Health inspection·February 13, 2025

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 store, prepare, handle, and serve food, in accordance with professional standards for food service safety for a highly vulnerable population of seven (7) residents who eat frood from the facility kitchen, when, two (2) oven gloves were observed with dark stains thick brown/black substance on the fingers and multiple patches of white substance. This failure had the potential to result in cross contamination and cause food borne illnesses in a highly vulnerable population of seven (7) residents who eat food from the kitchen. Findings: On February 10, 2025, at 10:53 a.m., during the initial tour of the kitchen with the Dietary Manager (DM), two (2) oven gloves were observed hanging on a hook on the wall for use by the cook. The oven gloves were observed with dark stains and a thick brown/black substance on the finger tips and, along the posterior of the hand piece and multiple patches of white substance were obsered up the sleeve of the overn gloves. One oven glove had worn area with loose threads with discoloration. In a concurrent interview, the DM stated the oven gloves should have been replaced and should not be used, due to possibility of cross-contamination and possible food borne illness to vulnerable residents. On February 10, 2025, at 10:58 a.m., [NAME] 1 stated the oven gloves should have been thrown away, to avoid cross-contamination and possibility of food-borne illness to the residents. On February 11, 2025, at 3:36 p.m., an interview was conducted with the Registered Dietician (RD). The RD stated the dirty oven gloves should not have been used and should have been laundered or replaced with new oven gloves. The RD further stated the oven gloves should not be used in that condition as it could cause cross-contamination and possible food borne illness to facility vulnerable residents. A review of the facility's policy and procedure titled, Food Safety and Food Storage, dated November 2024, indicated, .food will be .prepared, distributed and served .with professional standards of food service safety .food safety practices shall be followed throughout the entire food handling process .to include .other equipment that comes in contact with food .take precautions in critical control points to prevent, reduce, or eliminate potential hazards .all equipment used in the handling of food shall be clean and sanitized, and handled in a manner to prevent contamination . 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 4 Event ID: 055542 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 055542 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mission Care Center 8487 Magnolia Avenue Riverside, CA 92504 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)