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 implement their policy and
procedure (P&P) titled, Refrigerators and Freezers which indicated to monitor and record the refrigerator
and freezer temperatures daily, for 3 of 3 refrigerators and 2 of 2 freezers.This failure had the potential to
cause food spoilage (the deterioration of food due to various factors, resulting in an undesirable change in
its appearance, taste, texture, or nutritional value) and lead to foodborne illnesses (any illness caused by
consuming foods or beverages contaminated with harmful bacteria, viruses and parasites or their toxins
[poisonous substances produced by organisms like bacteria that harm the body]).Findings:During a
concurrent interview and record review on 01/05/2026 at 11 a.m., with the Dietary Supervisor (DS), in the
kitchen, the refrigerator and freezer temperature logs dated 2026, were reviewed.The refrigerator
temperature logs for the following days were blank and did not indicate monitoring was completed:On
1/1/2026 and 1/2/2026 for Produce and Breads, Milk and Dairy and Nourishment during the morning (AM)
shiftOn 1/1/2026 for Produce and Breads, Milk and Dairy during evening (PM) shiftThe freezer temperature
logs for the following days were blank and did not indicate monitoring was completed:On 1/1/2026 and
1/2/2026 for Frozen Vegetables and Ice cream and Frozen Meat during the AM shiftOn 1/1/2026 for Frozen
Vegetables and Ice Cream and Frozen Meat during the PM shiftThe DS stated the AM and PM cooks were
responsible for ensuring timely monitoring and documentation of the refrigerator and freezer logs and lack
of monitoring and documenting refrigerator and freezers temperatures may cause food spoilage.During a
review of the facility's P&P titled, Refrigerators and Freezers, dated 11/ 2022, the P&P indicated the facility
will ensure safe refrigerator and freezer temperatures and sanitation, and will observe food expiration
guidelines. Refrigerators and freezers are maintained in good working conditions. Refrigerators keep food
at or below 41 degrees Fahrenheit (a scale of temperature on which water freezes at 32 and boils at 212
under standard conditions) and freezers keep frozen foods frozen solid. The P&P indicated Food service
supervisors or designated employees check and record refrigerator and freezer temperatures daily with first
opening and at closing in the evening.
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
Page 1 of 2
Event ID:
055072
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
055072
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/05/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Rosecrans Care Center
1140 West Rosecrans Avenue
Gardena, CA 90247
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 potential for actual harm
Based on observation, interview and record review, the facility failed to implement its infection prevention
and control measures for one of two shower rooms (east shower room), by failing to ensure the shower
floor and wall were clean and disinfected from fecal matter (the solid waste passed out of the body of a
human through the bowel). This failure had the potential to spread bacteria and germs that could lead to
infection for facility residents. Findings:During a concurrent observation and interview on 01/05/2026 at
11:39 a.m., with the housekeeper (HK 1), in the east shower room, dry brown fecal matter was observed on
the wall of the 2nd shower stall, and a small drop of brown feces was observed on the floor. HK 1 stated
failure to clean and disinfect the walls and floors may increase the risk of residents getting sick.During a
review of the facility's Job Description titled, Housekeeper, dated 09/2025, the Job Description indicated the
primary purpose of this position is to perform the day-to-day activities of housekeeping as directed by the
housekeeping supervisor to assure the facility is maintained in a clean, safe and comfortable manner.
Perform cleaning procedures in accordance with established infection prevention and control procedures.
Clean walls and ceilings by washing, wiping, spot cleaning, disinfecting, deodorizing, etc. Remove dirt,
dust, grease, film, etc., from surfaces using proper cleaning/disinfecting solutions.During a review of the
facility's Policy and Procedure (P&P) titled, Policies and Practices-Infection Control dated 4/2012, the P&P
indicated the facility's infection P&Ps are intended to facilitate maintaining a safe, sanitary and comfortable
environment and to help prevent and manage transmission of diseases and infections.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055072
If continuation sheet
Page 2 of 2