Health inspection·November 3, 2022

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 expired food items were not stored in the refrigerator, readily available for use. Residents Affected - Some This failure had the potential to result in foodborne illness to an already vulnerable facility population. Findings: On October 31, 2022, at 9:13 a.m., an initial tour of the kitchen was conducted with the Lead [NAME] (LC). One aluminum steam table deep pan with enchilada sauce, covered with clear plastic wrap, dated 10/26, was observed in the walk-in refrigerator, readily available for use. In a concurrent interview, the LC stated 10/26 was the date it was prepared. The LC stated the enchilada sauce was only good for three days after the preparation date. The LC stated the enchilada sauce was expired and should have been discarded. Additionally, one aluminum steam table deep pan with baked beans, covered with clear plastic wrap, with a label of use by 10/27/22, was observed in the walk-in refrigerator, readily available for use. In a concurrent interview, the LC stated the beans were expired, and should not have been stored in the refrigerator, readily available for use. On October 31, 2022, at 9:17 a.m., the Dietary Services Supervisor (DSS) was interviewed. The DSS confirmed both the enchilada sauce and the baked beans were expired and should not have been stored in the refrigerator, readily available for use. On October 31, 2022, at 9:22 a.m., one aluminum steam table deep pan with gravy, covered with clear plastic wrap, with a date of 10/26 was observed in the reach-in refrigerator, readily available for use. In a concurrent interview, the DSS stated the gravy was prepared on October 26, 2022, and it was good for three days after it was prepared. The DSS stated the gravy was expired and should have been discarded. Additionally, one Ziplock bag containing a previously opened bag of non-dairy whipped cream topping, with a date of 8/9/22, was observed in the same reach-in refrigerator, readily available for use. (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 6 Event ID: 555390 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 555390 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/03/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corona Regional Medical Center D/P Snf 730 Magnolia Avenue Corona, CA 92879 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)