Health inspection·July 23, 2025

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 foods were stored, prepared, and distributed under sanitary conditions for all the residents who received food from the kitchen by failing to:1. Ensure food past the use-by date was not available for use in the kitchen.2. Ensure food stored in the kitchen had an open date.These failures placed all residents who received food from the kitchen at risk for foodborne illnesses (refers to illness caused by the ingestion of contaminated food or beverages). During a concurrent observation and interview on 07/23/2025 at 9:15 a.m. with the Dietary Supervisor in the facility kitchen walk-in refrigerator, a clear plastic container of diced tomatoes was observed labeled with an open date of 07/16/2025. The Dietary Supervisor stated, That (diced tomatoes) should have been discarded three days after opening (7/19/2025). It looks like it was missed. A clear plastic container of grape jelly with no open date was also observed in the walk-in refrigerator. The Dietary Supervisor stated the container of grape jelly was an opened item. The Dietary Supervisor stated, That jelly (container of grape jelly) should be labeled with the date it was opened and the discard date. We have a labeling policy that staff are expected to follow. The Dietary Supervisor pointed to the posted kitchen guidelines which indicated opened tomato products are to be discarded after three days.During a review of the facility's policy and procedure (P&P) titled, Refrigerators and Freezers, with a revision date of November 2022, the P&P indicated, The facility will ensure safe refrigerator and freezer maintenance, temperatures, and sanitation, and will observe food expiration guidelines.All food is appropriately dated to ensure proper rotation by expiration dates.‘Use by' dates are observed.and ‘use by' dates are indicated once food is opened. The P&P indicated, Supervisors are responsible for ensuring food items in refrigerators are not past ‘use by' or expiration dates.During a review of the facility's P&P titled, Food Receiving and Storage, with a revision date of July 2014, the P&P indicated, All foods stored in the refrigerator or freezer will be covered, labeled and dated (‘use by' date). 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: 055817 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 055817 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Monte Vista Healthcare Center 802 Buena Vista Street Duarte, CA 91010 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)