Health inspection·March 28, 2019

F 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, for two (Resident 20 and 28) of 17 sampled residents the facility failed to maintain the privacy of personal care information when signs indicating personal care instructions for Residents 20 and 28 were posted in locations visible to other residents and visitors. Residents Affected - Few This failure had the potential to result in Resident 20's and Resident 28's personal care information to be viewed by other residents and visitors. Findings: 1. Review of Resident 28's admission Record, printed 3/15/19, indicated Resident 28 was admitted to the facility on [DATE]. During an observation on 3/26/19 at 8 a.m., there was a sign that indicated swallowing guidelines and speech therapy instructions for Resident 20 which was posted above her bed and was viewable from the hallway. During an interview with Licensed Vocational Nurse (LVN) 1 on 3/27/19, at 7:57 a.m., LVN 1 stated Resident 28's care instructions that were posted above her bed needed to be covered to maintain Resident 20's privacy. During an interview on 3/27/19 at 8 a.m., Nurse Manager (NM) stated Resident 28's care instructions needed to be covered. Review of the facility's policy and procedure titled Quality of Life - Dignity, revised 8/15, indicated .9. Staff shall maintain an environment in which clinical information is protected 2. According to Resident 20's admission Record, printed 3/1/19, Resident 20 was admitted to the facility on [DATE]. During an observation and concurrent interview on 3/26/19, at 9:14 a.m., there was a sign posted on the wall over the head of Resident 20's bed that indicated her full name and care instructions of no BP (blood pressure), no blood draw, no injections, to right and left arms. Resident 20 stated she did not know the reason for the sign posted above her head, but the staff took her blood pressure on her legs. During an interview with Licensed Vocational Nurse (LVN) 1 on 3/26/19, at 9:18 a.m., LVN 1 stated the uncovered sign above Resident 20's bed was up there since Resident 20's admission (on 2/19/19). Page 1 of 7 056345 056345 03/28/2019 San Leandro Healthcare Center 368 Juana Avenue San Leandro, CA 94577

F 0583 Review of the facility's policy and procedure titled Quality of Life - Dignity, revised 8/15, indicated .9. Staff shall maintain an environment in which clinical information is protected Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 056345 Page 2 of 7 056345 03/28/2019 San Leandro Healthcare Center 368 Juana Avenue San Leandro, CA 94577

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 follow proper food handling practices when a dietary staff member during trayline (a system of food preparation in which trays move along an assembly line) did not change gloves and wash her hands after she opened two cabinet drawers while wearing gloves and then returned to trayline. This deficient practice had the potential to result foodbourne illness. Findings: During an observation of trayline on 3/27/19, at 11:54 a.m., [NAME] (CK) 1 stopped doing trayline, opened two cabinet drawers and removed clean utensils from the drawers. CK 1 then returned to trayline, and continued to handle clean plates, serving utensils and food. CK 1 did not remove her gloves and wash her hands between opening the cabinet drawers and returning to trayline. During an interview with CK 1 on 3/27/19, at 11:57 a.m., CK 1 stated she should have removed gloves and washed hands after touching cabinet drawers and before returning to trayline. During an interview with the Dietary Supervisor (DS) on 3/27/19, at 11:59 a.m., DS stated gloves should have been removed and hands washed once CK 1 touched the drawers. Review of the facility's policy and procedure titled, Glove Use Policy, dated 2018, indicated .Disposable gloves are a single use item and should be discarded after each use, and especially before handling clean food items .When gloves need to be changed .2. Before beginning a different task 056345 Page 3 of 7 056345 03/28/2019 San Leandro Healthcare Center 368 Juana Avenue San Leandro, CA 94577

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm During an observation on 3/26/19, at 12:37 p.m., without performing hand hygiene, RNA 1 removed Resident 3's food tray from the food cart, entered Resident 3's room, and placed the tray of food on Resident 3's over the bed table. RNA 1 then removed Resident 3's tray of food from her room and handed it to Certified Nursing Assistant (CNA) 2 to be held in the kitchen for Resident 3. CNA 2 then carried Resident 3's tray of food down to the kitchen. Residents Affected - Some During an observation and concurrent interview with [NAME] 2 (CK) 2 on 3/26/19, at 12:45 p.m., CK2 pointed out that Resident 3's tray was sitting on the kitchen counter. CK 2 stated a tray of food held for a resident was to be placed in the walk-in refrigerator to be given to the resident later when the resident was ready to eat. CK 2 picked up Resident 3's tray of food, walked to walk-in refrigerator, and opened refrigerator door to place Resident 3's tray of food inside, and was stopped by the state surveyor before CK 2 entered the refrigerator. During an interview with Registered Dietician (RD) on 3/26/19, at 12:47 p.m., RD stated held resident food trays were not to be stored in the walk-in refrigerator if it has been brought into the resident's room. Based on observation, interview and record review, for two of 17 sampled residents (Resident 188 and 3) the facility failed to ensure food was served under sanitary conditions when Rehabilitation Nurse Assistant (RNA) 1 did not perform hand hygiene (wash hands with soap and water or use an alcohol based hand rub) while serving meals to Residents 188 and 3 and [NAME] (CK) 2 attempted to store a tray of food that was previously placed on Resident 3's overbed table. For Resident 188 and Resident 3, this deficient practice had the potential to result foodborne illness. Findings: During an observation on 3/26/19, at 11:58 a.m., RNA 1 passed trays to residents without having first performed hand hygiene. RNA 1 spilled salad dressing on her hand, dumped the salad dressing from her hand onto Resident 188's salad, and then continued to serve food to other residents. RNA 1 then left the dining area without performing hand hygiene and assisted other staff with delivering trays of food to residents in their room. In a joint interview on 3/28/19, at 9:17 a.m., the Director of Staff Development (DSD) and Nurse Manager (NM) both stated the hand hygiene expectation was that it was to be done before and after resident care, or after eating. Review of the facility's policy and procedure, titled Handwashing/Hand Hygiene, revised 8/12, indicated 2. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infection to other personnel, residents, and visitors .5. Employees must wash their hands for at least 15 seconds using antimicrobial or non-antimicrobial soap and water under the following conditions: f. Before and after eating or handling food (hand washing with soap and water); g. before and after assisting resident with meals Review of the facility's policy and procedure, titled Preventing Foodborne Illness-Food Handling, revised 11/10, indicated Food will be .handled and served so that the risk of foodborne illness is 056345 Page 4 of 7 056345 03/28/2019 San Leandro Healthcare Center 368 Juana Avenue San Leandro, CA 94577

F 0880 minimized .1. The facility recognizes that the critical factors implicated in foodborne illness are: a. Poor personal hygiene of food service employees Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 056345 Page 5 of 7 056345 03/28/2019 San Leandro Healthcare Center 368 Juana Avenue San Leandro, CA 94577

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and record review, the facility had 18 resident (Rt) rooms (7, 8, 9, 10, 11, 12, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25) with multiple beds that provided less than 80 square feet (sq.ft) per resident who occupied these rooms. This failure had the potential to result in inadequate space for the delivery of care to each of the resident in each room, or for storage of the residents' belongings. Findings: During an observation on 3/26/19 at 8 a.m., the following sq.ft. were identified: Room Activity Room Size Floor Area 7 Rt room [ROOM NUMBER].68 sq.ft 71.42 sq.ft/bed 8 Rt room [ROOM NUMBER].03 sq.ft 70.25 sq.ft/bed 9 Rt room [ROOM NUMBER].03 sq.ft 70.25 sq.ft/bed 10 Rt room [ROOM NUMBER].56 sq.ft 70.14 sq.ft/bed 11 Rt room [ROOM NUMBER].31 sq.ft 72.15 sq.ft/bed 12 Rt room [ROOM NUMBER].60 sq.ft 72.94 sq.ft/bed 14 Rt room [ROOM NUMBER].60 sq.ft 72.94 sq.ft/bed 15 056345 Page 6 of 7 056345 03/28/2019 San Leandro Healthcare Center 368 Juana Avenue San Leandro, CA 94577

F 0912 Rt room [ROOM NUMBER].39 sq.ft 73.19 sq.ft/bed Level of Harm - Potential for minimal harm 16 Rt room [ROOM NUMBER].39 sq.ft 73.19 sq.ft/bed Residents Affected - Some 17 Rt room [ROOM NUMBER].39 sq.ft 73.19 sq.ft/bed 18 Rt room [ROOM NUMBER].41 sq.ft 72.70 sq.ft/bed 19 Rt room [ROOM NUMBER].89 sq.ft 72.44 sq.ft/bed 20 Rt room [ROOM NUMBER].70 sq.ft 70.90 sq.ft/bed 21 Rt room [ROOM NUMBER].48 sq.ft 70.82 sq.ft/bed 22 Rt room [ROOM NUMBER].48 sq.ft 70.82 sq.ft/bed 23 Rt room [ROOM NUMBER].48 sq.ft 70.82 sq.ft/bed 24 Rt room [ROOM NUMBER].99 sq.ft 71.32 sq.ft/bed 25 Rt room [ROOM NUMBER].48 sq.ft 70.82 sq.ft/bed During random observations of care and services from 3/26/19 to 3/28/19, there was sufficient space for the provision of care for the residents in all rooms. There was no heavy equipment kept in the rooms that might interview with resident care and each resident had adequate personal space and privacy. There were no complaints from residents regarding insufficient space for their belongings. There were no negative consequences attributed to the decreased space and/or safety concerns in the 18 RT rooms identified. Granting of room size waiver recommended. 056345 Page 7 of 7