Health inspection·September 25, 2024

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to ensure a sanitary environment was provided when: Residents Affected - Some 1. The dumpster's lid for garbage was not fully closed and 2. Leftover foods and some trashes were found on the ground of facility's garbage storage area. These failures had the potential to attract rodents and pests and may put residents' health and safety at risk. Findings: During a facility tour with the Director of Maintenance (DM) on 8/28/24 at 9:21 a.m., one dumpster for garbage was observed with broken lid and not fully closed. Leftover foods (cooked rice and food scraps), two empty food boxes, one green plastic bottle, several cardboards and papers were found on the ground of the facility's garbage storage area. The DM confirmed the above observations. The DM acknowledged the garbage lid should be fully closed and all wastes on ground should have been put inside the garbage bin to prevent attracting rodents and pest coming to the garbage storage area. During an interview with the Administrator (ADM) on 8/28/24 at 2:43 p.m., the ADM acknowledged dumpster garbage lid should be fully closed and wastes should be placed inside the garbage bin to prevent attracting pest and rodents. Review of the facility's undated policy and procedures titled Pest Control indicated, Keep facility grounds free of trash and brush. Keep the dumpster area clean and the lid closed. 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: 056058 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 056058 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Almaden Health and Rehabilitation Center 2065 Los Gatos-Almaden Road San Jose, CA 95124 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)