Health inspection·June 16, 2022

F 0730 Observe each nurse aide's job performance and give regular training. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to perform Annual Performance Evaluations for two of two Certified Nursing Assistants (CNAs), CNA 1 and CNA 2. Residents Affected - Few This failure had the potential for the facility to employ problematic staff. Findings: During a concurrent interview and record review on 6/15/22 at 12:05 p.m., with the Director of Staff Development (DSD), CNA 1's personnel file was reviewed. CNA 1's Notice to Employee document, dated 8/16/18 indicated CNA 1 was hired on 8/16/18. DSD stated CNA 1 did not have an Annual Performance Evaluation since CNA 1's date of hire. During a concurrent interview and record review on 6/15/22 at 12:09 p.m., with (DSD), CNA 2's personnel file was reviewed. DSD stated CNA 2 did not have an Annual Performance Evaluation since 11/1/2017. During an interview on 06/15/22 at 12:17 p.m., with DSD, DSD stated she was hired on 6/1/21 and she did not perform any Annual Performance Evaluations for any CNAs since she was hired. DSD stated Annual Performance Evaluations could find problematic staff, which was important because not all residents may voice complaints. DSD stated Annual Performance Evaluations were necessary to assure residents were getting the best care. During an interview on 06/16/22 at 11:43 a.m., DSD stated that she was responsible for conducting Annual Performance Evaluations for Certified Nursing Assistants. Page 1 of 2 055049 055049 06/16/2022 Pleasant Hill Post Acute 1625 Oak Park Boulevard Pleasant Hill, CA 94523

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure that food was stored under sanitary conditions when multiple undated food items were stored in the freezer, refrigerator and the dry storage room. This deficient practice had the potential of putting residents at risk for food-borne illness. Findings: During the initial kitchen tour with the Dietary Manager (DM) on 6/13/22 at 9:47 a.m., the following was observed in freezer #1: two bags of chicken breasts, one bag of veggie burgers, one roll of ground turkey, and two peach pies with no received dates or use by dates. During an interview with DM on 6/13/22 at 9:58 a.m., DM stated all food items needed to be labeled with receive dates and use by dates so the dietary staff can know when the food came in and when it needed to be discarded. DM stated labeling food items let the staff know if the food was still good. During the initial kitchen tour on 6/13/22 at 10:19 a.m., the following was observed in freezer #2: one angel food cake and one bag of snap peas with no received dates or use by dates. The following was observed in the refrigerator: one bag of lettuce (brownish in color), one bag of onions, and one box with multiple packs of butter with no received dates or use by dates. During the initial kitchen tour and concurrent interview with DM on 6/13/22 at 10:34 a.m., the following was observed in the dry storage room: one ten pound bag of pasta, one bag of cream base liquid, one opened box of individually packaged blue cheese salad dressing packets, two opened boxes of individually packaged Italian salad dressing packets, one opened box of individually packaged Greek salad dressing packets and one box of bananas with brown spots with no received dates or use by dates. DM stated all food items needed to be labeled, and she didn't know why the items were not labeled. During the initial kitchen tour and concurrent interview with DM on 6/13/22 at 10:37 a.m., the following was observed under the food prep table: the lids of one bin of flour, one bin of pasta and one bin of food thickener powder had several brown sticky spots. DM stated the bins were dirty, and she did not know what the brown sticky substances were. DM stated the bins should be clean because of sanitary reasons. Review of the facility's policy and procedure titled Food Receiving and Storage, revised 10/17, indicated .7. Dry foods that are stored in bins will be removed from original packaging, labeled and dated (use by date). Such foods will be rotated using a first in-first out system. 8. All foods stored in the refrigerator or freezer will be covered, labeled and dated (use by date) . 055049 Page 2 of 2