Health inspection·October 5, 2023

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 follow the correct serving sizes to seven Residents for a census of 32 residents (Resident 21, 10, 11, 25, 5, 30 and 2). This deficient practice resulted in residents not receiving the appropriate diet portions to meet each individual needs. Findings: During a concurrent interview and tray line observation on 10/2/23, at 11:45 a.m., with [NAME] (CK) 1, in the presence of Dietary Service Supervisor (DSS), CK 1 was observed using a number 8 scoop to trays of puree and regular texture cabbage, country fried steak, and mashed potatoes, to serve seven residents. CK 1 stated, he was aware of portion sizes but used number 8 scoop for all serving regardless of what was on the meal cards. During a concurrent interview and record review on 10/3/23, at 12:20 p.m., with DSS, showed facility's color-coded portion control chart. DSS confirmed CK 1 did not follow scoop size for residents as indicated on the chart which showed, gray scoop number 8 is a large portion scoop equivalent to 4 fl-oz (fluid ounce unit of measurement), green scoop number 12 is regular portion equivalent to 2.6 fl oz. and blue scoop number 16 is small portion equivalent to 2 fl-oz. During a concurrent interview and medical record review on 10/4/2,3 at 10:23 a.m., with Registered Dietician (RD), RD stated it was important to follow color coded scoops in order to meet dietary needs of each individual residents. RD further stated, Residents with Diabetes Mellitus (DM - a disease in which blood sugar levels are too high) should have received small starch portions (SSP), residents with Renal (Kidney) Disease should have received SPP (Small Protein Portions). RD also added, if dietary recommendations are not adequately met, Residents 21, 10, 11, 25, 5, 30 and 2's conditions can get worse. 1. During a review of Resident 21's face sheet on 10/4/23, indicated, Resident 21 was admitted to the facility in 2016 with multiple diagnoses that included Type 2 DM. During a review of Resident 21's order summary, dated 10/4/23, revealed a CCHO diet (Consistent, Constant or Controlled Carbohydrate Diet) pureed texture, regular consistency, SSP . 2. During a review of Resident 10's face sheet on 10/4/23, indicated, Resident 10 was admitted to the facility in 2020 and was readmitted in 2022. The face sheet showed Resident 10 had multiple diagnoses that included, Type 2 DM and Chronic Kidney Disease (CKD - kidney damage or gradual loss of Page 1 of 6 555461 555461 10/05/2023 Marina Garden Nursing Center 3201 Fernside Blvd. Alameda, CA 94501

F 0805 kidney function). Level of Harm - Minimal harm or potential for actual harm During a review of Resident 10's order summary, dated 10/4/23, revealed a CCHO diet . Lower portion sizes, small starch protein portions . Residents Affected - Some 3. During a review of Resident 11's face sheet, on 10/4/23, indicated, Resident 11 was admitted to the facility in 2022 with multiple diagnoses that included Type 2 DM and Acute Kidney Failure also known as Acute Renal Failure (ARF- when kidneys suddenly become unable to filter waste products from the blood). During a review of Resident 11's order summary, dated 10/4/23, revealed a CCHO diet . SSP . SPP . 4. During a review of Resident 25's face sheet, on 10/4/23, indicated, Resident 25 was admitted to the facility in 2022 with multiple diagnoses that included Type 2 DM and ARF. During a review of Resident 25's order summary, dated 10/4/23, revealed a CCHO diet . SSP, SPP . 5. During a review of Resident 5's face sheet, on 10/4/23, indicated, Resident 5 was admitted to the facility in 2017 and was readmitted in 2021 with multiple diagnoses that included ARF. During a review of Resident 5's order summary, dated 10/4/23, in a regular diet. 6. During a review of Resident 30's face sheet, on 10/4/23, indicated, Resident 30 was admitted to the facility in 2023 with multiple diagnoses that included, DM. During a review of Resident 30's order summary, dated 10/4/23, revealed a CCHO diet. 7. During a review of Resident 2's face sheet, on 10/4/23, indicated Resident 2 was admitted to the facility in 2016 with multiple diagnoses that included, DM with CKD. During a review of Resident 2's order summary, dated 10/4/23, revealed a NAS (low sodium) and CCHO diet . SSP . During a review of facility's policy and procedure (P&P) titled, Food Service Management- Portion Control, undated, the P&P indicated, Standard portion control equipment will be available and utilized for measuring and serving resident meal portions. During a review of facility's P&P titled, Small Portion Diet, dated 2022, the P&P indicated, under general description, The small portion diet provides for the normal nutritional needs of residents who require smaller portions than the regular diet. 555461 Page 2 of 6 555461 10/05/2023 Marina Garden Nursing Center 3201 Fernside Blvd. Alameda, CA 94501

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 store, prepare, and serve food under sanitary conditions when: Residents Affected - Many 1. a stainless-steel pasta tong had rust on its surface. 2. the ice machine had six wet black spots inside ice compartment and white build up residue on the right corner rim inside opening. 3. the mounted can opener had rust on the blade and surrounding parts. These failures had the potential to cause food contamination and food borne illness. Findings: 1. During the initial tour of the kitchen and concurrent interview on 10/2/23 at 9:45 a.m. with the Dietary Service Supervisor (DSS), a stainless-steel rusty tong was stored in the clean kitchen utensil storage bin. The DSS stated the tong was actively being used. The DSSacknowledged the tong was rusty then disposed the tong in the trash. During an interview on 10/4/23 at 10:23 a.m. with the Registered Dietitian (RD), RD stated, there should not have been any utensils with rust in the kitchen due to risk for botulism (serious illness caused by toxin that attacks the body's nerves) toxin if rust goes in the food that residents ingest. During a review of facility's policy and procedure (P&P) titled, Infection Control - Cleaning Procedure, dated 2014, the P&P revealed, 1. The DSS routinely checks all sanitation and housekeeping procedures within the Dietary department. 2. The DSS spot checks work performance and counsels employees as needed to ensure that all cleaning meets high standards. 2. During an observation and concurrent interview on 10/2/23 at 10:00 a.m. the facility's ice machine had six wet black spots inside ice compartment and white build up residue on right corner opening. DSS proceeded to wipe the black dots with white paper towel. DSS stated, staff inspects ice machine daily, but missed the black spots inside ice bin. DSS further added, residents could get sick if contaminated ice was consumed. During an interview 10/4/23 at 10:33 a.m. with the RD, RD stated, dirt inside interior compartment of ice machine was a potential for health hazard. RD further added, dirt from inside ice machine can carry bacteria such as e. coli (Escherichia coli- can cause severe stomach cramps, bloody diarrhea and vomiting) and salmonella infections (bacterial disease) which can get the residents very sick. RD further added, there should not have been any spots or dirt inside icecompartment. 555461 Page 3 of 6 555461 10/05/2023 Marina Garden Nursing Center 3201 Fernside Blvd. Alameda, CA 94501

F 0812 Level of Harm - Minimal harm or potential for actual harm During a review of facility's P&P titled, Ice Machine Cleaning and Sanitization, dated, 10/2023, the P&P indicated, the ice machine will be used and maintained to assure a safe and sanitary supply of ice. During a review of facility's P&P titled, Infection Control - Cleaning Procedure, dated 2014, the P&P showed, 9. c Residents Affected - Many all stainless-steel equipment, ice machines, the storeroom (including the shelves), carts ovens, and racks are cleaned and sanitized. During a review of the Center for Disease Control (CDC) Guidelines for Environmental Infection Control in Health Care Facilities, Recommendation of CDC and Healthcare Infection Control Practices Advisory committee (HICPAC), revised 7/19, the CDC Guidelines indicated, Microorganisms (an organism seen only by a microscope) may be present in ice, ice-storage chests, and ice-making machines ice from contaminated ice machines has been associated with blood stream infections, pulmonary (having to do with the lungs), and gastrointestinal (having to do with the stomach and intestinal tract) illnesses Some waterborne bacteria found in ice could potentially be a risk to immunocompromised (weakened immune system) patients if the consumed ice or drink beverages with ice. 3. During a follow up kitchen observation and concurrent interview on 10/3/23 at 10:35 a.m. with DSS, the mounted manual can opener had rust on the blade and surrounding parts. DSS acknowledged the can opener was rusty and stated it will be replaced immediately. DSS also added, if rust gets in the food, it could be potential risk to the health being of residents. During an interview on 10/4/23 at 10:23 a.m. with the RD. RD stated, she was aware the mounted manual can opener was replaced yesterday due to rust. RD stated, there was risk for botulism toxin if rust goes in the food that residents ingest. During a review or facility's P&P titled, Food Service Management - Equipment Maintenance dated, 2012, the P&P indicated, 1. The DSS will periodically check all equipment and report items needing repair to the maintenance department following facility procedure. 2. The maintenance department routinely monitors all equipment for proper functioning and safety and performs routine preventative maintenance as per facility procedures. During a review of facility's P&P titled, Infection Control - Cleaning Procedure, dated 2014, the P&P revealed 1. the DSS routinely checks all sanitation and housekeeping procedures within the Dietary department. 2. The DSS spot checks work performance and counsels employees as needed to ensure that all cleaning meets high standards.9. c .all stainless-steel equipment, ice machines, the storeroom (including the shelves), carts ovens, and racks are cleaned and sanitized 555461 Page 4 of 6 555461 10/05/2023 Marina Garden Nursing Center 3201 Fernside Blvd. Alameda, CA 94501

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Many Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility had fifteen resident's rooms (1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 14, 15, 16, and 17) with multiple beds that provided less than 80 square feet (sq. ft) per resident who occupied these rooms. This deficient practice had the potential to result in adequate space for the delivery of care to each of the residents in each room, or for storage of the residents' belongings. Findings: During an observation on 10/2/23, at 10:30 a.m., the following rooms and corresponding square footage (SQF) per bed were identified: room [ROOM NUMBER] had 2 beds, total SQF is 139.34 and SQF per bed is 69.67. room [ROOM NUMBER] had 2 beds, total SQF is 140.26 and SQF per bed is 70.13. room [ROOM NUMBER] had 2 beds, total SQF is 138.90 and SQF per bed is 69.45. room [ROOM NUMBER] had 2 beds, total SQF is 139.68 and SQF per bed is 69.84. room [ROOM NUMBER] had 2 beds, total SQF is 140.88 and SQF per bed is 70.44. room [ROOM NUMBER] had 2 beds, total SQF is 142.80 and SQF per bed is 71.40. room [ROOM NUMBER] had 2 beds, total SQF is 140.40 and SQF per bed is 70.20. room [ROOM NUMBER] had 2 beds, total SQF is 140.36 and SQF per bed is 70.18. room [ROOM NUMBER] had 2 beds, total SQF is 140.20 and SQF per bed is 70.10. room [ROOM NUMBER] had 2 beds, total SQF is 139.88 and SQF per bed is 69.94. room [ROOM NUMBER] had 2 beds, total SQF is 138.14 and SQF per bed is 69.07. room [ROOM NUMBER] had 2 beds, total SQF is 139.88 and SQF per bed is 69.94. room [ROOM NUMBER] had 2 beds, total SQF is 140.68 and SQF per bed is 70.34. room [ROOM NUMBER] had 2 beds, total SQF is 140.40 and SQF per bed is 70.20. room [ROOM NUMBER] had 2 beds, total SQF is 155.34 and SQF per bed is 77.67. During random observation of care and services from 10/2/23 to 10/5/23 there was sufficient space for the provision of care for the residents in all rooms. There was no heavy equipment kept in the rooms that might interfere with resident's care and each resident had adequate personal space and 555461 Page 5 of 6 555461 10/05/2023 Marina Garden Nursing Center 3201 Fernside Blvd. Alameda, CA 94501

F 0912 Level of Harm - Potential for minimal harm privacy. There were no complaints from the residents regarding insufficient space for their belongings. There were no negative consequences attributed the decreased space and/or safety concerns in the fifteen rooms. Granting of room size waiver recommended. Residents Affected - Many 555461 Page 6 of 6