Inspection visit

Health inspectionDecember 7, 2023

MANZANITA HEALTHCARE CENTERCMS #55508322 citations on this visit

22 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 22 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. Based on observation, interview and record review, the facility failed to maintain dignity for one of 27 sampled resident (Resident 14) when Resident 14's catheter bag (a bag that collects urine from an indwelling urinary catheter) was exposed. This failure had the potential to reduce Resident 14's right to respect and dignity. Findings: A review of the facility document titled, admission Record, indicated Resident 14 was admitted to the facility in 2023 with diagnoses including kidney failure. During a concurrent observation and interview on 12/4/23 at 8:51 a.m., in Resident 14's room, Resident 14's catheter bag was hanging off the bed with brown urine inside without a privacy cover. Certified Nursing Assistant 1 (CNA 1) confirmed there was no privacy cover over the catheter bag. CNA 1 confirmed there should have been a privacy cover for Resident 14's catheter bag. During an interview on 12/6/23 at 10:06 a.m., the Director of Nursing (DON) stated staff should have placed a privacy cover over the catheter bag. Review of the facility's policy titled, Resident Rights, revised date 2/2021, indicated, Employees shall treat all residents with kindness, respect, and dignity. Page 1 of 37 555083 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the Physician Orders for Life-Sustaining Treatment (POLST, a medical order that gives patients control over their care during a medical emergency) forms for two residents (Resident 187 and Resident 378), of 27 sampled residents, were valid in the electronic health records (EHRs) when POLST information did not match with EHR. This failure decreased the staff's potential to safely follow the residents' POLST during emergencies. Findings: A review of Resident 187's admission record indicated he was admitted in 11/23 with diagnoses including heart failure and severe obesity. A review of Resident 187's clinical record included the following documents: A POLST, dated [DATE], indicated Resident 187 had elected Cardiopulmonary Resuscitation (CPR) if he were to be found without a pulse and not breathing and full treatment be provided if he were to be found to have a pulse and/or was not breathing. A physician's order, dated [DATE], indicated Resident 187 had a code status of DNR (Do Not Resuscitate). In a concurrent record review and interview, on [DATE] at 2:39 p.m., Licensed Nurse 1 (LN 1) reviewed Resident 187's POLST and confirmed it indicated he had selected CPR and full treatment. LN 1 confirmed the EHR was inaccurate and documented Resident 187 as DNR. In a concurrent record review and interview, on [DATE] at 12:39 p.m., the Director of Nursing (DON) stated she expected a resident's POLST and the EHR to match. The DON confirmed the POLST and EHR did not match, the EHR was inaccurate and should have indicated Resident 187 selected CPR and full treatment. A review of an admission record indicated Resident 378 was admitted to the facility on [DATE] with diagnoses including heart failure, chest pain, and shortness of breath. A review of Resident 378's POLST, dated [DATE], indicated if Resident 378 had no pulse and was not breathing to attempt CPR. A review of Resident 378's Order Summary, dated [DATE], indicated Resident 378 wished to be Full Code/DNR. During an interview on [DATE] at 2:51 p.m. with LN 4, LN 4 stated Resident 378's order was inaccurate because it did not match with POLST which indicated CPR and not DNR. During an interview on [DATE] at 2:55 p.m. with the Resources Nurse Consultant (RNC), RNC confirmed Resident 378's POLST and order did not match. RNC stated the nurse was supposed to verify the order 555083 Page 2 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few because it was unclear and the POLST and order should have matched; otherwise, there was a potential that nurses might delay providing care to Resident 378 during an emergency. A review of the facility's policy titled, Advance Directives, dated 9/22, indicated, The plan of care for each resident is consistent with his or her documented treatment preferences .A resident will not be treated against his or her own wishes. 555083 Page 3 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview and record review the facility failed to maintain a comfortable and safe living environment for one of 27 sampled residents (Resident 49) when the bed provided for Resident 49 was very small and worn out. This failure increased resident 49's potential for discomfort, sleep disturbances, and injury. Findings: A review of Resident 49's admission record indicated he was admitted in 6/2023 with diagnoses including generalized muscle weakness, and had the capacity to make healthcare decisions. A review of Resident 49's Minimum Data Set (MDS, an assessment tool) dated 7/2023, indicated Resident 49 had no memory problems with a Brief Interview of Mental Status (BIMS, a cognitive assessment tool) score of 13 out of 15. During a concurrent observation and interview on 12/4/23 at 10:09 a.m., with Resident 49, he was observed lying in bed with no foot board and noticed both feet hanging and sticking out over the bed, foot board at the corner by the wall. Resident 49 stated maintenance staff had to take it off because he hits his heels on it whenever he moves causing pain to his feet because the bed was small, also added he gets back pains because of the mattress. Resident 49 stated, I have the oldest bed in this facility. Resident 49 mentioned he requested his bed to be changed from the time he was admitted . In an interview on 12/4/23 at 10:14 a.m. with Certified Nursing Assistant (CNA) 2, CNA 2 stated the maintenance staff knew about Resident 49's request for a bed change. She requested maintenance to check his [Resident 49] bed because CNA 2 noticed whenever she puts the head up, Resident 49 slides down and could fall. During a concurrent observation and interview on 12/5/23 at 11:23 a.m. with the Maintenance Manager (MM), MM recounted taking out Resident 49's foot board because the bed was small, and the resident complained of hitting his heels on it. MM confirmed Resident 49 needed a new bed. A concurrent interview and record review on 12/5/23 at 1:15 p.m. with the Unit Manager (UM), UM acknowledged Resident 49's bed was too small for him and should have been changed promptly to be able to assist Resident 49 rest comfortably and safely. During a review of the facility's Policy and Procedure (P&P) titled Accommodation of Needs revised 3/2021, the P&P indicated, The resident's needs and preferences, including the need for adaptive devices and modifications to the physical environment, are evaluated upon admission and reviewed on an ongoing basis. 555083 Page 4 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0637 Assess the resident when there is a significant change in condition Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to complete a significant change in status assessment (SCSA) in a timely manner for one of 27 sampled residents (Resident 47). Residents Affected - Few This failure had the potential of not providing appropriate care and interventions to Resident 47 based on her current status. Findings: Resident 47 was admitted in 6/2023 with diagnoses including metastatic lung cancer (cancer that spread from its origin in the lung), and dementia and did not have capacity to make their own choices. The daughter was listed as the responsible party (RP) who makes healthcare decisions. A review of facility MDS Brief Interview of Mental Status (BIMS, an assessment tool) score was 6 out 15, indicating severe cognitive impairment. During a review of Resident 47's Order Listing Report (OLR), indicated Resident 47 was admitted under hospice care (specialized treatment for people with serious illness or end of life care) and was discharged from the hospice program per physicians' order on 11/8/23, due to an extended prognosis. During a concurrent interview and record review on 12/5/23 at 10:15a.m. with the MDS Coordinator (MDSC), MDSC confirmed she knew Resident 47 was discharged from hospice and confirmed there was no SCSA found on the list of Minimum Data Set (MDS, an assessment tool) assessments completed for Resident 47. MDSC acknowledged an SCSA should have been done within 14 days after discharge from hospice because it is considered a significant change in status. During a review of the facility's Policy and Procedure (P&P) titled Comprehensive Assessments revised 3/ 2022 P&P indicated Significant Change in Status Assessment -The SCSA is a comprehensive assessment for a resident that must be completed when the IDT [interdisciplinary team] has determined that a resident meets the significant change guidelines for either major improvement or decline. 555083 Page 5 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to accurately assess one resident (Resident 36) of 27 sampled residents, when the Minimum Data Set (MDS; an assessment tool) inaccurately indicated Resident 36 had no behaviors. Residents Affected - Few This failure decreased the facility's potential to identify residents' care needs. Findings: A review of an admission record indicated Resident 36 was admitted to the facility in June 2021 with diagnoses including Alzheimer's disease (a brain disorder), dementia (impaired ability to remember, think, or make decisions), and major depressive disorder. A review of Resident 36's Order Summary Report, dated 10/31/23, indicated Resident 36 started to receive 2.5 milligrams (mg; a unit of measure) of olanzapine (an antipsychotic medication) at bedtime for agitation manifested by yelling out. A review of Resident 36's MDS, dated [DATE], indicated Resident 36 exhibited no verbal behavioral symptoms directed toward others. A review of Resident 36's Medication Administration Record (MAR), dated 11/23, indicated Resident 36 was monitored every shift for yelling out with five behaviors documented before 11/10/23. During an interview on 12/6/23 at 1 p.m. with Licensed Nurse 5 (LN 5), LN 5 stated Resident 36 had behaviors such as refusing showers, agitation, and yelling out to smoke. During an interview on 12/6/23 at 1:05 p.m. with LN 4, LN 4 stated she heard Resident 36 yelling out in the last month and his yelling was mostly to get out and smoke. During an interview on 12/6/23 at 1:08 p.m. with MDS Coordinator (MDSC), MDSC stated Resident 36 received olanzapine for yelling out and his MDS documentation was inaccurate based on nursing notes and MAR. During an interview on 12/6/23 at 1:23 p.m. with Resources Nurse Consultant (RNC), RNC stated Resident 36's MDS assessment was inaccurate, and it should have captured information in nursing notes and assessments. RNC further stated an inaccurate MDS assessment had the potential to impact the care and services provided to Resident 36 since it was a tracking tool for behaviors especially since he recently started on an antipsychotic medication. A review of the facility's policy titled, Comprehensive Assessments, dated 3/22, indicated Comprehensive assessments are conducted [accurately] in accordance with criteria and timeframes established in the Resident Assessment Instrument (RAI) User Manual. 555083 Page 6 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0655 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a baseline care plan for one resident (Resident 16) of 27 sampled residents within 48 hours after admission. This failure decreased the facility's potential to address the residents' initial goals and current health needs. Findings: A review of an admission record indicated Resident 16 was admitted to the facility on [DATE], with diagnoses including pneumonia (lung infection) and dialysis (treatment for kidney failure). A review of Resident 16's 48 Hour Baseline Care Plan, indicated the baseline care plan was completed on 11/17/23. During an interview on 12/6/23 at 2:42 p.m. with the Resources Nurse Consultant (RNC), RNC confirmed Resident 16's baseline care plan was not completed within 48 hours after admission. RNC stated the baseline care plan should have been completed within 48 hours because nurses could use it as a tool to get an idea about the resident's care and services and what areas to focus on and it would also help in the discharge process. A review of the facility's policy titled, Baseline Care Plans, dated 3/22, indicated A baseline plan of care to meet the resident's immediate health and safety needs is developed for each resident within forty-eight (48) hours of admission. 555083 Page 7 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a comprehensive person-centered care plan for one resident (Resident 36) of 27 sampled residents, when the care plan did not address Resident 36's behavioral needs and interventions. This failure decreased the facility's potential to address the residents' individualized and specific needs. Findings: A review of an admission record indicated Resident 36 was admitted to the facility on [DATE] with diagnoses including Alzheimer's disease (a brain disorder), dementia (impaired ability to remember, think, or make decisions), and major depressive disorder. A review of Resident 36's Order Summary Report, dated 10/31/23, indicated Resident 36 started to receive 2.5 milligrams (mg; a unit of measure) of olanzapine (an antipsychotic medication) at bedtime for agitation manifested by yelling out. A review of Resident 36's Order Summary Report, dated 11/1/23, indicated to monitor Resident 36 for yelling out every shift. During an interview on 12/6/23 at 1 p.m. with Licensed Nurse 5 (LN 5), LN 5 stated Resident 36 had behaviors such as refusing showers, agitation, and yelling out to smoke. During an interview on 12/6/23 at 1:05 p.m. with LN 4, LN 4 stated she heard Resident 36 yelling out in the last month and his yelling was mostly to get out and smoke. During a concurrent interview and record review on 12/6/23 at 1:23 p.m. with the Resources Nurse Consultant (RNC), Resident 36's Care Plan was reviewed. RNC confirmed Resident 36 had no care plan for his behaviors after he started receiving an antipsychotic medication. RNC stated nurses should have care planned Resident 36's specific behaviors because, without a care plan, there could be an impact on monitoring the effectiveness of the antipsychotic medication given by nurses. A review of the facility's policy titled, Comprehensive Person-Centered Care Plans, dated 3/22, indicated A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident. 555083 Page 8 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. 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, the facility failed to provide services according to professional standards of quality for two residents (Resident 36 and Resident 47) of 27 sampled residents, when: Residents Affected - Few 1. Resident 36's oxygen was not administered as indicated in physician's order; and, 2. Resident 47's physician order for the use of an external catheter was not obtained. These failures had the potential to jeopardize resident health when physician orders were not obtained or followed. Findings: 1. A review of an admission record indicated Resident 36 was admitted to the facility on [DATE] with diagnoses including palliative care (specialized medical care for people living with a serious illness), dementia (impaired ability to remember, think, or make decisions), tobacco use, and chronic obstructive pulmonary (lung) disease. A review of Resident 36's Minimum Data Set (MDS; an assessment tool), dated 11/10/23, indicated Brief Interview of Mental Status (BIMS) score was two of 15 with memory loss. A review of Resident 36's Order Summary Report, dated 11/1/23, indicated to administer oxygen at two liters per minute (a measurement of oxygen/dose) via nasal cannula as needed for shortness of breath or chest pain or oxygen saturation less than 90% and to notify the physician. During an observation on 12/4/23 at 9:38 a.m., in Resident 36's room, Resident 36 was lying in his bed and connected to oxygen at three liters per minute via nasal cannula. A review of Resident 36's Weekly Nursing Summary, dated 12/5/23, indicated Resident 36 used oxygen continuously this week at four liters per minute via nasal cannula and his oxygen saturation range was 90%. During an observation on 12/7/23 at 9:29 a.m., in Resident 36's room, Resident 36 was lying in his bed and connected to oxygen at five liters per minute via nasal cannula. During an interview on 12/7/23 at 9:33 a.m. with Licensed Nurse 5 (LN 5), LN 5 confirmed Resident 36 was connected to oxygen at five liters per minute via nasal cannula. LN 5 stated Resident 36 was supposed to be connected to oxygen at two liters per minute for oxygen saturation less than 90% as indicated in the physician's order and, if his oxygen continued to be low, then she should have notified the physician. LN 5 further stated Resident 36 was on oxygen yesterday with an oxygen saturation was between 97% and 98% ,and sometimes 90%, and today at 8:30 a.m. his oxygen saturation was 93%. During an interview on 12/7/23 at 9:45 a.m. with the Director of Nursing (DON) and Resources Nurse Consultant (RNC), DON and RNC confirmed nurses were not following Resident 36's physician's order for oxygen at two liters per minute. DON and RNC stated the physician order clearly said to administer oxygen at two liters per minute and, if the oxygen saturation was less than 90%, the nurses should have followed the physician's order. 555083 Page 9 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of the facility's policy titled, Administering Medications, dated 4/19, indicated Medications [and treatments] are administered in a safe and timely manner, and as prescribed. 2. Resident 47 was admitted in 6/2023 under Hospice care (treatment for end of life care) with diagnoses including metastatic lung cancer (cancer that has spread beyond the lungs) and dementia. Resident 47 did not have the capacity to make choices, and the daughter was the responsible party (RP) who made healthcare decisions. Brief Interview of Mental Status (BIMS, an assessment tool) score was 6 out 15, with severe cognitive impairment. Resident 47 required extensive assistance with toileting, personal hygiene, and bed mobility. During a concurrent observation and interview on 12/5/23 at 9:44 a.m., inside Resident 47's room, three Certified Nurse Assistants (CNAs) were observed assisting Resident 47 with activities of daily living (ADLs), noted Resident 47 to have an external catheter connected to a tube and attached to a collecting canister. CNA 2 stated Resident 47 has been using the catheter for months already. During a review of Resident 47's Physician's Order, dated 11/2023, there was no order documented for the use of an external catheter. Furthermore, nursing measures like monitoring for placement and skin integrity were not tracked. In a concurrent interview and record review on 12/5/23 at 9:50 a.m. with Licensed Nurse 2 (LN 2), LN2 confirmed Resident 47's use of the external catheter was per family's request. LN 2 also verified that an order for the use of an external catheter was missing in the physician's orders. During a concurrent interview and record review on 12/5/23 at 9:56 a.m. with the Director of Nursing (DON), DON acknowledged that there was no order for Resident 47's use of an external catheter and stated nursing staff should have obtained an order from the doctor before allowing the use of the device. The order must include the monitoring of its placement to ensure it is working properly and the monitoring of skin integrity to prevent the risk of infection. During a review of the facility's Policy and Procedure (P&P), revised 11/ 2014, titled, Medication Orders, the P&P indicated, A current list of orders must be maintained in the clinical record of each resident . Orders must be written and maintained in chronological order. 555083 Page 10 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to assist one of 27 sampled residents (Resident 61) to receive a hearing assessment when Resident 61 had difficulty hearing. Residents Affected - Few This failure decreased Resident 61's ability to communicate needs properly and negatively affected her psychosocial well-being. Findings: Resident 61 was admitted in early 7/2023 with diagnoses including recurrent major depressive disorder, able to understand choices and make own healthcare decisions. Resident 61 had intact memory and a Brief Interview of Mental Status (BIMS, an assessment tool) score of 14 out of 15. A review of Resident 61's admission notes, dated 7/12/23, indicated the admitting nurse noted a report from the acute hospital that Resident 61 was hard of hearing. A review of the social services notes, dated 7/13/23, indicated Resident 61 used hearing aids, but were left at home. A review of Resident 61's physical examination, done on 8/15/23, the Physician confirmed Resident 61 had moderate bilateral hearing loss. During a concurrent observation and interview on 12/4/23, at 10:43 a.m. with Resident 61, observed Resident 61 to lip read. Surveyor had to speak loudly and repeat words several times during the interview. Resident 61 stated she's been hard of hearing for years and needed new hearing aids. She chose not to participate with any activities or talk with other residents because she cannot hear properly. She mentioned the staff knew that she's hard of hearing since admission but was not made aware the facility can assist her to have a hearing assessment done then get new hearing aids. During a concurrent observation and interview on 12/4/23 at 10:43 a.m. inside Resident 61's room, observed Certified Nurse Assistant 2 (CNA 2) had to speak loudly with Resident 61 while providing care, CNA 2 stated she had to talk louder for Resident 61 to hear what was being said. In an interview on 12/5/23 at 8:35 a.m. with Activities Staff (AS), AS stated he had to speak loudly whenever he's talking to Resident 61 and admitted she needs to use hearing aids to be able to communicate better with others. During a concurrent observation and interview on 12/5/23 at 10:25 a.m. with Social Services Director (SSD), observed SSD had to repeat the same question three times while leaning forward towards Resident 61's left side before she [Resident 61] was able to hear and understand what was said. SSD acknowledged Resident 61 was hard of hearing and may benefit to see an audiologist (a physician who specializes in hearing) for a hearing assessment. There was no documented evidence in Resident 61's clinical record of a hearing evaluation or assessment completed by an audiologist. 555083 Page 11 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0685 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a concurrent interview and record review on 12/6/23 at 9:35 a.m. with the MDS Coordinator (MDSC), MDSC verified there was no care plan done for Resident 61's hearing impairment. A review of the facility's Policy and Procedure (P&P) titled Hearing Impaired Resident, Care of, revised 2/2018, indicated Staff will assist hearing impaired residents to maintain effective communication with clinicians, caregivers, other residents and visitors .The staff will assist the resident (or representative) with locating available resources, scheduling appointments, and arranging transportation to obtain needed services. A review of the facility's P&P titled Accommodation of Needs, revised 3/2021, indicated In order to accommodate individual needs and preferences, staff attitudes and behaviors are directed towards assisting the residents in maintaining independence, dignity and well-being to the extent possible and in accordance to residents' wishes. For example . maintaining hearing aids . 555083 Page 12 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to provide respiratory care for one of 27 sampled residents (Resident 185) when a Continuous Positive Airway Pressure machine (CPAP; a machine that uses mild air pressure to keep breathing airways open while sleeping) treatment had not been applied nightly as ordered by the physician (MD). Residents Affected - Few This failure had the potential to negatively impact Resident 185's sleep and respiratory status. Findings: A review of Resident 185's admission record indicated she was admitted in 12/23 with diagnoses including acute respiratory failure with hypoxia (low blood oxygen levels) and obstructive sleep apnea (intermittent airflow blockage during sleep). The record also indicated Resident 185 was her own responsible party (RP). An MD order, dated 12/1/23, indicated Resident 185 was to wear a CPAP at night while sleeping. A MAR (Medication Administration Record), dated 12/23, indicated Resident 185 had worn the CPAP at night 12/1/23- 12/5/23. An Administration Note, dated 12/4/23, indicated Resident 185 was not using the CPAP machine. In a concurrent observation and interview, on 12/6/23 at 7:57 a.m., Resident 185 was awake sitting up in bed. A CPAP machine and package of tubing were on the bedside table and were unopened. Resident 185 stated the physician had prescribed it for her because she had sleep apnea but, no one had assisted her to use it yet and stated she had not refused to wear it. In a concurrent observation and interview, on 12/6/23 at 8:39 a.m., Licensed Nurse 1 (LN 1) confirmed Resident 185 had an MD order to wear the CPAP nightly, looked at the CPAP packaging and confirmed it was unopened and agreed if nursing documentation reflected it had been applied at night it was inaccurate. In an interview, on 12/6/23 at 8:49 a.m., the Director of Nursing (DON) stated it was her expectation that nurses followed MD orders and documented treatments accurately on the MAR. The DON confirmed Resident 185 had an order for the CPAP machine nightly and the MAR indicated she had received the treatment on 12/1, 12/2, 12/3, and 12/5. The DON agreed the documentation of her use of the CPAP on the MAR was inaccurate, did not indicate she was refusing it and stated she expected LNs to assist the resident with applying the mask and treatment. A review of the facility's policy titled, Administering Medications, revised 4/19, indicated medications and treatments not given would be documented as such on the MAR. 555083 Page 13 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review the facility failed to provide medically related social services for one of 27 sampled residents (Resident 45) when Resident 45's request to acquire a 4-wheeled walker with a seat was not facilitated in a timely manner. Residents Affected - Few This failure had the potential to decrease Resident 45's ability to maintain her highest practicable physical well-being. Findings: Resident 45 was admitted in 9/2021 with diagnoses including transient ischemic attack (TIA, mini stroke disruption of blood supply to the brain). Resident 45 did not have the capacity to make own healthcare decisions, and required supervision assistance for locomotion on/off the unit in a wheelchair and with ambulation using a walker. During a concurrent observation and interview on 12/4/23 at 8:41 a.m. Resident 45 was walking by the hallway while using her wheelchair as a walker. Resident 45 stated she's been requesting a walker with a seat for a long time, but never got it, and her wheelchair stops suddenly whenever she propels in it, that was the reason why she just used the wheelchair as a walker. In an interview on 12/4/23 at 9 a.m. with the Maintenance Manager (MM), MM confirmed Resident 45's request for a 4-wheeled walker and mentioned the Social Services Director (SSD) was aware of it. During an interview on 12/4/23 at 1:25 p.m., SSD verified he knew of Resident 45's request for a 4wheeled walker, had spoken with her the previous week about the request, and explained that a physical therapist must evaluate her first before he can place the order. There was no documented evidence of a communication initiated by the SSD that was directed to the Director of Rehab (DOR) regarding Resident 45's request. In an interview on 12/5/23 at 3 p.m. with SSD, he indicated that he did not document in writing the meeting he had with Resident 45 the previous week and admitted the DOR was not informed regarding the need to evaluate Resident 45 for the use of a 4-wheeled walker. During an interview on 12/6/23 at 10 a.m. with the DOR, DOR confirmed he had just received an email from the SSD about Resident 45's request. During an interview on 12/6/23 at 1:20 p.m. with the Director of Nursing (DON) the DON stated she expects the SSD to act on residents' requests in a timely manner and giving a delayed response on a residents' request was unacceptable. During a review of the facility's Policy and Procedure (P&P) titled Social Services, revised 9/2021, the P&P indicated, The director of social services is a qualified social worker and is responsible for: meeting or assisting with the medically-related social service needs of residents . Medically-related social services are provided to maintain or improve each resident's ability to control everyday physical needs (e.g. appropriate adaptive equipment for eating, ambulation, etc.) . 555083 Page 14 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 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: 1. Have an efficient system in place to accurately document and secure emergency medications (E-kit) for a census of 97; and, 2. Store controlled medications (those with high potential for abuse or addiction) to limit access in accordance with facility policy. These failures had the potential for emergency medications to be unavailable when needed, the potential for not meeting the residents' therapeutic needs or worsening of their medical conditions, and potential for diversion of controlled medications. Findings: 1. During an inspection of the medication storage room on 12/4/23 at 11:27 a.m. with Director of Nursing (DON), the First Dose Oral Medications and Intravenous (into the vein) E-kits were sealed with red plastic ties indicating they had been opened by nursing staff. Inside the oral medications E-kit were nine E-kit logs (a document completed by nursing staff whenever a medication is removed from the emergency supply), with the earliest entry into the kit documented on 11/29/23. One of the nine logs was incomplete with no date for which the medication was removed from the kit. Inside the IV E-kit were two logs, dated 11/25/23 and the second log was undated. DON confirmed the finding and stated nursing staff were expected to complete the E-kit log in full and reorder a replacement from the pharmacy the same day. She stated it was important to have the kit replaced timely by the pharmacy to ensure there was a fully supplied E-kit available for use when needed. During a review of the facility's policy and procedure (P&P) titled, Emergency Pharmacy Service and Emergency Kits, dated March 2018, the P&P indicated, Procedures . I. The nurse opening the kit also records use of the kit in the Emergency kit logbook. The nurse records the date, time, resident name, medication name, strength, and dose . K . opened kits are replaced with sealed kits within 72 hours of opening . 2. During an inspection of the vaccine storage refrigerator on 12/4/23 at 11:50 a.m. with DON, four bottles of lorazepam (a controlled medication to treat anxiety) 2 milligrams/milliliter (mg/ml, a unit of measurement), and one bottle hydromorphone (a controlled medication to treat pain) 5 mg/5 ml were identified. Inside the refrigerator were other non-controlled medications. The DON confirmed the facility stored refrigerated controlled and non-controlled medications together and shared the same access. During a review of the facility's P&P titled, Storage of Medications, dated November 2020, the P&P indicated, Policy Interpretation and Implementation . 8. Schedule II-V controlled medications are stored in a separately locked, permanently affixed compartments. Access to controlled medication is separate from access to non-controlled medications. 555083 Page 15 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. 2. A review of Resident 71's admission record indicated he was admitted in 11/23 with diagnoses including schizophrenia (a disorder that affects a person's ability to think, feel and behave clearly). A review of Resident 71's clinical record included the following documents: A physician's order, dated 11/2/23, indicated an order for risperidone, 2 mg tablet, two tablets daily. The order did not indicate, as manifested by, or a target behavior. In a concurrent interview and record review, on 12/5/23 at 3:07 p.m., the Director of Staff Development (DSD) stated psychotropic medication orders should include the resident's diagnosis, a behavior manifestation and there should be an order for behavior monitoring. The DSD reviewed Resident 71's physician's orders and confirmed there was no behavior manifestation and no behavior monitoring for the risperidone. In a concurrent interview and record review, on 12/6/23 at 8:17 a.m., the DON stated it was her expectation psychotropic medication orders included a target behavior and there was an order for behavior monitoring. The DON confirmed there was no target behavior in the physician's order and no behavior monitoring for Resident 71. During a review of the facility's policy and procedure (P&P) titled, Psychotropic Medication Use, dated July 2022, the P&P indicated, Policy Interpretation and Implementation . 3. Residents, families and/or the representative are involved in the medication management process. Psychotropic medication management includes . d. adequate monitoring for efficacy and adverse consequences . 10. Non-pharmacological approaches are used (unless contraindicated) to minimize the need for medications, permit the lowest possible dose, and allow for discontinuation of medication when possible. Based on interview and record review, the facility failed to ensure two of 27 sampled residents (Residents 44 and Resident 71) were free from unnecessary psychotropic (drugs that affects brain activities associated with mental processes and behavior) medications when: 1. Resident 44 received quetiapine (an antipsychotic) without target behavior monitoring and non-pharmacological (non-drug) interventions; and 2. Resident 71 received risperidone (an antipsychotic) without adequate indication and behavior monitoring. This failure had the potential to result in unnecessary use of medication. Findings: 1. Resident 44 was admitted to the facility in November 2023 with diagnoses which included post-traumatic stress disorder and major depressive disorder. A review of Resident 44's medical record (MR) indicated a physician's order for quetiapine 100 milligrams (mg, a unit of measurement), give 1 tablet at bedtime related to post-traumatic stress 555083 Page 16 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0758 disorder m/b (manifested by) inability to relax, dated 11/8/23. Level of Harm - Minimal harm or potential for actual harm Resident 44's MR indicated the facility was not monitoring for target behaviors related to quetiapine and non-pharmacological interventions were not being implemented. Residents Affected - Some During a concurrent interview and record review on 12/5/23 at 1:41 p.m. with Licensed Nurse (LN) 6, Resident 44's MR was reviewed. LN 6 stated Resident 44 was not being monitored for target behaviors for which the quetiapine was prescribed for. She stated it was important for the facility to monitor for target behaviors so they could evaluate if the psychotropic medication was effective or not. During a concurrent interview and record review on 12/5/23 at 1:53 p.m., with Director of Nursing (DON), Resident 44's MR was reviewed. DON confirmed whenever a psychotropic medication was prescribed for a resident, the resident was also monitored for side effects and behaviors. She confirmed Resident 44 was not being monitored for behaviors related to the use of quetiapine. DON stated non-pharmacological interventions were implemented for residents with PRN (as-needed) psychotropic medication orders, so they were not a part of Resident 44's care. 555083 Page 17 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure medications were stored safely for a census of 97 when: 1. Opened multi-dose medications and biologicals were dated with an open and discard date, expired medications were not available for resident use, pharmacy dispensed insulin (a medication to treat diabetes) were labeled, and medications were stored in the medication carts (med carts) in a safe and sanitary manner; and, 2. Medications were locked in a medication cart when unattended. These failures had the potential for residents to receive medications with unsafe and reduced potency from being used past their discard date, receive incorrect medications from inadequate labeling and unsafe storage, and the potential for medication misuse and diversion. Findings: 1. During a concurrent observation and interview on 12/4/23 at 11:27 a.m. with Director of Nursing (DON), an inspection of the medication storage room refrigerator identified one vial Tubersol (an injectable used to diagnose exposure to tuberculosis, a bacterial disease that affects the lungs) and 1 package tafluprost (eye drops to treat elevated eye pressure) 0.0015% ophthalmic solution, both opened and unlabeled with an open date. DON reviewed the manufacturer's labeling on the tafluprost package and stated it expired 30 days from when it was opened. She stated both the tafluprost and Tubersol should have been labeled with an open date. Two bottles compounded (customized medication) Magic Mouthwash expired 11/1/23 and 11/22/23, were identified and DON confirmed both should have been removed from the facility's medication supply. During a review of the facility's policy and procedure (P&P) titled, Dating of Containers When Opened, dated March 2018, the P&P indicated, Policy: Some medications require the container to be dated when opened and discarded a number of days after opening as defined by the manufacturer . Procedures . C. Medication in Multi-dose (injection) vials: are to be dated when opened and discarded after 28 days unless the manufacturer recommends shorter expiration date . During a concurrent observation and interview on 12/4/23 at 11:50 a.m. with DON, an inspection of the vaccine storage refrigerator identified one vial Humalog (a rapid-acting insulin to treat diabetes) and one insulin glargine (a long-acting insulin to treat diabetes) without pharmacy labels. DON confirmed both should have been labeled with a pharmacy label to indicate which resident they were for. During a review of the facility's P&P titled, Storage of Medications, dated November 2020, the P&P indicated, Drug containers that have missing, incomplete, improper, or incorrect labels are returned to the pharmacy for proper labeling before storing. During a concurrent observation and interview on 12/4/23 at 12:35 p.m. with DON, an inspection of the over the counter (OTC) medication storage room identified six bottles vitamin D 10 micrograms (mcg, a unit of measurement), expired 11/2023. DON confirmed the finding and agreed they should not 555083 Page 18 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0761 have been in the facility's OTC supply. Level of Harm - Minimal harm or potential for actual harm During a review of the facility's P&P titled, Storage of Medications, dated November 2020, the P&P indicated, Discontinued, outdated, or deteriorated drugs or biologicals are returned to the dispensing pharmacy or destroyed. Residents Affected - Some During a concurrent observation and interview on 12/4/23 at 12:59 p.m. with DON, an inspection of Med Cart C identified nine loose tablets and capsules at the bottom the med cart drawer. DON stated, The pills should not be there. During a concurrent observation and interview on 12/4/23 at 2:38 p.m. with DON, an inspection of Med Cart D identified four loose tablets the med cart drawer. DON confirmed the tablets should have been removed and disposed of. Inside the med cart drawer intended for oral medications, underneath cards containing individual resident medications, a plastic bag containing Lovenox (an injectable medication to prevent blood clots) was identified. DON stated, I'd like to see injectable separate from oral. 2. During an observation on 12/5/23 at 12:55 p.m., the medication cart C was left unlocked and unattended. There were other staff and residents walking in the hallway. During an interview on 12/5/23 at 1:09 p.m., Licensed Nurse 2 (LN 2) confirmed the medication cart should have been locked when unattended. During an interview on 12/6/23 at 10:06 a.m., the Director of Nursing (DON) confirmed the medication cart should have been locked when the nurse was not present. During a review of the facility's P&P titled, Storage of Medications, dated November 2020, the P&P indicated, Policy Statement: The facility stores all drugs and biologicals in a safe, secure, and orderly manner . Policy Interpretation and Implementation . 3. The nursing staff is responsible for maintaining medication storage and preparation areas in a clean, safe, and sanitary manner. 555083 Page 19 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0801 Level of Harm - Minimal harm or potential for actual harm Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on observation, interview and record review, the facility failed to ensure that the Food/Nutrition Director had the qualifications needed to oversee the dietary department. Residents Affected - Many This had had the potential of unsafe food practices and food borne illness for the 94 residents eating facility prepared foods. Findings: During an interview with the Food/Nutrition Director (FND) on 12/5/23 at 9:28 a.m. a certificate of education completion was not observed in his office. When asked about his path to becoming the Food/Nutrition Director, he stated he had experience running a kitchen under the direction of a Registered Dietitian (RD) but had no formal education. Review of California Health and Safety Code (HSC) § 1265.4 indicated that if A health facility that employs a registered dietitian less than full time, shall also employ a full-time dietetic services supervisor who meets the requirements of subdivision (b) to supervise dietetic service operations. (b) The dietetic services supervisor shall have completed at least one of the following educational requirements: (1) A baccalaureate degree with major studies in food and nutrition, dietetics, or food management . (2) A graduate of a dietetic technician training program approved by the American Dietetic Association, . (3) A graduate of a dietetic assistant training program approved by the American Dietetic Association. (4) Is a graduate of a dietetic services training program approved by the Dietary Managers Association and is a certified dietary manager credentialed by the Certifying Board of the Dietary Managers Association, . (5) Is a graduate of a college degree program with major studies in food and nutrition, dietetics, food management, culinary arts, or hotel and restaurant management and is a certified dietary manager credentialed by the Certifying Board of the Dietary Managers Association, (6) A graduate of a state approved program that provides 90 or more hours of classroom instruction in dietetic service supervision, or 90 hours or more of combined classroom instruction and instructor led interactive Web-based instruction in dietetic service supervision. (7) Received training experience in food service supervision and management in the military equivalent in content to paragraph (2), (3), or (6). Review of the job posting for the Food and Nutrition Manager position duties on 12/6/23 at 9:02 555083 Page 20 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0801 a.m. included the following duties: Level of Harm - Minimal harm or potential for actual harm -Provide nutritional counseling and guidance to patients . -Conduct diagnostic evaluations and patient dietary recommendations . Residents Affected - Many -Educate patients on . nutrition . -Monitor patients' progress . -Stay up-to-date with the latest research and developments in the field of nutrition. Skills included: -Health coaching . -Evaluation . -Patient assessment . -Physiology of how the body processes nutrients and the impact of nutrition on overall health . -Tube feeding expertise . Though no education requirements were listed on the job posting, all of these duties fall under the California Business and Professions Code Sections 2585-2586 for Registered Dietitians. Section 2585 lists the acceptable education requirements such as a bachelor's degree in dietetics, completion of 900 hours of supervised experience, and passage of a national board exam. Section 2586 specifies that RDs are authorized to prescribe dietary treatments, provide nutritional and dietary counseling, conduct nutritional and dietary assessments, and develop nutrition and dietary treatments, including therapeutic diets. During a review of facility provided Food/Nutrition Director application on 12/06/23 at 9:49 a.m., no education or professional affiliations were written on the application, though these sections were included. These areas were left blank by the applicant. During a visit to the kitchen on 2/5/23 at 12:05 p.m. for the lunch meal plating, the consultant Registered Dietitian (RD) was in attendance. During an interview with the RD, she stated she had started work at the facility about a month ago. The plan was for her to work onsite about 16 hours per week plus some remote work. The RD stated her involvement in the kitchen was to do a monthly inspection/audit but would mostly be involved in resident nutritional care such as assessments, preventing weight loss, and wound care. She further indicated that she also worked as a consultant for two other facilities. Review of Register Dietitian's contract on 12/6/23 at 8:46 a.m. showed the following duties: -Completes nutritional assessment and follow ups . -Documents assessment of patients with nutritional goals and interventions . 555083 Page 21 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0801 -Provides education to the patients and/or family . Level of Harm - Minimal harm or potential for actual harm Work Schedule listed a minimum of 20 hours per week, not to exceed a max of 40 hours per week. Approx 40% of the hours will be completed on a remote basis. Residents Affected - Many Kitchen Organizational Chart showed the RD being equal with the Dietary Supervisor position, though with no oversight of the dietary employees. 555083 Page 22 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0804 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure food served was palatable, attractive, and at a safe temperature for eight of 94 Residents (Resident 12, 23, 34, 39, 40, 184, 185, and 379) whose meals were delivered and served cold. Residents Affected - Some These failures had the potential for decreased meal intake which could result in weight loss, decreased nutritive value, and negatively impact the residents' quality of life. Findings: During an interview on 12/04/23 at 09:19 a.m., Resident 379 stated, My breakfast was cold this morning including the sausage. During an interview on 12/4/23 at 9:50 a.m., Resident 40 stated, Food/soup is always cold and has no taste. During an interview on 12/4/23 at 9:59 a.m., Resident 34 stated, Soup was always served cold. During an interview on 12/04/23 at 10:52 a.m., Resident 12 stated, Today's breakfast was cold, the pancake and sausage were cold. The hot oatmeal was cold. I told the staff, and they responded the food was hot when it arrived. I wanted the food rewarmed and that did not happen. They seemed to be very busy, and I was about to choke with the cold meat. During an interview on 12/4/23 at 1:45 p.m., Resident 23 stated, My lunch was served cold, and my breakfast was cold, soupy oatmeal. During an interview on 12/5/23 at 12:30 p.m., Resident 184 stated, The food here is one of the worst I have ever had. It's served cold 90% of the time and when they microwave it becomes tough. The vegetables are mushy. During an interview on 12/5/23 at 11:23 a.m., with the Registered Dietician (RD), the RD had been made aware of the issue. The RD had recommended that the heated bottoms that were no longer working be replaced but they had not been purchased. During an interview on 12/6/23 at 7:30 a.m., Resident 185 was sitting up in bed eating her breakfast. Resident 185 Stated, Breakfast is cold again. Cream of wheat was ice cold, and food is always cold here. During an interview on 12/6/23 at 1:38 p.m., Resident 39 stated, Seems like we are the last ones to get our meal trays. My food has never been served hot since I have been here. During the lunch meal on 12/6/23 at 1:03 p.m., two test tray were placed on the final meal cart (a regular diet and a pureed texture). The two test trays were noted not to have a heated bottom but had a dome to cover the plate. After the last tray was served to the resident, the two test trays were picked from the cart at 1:29 p.m. Food items tasted, and temperatures were: 555083 Page 23 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0804 Regular Fish Italiano - 123ºF, Level of Harm - Minimal harm or potential for actual harm Pureed Fish Italiano -130ºF, Creamy Risotto Style [NAME] with peas - 112ºF, Residents Affected - Some Pureed Risotto - 115Fº, and Carrots - 102º. The mouth feel of the carrots were cold, the fish and rice were tepid. During an interview with the facility Resident Council President, Resident 11, on 12/7/23 at 10:35 a.m., he stated that food being served cold was a topic that came up during several resident council meetings. The ADM who attended the Residents' Council meeting is aware of food being served cold. There had not been any improvement with hot food items been served cold. During an interview with the administrator (ADM) on 12/6/23 at 2:45 p.m., the ADM concurred that this is an issue we are trying to work on. A review of the facility's policy titled, Food Preparation and Services, indicated Food and nutrition services employees prepare, distribute, and serve food in a manner that complies with safe food handling practices. (2001 MED-PASS, Inc. Revised November 2022), indicated, Food Preparation, Cooking and Holding Time/Temperatures (1) The danger zone for food temperatures is above 41º F and below 135º F. This temperature range promotes the rapid growth of pathogenic microorganisms that cause foodborne illness. (3) . danger zone the greater the risk for growth of harmful pathogens.maintained at or below 41º F or at or above 135º F. (7) Fresh, . fruits and vegetables are cooked to a holding temperature of 135º F. 555083 Page 24 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards for food service safety for 94 residents eating facility prepared meals as evidenced by: 1) Food preparation items were found dirty; 2) Food preparation and service equipment were found substandard; 3) Food service items were found stacked wet; 4) Opened containers were found in dry storage; 5) Multiple food items not correctly dated; 6) Fruit/vegetable sink lacked an air gap; and 7) Expired food produce. These failures had the potential to cause foodborne illness (illness that results from ingestion of contaminated food) to residents receiving food prepared in the facility kitchen. Findings: 1. During the initial kitchen tour on 12/4/23 at 9:01 a.m., the following food preparation items were found dirty: a. A metal container with utensils found to have food residue and crumbs; b. Food processor was found to have yellow and brown markings including the plastic wrap around the food processor; 555083 Page 25 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many c. The kitchen stove was observed to have yellow, brown, and white streaks running down the side, plus areas of rust; d. The inside of the oven and oven racks, were observed to have brown and black markings; and, e. The Heating/Ventilation/Air Conditioning auxillary panel was observed to have yellow, brown, and black markings inside the cover and around the sides. During a concurrent interview and observation on 12/4/23 at 9:07 a.m., with the Food/Nutrition Director (FND), the FND concurred with these observations stating that the food preparation area should be always kept clean. A review of the facility's policy titled, Sanitation, (Healthcare Menus Direct, LLC. 2023), indicated, All utensils, counters, shelves, and equipment shall be kept clean, maintained in good repair and shall be free from breaks, corrosion, open seam, cracks, and chipped areas. According to the FDA Food Code 2022, Section 4-601.11, Equipment, Food-Contact Surfaces, Nonfood-Contact Surfaces, and Utensils, it indicated that: (A) EQUIPMENT FOOD-CONTACT SURFACES and UTENSILS shall be clean to sight and touch. (B) The FOOD-CONTACT SURFACES of cooking EQUIPMENT and pans shall be kept free of encrusted grease deposits and other soil accumulations. (C) Non-FOOD-CONTACT SURFACES of EQUIPMENT shall be kept free of an accumulation of dust, dirt, FOOD residue, and other debris. A review of the Food and Drug Administration (FDA) Food Code 2022, Section 4-602.13, indicated the presence of food debris or dirt on nonfood contact surfaces may provide a suitable environment for the growth of microorganisms which employees may inadvertently transfer to food. If these areas are not kept clean, they may also provide harborage for insects, rodents, and other pests. 2. During the initial kitchen tour on 12/4/23 at 9:09 a.m., food preparation and service equipment were observed to be substandard when a jagged spatula was noted on the blender, five out of nine cutting boards had deep gouges and discoloration, and a clear plastic rectangular container was noted to have a missing corner. During a concurrent interview on 12/4/23 at 9:12 a.m. with the FND, the FND concurred that the spatula had cut markings, the cutting boards had cracks and deep grooves, and the food container corner was missing, all of which could cause cross contamination. A review of the facility's policy titled, Sanitation, (Healthcare Menus Direct, LLC. 2023), indicated, All utensils, counters, shelves, and equipment shall be kept clean, maintained in good repair and shall be free from breaks, corrosion, open seam, cracks, and chipped areas. 3. During the initial kitchen tour on 12/4/23 at 9:14 a.m., food service items were observed stacked wet in the ready to use area. This included two (of five) large round metal bowls, and two (of four) 2- quart plastic containers. 555083 Page 26 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During a concurrent interview on 12/4/23 at 9:15 a.m. with the FND, the FND concurred and stated all food containers should be air dried before storing as this could lead to bacteria growth. A review of the facility's policy titled, Dishwashing (Healthcare Menus Direct, LLC. 20123), indicated under the policy description that, All dishes will be properly sanitized through the dishwasher . Dishes are to be air dried in racks before stacking and storing. 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: (A) shall be air-dried . Items must be allowed to drain and to air-dry before being stacked or stored. Stacking wet items such as pans prevents them from drying and may allow an environment where microorganisms can begin to grow. Cloth drying of equipment and utensils is prohibited to prevent the possible transfer of microorganisms to equipment or utensils (FDA Food Code Annex 4-901.11). 4. During the initial kitchen tour on 12/4/23 at 9:19 a.m., opened containers of lemon juice and Worcestershire sauce were found in dry storage, despite manufacture's instruction on the label, which stated to refrigerate after opening. During a concurrent interview on 12/4/23 at 9:21 a.m., with FND, the FND stated, the lemon juice and the Worcestershire sauce should be refrigerated after opening. A review of the facility's policy titled, Storage of Food and Supplies, (Healthcare Menus Direct, LLC. 2023), indicated, Food and supplies will be stored properly and in a safe manner . Check food labels closely to verify if a food needs to be refrigerated once opened. 5. During the initial kitchen tour on 12/4/23 at 9:31 a.m., multiple, leftover food items were observed and dated by staff as follows: -Chicken soup 12/3 -Tomato soup 12/3 -Chicken base 11/27 -Vegetable base 11/29 -Blended cheese 11/29 555083 Page 27 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0812 -Beef base Level of Harm - Minimal harm or potential for actual harm 11/30 -Garlic Residents Affected - Many 10/18 -Diced ham 12/2 -Vanilla wafers 10/20 During a concurrent interview on 12/4/23 at 9:25 a.m., with FND, the FND concurred the year was missing and stated, It only has the date and month written on it so staff would not know when to discard the items. A review of the facility's policy titled, Labeling and Dating of Foods (Healthcare Menus Direct, LLC. 2023), indicated, . All food will be dated - month, day, year. 6. During the initial kitchen tour on 12/4/23 at 9:49 a.m., the fruit and vegetable sink was observed without an air gap (a backflow prevention device). During a concurrent interview on 12/4/23 at 9:53 a.m., with FND, the FND concurred that he did not see an air gap. During an interview and observation on 12/4/23 at 9:57 a.m., with the Maintenance Manager (MM), the MM stated, I have been here for 36 years, and we have never had an air gap. A review of the facility's policy titled, Accident Prevention - Safety Precautions (Healthcare Menus Direct, LLC. 2023), indicated, Backflow prevention/Air Gaps .food preparation sinks, .shall be drained through an air gap into an open floor sink. According to the FDA Food Code 2022, Section 5-202.13 Backflow Prevention, Air Gap; indicated, An air gap between the water supply inlet and the flood level rim of the PLUMBING FIXTURE, EQUIPMENT, or nonFOOD EQUIPMENT shall be at least twice the diameter of the water supply inlet and may not be less than 25 mm (1 inch). According to the FDA Food Code 2022, Section 5-203.14; indicated, Backflow Prevention Device, When Required, A PLUMBING SYSTEM shall be installed to preclude backflow of a solid, liquid, or gas contaminant into the water supply system at each point of use at the FOOD ESTABLISHMENT, including on a hose [NAME] if a hose is attached or on a hose [NAME] if a hose is not attached and backflow prevention is required by LAW, by: (A) Providing an air gap as specified under § 5-202.13; or 555083 Page 28 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0812 (B) Installing an APPROVED backflow prevention device as specified under § 5-202.14. Level of Harm - Minimal harm or potential for actual harm 7. During the initial kitchen tour on 12/4/23 at 10:19 a.m., in the walk-in-refrigerator, an opened, uncovered box of celery was observed with the date of 10/20/2023. Residents Affected - Many During a concurrent interview on 12/4/23 at 10:23 a.m., with FND, the FND got the box of celery from the shelf and stated, I don't think this should be consumed. A review of the facility's policy titled, Storing Produce (Healthcare Menus Direct, LLC. 2023), indicated, . storing vegetables that should remain crisp, such as .celery, .stay fresh longer if you place them in a sealed bag or container. 555083 Page 29 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to maintain a complete and accurate medical record for one resident (Resident 36) of 27 sampled residents, when the Medication Administration Record (MAR) did not include Resident 36's use of oxygen. This failure increased the facility's potential for oversight in Resident 36's assessment, care, and treatment. Findings: A review of an admission record indicated Resident 36 was admitted to the facility on [DATE] with diagnoses including palliative care (specialized medical care for people living with a serious illness), dementia (impaired ability to remember, think, or make decisions), tobacco use, and chronic obstructive pulmonary (lung) disease. A review of Resident 36's Care Plan, dated 11/15/23, indicated Resident 36 was a smoker. During an observation on 12/4/23 at 9:38 a.m., in Resident 36's room, Resident 36 was lying in his bed and connected to oxygen at three liters per minute via nasal cannula (a device that delivers extra oxygen through a tube and into the nose). A review of Resident 36's Weekly Nursing Summary, dated 12/5/23, indicated Resident 36 used oxygen continuously this week at four liters per minute via nasal cannula. During an observation on 12/7/23 at 9:29 a.m., in Resident 36's room, Resident 36 was lying in his bed and connected to oxygen at five liters per minute via nasal cannula. A review of Resident 36's Order Summary Report, dated 11/1/23, indicated to administer oxygen at two liters per minute via nasal cannula as needed for shortness of breath or chest pain or oxygen saturation less than 90%. A review of Resident 36's Minimum Data Set (MDS; an assessment tool), dated 11/10/23, indicated oxygen therapy was not performed for Resident 36 within the last 14 days. A review of Resident 36's Safe Smoking Evaluation, dated 11/15/23, indicated Not Applicable for Resident 36 to remove oxygen prior to smoking. During a concurrent interview and record review on 12/7/23 at 9:33 a.m. with Licensed Nurse 5 (LN 5), Resident 36's MARs, dated 11/23 and 12/23 were reviewed. LN 5 confirmed there were no documentation for use of oxygen in Resident 36's MARs. LN 5 stated Resident 36 used oxygen yesterday and today and staff would remove his oxygen and check his oxygen saturation every time he wanted to smoke. During an interview on 12/7/23 at 9:45 a.m. with Director of Nursing (DON) and Resources Nurse Consultant (RNC), DON and RNC confirmed nurses did not document the use of oxygen in Resident 36's MAR. DON and RNC stated nurses were supposed to document the use of oxygen in Resident 36's MAR; otherwise, staff would not have an idea of his baseline for oxygen use and how often he needed it especially 555083 Page 30 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0842 that he was a smoker. Level of Harm - Minimal harm or potential for actual harm A review of the facility's policy titled, Documentation of Medication Administration, dated 4/07, indicated The facility shall maintain a medication administration record to document all medications [and treatments] administered. Residents Affected - Few 555083 Page 31 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0847 Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure residents' rights were protected when entering into a binding arbitration agreement for a census of 97 when the agreement did not explicitly state the resident, or his or her responsible party (RP), had 30 days to rescind the agreement and did not contain an acknowledgement of the resident's or RP's understanding of the agreement. Residents Affected - Many These failures had the potential to result in residents and/or their RPs entering into binding arbitration agreements without fully understanding the consequences. Findings: In an interview, on 12/4/23 at 8:49 a.m., the Administrator (ADM) stated the facility had asked residents and/or their RP's to enter into binding arbitration agreements. A review of the facility's binding arbitration agreement, on 12/5/23 at 10:51 a.m., indicated it did not contain an explicit statement the resident or RP had the right to rescind the agreement within 30 days of signing and did not include an acknowledgement of understanding by the resident or RP. In a concurrent record review and interview, on 12/7/23 at 8:44 a.m., the Director of Business Development (DBD) confirmed the arbitration agreement did not include notice of the right to rescind the agreement within 30 days of signing and did not contain an acknowledgement of understanding. A review of the facility's policy titled, Arbitration Agreement, revised 2023, stipulated, The resident acknowledges that he or she understands the agreement. 555083 Page 32 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to establish and maintain infection control practices designed to provide a sanitary environment for one of 27 sampled residents (Resident 129) when staff did not maintain hand hygiene practices and change gloves during wound care. Residents Affected - Few This failure had the potential to result in transmission of infection in the facility and cause illness. Findings: Review of the admission Record, Resident 129 was admitted to the facility in 2023 with diagnoses including a pressure ulcer (injury to the skin and underlying tissue resulting from prolonged pressure on the skin) on the buttock. During an observation on 12/5/23 at 3:06 p.m., with Licensed Nurse 3 (LN 3) during wound care for a right buttock wound for Resident 129, LN 3 was preparing wound care supplies, touched the trash can, removed the soiled dressing, cleaned the wound, and applied the new dressing using the same gloves. During an interview on 12/5/23 at 3:19 p.m., LN 3 confirmed she should have changed gloves and maintained hand hygiene practice during wound care. During an interview on 12/6/23 at 10:10 a.m., the Director of Nursing (DON) confirmed nurses should remove gloves, wash their hands, or use hand sanitizer during wound care. A review of the facility's policy titled, Handwashing/Hand Hygiene, revised date 8/2019, indicated, Use an cohol-based hand rub containing . soap . and water . before and after direct contact with residents . after handling used dressing .after removing gloves . 555083 Page 33 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to maintain the freezer in safe operating condition when ice buildup was noted on the door, curtains, walls and floor. This had the potential to affect the safety and quality of the food served at the facility for the 94 residents eating facility prepared meals. Residents Affected - Many Findings: During the initial kitchen tour on 12/4/23 at 9:58 a.m., the freezer door was opened. On the back of the door was a build up of ice starting about 6 (inches) from the top of the door. The ice pattern was close to 1.5' (feet) in length and approximately 10 across at its widest point. The top portion of the ice curtains were also covered in ice as well as the right side walls, and ice was observed dripping from the pipes, and ice chunks had collected on the freezer floor. During a subsequent interview with the Maintenance Manager (MM) on 12/4/23 at 10:22 a.m., he stated that the leakage through the walls had been had fixed last month. He further explained that he wasn't aware that this was still a problem. During a return visit to the kitchen on 12/5/23 at 9:11 a.m., the freezer had been cleaned of ice, but a new trail was seen developing on the inside door. In a return visit to the kitchen on 12/06/23 at 9:06 a.m., the freezer again had ice buildup starting on the inside of the door as well as the freezer curtains. During a subsequent interview with the MM on 12/06/23 at 9:37 a.m., he stated that the repair company had evaluated this ice build-up a few months ago. As a result, the facility replaced the door and sealed leaks. Repair company invoice from 9/26/23 indicated that Checked refrigerant components for signs of leaks. Found some repairs needed will quote. Review of the website Commercial Equipment Service, (https://commercialequipmentserviceinc.com > 2021/07) indicated: One of the most common issues that occurs in commercial freezers is an excessive buildup of ice. Over time, icing can reduce the efficiency of the system, and potentially compromise the freshness and quality of the food due to the elevated moisture content in the unit .In most cases, ice buildup in a freezer is a result of a combination of warm, humid air in the cold environment of the freezer.If left unaddressed, the ice buildup caused by the above issues can damage freezer components, drastically increase operating costs and utility expenses and reduce the lifespan of your commercial freezer. Review of the United States Food and Drug (FDA) Food Code 2022 section 4-501.11 for Good Repair and Proper Adjustment indicated (A) EQUIPMENT shall be maintained in a state of repair and condition that meets the requirements specified under Parts 4-1 and 4-2. (B) EQUIPMENT components such as doors, seals, hinges, fasteners, and kick plates shall be kept intact, tight, and adjusted in accordance with manufacturer's specifications. 555083 Page 34 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many The FDA Food Code 2022 further indicated that Proper maintenance of equipment to manufacturer specifications helps ensure that it will continue to operate as designed. Failure to properly maintain equipment could lead to violations of the associated requirements of the Code that place the health of the consumer at risk. For example, refrigeration units in disrepair may no longer be capable FDA Food Code 2022 Annex 3. Public Health Reasons/Administrative Guidelines Annex 3 - 171 of properly cooling or holding time/temperature control for safety foods at safe temperatures. 555083 Page 35 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0919 Make sure that a working call system is available in each resident's bathroom and bathing area. 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, the facility failed to ensure the call lights were within reach for four residents (Resident 27, Resident 36, Resident 62, and Resident 380) of 27 sampled residents, when the call lights were stuck behind the residents' beds and dressers on the floor. Residents Affected - Some This failure decreased the residents' potential to get assistance from staff in a timely manner when needed. Findings: A review of an admission record indicated Resident 36 was admitted to the facility on [DATE] with diagnoses including hemiplegia (paralysis of one side of the body), dementia (impaired ability to remember, think, or make decisions), and history of falling. A review of an admission record indicated Resident 380 was admitted to the facility on [DATE] with diagnoses including dementia and shortness of breath. A review of an admission record indicated Resident 27 was admitted to the facility on [DATE] with diagnoses including parkinsonism (brain conditions that cause slowed movements and stiffness), dementia, and history of falling. A review of an admission record indicated Resident 62 was admitted to the facility on [DATE] with diagnoses including communication deficit, dementia, and repeated falls. During an observation on 12/4/23 at 9:38 a.m. in Resident 36's room, the call light was on the floor, stuck behind the bed, and not within Resident 36's reach. During an observation on 12/4/23 at 9:50 a.m. in Resident 380's room, the call light was on the floor, stuck behind the bedside dresser, and not within Resident 380's reach. During an observation on 12/4/23 at 9:57 a.m. in Resident 27's room, the call light was on the floor, stuck behind the bedside dresser, and not within Resident 27's reach. During an observation on 12/4/23 at 10:05 a.m. in Resident 62's room, the call light was on the floor, stuck behind the bedside dresser, and not within Resident 62's reach. During a concurrent observation and interview on 12/4/23 at 10:10 a.m. with Unit Manager (UM), UM stated Resident 36's and Resident 380's call lights were press-buttons and Resident 27's and Resident 62's call lights were soft to touch when squeezed. UM confirmed the call lights were not within Resident 27's, Resident 36's, Resident 62's, and Resident 380's reach and were stuck behind their beds and dressers on the floor. During an interview on 12/6/23 at 9:26 a.m. with Director of Nursing (DON), DON stated the call lights should have been within the residents' reach because staff would not know when residents needed help which might delay providing help and increase the residents' fall risk. A review of the facility's policy titled, Answering the Call Light, dated 9/22, indicated Ensure 555083 Page 36 of 37 555083 12/07/2023 Manzanita Healthcare Center 5318 Manzanita Avenue Carmichael, CA 95608

F 0919 that the call light is accessible to the resident when in bed, from the toilet, from the shower or bathing facility and from the floor. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 555083 Page 37 of 37

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Citations

22 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0908GeneralS&S Fpotential for harm
F908 - Maintain all mechanical, electrical, and patient care equipment in safe
Keep all essential equipment working safely.
0557GeneralS&S Dpotential for harm
F557 - Respect and Dignity
Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
0578GeneralS&S Dpotential for harm
F578 - The right to request, refuse, and/or discontinue treatment, to participate in or
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
0847GeneralS&S Fpotential for harm
F847 - Entering Into Binding Arbitration Agreements
Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse.
0584GeneralS&S Dpotential for harm
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
0637GeneralS&S Dpotential for harm
F637 - Within 14 days after the facility determines, or should have determined,
Assess the resident when there is a significant change in condition
0641GeneralS&S Dpotential for harm
F641 - Accuracy of Assessments
Ensure each resident receives an accurate assessment.
0655GeneralS&S Dpotential for harm
F655 - Comprehensive Person-Centered Care Planning
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
0656GeneralS&S Dpotential for harm
F656 - Comprehensive Care Plans
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
0658GeneralS&S Dpotential for harm
F658 - Comprehensive Care Plans
Ensure services provided by the nursing facility meet professional standards of quality.
0685GeneralS&S Dpotential for harm
F685 - Vision and hearing
Assist a resident in gaining access to vision and hearing services.
0695GeneralS&S Dpotential for harm
F695 - Respiratory care, including tracheostomy care and tracheal suctioning
Provide safe and appropriate respiratory care for a resident when needed.
0745GeneralS&S Dpotential for harm
F745 - The facility must provide medically-related social services to attain or
Provide medically-related social services to help each resident achieve the highest possible quality of life.
0758GeneralS&S Epotential for harm
F758 - Medication Errors
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
0761GeneralS&S Epotential for harm
F761 - Labeling of Drugs and Biologicals
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
0801GeneralS&S Fpotential for harm
F801 - Staffing
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
0804GeneralS&S Epotential for harm
F804 - Food and drink
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
0812GeneralS&S Fpotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0842GeneralS&S Dpotential for harm
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
0880GeneralS&S Dpotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0919GeneralS&S Epotential for harm
F919 - Resident Call System
Make sure that a working call system is available in each resident's bathroom and bathing area.
0755GeneralS&S Epotential for harm
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

FAQ · About this visit

Common questions about this visit

What happened during the December 7, 2023 survey of MANZANITA HEALTHCARE CENTER?

This was a inspection survey of MANZANITA HEALTHCARE CENTER on December 7, 2023. The surveyor cited 22 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at MANZANITA HEALTHCARE CENTER on December 7, 2023?

Yes, 22 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Keep all essential equipment working safely."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

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Data from CMS Care Compare public records. Dataset last refreshed June 29, 2026. If you believe any information is inaccurate, report it here.

Health inspection·December 7, 2023