Health inspection·July 17, 2025

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 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 food was stored, prepared and served safely in accordance with professional standards of food service when:1. Soiled equipment was observed in a food prep area;2. The floor was noted to have solid food debris, built up dust, and dirt underneath the sink and behind the oven;3. Kitchen staff did not monitor the tray line food temperatures; and,4. Kitchen staff did not use facial hair nets.These failures posed the risk for food borne illnesses for 57 of 57 residents who resided in the facility and consumed food prepared in the kitchen.Findings:1. During an observation on 7/16/25 at 12:15 p.m., the following observations were made:The stovetop had black residue and debris in burner wells; The dishrack had visible grime and black residue; The ceiling vents over the steamtable had a large amount of dust build up; and the air conditioning unit had dust build up on the vents over the food prep table. During an interview on 7/17/25 at 12:20 p.m., the Corporate Registered Dietician (CRD) acknowledged the kitchen equipment needed to be cleaned. The CRD stated she ensured a deep cleaning was performed every month but did not have a cleaning log. The CRD further stated cleaning was not being monitored since the Dietary Manager (DM) left a few months ago. The CRD stated she was attempting to get dietary staff to take ownership for a clean kitchen.A review of a facility document titled Sanitization dated 2001, indicated, The food service area shall be maintained in a clean and sanitary manner. All.equipment shall be kept clean.According to the FDA Food Code 2022, Section 4-601.11, Food Contact Surfaces, Nonfood Contact Surfaces, and Utensils (A) Equipment, food contact surfaces, and utensils shall be clean to sight and touch, (C) Nonfood contact surfaces of equipment shall be kept free of an accumulation of dust, dirt, food residue, and other debris.2.During an observation on 7/16/25 at 12:15 p.m., food debris located on the floor in the corner by the sink and behind the stove was noted. An accumulation of dust, dried liquid, and small black particulates was noted in the area directly beneath the sink. A sample was gathered for CRD confirmation.During an interview on 7/17/25 at 2:30 p.m., the CRD was unable to identify the bits of food taken from the corner underneath the sink. The CRD again stated she was attempting to gain staff buy in to clean the kitchen and will begin to establish a routine cleaning schedule. During a review of document titled Sanitization, dated 2001, indicated All kitchens, kitchen areas.shall be kept clean, free from litter and rubbish.According to the FDA Food Code 2022, Section 6-501.12 (a), Physical facilities, including floors, walls, ceilings, and other structural components, must be cleaned as often as necessary to keep them clean. This means facilities should establish and maintain a regular cleaning schedule based on the level of activity and potential for contamination in each area.3. During a concurrent interview and observation on 7/17/25 at 11:34 a.m., [NAME] 1 (CK 1) was taking temperatures of food on the steamtable in preparation for the lunch tray line and entering the temperatures in a logbook. She stated entries in the tray line temperature log must be made with every meal to prevent the residents getting sick. During a concurrent interview and observation on 7/17/25 at 11:55 a.m., there were several temperature entries missing for several days in the tray line logbook. The CRD confirmed the missing temperature entries and stated, Food temperature logs must be filled out with each meal, every day. This helps us to keep the hot food hot. The CRD stated food temperatures below 135 degrees will begin to multiply with bacteria growth that would cause food borne illnesses amongst the residents. A review of facility policy titled Meal Serving Temperatures dated 2023, indicated, .food temperatures will be taken while the hot food items are on the steamtable just prior to serving.these temperatures will be recorded on the form called Food Temperature Log.According to the FDA Food Code 2022, Section 3-501.16, the requirements for maintaining hot foods at safe (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055499 If continuation sheet Page 2 of 3 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 055499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rocky Point Care Center 625 16th Street Lakeport, CA 95453 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 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete temperatures. It stipulates that hot TCS (Time/Temperature Control for Safety) foods must be held at 135 F (57 C) or above. 4.During a concurrent observation and interview on 7/17/25 at 11:45 a.m., Dietary Aide (DA) was observed not wearing a facial hair restraint while in the kitchen prepping for tray line. The DA stated he was not aware he needed to wear one. The DA obtained a surgical mask to wear from the CRD.During a concurrent observation and interview on 7/17/25 at 11:50 a.m., the CK 2 was observed not wearing a facial hair restraint while in the kitchen preparing cookies. CK 2 stated there were no facial hair restraints available. CK 2 obtained a surgical mask to wear from the CRD.During an interview on 7/17/25 at 12:15 p.m., the CRD stated she had ordered more facial hair restraints, and the order had not arrived yet. She confirmed the necessity for facial hair nets was to prevent contamination of food with hair. The CRDO confirmed surgical masks would not contain hair from dropping into food or equipment used in food prep. During a review of facility document titled Preventing Foodborne Illness-Employee Hygiene and Sanitary Practices dated 2001, indicated, Hair nets or caps and/or beard restraints must be worn to keep hair from contacting exposed food, clean equipment, utensils and linens.According to FDA Food Code 2022 2-402.11 (A) Food employees shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from contacting exposed food; clean equipment, utensils, and linens; and unwrapped single service and single-use articles. Event ID: Facility ID: 055499 If continuation sheet Page 3 of 3