Health inspection·June 6, 2024

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation and interview, the facility failed to ensure refuse (any disposable materials, which include recyclable and non-recyclable materials) was disposed of properly when the lid of the garbage disposal bin in the kitchen was not placed. This failure had the potential to attract insects, rodents, and other pests to the facility and could affect the 238 residents in the facility. Residents Affected - Some Findings: During an observation on 6/6/24 at 10:55 a.m., three garbage disposal bins were observed in the kitchen. One garbage disposal bin with a folded box, a cup, two plastic food containers, and a metal food container on top of the closed bin was observed. One garbage disposal bin without its lid was observed, and refuse in the garbage disposal bin was exposed to air. During an observation and concurrent interview on 6/6/24 at 11:13 a.m. with the registered dietitian (RD), he confirmed the above observation. During an interview on 6/6/24 at 11:18 a.m. with the RD, he stated that the garbage disposal bin should have been closed with its lid. During a review of the facility's policy and procedure (P&P) titled Sanitation and Infection Control dated 2023, the P&P indicated, 2. Kitchen waste that cannot be disposed of by mechanical means will be kept in a clean, leak proof, nonabsorbent, tightly closed metal or plastic container with a plastic liner. Review of the Food and Drug Administration's 2022 Food Code 5-501.113, Covering Receptacles, indicated waste handling for refuse shall be kept covered. Page 1 of 2 055318 055318 06/06/2024 Skyline Healthcare Center - San Jose 2065 Forest Avenue San Jose, CA 95128

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure the environment was free of pests, as evidenced by multiple flying insects seen in the resident's room and the hallway. This failure had the potential to cause a health hazard to the 238 residents residing in the facility. Residents Affected - Some Findings: During an interview on 5/1/24 at 1 p.m. with licensed vocational nurse A, she stated there were lots of flies in Resident 1's room because of old foods in the resident's room. During a concurrent observation and interview on 5/1/24 with certified nurse assistant B (CNA B), approximately more than ten black flying insects (fruit flies) were observed in Resident 1's room. CNA B confirmed the observation. During an observation on 6/6/24 in Resident 1's room, two fruit flies were observed near bananas on the over-the-bed table in Resident 1's room. During a concurrent observation and interview on 6/6/24 with CNA B, Resident 1 was sitting up in his electric wheelchair in the hallway in front of the nursing station, and one fruit fly was observed near Resident 1. CNA B confirmed the observation. During a concurrent interview and the facility's pest control/sightings log on 6/6/24 at 12:55 p.m. with the maintenance supervisor (MS), he confirmed there was no report of fruit fly in Resident 1's room from 5/1/24 to 6/6/24. The MS stated he did not receive any report of fruit fly in Resident 1's room. During a review of the facility's undated policy and procedure (P&P) titled Pest Control, the P&P indicated, Insect or pest sightings are reported to the housekeeping/maintenance supervisor. 055318 Page 2 of 2