Other·February 27, 2024

Facility: Skyline Healthcare Center Event ID: DT0C11 Exit date: 1/31/24 California Code of Regulations, Title 22, Section: § 72345 Dietetic Sanitation. (a) All kitchens and kitchen areas shall be kept clean, free from litter and rubbish and protected from rodents, roaches, flies, and other insects. The facility failed to provide safe food prepared under sanitary conditions in a kitchen free of pests including cockroaches. Unsanitary Foodservice Kitchen Practices During the initial kitchen tour on 1/22/24 at 8:58 AM, an observation of the back walls in the kitchen with shelves, a metal food prep counter and food prep sink had uncovered holes and pealing baseboards. Additionally, there were multiple broken and non-operation kitchen appliances, including a large reach-in refrigerator, a walk-in refrigerator, and condensation build-up on the ceiling of the walk-in freezer. The kitchen floor had food crumbs, debris, plastic strips, food wrappers, and other trash scattered all throughout the entire kitchen floor. Additionally, unsanitary practices including dirty dishes stored as clean dishes, light brown food crumbs and stains inside the two large reach-in refrigerators inside the DSM's office. One of three refrigerator door gaskets was ripped hanging off the inside of the door with a dark brown sticky substance on it. And a fire sprinkler was inside the walk-in freezer ceiling protruding from a large open hole. These physical environment conditions prevented adequate cleaning and sanitizing that allowed for and contributed to the harborage of pests. On 1/22/24 at 9:14 AM, an observation and interview were conducted in the Dietary Manager's office. A large Ziploc bag labeled puree kit dated 1/18/24 was found in the larger reach-in refrigerator with other nourishments. The Ziploc bag had a container of cooked cream of wheat and a bowl of soup. The DSM acknowledged the expired food items and stated they should have been thrown out. On 1/22/24 at 9:31 AM, a concurrent observation and interview were conducted with the DSM. There was a large clear plastic bin found in an open space underneath a food prep counter with a bag of 32 yellow onions, and 23 had multiple dark black, gray, and brown spots resembling mold, and soft to touch. The DSM acknowledged the 'mold-like' colored areas on the onions and stated the onions should have been rejected when they were delivered. On 1/22/24 at 9:59 AM, a concurrent observation and interview were conducted with the DSM. There was a scooper left inside a box of diced carrots in the walk-in freezer. The DSM acknowledged the scooper and stated, "it should not be left there." The DSM did not know how long the scooper was left inside the case of carrots. During a review of a County of Santa Clara, Department of Environmental Health Inspection report dated 4/15/22, the report indicated " ...observed some uncovered holes in the kitchen walls behind storage shelves ...to prevent rodent/insect infestation, seal all possible holes leading to the kitchen area..." During a review of the facility's policy and procedure (P&P) titled "Sanitation and Infection Control," dated 2023, the P&P indicated " ...All perishable food items ...will be stored properly ...8. Fresh ...vegetables should be stored in designated bins or containers in a designated area of the refrigerator ..." During a review of the facility's policy and procedure (P&P) titled "Food Purchasing, Receiving and Production" dated 2023, the P&P indicated " ...All food will be of good quality and obtained from sources approved or considered satisfactory ...3. All fresh ...vegetables will be of good quality and freshness. Fresh produce should be purchased 1-2 times per week to ensure freshness and maximum nutritional value ..." During a kitchen observation on 1/22/24 at 10:03 AM and interview with a dishwasher Diet Aide (DA) J and the DSM, DA J stated the dish machine wash temperature should be 110 degrees F, and he thinks the sanitizer should be at 200 ppm (parts per million). DA J tested the sanitizer with a test strip from a chlorine test strip container and dipped it into the sanitizer solution from the dish machine for 13 seconds. DA J then compared the result against the test strip container results and shook his head. DA J took another test strip and redipped it for 10 seconds in the dish machine solution, then redipped the same strip for 8 more seconds and stated he is looking for a different result than what he's getting. DA J stated the sanitizer solution was not hot enough, that is why he did not get the desired result on the test strip because the color was gray, which was close to 200 ppm but not at 200 ppm. DA J stated he got trained on testing the sanitizer level in 2016 when he was hired and then again last week, but he doesn't remember the training. On 1/22/24 at 10:17 AM, the DSM acknowledged DA J's sanitizer test demonstration and stated he should know how to test this correctly. The DSM then placed a stainless-steel container upside down and ran it through the dish machine. She dipped a test strip from the chlorine test strip container on top of the stainless-steel container. The test strip was medium gray, which read 50-100 ppm (parts per million). The DSM stated, "this is the correct level, it should be between 50-100 ppm, and the wash temperature at 140 degrees F." During a review of the facility's undated policy and procedure (P&P) titled "Dietary Cleaning," the P&P indicated " ...Proper cleaning and sanitation of equipment ensures removal of residual food, chemicals, and bacteria ...More sanitizer is not better; too much sanitizer can cause chemical poisoning. Use test strips to determine the proper strength of sanitizer ...4. ...Removable parts can be washed, rinsed, and sanitized manually ...Non-removable parts will be washed, rinsed, air dried, and sprayed with sanitizing solution ..." During a concurrent observation and interview with the RD and DSM on 1/22/24 at 3:17 PM at nursing station 4 (NS 4), a dead baby cockroach was found inside the ice machine cover facing the ice curtain. RD and DSM confirmed the finding of the dead baby cockroach inside the ice machine cover, and the DSM stated, "Oh wow." RD and DSM stated they did not know the last time the ice machine was cleaned and sanitized. During an observation on 1/22/24 at 3:23 PM of the ice machine at station 4 and interview with the facility's Regional Maintenance Director (FMD), the FMD acknowledged the black residue and brown crusty buildup inside the ice machine curtain, chute, and tiny black residue in the ice bin. The FMS stated the ice machine should be always clean, without the residue. The RD, DSM and the FMD acknowledged the dirty thick black and brown buildup and residue. The FMD further stated the ice machine should be cleaned every month using the manufacturer's guidelines. During an interview with the ADM on 1/22/24 at 4:01 PM, the ADM stated the maintenance supervisor probably just cleaned the inside of the ice machine and the dietary staff cleaned the outside of the ice machine. According to the 2022 Federal FDA Food Code, section 4-204.17, titled Ice Units, Separation of Drains, "Liquid waste drain lines passing through ice machines and storage bins present a risk of contamination due to potential leakage of the waste lines and the possibility that contaminants will gain access to the ice... the potential for mold ...growth in this area is very likely due to the high moisture environment. Molds ... that form on the drain lines are difficult to remove and present a risk of contamination to the ice stored in the bin." During a review of the facility's undated policy and procedure (P&P) titled "Ice Machines," the P&P indicated " ...Follow the manufacturer's guidelines for cleaning ...Cleaning 1. Disinfect the drop opening of the ice machine once a week with an appropriate disinfectant or use 10-20 cc's (cubic centimeters which equals milliliters of volume) of bleach to 1,000 cc's of warm water ..." During an observation on 1/23/24 at 10:18 AM of the red bucket sanitizer and interview with DA CC, DA CC tested the sanitizer solution by dipping the test strip in the red bucket for 5 seconds then compared the result with the test strip container and it was dark green. DA CC stated the strip should be at 400 ppm, which is dark green because "that is a good level." The DSM acknowledged the incorrect sanitizer test demonstration. The DSM stated, "the sanitizer in the red bucket should be between 200 ppm and 300 ppm, and DA CC should know the correct process." Concurrently, on 1/23/24 at 10:22 AM, an interview was conducted with the DSM. The DSM was asked what the expected concentration of the sanitizer solution in the red bucket should be, and the DSM stated "200" ppm (parts per million). During a review of the manufacturer's label on the sanitizer bottle for the sanitizer used in the red buckets, the effective concentration to sanitize should be at 150-400 PPM. The chem test strips from the vial that the facility used provided a color-coded graph in increments of 100 PPM, 200 PPM, 300 PPM, 400 PPM, and 500 PPM. There was no measurement on the chem strip vial available to determine 150 PPM. According to the 2022 Federal Food and Drug Administration (FDA) Food Code, section 4-302.14, titled Sanitizing Solutions, Testing Devices, "A test kit or other device that accurately measures the concentration in MG/L (milligrams per liter) of sanitizing solutions shall be provided. During a review of a County of Santa Clara, Department of Environmental Health Inspection report dated 4/15/22, the report indicated " ...observed some uncovered holes in the kitchen walls behind storage shelves ...to prevent rodent/insect infestation, seal all possible holes leading to the kitchen area..." During a review of the Santa Clara County Environmental Health Department Inspection report dated 5/3/23, the report indicated " ...Major Violations ...The maximum water temperature on the mechanical dishwasher was measured at 150 degrees F ...If a high temperature mechanical dishwasher is used to sanitize dishes, the minimum temperature must be adjusted to 160 degrees F ..." During a review of the facility's undated policy and procedure (P&P) titled "Dietary Cleaning," the P&P indicated " ...Proper cleaning and sanitation of equipment ensures removal of residual food, chemicals, and bacteria ...More sanitizer is not better; too much sanitizer can cause chemical poisoning. Use test strips to determine the proper strength of sanitizer ...4. ...Removable parts can be washed, rinsed, and sanitized manually ...Non-removable parts will be washed, rinsed, air dried, and sprayed with sanitizing solution ..." According to a manufacturer (name of company), "A single cockroach sighted during the day can indicate that there is a significant infestation. Cockroaches, also known as 'roaches,' are nocturnal and prefer to live and breed in dark shelters near food and moisture. But if a harborage site is overpopulated, they can be forced out in daylight, often in search of food ..., to get to the food they can tread across the floor and through garbage in search of food, then crawl across the food-contact surfaces ..." (http://www.(name of company).com/pages/the-dangers-cockroaches-bring-to-food-safety) During a concurrent kitchen observation and interview on 1/23/24 at 11:31 AM, a dead roach was found on the floor in the food prep area. The Dietary Services Manager (DSM) acknowledged the dead cockroach and stated, "not ok." Three more dead cockroaches were spotted in a corner on the floor near the steamer in the food prep area. Then a live cockroach was spotted on the floor crawling from the food prep counter adjacent to the tray line station. The DSM verified the three dead cockroaches in the corner and acknowledged the live cockroach crawling from the food prep counter, then stepped on it to kill it. On 1/23/24 at 12:26 PM, during a subsequent observation and interview in the kitchen, another dead cockroach was found on an electrical outlet under the food prep sink area. The DSM verified the dead cockroach on the electrical outlet. Review of a pest control company invoice dated 1/26/24 indicated " ...Full kitchen clean out for German cockroaches' infestation: performed crack and crevice treatment in the kitchen using several methods. 1) open up all electrical sockets drilled holes in the walls and treated ...2) ...did a baseboard treatment under and behind all equipment ...strongly recommend weekly services along with daily follow ups, and placing out monitors to evaluate activity ... " Further review of an outside company's pest control reports dated 5/2/23, 7/20/23, 10/19/23, 1/18/24 indicated "...Heavy roach infestation in kitchen ...recommending roach clean out services ...,treated kitchen ...12 refrigerators that (DSM name) pulled out due to German cockroaches being spotted on them ...,treated...under food carts...food cart storage room ..." According to the Food and Drug Administration, "Insects and rodents carry disease-causing microorganisms which may be transmitted to humans by contamination of food and food-contact surfaces. The presence of insects and rodents is minimized by protecting outer openings to the food establishment." (FDA 2022 Annex 3 - Public Health Reasons/Administrative Guidelines, 6-202.15 Outer Openings, Protected.) Review of the County of Santa Clara, Department of Environmental Health Inspection report dated 1/23/24, the report indicated " ...Major Violations ...3 live adult cockroaches and 2 live juvenile cockroaches found behind equipment at cookline. 3 juvenile cockroaches found on the wall at the dish station. One live adult cockroach laying an egg sack found on wall at dish station. Moderate amount of dead cockroaches found throughout the kitchen (behind tape) ...The premises of each food facility shall be kept free of vermin (pests). A food facility shall not operate when there is a vermin infestation that has resulted in the contamination of food contact surfaces, food packaging, utensils, food equipment, or adulteration of food(s). The food facility shall cease operation of the food facility immediately. The food facility shall remain closed until there is no longer evidence of a vermin infestation; all contaminated surfaces have been cleaned and sanitized; and contributing factors such as cleaning, repairs, and the elimination of harborages have been resolved." Further review of prior County of Santa Clara, Department of Environmental Health Inspection reports dated 4/15/22 and 5/3/23 indicated " ...Many dead cockroaches and one live cockroach was observed on cockroach traps located inside the (Dietary) office which is also used for food storage ...Major Violations ...Multiple dead cockroaches were observed below the cooking, preparation, washing, storage tables in the kitchen area. Many live cockroaches were observed below these structures ...The dead cockroaches must be cleaned, and the floor area properly sanitized immediately ..." 2. Resident complaints of cockroaches and 1 facility staff a) During an interview with Resident 223 on 1/22/24 at 10:20 a.m., Resident 223 stated he saw a cockroach in his room on the wall last week. b) During a review of Resident 8's minimum data set (MDS, an assessment tool), dated 12/20/23 indicated her brief interview for mental status (BIMS) score was 15 (a score 13 to 15 indicates the resident is cognitively intact). During an interview on 1/23/24 at 1:30 p.m. with Resident 8, the resident stated she had seen one baby cockroach crawling on the plastic top of her juice cup. Resident 8 further stated that there was another dead cockroach on her meal tray "not too long ago." c) Review of Resident 218's face sheet (a document that contains a summary of a patient's personal and demographic information) indicated, Resident 218 was admitted to the facility with diagnoses including severe sepsis (the body's extreme response to an infection), depression (loss of pleasure or interest in activities for long periods of time), and paroxysmal atrial fibrillation (occurs when a rapid, erratic heart rate begins suddenly and then stops on its own within 7 days). Rev