Health inspection·November 17, 2022

F 0812 Level of Harm - Minimal harm or potential for actual harm 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 safe food storage and preparation when: Residents Affected - Some 1. Frozen fish products were stored on the same level as frozen poultry products. 2. Staff did not perform hand hygiene when switching between tasks. 3. Personal items were stored in the dried food storage area. These failures placed residents at risk for food borne illness. Findings: 1. During a concurrent observation and interview on 11/14/22, at 12:05 p.m., with [NAME] 1 (CK 1), two boxes of frozen tilapia, one box of frozen salmon and a tub of frozen turkeys in original packaging were observed on the same shelf on a rack in a refrigerator. CK 1 stated that the boxes of frozen fish were not stored properly and should be on a higher level than the thawing turkeys. CK 1 moved the boxes of frozen fish products to the shelf with other frozen fish above the turkeys. During an interview on 11/16/22, at 2:15 p.m., with Registered Dietitian (RD), RD stated cooks were responsible for proper thawing and separation of meats and other frozen food products from each other. During a concurrent interview and record review on 11/17/22, at 10:00 a.m., with Director of Dietary Services (DDS), the facility's policy and procedure (P&P) titled, Food and Supply Storage, dated 01/2021, was reviewed. The P&P indicated if raw animal foods are stored on the same rack, fish should be stored on a higher shelf than poultry. DDS stated it was the responsibility of cooks and DDS to properly separate thawing foods according to facility policy. A review of Federal Food Code, dated 2017, indicated food be protected from cross contamination by separating raw animal foods from each other including fish and poultry during holding and storage. 2. During an observation on 11/14/22, at 11:10 a.m., CK 1 was observed in the meat side of the kitchen assembling bowls and containers for food preparation. CK 1, without putting on gloves or performing hand hygiene, then went to the meat side of kitchen stove and stirred a large pot of food using a large stirring utensil. Page 1 of 5 055534 055534 11/17/2022 The Reutlinger Community 4000 Camino Tassajara Danville, CA 94506

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an observation on 11/14/22, at 12:15 p.m., CK 1 was observed in the meat side of the kitchen preparing cookware for food preparation. CK 1, without putting on gloves or performing hand hygiene, then went to the dairy side of the kitchen stove and stirred a large pot of food using a large stirring utensil. During an observation on 11/15/22, at 11:45 a.m., Server 1 (SR 1) was observed cleaning the juice dispensing machine. Prior to starting the cleaning procedure, SR 1 entered the kitchen from the dining area without changing gloves or performing hand hygiene. SR 1 removed the juice dispensing nozzles and drip tray from the machine and went to the dishwashing area to clean those items. SR 1 rinsed the nozzles using a hand operated water spraying faucet and sanitized the drip tray through the dishwashing machine. Without changing gloves or performing hand hygiene, SR 1 moved to the clean side of the dishwashing area and removed the drip tray from the dishwashing machine. With the nozzles and drip tray, SR 1 moved back to the juice dispensing machine and installed the nozzles and drip tray back onto the juice machine. During an interview on 11/15/22, at 12:05 p.m., with DDS, DDS stated staff should wear gloves during preparation of food and when moving from the dirty to clean side of the dishwashing area. During an interview on 11/16/22, at 2:15 p.m., with RD, RD stated staff should wear gloves for all aspects of food preparation including stirring pots of food. RD stated staff should change gloves when moving from dirty to clean sides of the dishwashing area as well as when performing tasks such as cleaning equipment. A review of facility P&P titled, Hand Hygiene, dated 1/2021, indicated kitchen staff should wear gloves when handling clean utensils/dishes/equipment and when serving food or assembling patient meals. A review of facility P&P titled, Disposable Glove Use, dated 1/2020, indicated kitchen staff should change gloves when moving from one task to another, such as moving from handling dirty dishes to handling clean dishes. A review of the Federal Food Code, dated 2017, indicated staff should wash their hands after handling soiled equipment or utensils, during food preparation to prevent cross contamination, after engaging in activities that contaminate the hands, and before donning gloves. In addition, single-use gloves shall be used for only one task such as working with ready-to-eat food, used for no other purpose, and discarded when damaged or soiled, or when interruptions occur in the operation. 3. During an observation on 11/14/22, at 11:50 a.m., a gray sweater and a black purse were found on a wire rack in a dry food storage room. The sweater and purse were observed in direct contact with a container of dried rice and over other containers of dried foods. During an interview on 11/16/22, at 2:15 p.m., with RD, RD stated food storage areas were inappropriate for storing personal items. RD further clarified staff should store personal items in storage areas for staff. During a concurrent interview and record review on 11/17/22, at 10:00 a.m., with DDS, the facility's P&P titled, Associate Security Policies for Department, dated 1/2021, was reviewed. DDS stated staff should not store personal items in food storage areas. DDS stated policy indicated, jackets, sweaters, handbags, cell phones and other personal items are to be stored in appropriate locations 055534 Page 2 of 5 055534 11/17/2022 The Reutlinger Community 4000 Camino Tassajara Danville, CA 94506

F 0812 .these items must not be stored in food production or service areas. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 055534 Page 3 of 5 055534 11/17/2022 The Reutlinger Community 4000 Camino Tassajara Danville, CA 94506

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, for two of two sampled residents (Resident 22 and Resident 7), the facility failed to implement infection prevention and control practices when: Residents Affected - Few 1. Licensed Vocational Nurse 2 (LVN 2) did not wear gloves prior to Resident 22's eye drop administration to both eyes. 2. LVN 1 did not perform hand hygiene and glove changes on two occasions; did not set up a clean area for the treatment supplies; did not sanitize reusable scissors after use; and did not dispose and/or sanitize contaminated supplies after performing Resident 7's wound care to top of head, right heel, and left heel. These failures created a risk for cross-contamination (transfer of bacteria or other microorganisms from one substance to another) that could result in infection or spread of infection. Findings: 1. A review of Resident 22's admission Record, dated 4/28/22, indicated Resident 22 was admitted to the facility in 2021 with diagnosis of Glaucoma (a group of eye conditions that causes blindness). A review of Resident 22's Physician Order with a start date of 4/24/22, indicated an order for Dorzolomide HCl-Timolol Mal PF Solution 2-0.5% instill 1 drop in both eyes two times a day for Glaucoma. During a concurrent medication observation and interview on 11/15/22, at 9:25 a.m., LVN 2 entered Resident 22's room to deliver the eye drops. LVN 2 performed handwashing and without donning gloves, administered the eye drops to Resident 22's eyes. LVN 2 acknowledged she forgot to wear gloves during eye drop administration and stated she should have worn gloves to prevent contamination. During an interview on 11/16/22, at 9:23 a.m., with the Director of Nursing (DON), the DON stated after performing handwashing or hand hygiene, the licensed nurse (LN) should don gloves during eye drop administration to prevent contamination. Review of the facility's policy and procedure (P&P) titled, Medication Administration Eye Drops, dated 2007, indicated, To administer ophthalmic solution into eye in a safe and accurate manner .With a gloved finger, gently pull down lower eyelid .Remove and dispose of gloves . Review of the facility's P&P titled, Medication Administration General Guidelines, dated 2007, indicated, Medications are administered as prescribed in accordance with manufacturers' specifications, good nursing principles and practices .Hands are washed with soap and water and gloves applied before administration of topical, ophthalmic . 2. A review of Resident 7's admission Record, dated 11/15/22, indicated Resident 7 was readmitted to the facility in 2022 with diagnosis of chronic ulcer to lower leg. During an observation on 11/15/22, at 8:14 a.m., LVN 1 entered Resident 7's room to provide wound care to three wounds on the top of the head, right heel and left heel. LVN 1 placed a spray bottle of wound cleanser, a stack of gauze and bandage on top of an overbed table without sanitizing or placing a barrier on top of the table. LVN 1 removed Resident 7's scalp bandage, cleansed the wound with 055534 Page 4 of 5 055534 11/17/2022 The Reutlinger Community 4000 Camino Tassajara Danville, CA 94506

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few wound cleanser, then applied a new bandage without changing gloves or performing hand hygiene. LVN 1 then doffed his gloves, performed hand hygiene, donned new gloves, removed the old dressing from the right heel, cleansed the wound and placed a new dressing without changing gloves or performing hand hygiene. LVN 1 removed his soiled gloves, sanitized and donned new gloves to get a pair of scissors from the treatment cart, and completed wound care to Resident 7's right heel. LVN 1 went back out to the treatment cart, removed his old gloves and without sanitizing, donned new gloves to get some gauze, kerlix, and tape. LVN 1 removed the old dressing to Resident 7's left heel, applied gauze, wrapped with kerlix and then applied the socks to both of Resident 7's feet. After wound treatment, LVN 1 returned the bottle of wound cleanser and contaminated scissors back to the treatment cart. During an interview on 11/15/22, at 8:40 a.m., LVN 1 stated the same bottle of wound cleanser and scissors which were used for Resident 7's wound treatment would be used for other residents. During an interview on 11/16/22, at 12:36 p.m., with the Infection Preventionist (IP), the IP stated staff should perform hand hygiene in between glove changes, sanitize the table and cover with a barrier prior to placing the treatment supplies on the table, and sanitize contaminated supplies brought in the resident's room during wound treatment before placing supplies back on the treatment cart. Review of the facility's P&P titled, Hand Hygiene Program, with revised date 6/6/20, indicated, All personnel shall follow established hand hygiene procedures to prevent the spread of infection and disease to other personnel, residents, and visitors .Alcohol hand rubs may be used when hands are NOT visibly soiled .Handwashing of approximately 20 seconds must be performed under the following conditions: .Before handling clean or soiled dressing, gauze pads, etc.; after removing gloves .the use of gloves does not replace hand hygiene . Review of the facility's P&P titled, Supplies and Equipment, Nursing Services, with revised date 5/18/16, indicated, Nursing service personnel must use assigned equipment and supplies with care to promote safety and accuracy .Equipment will be cleaned/disinfected with appropriate disinfecting agents. Review of the facility's P&P titled, Wound Dressings, with revised date 11/17/15, indicated, All wound dressings will be handled in a safe and sanitary manner and disposed of in a manner to avoid contamination .Disposable items such as bandages, applicators, gauze pads, etc., contaminated with infective material .must be placed in a bag and removed from the resident's room upon completion of the procedure . 055534 Page 5 of 5