Health inspection·June 24, 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, prepared, distribute and serve food in accordance with professional standards for food service safety when .1. Dishes were stacked on top of each other while wet; and,2. Pots, pans, and food holding containers were dirty and damaged from use; and,3. A container of scoops, serving ladles, and utensils were left open; and,4. A steamer container had a yellowish residue located inside of it; and,5. A stove top had black sticky grime and food residue on top of it.These failures had the potential of leading to food borne illness in the 94 residents eating facility prepared meals.Findings:1. During a concurrent observation and interview on 6/24/25 at 9:09 AM with the Dietary Services Supervisor (DSS), in the kitchen, a stack of pots and food holding containers were stacked on top of each other while wet. The DSS confirmed that the dishes were still wet. During an interview on 6/24/25 at 12:44 PM with Dietary Aide (DA) 1, DA 1 stated she washed the dishes that morning. DA 1 confirmed that the pots and other dishes that were stacked still had water on them and were not fully air dried. During an interview on 6/24/25 at 1:06 PM with [NAME] 1, [NAME] 1 stated that all dishes should be completely dry and not have water on them. [NAME] 1 also stated that there was a risk for bacteria to grown on the dishes if not dried properly.During an interview on 6/24/25 at 1:35 PM with the DSS, the DSS stated there was an infection control risk if the dishes were not completely dry. The DSS stated the residents could be at risk for food borne illnesses with dishes not being properly dried. During an interview on 6/24/25 at 2:15 PM with the Director of Nursing (DON), the DON stated the residents could be at a high risk for infections if the kitchen had unsanitary practices occurring. According to the Food and Drug Administration (FDA) Food Code 2022, Section 4-901.11 Equipment and Utensils, Air-Drying Required, .After cleaning and sanitizing, equipment and utensils: shall be air-dried .2. During a concurrent observation and interview on 6/24/25 at 10:04 AM with the DSS, in the kitchen, various pots, pans, and food holding containers were dirty. The DSS confirmed that the various dishes and food equipment were dirty and some pans were damaged by use. The DSS stated some of the pots and pans needed to be replaced. During an interview on 6/24/25 at 12:55 PM with DA 2, DA 2 stated that some of the pots and pans were damaged from use. DA 2 also stated that it was not good to use dirty or damaged pots and pans to cook. DA 2 further stated that bacteria could get in the food if those damaged cooking tools were used.During an interview on 6/24/25 at 1:06 PM with [NAME] 1, [NAME] 1 stated that the dirty pots and pans should not be used. [NAME] 1 also stated that the pots and pans should have been cleaned to prevent cross contamination. [NAME] 1 further stated that some of the pans were too oily and not safe to use. [NAME] 1 expressed that a fire could break out if oily and dirty pans were used. During an interview on 6/24/25 at 1:35 PM with the DSS, the DSS stated that he needed to come up with a better cleaning schedule for the pots and pans. The DSS also stated that it was the responsibility of the dietary aides to clean the pots and pans after each use. During a review of the facility's undated document titled, SANITATION, the (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 3 Event ID: 056216 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 056216 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Guardian Care and Rehabilitation Center 410 Eastwood Ave Manteca, CA 95336 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)