Health inspection·May 30, 2019

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on observation, interview, and record review, the facility failed to ensure accurate dispensing and accounting of emergency medications when the intravenous (IV - administered through vein) emergency kit (IV E-Kit) was not replaced after it was opened and used items was not accounted. This deficient practice placed residents at risk for not receiving the necessary IV supplies in an emergency. Findings: During an observation on 5/28/19, at 10:59 a.m., the IV E-kit in the medication room was open, but was not resealed. During interview with Registered Nurse (RN) 1 on 5/28/19, at 10:59 a.m., RN 1 stated somebody opened the IV e-kit but he did not know who. During interview with RN 2 on 5/30/19, at 11:52 a.m., RN 2 stated the facility's process for using the E-kit included filling out the form that was inside the E-kit, leaving the white copy inside the e-kit, and the yellow copy was to be attached to the e-kit log; then fill out the Emergency Medication Administration Log, then reseal the e-kit with red colored tie. Review of facility records did not show any documentation or log of when the IV E-kit was opened and what was used. Review of the facility policy and procedure Emergency Pharmacy Service and Emergency kits (E-kits) dated 09/10 indicated, upon removal of any items from the emergency kit, the nurse documents the medication or item used on an emergency kit log Items to be documented on the log include: Residents name, medication name, strength and quality, date and time of medication removal .signature of nurse removing and administering dose .faxed log sheet will inform the pharmacy of items used form the emergency kit, this will notify the pharmacy to replace the kit Page 1 of 2 056457 056457 05/30/2019 Greenridge Post Acute 2150 Pyramid Drive El Sobrante, CA 94803

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, the facility failed to prepare, store, and serve food under sanitary conditions when dirty ladles, plates, tong and drawer were stored in the same drawer with clean utensils. Residents Affected - Few These failures placed residents at risk for contracting food borne illness. Findings: During an observation of the dietary department on 5/29/19 at 12:06 p.m., with the Certified Dietary Manager (CDM) and Dietary Staff (DS), the following items were noted: a. One six ounce ladle had small black particles inside the scoop. b. One eight ounce ladle had black debris and water pooled inside the scoop. c. Two eight ounce ladles had black debris and dust. d. One twelve inch tong had white substance on the handle. e. Three plates with caked-on yellow matter, and black debris, were stored on the plate warmer with clean plates. f. The drawer where the cook's clean utensils were stored had substance and black debris. During an interview with the CDM on 5/29/19 at 12:06 p.m., she stated the person assigned to wash dishes was responsible for ensuring the dishes were clean and dry before storing the items. During an interview and observation with the DS on 5/29/19 12:10 p.m., she acknowledged the drawer where the cook's clean utensils were stored was dirty. DS touched the black debris inside the drawer and it created a black smear. During a second interview with the DS on 5/30/19 at 12:08 p.m., she stated every kitchen staff including cooks were responsible for ensuring the drawers for utensils were kept clean. 056457 Page 2 of 2