evaluation from occupational health if symptoms recur or worsen. If symptoms recur (e.g. [for example], rebound) these HCP should be restricted from work and follow recommended practices to prevent transmission to others (e.g., use of well-fitting source control) until they again meet the healthcare criteria below to return to work unless an alternative diagnosis is identified. HCP with mild to moderate illness who are not moderately to severely immunocompromised could return to work after the following criteria have been met: At least 7 days have passed since symptoms first appeared if a negative viral test* is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7), and at least 24 hours have passed since last fever without the use of fever-reducing medications, and symptoms (e.g., cough, shortness of breath) have improved. *Either a NAAT [Nucleic Acid Amplification Test] (molecular) or antigen test may be used. If using an antigen test, HCP should have a negative test obtained on day 5 and again 48 hours later . Review on 4/10/23 of the CDC Strategies to Mitigate Healthcare Personnel Staffing Shortages, updated September 23, 2022, . Key Points . CDC's mitigation strategies offer a continuum of options for addressing staffing shortages. Contingency strategies followed by crisis strategies are provide to augment conventional strategies and are meant to be considered and implemented sequentially (i.e.[that is], implementing conventional strategies followed by contingency strategies followed by crisis strategies. Introduction . CDC's mitigation strategies offer a continuum of options for addressing staffing shortages. Contingency, followed by crisis capacity strategies, augment conventional strategies and are meant to be considered and implemented sequentially (i.e., implementing contingency strategies before crisis strategies) . Allowing HCP with SARS-CoV-2 infection to return to work before meeting the conventional criteria could result in healthcare-associated SARS-CoV-2 transmission. Healthcare facilities (in collaboration with risk management) should inform patients and HCP when the facility is utilizing these strategies, specify the changes in practice that should be expected, and describe the actions that will be taken to protect patients and HCP from exposure to SARS-CoV-2 if HCP with suspected or confirmed SARS-CoV-2 infection are requested to work to fulfill staffing needs. As part of conventional strategies, it is recommended that healthcare facilities: Ensure any COVID-19 vaccine requirements for HCP are followed, and where none are applicable, encourage HCP to remain up to date with all recommended COVID-19 vaccine doses. Understand their normal staffing needs and the minimum number of staff needed to provide a safe work environment and safe patient care under normal circumstances. Understand the local epistemology of COVID-19-related indicators (e.g., community transmission levels). Communicate with local healthcare coalitions and federal, state, and local public health partners (e.g., public health emergency preparedness and response staff) to identify additional HCP (e.g., hiring additional HCP, recruiting retired HCP, using students or volunteers), when needed . When staffing shortages are anticipated, healthcare facilities and employers, in collaboration with human resources and occupational health services, should use contingency capacity strategies to plan and prepare for mitigating this problem. These include: Adjusting staff schedules, hiring additional HCP, and rotating HCP to positions that support patient care activities. Cancel all non-essential procedures and visits. Shift HCP who work in these areas to support other patient care activities in the facility. Facilities will need to ensure these HCP have received appropriate orientation and training to work in these areas that are new to them. Attempt to address social factors that might prevent HCP from reporting to work, such as need for transportation or housing that allows for physical distancing, particularly if HCP live with individuals with underlying medical conditions or older adults. Consider that these social factors disproportionately affect persons from some racial and ethnic groups, who are also disproportionally affected by COVID-19 (e.g., African Americans, Hispanics and Latinos, and American Indians and Alaska Natives). Identify additional HCP to work in the facility. Be aware of state-specific emergency waivers or changes to licensure requirements or renewals for select categories of HCP. As appropriate, request that HCP postpone elective time off from work. However, there should be consideration for the mental health benefits of time off and that care-taking responsibilities may differ substantially among staff. Developing regional plans to identify designated healthcare facilities or alternate care sites with adequate staffing to care for patients with SARS-CoV-2 infection. Allowing HCP with SARS-CoV-2 infection who are well enough and willing to work to return to work as follows: HCP with mild to moderate illness who are not moderately to severely immunocompromised: At least 5 days have passed since symptoms first appeared (day 0), and at least 24 hours have passed since last fever without the use of fever-reducing medications, and symptoms (e.g., cough, shortness of breath) have improved. Healthcare facilities may choose to confirm resolution of infection with a negative nucleic acid amplification test (NAAT) or a series of 2 negative antigen tests taken 48 hours apart*. HCP who were asymptomatic throughout their infection and are not moderately to severely immunocompromised: At least 5 days have passed since the date of their first positive viral test (day 0) . Review on 4/10/23 of the facility's policy titled A Staffing in Emergencies updated 4/15/22, revealed . Most of our staff work 8 hr [hour] shifts. If we got in to an emergency situation, we could switch to 12 hour shifts 3 days on and 3 days off .With administrators approval incentive can be offered for staff to work extra .There may be times when we need to use discretion and weigh the benefits and risks of a staff member entering the building and performing their department tasks. Departments with staff shortages: If a department has 50% [percent] of their staff out because of illness related to the pandemic we will use the contingency category for work restrictions from the CDC .