Health inspection·August 15, 2024

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: Residents Affected - Few 1). Maintain the Ice/Water Dispensing machine per manufacturer recommendations allowing a buildup of moist, black residue to collect on the water supply nozzle and; 2). Maintain a functioning drain for the dishwashing machine allowing water to spill out of the drain and onto the floor. These failures had the potential to negatively impact resident health. Findings: 1. A review of the facility's policies and procedures (P&P) titled, Cleaning and Sanitizing Ice Machines, revised 7/1/21, indicated, Ice machines will be cleaned and sanitized per manufactures guidelines. During a concurrent observation, interview, and record review, on 8/14/24 at 9:25 AM, located in the resident's kitchenette (a small kitchen), the Ice/Water Dispensing machine was observed with Biomed (BM). A white paper towel was used to wipe the water supply nozzle and a moist, black residue was observed. BM stated, the water supply nozzle should be clean and was not. BM stated, the facility utilized an outside contractor to clean the Ice/Water Dispensing machine every six months, per the manufacture's recommendations. BM reviewed the Job Invoice, dated 2/12/24, and stated, the Ice/Water Dispensing machine was last cleaned on 2/1/24. A review of the Ice/Water Dispensing machine's Service Manual, revised 9/24/14, indicated, the maintenance schedule was to be used as a guideline and more frequent maintenance could be required. During an interview on 8/14/24 at 9:30 AM, the Activities Director confirmed, resident drinking water was obtained from the Ice/Water Dispensing machine located in the resident's kitchenette area. 2. A review of the facility's P&P titled, Equipment Management Program, revised 10/1/21, indicated, when there was an equipment failure, facility staff would report the failure to the appropriate department. During a concurrent observation and interview on 8/14/24 at 2:09 PM, located in the kitchen, the drain for the dishwashing machine was observed. Dietary Aide (DA) stated, when draining the dishwasher, DA was required to release the water down the drain, using a stop and go method, so the water would not overflow the drain. DA demonstrated what would happen if DA did not utilize a stop and go Page 1 of 2 555433 555433 08/15/2024 Eastern Plumas Hospital- Portola Campus Dp/Snf 500 First Street Portola, CA 96122

F 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few water release method and the water overflowed the drain and onto the floor. Dietary Manager (DM) was present and confirmed there had been an ongoing issue with the drain under the dishwasher. DM stated, when there was an equipment failure, DM was responsible to report the failure to the facility's Maintenance Director (MD). DM stated, she did not report the equipment failure to the MD and should have. During a concurrent interview and observation on 8/14/24 at 3:00 PM, MD took a picture of the drain under the dishwashing machine. The picture showed a moist, thick, black residue in the drain and MD stated, the drain was clogged and that was what caused the water to overflow the drain and onto the floor. MD stated, approximately six months ago, there had been a water overflow issue and it had been repaired. MD confirmed, DM had not notified MD that the dishwashing machine drain had a water overflow issue 555433 Page 2 of 2