Health inspection·August 27, 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 store, prepare, and serve food in a safe and sanitary manner when:1. Muffins with mold (mold is a type of fungus that can grow on food) were served on breakfast trays, and six residents consumed them.2. Dry goods were improperly stored when expired cocoa powder was in the storage area, a gravy packet had leaked, chocolate chips were in an open plastic bag without a date when it was opened.3. Deli meat in a refrigerator was ten days past its use by date.4. Frozen pancakes and frozen egg rolls did not have a date when they were received.5. Trash cans were uncovered during tray line (name of process where food was served on resident's plates). This failure had the potential to cause food-borne illness in 64 of 64 vulnerable residents.Findings:1. During an interview on 8/26/25 at 2:15 p.m., [NAME] A stated she received a report from Dietary Aide B (DA B) that moldy muffins were served to residents on [NAME] A's day off.During an interview on 8/26/25 at 4 p.m., Licensed Nurse C (LN C) stated the moldy muffins were served on a weekend. LN C was informed about the muffins during stand-up (a daily meeting where staff discussed significant events). LN C stated the Director of Nursing (DON) put residents who ate the moldy muffins on a 72-hour alert charting. LN C stated eating moldy muffins could have had serious effects on an immunocompromised (a condition where the system to protect the body from infections and other harmful substances was not working as well as it should) resident, or a resident with gastrointestinal (GI - having to do with the digestive tract) issues.During a concurrent record review and interview on 8/27/25 at 10:18 a.m., the DON confirmed the names of six residents (Resident 1, Resident 2, Resident 3, Resident 4, Resident 5, and Resident 6) who were on alert charting after eating moldy muffins.During an interview on 8/27/25 at 11:10 a.m., Resident 1 stated he was served a moldy muffin, and he ate it because he thought the black spots were blueberries. Resident 1 stated a Certified Nurse Assistant (CNA) later told him the black spots were mold and not blueberries.During an interview on 8/27/25 at 11:18 a.m., Licensed Nurse D (LN D) stated CNA E reported mold on the muffins during breakfast service on 8/17/25. LN D and other nursing staff removed the muffins from the breakfast trays after six residents had already consumed all or part of the moldy muffins. The muffins were individually wrapped, and it was obvious there was white or black mold on the muffins when they were unwrapped by the CNAs delivering the breakfast trays.During an interview on 8/27/25 at 11:45 a.m., DA B stated a CNA had reported the moldy muffins on the breakfast trays to [NAME] F who then stopped putting them on the breakfast trays.A record review of the facility's policy titled Food Storage revised on 12/1/21 indicated, .prepare.and serve food in accordance with professional standards for food service safety.A record review of the Food & Drug Administration (FDA) 2022 Food Code, Annex 4, Table 2a indicated, Naturally occurring chemical hazards [in food] include mycotoxins [natural toxins produced by certain types of mold.].found in.corn products.other grains. require control measures.[including] do not use spoiled or moldy food. 2. During a concurrent observation and interview on 8/26/25 at 11 a.m. in the dry storage area (continued on next page) 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: 055499 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 08/27/2025 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)