Inspection visit
Health inspection
8 citations recorded
Inspector’s narrative
What the inspector wrote
This survey cited 8 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
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 a copy of the Advance Directive (AD - written
statement of a person's wishes regarding medical treatment) was available in the resident's record and
accessible to staff, for one of three residents reviewed for AD (Residents 15).
This failure had the potential to make Resident 15's AD not readily retrievable by the staff and the
physician, leaving them unaware of and unable to honor the residents' wishes regarding their medical
treatment.
Findings:
On May 8, 2024, Resident 15's record was reviewed. Resident 15 was admitted to the facility on [DATE].
A review of Resident 15's History and Physical dated March 1, 2024, indicated, .has the capacity to
understand and make decisions .
A review of Resident 15's Minimum Data Set (an assessment tool), dated February 29, 2024, indicated
Resident 15 had a Brief Interview of Mental Status (a tool used to screen and identfy the cognitive condition
of residents) Score of 12 (moderate impairment in cognition).
A review of Resident 15's Advance Directive Acknowledgement Form, dated February 29, 2024, indicated,
.I do have an Advance Directive .
There was no documented evidence a copy of the AD was provided in Residents 15's medical record.
On May 9, 2024, at 08:47 a.m., during a concurrent interview and review of Resident 15's record with the
Social Service Director (SSD), the SSD stated she is responsible for AD formulation and follow-up. The
SSD further stated if the resident has an AD, copy of the AD is obtained and place in the resident's record.
The SSD stated Resident 15 has an AD, but it was not available in the resident's record. The SSD further
stated, Resident 15's AD should have been available and accessible to the staff and physician.
The facility Policy and Procedure titled, Advance Directives, dated December 2023, indicated, .Prior to,
upon, or immediately after admission, the facility staff will ask residents, and/or their family members about
the existence of any advance directives .Should a resident indicate that he or she has issued advance
directive about his/her care and treatment .a copy of such directives be included
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 16
Event ID:
555365
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0578
in the medical records .
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 2 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
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 document review, the facility failed to ensure medications in
emergency medication supply containers (EKITs) were safely stored, with individual medications placed in
its own space to distinguish one from others.
Two EKITs contained multiple different unit-dose medications in each compartment.
This failure had the potential for delay in locating and administering the needed medication, and to increase
medication errors.
Findings:
On May 7, 2024, at 11:10 a.m., during an inspection of the medication room with the Registered Nurse
Supervisor (RNS), it was noted there were two EKITs, one EKIT contained 48 different medications and the
other contained 40 different medications.
The EKIT labeled, Nonantibiotic EKIT #1 (A-L), had 13 compartments for 48 different medications, each
compartment containing multiple different medications in manufacturer's unit dose packaging, mixed
together.
The EKIT labeled, Nonantibiotic EKIT #2 (M-W), had 17 compartments for 40 different medications, each
compartment containing multiple different medications in manufacturer's unit dose packaging, mixed
together.
The medications were alphabetically placed in the compartments and medications that sounded similar to
each other were placed in the same compartment. Observed in one compartment placed together, were
citalopram, carvedilol, and carbidopa/levodopa.
On May 10, 2024, at 11:25 a.m., during an interview, the Consultant Pharmacist (CP) stated, medications
in EKITs should be compartmentalized, with each medication stored separately in its own compartment.
The CP agreed that having one medication per compartment would be safer for picking the right medication
in the EKIT.
The facility's policy and procedure titled, Medication Storage in the Facility Storage of Medications, dated
December 12, 2023, indicated, .Medications and biologicals are stored safely .Medication storage areas
are .free of clutter .
According to the Institute for Safe Medication Practices (ISMP- a nationally recognized organization
devoted entirely to preventing medication errors,) indicated, .ISMP's List of Confused Drug Names contains
look-alike and sound-alike (LASA) name pairs of medications that have been published in the ISMP
Medication Safety Alert!® Acute Care, the ISMP Medication Safety Alert!® Community/Ambulatory
Care, and the FDA and ISMP Lists of Look-Alike Drug Names with Recommended Tall Man Letters .Use
this list to determine which medications require special safeguards to reduce the risk of errors and minimize
harm .
According to ISMP article titled, Adopt Strategies to Manage Look-Alike and/or Sound-Alike Medication
Name Mix-Ups, dated June 2, 2022, indicated, .Store medications with problematic, error-prone,
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 3 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0755
look-alike and/or sound-alike names in separate physical locations away from each other .
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 4 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0802
Level of Harm - Minimal harm
or potential for actual harm
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition
service.
Based on observation, interview, and record review, the facility failed to ensure the dietary staff were able to
carry out the functions of food and nutrition services safely and effectively when:
Residents Affected - Many
1. Food service workers did not follow the facility's cleaning procedure to clean food preparation surfaces
and stationary equipment. (Cross referred F 812)
This failure had the potential to cause foodborne illness for 64 of 64 sampled residents who received food
from the kitchen.
2. [NAME] (CK) 1 served chunky pasta for 10 of 10 sampled residents who had a physician prescribed
pureed diet (food that has been ground, pressed and/or strrained to a soft smooth consistency like pudding)
during lunch on May 8, 2024. (Cross referred F 805)
These failures had the potential to place the residents at risk of aspiration (accidentally inhaling food or
liquid into the lungs), choking, and decreased meal intake.
Findings:
1. On May 8, 2024, at 10:54 a.m., an observation was conducted with CK 1. CK 1 cleaned the prep table
surface and blender base with sanitizer after preparing mechanical soft chicken.
On May 8, 2024, at 11:10 a.m., an interview was conducted with CK 1. She stated she used sanitizer to
clean the prep table surface and blender base.
On May 8, 2024, at 11:11 a.m., an interview was conducted with the Dietary Supervisor (DTR). She stated
the dietary staff used sanitizer to clean the prep table surface and stationary equipment after use.
On May 9, 2024, at 11:24 a.m., interviews were conducted with CK 2 and CK 3. CK 2 and CK 3 were asked
how to clean the prep table surface and stationary equipment after use. Both stated, they use sanitizer to
clean the prep table surface and stationary equipment.
During a review of the facility Procedure title, SHELVES, COUNTERS, AND OTHER SURFACES
INCLUDING SINKS (HANDWASHING, FOOD PREPARATION, ETC.), indicated, .Remove any large debris
and wash surface with a warm detergent solution .Rinse with clear water using a clean sponge or cloth.
Wipe dry with a clean cloth. 3. Spray with a sanitizer .
During a review of the facility's Policy and Procedure titled, SANITATION, indicated, .The Food and Nutrition
Services Director (Dietary Supervisor) is responsible for instruction employees in the fundamentals of
sanitation in food service and for training employees to use appropriate techniques .
During a review of the job description Cook, indicated, .The primary purpose of your job position is to
prepare food in accordance with current applicable federal, state, and local standards, guidelines and
regulations, with our established policies and procedures .in accordance with sanitary regulations .
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 5 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0802
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Many
2. On May 8, 2024, at 10:38 a.m., an interview was conducted with CK 1. She stated she finished preparing
all pureed food items (chicken, noodles, and vegetable) for lunch.
On May 8, 2024, at 1:05 p.m., a test tray (to evaluate the quality of a meal during a meal service and
identify any areas for improvement) was conducted with the DTR. The DTR stated the pureed noodles had
chunks and did not have a smooth consistency.
On May 9, 2024, at 2:39 p.m., an interview was conducted with Registered Dietitian (RD) 2. She stated a
pureed diet should be smooth in consistency with no chunks. The RD 2 further stated her expectation was
for the cooks to follow the puree diet menu and recipe.
During a review of the job description Cook, indicated, .Prepare food for therapeutic diets in accordance
with planned menus .Prepare food in accordance with standardized recipes and special diet orders .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 6 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0805
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual
needs.
Based on observation, interview, and record review, the facility failed to ensure the appropriate food texture
was provided for 10 of 10 sampled residents (Resident 6, 11, 13, 32, 39, 62, 63, 219, 170 and 369) who
had a physician-prescribed pureed diet (food the has been grounded, pressed and/or starined to a soft
smooth consistency like pudding) received chunky noodles during lunch on May 8 2024.
This failure had the potential to place the residents at risk of aspiration (accidentally inhaling food or liquid
into the lungs), choking, and decreased meal intake.
Findings: (Cross reference 802)
On May 8, 2024, at 1:05 p.m., a test tray (to evaluate the quality of a meal during a meal service and
identify any areas for improvement) was conducted with the Dietary Supervisor (DTR). The surveyor tried
one teaspoon of the pureed noodles and observed the pureed noodles had chunks and did not have a
smooth consistency.
The DTR stated the pureed noodles were not smooth and contained chunks. The DTR further stated, the
potential risk for the residents on pureed diet who consumed the chunky noodles were choking and
aspiration.
On May 9, 2024, at 2:39 p.m., an interview was conducted with Registered Dietitian (RD) 2. She stated
pureed diet should be smooth in consistency with no chunks. RD 2 further stated residents who had a
physician order for a pureed diet and were served chunky noodles could experience difficulty chewing and
swallowing which could lead to choking and aspiration.
During a review of the Physician Prescribed Diet Orders, indicated, .Residents 6, 11, 13, 32, 39, 62, 63,
219, 170 and 369 .on pureed diet .
During a review of recipe, PUREED STARCH (Rice, Pasta, Potatoes), undated, indicated .Puree should
reach a consistency slightly softer than whipped topping .
During a review of the document tiletd, Regular Pureed Diet Definition from Diet Menu, dated 2023,
indicated, .The pureed diet is a regular diet that has been designed for residents who have difficulty
chewing/or swallowing .The texture of the food should be of a smooth and moist consistency .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 7 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0806
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure each resident receives and the facility provides food that accommodates resident allergies,
intolerances, and preferences, as well as appealing options.
Based on observation, interview, and record review, the facility failed to ensure a resident's food preference
was honored for one of 64 sampled residents (Resident 39) when milk and soup were not served during
lunch on May 7, 2024.
This failure had the potential to result in decreased food intake and could lead to unplanned weight loss,
further compromising Resident 39's nutritional and medical status.
Findings:
On May 7, 2024, at 12:39 p.m., a concurrent dining room observation, interview, and review of Resident
39's Meal Tray Ticket was conducted with Resident 39 and Certified Nurse Assistant (CNA) 1.
Resident 39's Meal Tray Ticket (menu based on the resident's diet physician order and food preference),
dated 5/7/24, indicated, .Beverage: 4 oz.(ounce- unit of measurement) Milk .Likes: Puree soup .
CNA 1 stated Resident 39 did not receive the 4 oz. of milk and pureed soup with his meal.
Resident 39 stated he would like to have soup with his lunch.
On May 8, 2024, at 9:45 a.m., an interview was conducted with the Dietary Supervisor (DTR). She stated
she updates the residents food preferences upon admission, quarterly, annually, and as needed and enters
the information into the tray card system (a computer software) to generate meal tray tickets. The DTR
further stated the food service workers should follow the food items on the meal tray ticket and serve the
residents.
The DTR stated Resident 39 did not receive 4 oz. of milk and pureed soup with his lunch meal on May 7,
2024. The DTR further stated there was no soup available to serve Resident 39 and an alternative was not
offered.
On May 8, 2024, at 2:39 p.m., an interview was conducted with the DTR and Registered Dietitian (RD) 2.
RD 2 stated it was important to honor the residents food preferences. The DTR stated residents may not
eat their meals, which could result in an unplanned weight loss if their food preferences were not honored.
During a review of the document titled, Nutrition-Quarterly Evaluation done by DTR, dated August 9, 2023,
indicated, .Food Likes .Food preferences, like and dislikes obtained and updated and carried out, continue
to adhere to food preferences .Likes soup with lunch and dinner meals .
During a review of the facility's policy and procedure titled, FOOD PREFERENCES, dated 2023, indicated,
.Resident's food preferences will be adhered to within reason .
During a review of the facility policy and procedure titled, TRAY CARD SYSTEM, dated 2023, indicated,
.Each meal tray at breakfast, lunch, and dinner will have a tray card which designates the resident's name,
diet, food dislikes, food requests, allergies, beverage preference .
During a review of the facility policy and procedure titled, MEAL SERVICE, dated 2023, indicated,
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 8 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0806
Level of Harm - Minimal harm
or potential for actual harm
.Meals that meet the nutritional needs of the resident will be served in an accurate and efficient manner
.Nursing personnel will serve the trays immediately upon checking the tray to be sure nothing is missing
from the tray .
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 9 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0808
Level of Harm - Minimal harm
or potential for actual harm
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or
licensed dietitian, to the extent allowed by State law.
Based on observation, interview, and record review, the facility failed to ensure the physician orders were
followed for one residnets(Resident 32) during a dinning observation of 15 residents when :
Residents Affected - Few
1. Resident 32, who had a Pureed diet (foods the has been ground, pressed and/or strained to a soft
smooth consistency like pudding) order received a regular texture salad during lunch on May 7, 2024.
2. Resident 32 received an Oral Nutrition Supplement (ONS- Nutrition drinks that has high calories to help
maintain or gain weight) with fewer calories than what the physician had ordered during lunch on May 7,
2024.
These failures had the potential to result in choking, aspiration (accidentally inhaling food or liquid into the
lungs), and unplanned weight loss, further compromising Resident 32's nutritional and medical status.
Findings:
1. A review of the Resident 32's Physician Diet Order dated October 8, 2023, indicated, .Pureed texture .
A review of Resident 32's Meal Tray Ticket (menu based on the resident's diet physician order), dated May
7, 2024, indicated, .Puree .
On May 7, 2024, at 12:43 p.m., a concurrent dining room observation, interview, and review of Resident
32's Meal Tray Ticket were conducted with the Activities Supervisor (AS) and Activities Assistant (AA). The
AS and AA stated Resident 32 was served a bowl of regular texture salad. The AS further stated, Resident
32 is on pureed diet and should not have received the salad.
On May 8, 2024, at 9:45 a.m., an interview was conducted with the Dietary Supervisor (DTR). She stated
Resident 32 was served a bowl of regular texture salad during lunch on May 7, 2024. The DTR further
stated Resident 32 had a pureed diet order and was at risk of aspiration and choking if the resident
consumed the salad.
On May 9, 2024, at 9:31 a.m., an interview was conducted with the Director of Staff Development (DSD).
The DSD stated he checked the meal trays daily during lunch for missed items, food preferences being
honored, and diets (therapeutic, texture) were correct. The DSD stated Resident 32 had a pureed diet order
and should not have been served a regular texture salad during lunch on May 7, 2024. The DSD fruther
stated Resident 32 could have aspirated and chocked.
On May 9, 2024, at 2:39 p.m., an interview was conducted with Registered Dietitian (RD) 2. She stated it
was important to follow the physician's diet orders as it directly affects the residents and is a part of the
medical treatment.
RD 2 stated Resident 32 had pureed diet order and should not have received a regular texture salad. RD 2
further stated, Resident 32 got easily tired chewing regular texture foods and was at risk of choking and
aspiration.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 10 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0808
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
During a review of the facility policy and procedure titled, DIET ORDERS, dated 2023, indicated, .Diet
orders as prescribed by the physician will be provided by the Food & Nutrition Services Department .
During a review of the facility policy and procedure titled, MENU PLANNING, dated 2023, indicated, .The
menus are planning to meet nutritional needs of residents in accordance with .Physician's orders and, to
extent medically possible .
During a review of the facility policy and procedure titled, MEAL SERVICE, dated 2023, indicated, .Meals
that meet the nutritional needs of the resident will be served in an accurate and efficient manner .Nursing
personnel will serve the trays immediately upon checking the tray to be sure nothing is missing from the
tray and the diets are correct .
During a review of the document titled Cooks Spreadsheet (the document used to guide dietary staff on
food items, portions, and therapeutic diet), dated 5/7/24, indicated, .Pureed: Providing pureed Fresh
[NAME] Salad with dressing .
2. A review of Resident 32's Dietary-Supplement Order, dated April 5, 2024, indicated, .Boost two times a
day for supplement .Give 1 cartoon with lunch and dinner .
A review of Resident 32's Meal Tray Ticket, dated May 7, 2024, indicated, .Boost 1 carton .
On May 7, 2024, at 12:43 p.m., a dining room observation was conducted. Resident 32 was served Boost
Glucose Control 1 cartoon 237ml (milliliters - a unit of measurement).
On May 10, 2024, at 9:03 a.m., a concurrent interview and review of Resident 32's Dietary-Supplement
Order, and Boost Glucose Control nutrition label were conducted with the DTR. The DTR stated Resident
32 was given Boost Glucose Control during lunch on May 7, 2024.
The DTR stated Boost Glucose Control had 190 calories per cartoon and Boost had 240 calories per
cartoon. The DTR further stated, providing Resident 32 with fewer calories would place Resident 32 at risk
for not gaining weight.
On May 10, 2024, at 9:40 a.m., a concurrent interview and record review of Resident 32's
Dietary-Supplement order was conducted with the Director of Nursing (DON). The DON stated Resident 32
had a dietary supplement order for Boost 1 carton two times a day.
The DON stated Resident 32 did not receive the Boost 1 carton supplement during lunch on May 7, 2024,
as ordered by the physician. The DON further stated Residenrt 32 received Boost Glucose Control which
contained fewer calories. The DON stated this placed Resident 32 at risk to not gain weight.
During a review of the facility policy and procedure titled, DIET ORDERS, dated 2023, indicated, .Diet
orders as prescribed by the physician will be provided by the Food & Nutrition Services Department .
During a review of the facility policy and procedure titled, MEAL SERVICE, dated 2023, indicated, .Meals
that meet the nutritional needs of the resident will be served in an accurate and efficient manner .Nursing
personnel will serve the trays immediately upon checking the tray to be sure nothing is missing from the
tray and the diets are correct .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 11 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve
food in accordance with professional standards.
Based on observation, interview, and record review, the facility failed to ensure safe and sanitary food
preparation and storage practices in the kitchen when:
Residents Affected - Some
1. Food service workers did not follow the facility's cleaning procedure to clean food preparation surfaces
and stationary equipment. (Cross reference 802);
2. [NAME] (CK) 2 did not cover his mustache;
3. Five cracked tiles were found on the kitchen floor;
4. There was missing grout found in the kitchen dirty area;
5. There was peeling paint and holes found on the wall;
6. Four of four storage shelves in the dry storage room were rusted;
7. There was grease buildup found on the fire hoods;
8. The microwave had buildup;
9. The grid divider was covered with dust in the pot and pans area;
10. The ice machine pipes had buildup; and
11. Seven out of eleven white storage shelves in reach-in refrigerator had chipped paint.
These failures had the potential to increase the risk of cross-contamination and exposure to
microorganisms that harbor foodborne pathogens, resulting in foodborne illness (stomach illness acquired
from ingesting contaminated food) for 64 out of 64 sampled residents who received food from the kitchen
and are medically compromised.
Findings:
1. On May 8, 2024, at 10:54 a.m., an observation was conducted with CK 1. CK 1 cleaned the prep table
surface and blender base with sanitizer after preparing mechanical soft chicken.
On May 8, 2024, at 11:10 a.m., an interview was conducted with CK 1, she stated she used the sanitizer to
clean the prep table surface and blender base.
On May 8, 2024, at 11:11 a.m., an interview was conducted with the Dietary Supervisor (DTR). She stated
the dietary staff used sanitizer to clean the prep table surface and stationary equipment after use.
On May 9, 2024, at 11:24 a.m., interviews were conducted with CK 2 and CK 3. CK 2 and CK 3 were asked
how to clean the prep table surface and stationary equipment after use. Both stated, they use sanitizer to
clean the prep table surface and stationary equipment.
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 12 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
On May 9, 2024, at 2:39 p.m., interviews were conducted with Registered Dietitian (RD) 2, RD 3 and the
DTR. RD 3 stated the proper procedure for cleaning the prep table surface and stationary equipment was to
wash, rinse, and sanitize after use. RD 2 and DTR stated not following the proper cleaning procedure could
result in potential cross-contamination of the preparation areas and equipment.
During a review of the facility Procedure titled, SHELVES, COUNTERS, AND OTHER SURFACES
INCLUDING SINKS (HANDWASHING, FOOD PREPARATION, ETC.), indicated, .Remove any large debris
and wash surface with a warm detergent solution .Rinse with clear water using a clean sponge or cloth.
Wipe dry with a clean cloth. 3. Spray with a sanitizer .
2. On May 7, 2024, at 10:19 a.m., CK 2 was observed to not have his mustache covered during meal
preparation.
On May 7, 2024, at 1:08 p.m., an interview was conducted with the DTR. She stated CK 2 should have had
his mustache covered while in the kitchen.
On May 9, 2024, at 2:39 p.m., an interview was conducted with RD 2. She stated CK 2 should have had his
mustache covered while working in the kitchen to prevent cross-contamination.
During a review of the facility Policy and Procedure titled, DRESS CODE, dated 2023, indicated, .If
applicable, beards and mustaches (any facial hair) must wear beard restraint .
3. During the initial kitchen tour conducted on May 7, 2024, at 9:15 a.m., a concurrent observation and
interview was conducted with the DTR. She stated there were five broken tiles found in the kitchen in the
following areas:
i) Under the dish machine
ii) In front of the dish machine
iii) In the dirty area
iv) In front of the pot and pan area
On May 9, 2024, at 2:39 p.m., an interview was conducted with RD 2. She stated cracked tiles need to be
replaced in order to have a smooth surface that is easily cleaned.
4. On May 7, 2024, at 10:43 a.m., a concurrent observation and interview was conducted with the DTR in
the dirty area of the kitchen. There was missing grout on the floor. The DTR stated the missing grout should
be filled.
On May 9, 2024, at 2:39 p.m., an interview was conducted with RD 2. She stated the missing grout should
be filled in order to have a smooth surface that is easily cleaned.
During a review of the U.S. Food and Drug Administration's (FDA) Food Code 2022, Annex 3: Section
6-201.12 Floors, Walls, and Ceilings, Utility Lines, indicated, .Floors that are of smooth, durable
construction and that are nonabsorbent are more easily cleaned .Requirements and restrictions regarding
floor coverings, utility lines, and floor/wall junctures are intended to ensure that regular and effective
cleaning is possible and that insect and rodent harborage is minimized .
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 13 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
5. On May 7, 2024, at 10:43 a.m., a concurrent observation and interview was conducted with the DTR in
the dirty area of the kitchen. The DTR stated there were 2 holes and chipped paint on the wall.
On May 9, 2024, at 2:39 p.m., an interview was conducted with RD 2. She stated the walls should not have
chipped paint or holes and should have a smooth surface that is easily cleaned.
Residents Affected - Some
During a review of the facility policy and procedure titled, WALLS, CEILINGS, AND LIGHT FIXTURES,
dated 2023, indicated, .Walls .must be free of chipped and /or peeling paint .It is important to repair peeling
paint areas as soon as they appear .
6. On May 7, 2024, at 11:08 a.m., a concurrent observation and interview was conducted with the DTR and
the Maintenance Supervisor (MTD) in the dry storage area. Four out of four silver storage shelves had
brown grime. The DTR stated all four silver storage shelves had brown grime. The MTD stated the brown
grime was rust.
On May 9, 2024, at 2:39 p.m., an interview was conducted with RD 2. She stated the storage shelves need
to have a smooth surface that is easily cleaned. RD 2 further stated the rusted storage shelves should be
replaced.
During a review of the facility policy and procedure titled, SANITATION, dated 2023, indicated, .All .shelves
.shall be kept clean, maintained in good repair and shall be free from breaks, corrosions, open seam,
cracks, and chipped areas .
7. On May 7, 2024, at 10:38 a.m., a concurrent observation and interview was conducted with the DTR in
front of the stove in the kitchen. There was black grease buildup on the fire hood pipes. The DTR stated the
black grease buildup on the fire hoods could potentially drop into food while the cooks prepared food on the
stove.
On May 9, 2024, at 2:39 p.m., an interview was conducted with RD 2. She stated the fire hood pipes above
the stove should be kept clean.
During a review of the facility policy and procedure titled, HOODS, FILTERS, AND VENTS, dated 2023,
indicated, .Hoods must be free of dust and grease .
During a review of the U.S. Food and Drug Administration's (FDA) Food Code 2022, Annex 3: Section
4-204.11 Ventilation Hood Systems, Drip Prevention, indicated, .The dripping of grease or condensation
onto food constitutes adulteration and may involve contamination of the food with pathogenic organisms .
8. On May 7, 2024, at 9:17 a.m., a concurrent observation and interview was conducted with the DTR
regarding the microwave in the kitchen. There was brown grime buildup inside the microwave. The DTR
stated the microwave had buildup.
On May 9, 2024, at 2:39 p.m., an interview was conducted with RD 2. She stated the microwave should not
have buildup and should have been kept clean.
During a review of the facility policy and procedure titled, SANITATION, dated 2023, indicated, .All
.equipment shall be kept clean .
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 14 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0812
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
9. On May 7, 2024, at 9:48 a.m., a concurrent observation and interview was conducted with the DTR and
RD 1 in the pot and pan area of the kitchen. The grid divider was covered with brown debris and black
grime buildup. The DTR stated the brown debris was dust, and RD 1 stated there should not have been any
grime, debris or dust on the grid divider.
On May 9, 2024, at 2:39 p.m., an interview was conducted with RD 2. She stated the grid divider should be
kept clean to prevent cross-contamination.
During a review of the facility policy and procedure titled, SANITATION, dated 2023, indicated, .All
.equipment shall be kept clean .
10. On May 7, 2024, at 11:10 a.m., an interview was conducted with the DTR regarding the ice machine in
the kitchen. The DTR stated there is one ice machine used for the facility.
On May 7, 2024, at 11:10 a.m., a concurrent observation and interview was conducted with the MTS
regarding the ice machine in the kitchen. Inside the ice machine under the ice maker, there was brownish
buildup on the pipes.
The MTS stated there was brownish buildup on the pipes and he did not clean the ice machine pipes.
On May 9, 2024, at 2:39 p.m., an interview was conducted with RD 2. She stated the pipes under the ice
maker were not supposed to have buildup and should be kept clean.
During a review of the facility policy and procedure titled, SANITATION, dated 2023, indicated, .All
.equipment shall be kept clean .Ice which is used in connection with food or drink shall be from a sanitary
source and shall be handled and dispensed in a sanitary manner .
During a review of the facility policy and procedure titled, ICE MACHINE CLEANING PROCEDURES,
dated 2023, indicated, .The internal components cleaned monthly or per manufacturer's recommendations
.Information about .cleaning and care of the ice machine can obtained from owner's manual .
During a review of the document titled, Ice Machine Owner's Manual, indicated, .Clean and sanitize the ice
machine a minimum of once every six months for efficient operation .If the ice machine requires more
frequent cleaning and sanitizing, consult a qualified service company to test the water quality and
recommend appropriate water treatment .
11. On May 7, 2024, at 11:54 a.m., a concurrent observation and interview was conducted with the DTR
regarding Reach-in refrigerator number (#) 3. Seven of eleven white storage shelves inside the Reach-in
refrigerator had chipped paint. The DTR stated the white storage shelves had chipped paint.
On May 9, 2024, at 2:39 p.m., an interview was conducted with RD 2. She stated the white storage shelves
in the Reach-in Refrigerator # 3 should not have chipped paint and should be replaced. RD 2 further stated
the white storage shelves need to have a smooth surface to be easily cleaned.
During a review of the facility policy and procedure titled, SANITATION, dated 2023, indicated, .All .shelves
.shall be kept clean, maintained in a good repair and shall be free from breaks, corrosions, open seam,
cracks, and chipped areas .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 15 of 16
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
555365
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
05/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Palm Terrace Care Center
11162 Palm Terrace Lane
Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0880
Provide and implement an infection prevention and control program.
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 Treatment Nurse (TN) changed
gloves and perform hand hygiene during wound care for one of one resident reviewed for pressure injury
(Resident 64).
Residents Affected - Few
This failure had the potential to result in cross-contaminatin, increasing the spread of infection for Resident
64.
Findings:
During a wound care observation in Resident 64's room, on May 9, 2024, at 9:15 a.m. with the TN, the TN
removed and discarded the soiled wound dressing (a type of bandage used to cover a wound by sticking to
the surrounding skin) then proceeded to clean Resident 64's wound with normal saline (a sterile solution of
salt in water). The TN did not change gloves and perform hand hygiene in between.
During an interview with the TN on May 09, 2024, at 2:43 p.m., the TN stated he did not follow good
infection control practice. The TN stated, he did not change his gloves and did not perform hand hygiene
after discarding the soiled wound dressing and before cleaning Resident 64's wound.
During an interview with the Director of Nursing (DON) on May 10, 2024, at 11:50 a.m., she stated the TN
should have changed gloves and performed hand hygiene after removing Resident 64's soiled wound
dressing to prevent cross-contamination and infection.
During a review of Resident 64's face sheet (a document that contains resident's basic demographic
information), it indicated Resident 64 was admitted to the facility on [DATE], with diagnoses which included
pressure ulcer of sacral region Stage 4 (Full thickness tissue loss with exposed bone, tendon, or muscle)
and local infection of the skin and subcutaneous (fat) tissue.
During a review of Resident 64's Treatment Administration Record, from May 1, 2024- May 31, 2024,
indicated, .TX (treatment): Cleanse Sacrococcyx area with NS (normal saline), pat dry, apply Silvadene 1%
(topical antibiotic cream) and Gentamicin 0.1% ointment (topical antibiotic medication) then calcium AG
(alginate - derived from seaweed used for wound dressing), Cover with Foam Dressing daily x21 days and
re-evaluate for stage 4 pressure injury every day shift for 21 days .
The facility Policy and Procedure titled, Wound Treatment, dated January 2024, indicated, .it is the policy of
the facility to provide guidelines for good technique in doing wound care .wash your hands .put on gloves
.remove the soiled dressing .remove the gloves .wash your hands .put on clean gloves .clean the wound
according to the order .apply clean dressing as ordered .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555365
If continuation sheet
Page 16 of 16
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Back to topCitations
8 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.
F880 - Infection Control
Provide and implement an infection prevention and control program.
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.
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
F802 - Staffing
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
F808 - Therapeutic Diets
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
F806 - Food and drink
Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
F805 - Food and drink
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
FAQ · About this visit
Common questions about this visit
What happened during the May 10, 2024 survey of PALM TERRACE CARE CENTER?
This was a inspection survey of PALM TERRACE CARE CENTER on May 10, 2024. The surveyor cited 8 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at PALM TERRACE CARE CENTER on May 10, 2024?
Yes, 8 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Provide and implement an infection prevention and control program."
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 . If you believe any information is inaccurate, report it here.