Health inspection·December 9, 2021

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 document review the facility did not ensure food and nutrition service staff were able to competently carry out their job duties when: Residents Affected - Some 1. A Dietary employee did not air-dry clean dishes and stacked them wet. 2. A Dietary employee did not correctly label and date TCS (time controlled for food safety) foods in the kitchen. 3. A Dietary employee did not allow the dish machine to reach correct wash temperature while washing the dishes. As a result, this could have led to foodborne illnesses at the facility. Cross Reference F812 and F908 Findings: 1. On 12/06/21 at 7:56 A.M., a kitchen observation was conducted. Next to the juice machine there was a large plastic bin with 4 oz. cups stacked wet on top of each other with water dripping down inside the cups. On 12/06/21 at 8:04 A.M., an interview and observation were conducted during the dish washing process with [NAME] 1. Observed [NAME] 1 unloading wet dishes from dish racks after they came out of the dish washing machine and stacked the dishes on top of each other wet on a storage shelf next to the dishwashing machine counter. [NAME] 1 stated they did not have room in the kitchen to air dry dishes before putting them away. [NAME] 1 stated the staff normally just stacks dishes on the racks wet because there was no room in kitchen. On 12/06/21 at 9:06 A.M., an interview and observation were conducted during the dishwashing process with the facility's Food & Nutrition Services Director (FANSD). The FANSD observed [NAME] 1 stacking wet dishes from dishwashing machine rack to the storage shelf next to the dishwashing machine counter. The FANSD interjected and explained to [NAME] 1 that the dishes must air dry before they are put away. The FANSD stated the dishes shouldn't be stored wet because that could produce bacterial growth on the dishes. The FANSD stated the dishes should be air dried before they are put away. Page 1 of 18 555545 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A facility document review was conducted on 12/8/21. The document titled Dish Washing dated 2018 indicated, .5. Dishes are to be air dried in racks before stacking and storing . According to the 2017 Federal Food and Drug Administration (FDA) Food Code, Section 4-901.11 Equipment and Utensils, Air-Drying Required, After cleaning and sanitizing, equipment and utensils: shall be air-dried . 2. On 12/06/21 at 8:04 A.M., an interview and observation were conducted in the kitchen with [NAME] 1. [NAME] 1 was asked what the OD date meant that was labeled on the outside of the food containers. [NAME] 1 stated he was unsure what the OD date was on the outside of the food containers. On 12/06/21 at 9:06 A.M., an interview was conducted in the kitchen with the facility's Food and Nutrition Services Director (FANSD). The FANSD stated OD next to a date on the food containers and food was the Open Date and is used to calculate when the food would expire. The FANSD stated the food containers should also have a use by date label on the container as well. According to the 2017 Federal FDA Food Code, Section 3-501.17 (B) titled Labeling and Dating, .For commercially prepared, refrigerated, ready-to-eat TCS food, the food is to be marked with the time the container is opened. If the food will be held for more than 24 hours, it is to indicate the date or day it will be consumed or discarded. A facility document review was conducted on 12/8/21. The document titled Labeling and Dating of Foods dated 2020 indicated, .Newly opened food items will need to be closed and dated with an open date and used by date that follows the guidelines . 3. On 12/06/21 at 8:04 A.M., an observation of the dishwashing process was conducted. Observed [NAME] 1 unloading wet dishes from dish racks after they came out of the dish washing machine and stacked the dishes on top of each other wet on a storage shelf next to the dishwashing machine counter. On 12/06/21 at 8:04 A.M., an interview and observation were conducted in the kitchen with [NAME] 1. [NAME] 1 stated they do not have room in the kitchen to air dry dishes before putting them away. [NAME] 1 stated the staff normally just stacks dishes on the racks wet because there is no room in kitchen. [NAME] 1 stated the dishwashing machine temperature needs to reach a temperature of 110 degrees to clean the dishes properly. Observation of temperature gauge on dishwasher while running read 115 degrees. On 12/06/21 at 9:06 A.M., an interview and observation were conducted during the dishwashing process with the facility's Food & Nutrition Services Director (FANSD). The FANSD stated the dishwashing machine temperature requirement for proper cleaning of the dishes was 120 degrees. The FANSD stated they have been told by maintenance that they must run dishwashing machine two or three times in the beginning of washing to get the dishwasher temperature up to 120 degrees. Observed the dishwashing machine go through 3 cycles and the temperature gauge only reached 118 degrees. According to the 2017 Federal FDA Food Code, Section 4-501.110 titled Mechanical Warewashing Equipment, Wash Solution Temperature, .(B) The temperature of the wash solution in spray-type warewashers 555545 Page 2 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0802 that use chemicals to sanitize may not be less than .120 degrees F. Level of Harm - Minimal harm or potential for actual harm According to the 2017 Federal FDA Food Code, Section 4-501.11, titled Equipment, Good Repair and Proper Adjustment .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 of properly cooling or holding time/temperature control for safety foods at safe temperatures. Residents Affected - Some A facility document review was conducted on 12/8/21. The document titled Dish Washing dated 2018 indicated, . Low-temperature machine: Use the machine at a range of 120-140 (degree symbol) F . 555545 Page 3 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

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 document review the facility did not ensure that food was served at an appetizing and palatable temperature for 10 sampled residents. Residents Affected - Some As a result, the 10 sampled residents were at risk for decreased food intake and the potential for nutritional deficits. In addition, this could have potentially affected all residents that receive meal trays from the kitchen at the facility. Cross reference F920 Findings: On 12/06/21 at 9:22 A.M., Resident 40 stated the food was bad and her breakfast was cold. On 12/06/21 at 9:29 A.M., Resident 17 stated the food at the facility was cold, like ice. On 12/06/21 at 9:37 A.M., Resident 11 stated the food is ok but cold. Resident 11 stated breakfast was cold, but the staff will heat it up. On 12/06/21 at 9:56 A.M., Resident 47 stated food is awful!. Resident 47 stated the food is cold, but they will heat it up. On 12/06/21 at 10:11 A.M., Resident 49 stated the food is not very good and cold. On 12/06/21 at 10:12 A.M., Resident 8 stated the food is not good at all. Resident 8 stated the food comes cold. On 12/07/21 at 10:00 A.M., interviews were conducted in the resident council meeting. Four confidential residents stated the food at the facility is served too cold. On 12/07/21 at 1:01P.M., an interview and observation were conducted with the facility's Registered Dietitian (RD) and the Food and Nutrition Services Director (FANSD) evaluating a meal tray. The facility's RD agreed the milk was warm and not at an appropriate temperature for food safety and the regular meal entrée temperature was below 120 degrees F, which did not meet the facility's policy for food delivery temperatures served to residents. The RD stated the food was a little cooler than it should be for palatability purposes. The FANSD agreed with the RD that the food was a little cool. On 12/08/21 at 2:24 P.M., an interview was conducted with the facility's Administrator (ADM). The ADM stated it was her expectation that the facility's food should be served palatable to the residents. A facility document review was conducted. The document titled Resident Council dated 11/8/2021 indicated, .Dietary: One resident felt her coffee can be too cold in the morning .One resident felt that some meals are not served warm enough . A facility document review was conducted. The document titled Meal Service dated 2018 indicated, .7. Temperature of the food when the resident receives it is based on palatability. The goal is to 555545 Page 4 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0804 serve cold food cold and hot food hot .recommended temp at delivery to resident .hot entrée >= 120 degrees F . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 555545 Page 5 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

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 document review the facility did not maintain sanitary conditions for food safety in the kitchen according to standards of practice when: Residents Affected - Some 1. The ice machine was not cleaned per manufacturer's guidelines. 2. The juice machine was not cleaned per manufacturer's guidelines. 3. The food was not dated per facility policy. 4. The food in 2 refrigerators and a dry storage room were expired. 5. The dietary staff did not follow proper cleaning and sanitizing of surfaces per facility policy. 6. The dietary staff did not air-dry clean dishes before stacking them and storing them. 7. Two staff members removed ice from ice machine in the kitchen without performing hand hygiene. 8. The refrigerators and freezer had food debris on bottom shelves and there were brown stains on the outside of one refrigerator. 9. The kitchen stove had caked on debris on burner racks, gas lines to oven were covered in caked on black debris, floor had black areas over floor repair work and over various areas of the the laminate floor. 10. The counter on clean side of dishwasher had food debris under clean dishes and clean dish racks. 11. The dishwasher did not reach required wash temperature per the manufacturer's guidelines of 120 degrees Fahrenheit when washing dishes. As a result, this could have led to foodborne illnesses at the facility. Cross Reference F802 and F908 Findings: 1. On 12/06/21 at 10:03 A.M., an interview was conducted with the facility Maintenance Direct (MD) in the kitchen. The MD stated he uses 1 part water and ten parts bleach to clean the ice machine monthly. A document review was conducted on 12/06/21. The document titled Hoshizaki Instruction Manual with a revision date of 10/15/2021 indicated, .1. Cleaning Solution Dilute 9.6 fl.oz. (0.29 l) of Hoshizaki Scale Away with 1.6 gal. (6.0 l) of warm water .Sanitizing Solution Dilute 2.5 fl. Oz. (74 ml or 5 tbs) of 5.25% sodium hypochlorite solution (chlorine bleach) with 5 gal. (10 l) of warm water . 555545 Page 6 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0812 Level of Harm - Minimal harm or potential for actual harm On 12/06/21 at 12:40 P.M. an interview and observation were conducted with the MD in the facility's maintenance closet outside the facility. The MD presented the bleach bottle he uses to clean the ice machine with that had written on the outside of the bottle, Active Ingredient: Sodium Hypochlorite of 8.25% . The MD stated he does not use the recommended descaler product per the manufacturer's instructions when cleaning the ice machine. MD stated he just uses the diluted bleach of 10 % bleach and 90% water. Residents Affected - Some According to the 2017 Federal Food and Drug Administration (FDA) Food Code, Section 4-501.11, titled Equipment, Good Repair and Proper Adjustment .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 of properly cooling or holding time/temperature control for safety foods at safe temperatures. 2. On 12/06/21 at 7:59 A.M., a kitchen observation was conducted. Observed 2 juice machine sprayers that had black and tan colored build-up inside the clear sprayer handset gun. On 12/06/21 at 09:06 A.M. an interview and observation were conducted with the facility's Food and Nutrition Services Director (FANSD) in the kitchen. The FANSD observed both juice machine sprayer handsets guns and acknowledged that there was black and tan discoloration inside the clear handset guns. The FANSD stated the juice machine company cleans the juice gun tubing once a week but is unsure if they clean the inside of the handset guns. The FANSD stated the kitchen staff cleans the outside of the handset, tubing and machine once a day. A document review was conducted on 12/06/21. The undated document titled Eagle Beverage Cleaning Procedures .indicated, .Proper Care and Maintenance .the dispenser can be soaked in warm water daily, which we recommend to keep the juice gun clean . Daily Cleaning .5. Place juice gun in sanitizing solution for 10 minutes (or per directions on sanitizer), remove gun and air dry . According to the 2017 Federal Food and Drug Administration (FDA) Food Code, Section 4-501.11, titled Equipment, Good Repair and Proper Adjustment .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 of properly cooling or holding time/temperature control for safety foods at safe temperatures. 3. On 12/06/21 at 7:59 A.M., a kitchen observation was conducted. Observed items in the dairy refrigerator. Observed white shredded cheese that was in a plastic bag that had a written date of 11/24/21 on the bag. Observed orange shredded cheese in a plastic bag with just a received date of 12/2/21 label on the bag. On 12/06/21 at 7:59 A.M. An observation and interview were conducted in the kitchen with [NAME] 1. Observed a parsley container that was labeled O.D. 8-31-21. [NAME] 1 stated he was unsure of what O.D. (open date) stood for on the container. Did not observe any other date on the container of parsley. 555545 Page 7 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 12/06/21 at 9:06 A.M., an interview and observation were conducted in the kitchen with the facility's Food and Nutrition Services Director (FANSD). The FANSD stated OD next to a date on the food containers and food was the Open Date and is used to calculate when the food would expire. The FANSD stated the food containers should also have a use by date (UD) label on the container as well. The FANSD stated there was no date opened (DO) labels on both the shredded orange cheese or the white shredded cheese bags. The FANSD stated there was no date open (DO) labels or use by date (UD) on both, the shredded white a cheddar cheese bags. The FANSD stated he was unsure of what the written date of 11/24/21 was on the white shredded cheese bag. The FANSD stated both the white and orange shredded cheeses should have a received date label (RD), an opened date (OD) label and a use by date (UD) label on the outside of the plastic bags. A facility document review was conducted on 12/06/21. The document titled Label and Dating of Foods dated 2020 indicated, .All food items in the storeroom, refrigerator, and freezer need to be labeled and dated .Food delivered to the facility needs to be marked with a received date .Newly opened food items will need to be closed and labeled with an open date and a use by date that follows the guidelines . 4. On 12/06/21 at 7:59 A.M., a kitchen observation was conducted. Observed in the dairy refrigerator a container of Thick and Easy dairy beverage with an opened date on it of 11/22/21. Manufacturer's instructions outside of carton says product expires 3 days after opening. Observed in the daily refrigerator a second container of Thick and Easy dairy beverage in the that had been opened but could not locate on carton an open date label or a use by date label. Observed in the dairy refrigerator a plastic bag with white creamy like substance in it with no label dates or identification of what the item is on the outside of the bag. On 12/06/21 at 9:06 A.M., an observation and interview were conducted in the kitchen with the facility's Food and Nutrition Services Director (FANSD). Observed 1 package of flour tortillas in the storage room that had a written date of 11/23/21. The FANSD stated tortillas are good for 7 days after opening. The FANSD stated the tortillas were expired. The FANSD stated container of Thick and Easy dairy beverage with an opened date on it of 11/22/21 that was located in the dairy refrigerator was expired and the 2nd opened carton of Thick and Easy dairy beverage would need to be disposed of too because it did not have an open date or use by date on the carton. The FANSD stated he was unaware that the manufacturer's instructions on outside of Thick and Easy dairy beverage carton said product expires 3 days after opening. The FANSD stated the unlabeled and undated plastic bag with white creamy substance in the dairy refrigerator was whipped cream. The FANSD stated the whipped cream would be disposed of because it was not labeled appropriately. On 12/06/21 at 12:04 P.M., an observation and interview were conducted in the break room where the resident refrigerator is located. Observed 2 expired sandwiches located in the crisper drawer of the refrigerator. One sandwich was tuna with an expiration date of 11/27/21 and the second sandwich was peanut butter and jelly with an expiration date of 11/30/21. The Food and Nutrition Services Director (FANSD) stated the food in the resident refrigerator is only kept for 3 days and should have been thrown out. The FANSD acknowledged the 2 sandwiches were expired. A facility document review was conducted on 12/06/21. The document titled Label and Dating of Foods dated 2020 indicated, .All food items in the storeroom, refrigerator, and freezer need to be labeled and dated .Food delivered to the facility needs to be marked with a received date .Newly opened 555545 Page 8 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some food items will need to be closed and labeled with an open date and a use by date that follows the guidelines . 5. On 12/07/21 at 8:45 A.M., On observation and interview were conducted in the kitchen with Dietary Aide (DA) 1. DA 1 demonstrated how she would clean and sanitize counters in the kitchen while working. DA 1 stated she just uses the red sanitizing bucket that has the sanitizing solution to clean and sanitize surfaces after food preparation. DA 1 stated sometimes she just uses the One Step RTU (disinfectant solution) spray bottle to clean counters after food preparation if the red bucket is not in the area. DA 1 stated they kitchen staff only uses the red bucket with the sanitizing agent in it to clean and sanitize surfaces in the kitchen. DA 1 stated they do not use a separate bucket or cloth to clean off surfaces first before sanitizing the surfaces. On 12/7/21 at 9:03 A.M., AN interview was conducted with the facility's Food and Nutrition Services Director (FANSD). The FANSD stated he trains all kitchen staff when they are newly hired and does monthly in-services for the kitchen staff. The FANSD stated the kitchen only uses a red bucket with sanitizing solution in it to clean and sanitize counters and other surfaces in the kitchen. The FANSD stated they do not use a separate bucket or cloth to clean surfaces before they sanitize. The FANSD stated he was unaware of the process of using a separate bucket (i.e. green) and cloth to clean surfaces and counters with a cleaning solution first before using the sanitizing bucket (red) and cloth with sanitizing solution to sanitize the surfaces and counters after it has been cleaned. The FANSD stated we just use the red bucket for both cleaning and sanitizing. A facility document review was conducted. The document titled Shelves Counter and Other Surfaces Including Hand Washing Sink dated 2018 indicated, 1. Wash surface with warm detergent solution following manufacturers instructions .2. Rinse with clear water using a clean sponge or cloth. Wipe dry with a clean cloth. 3. Spray with a sanitizer. Read sanitizer directions to learn how long surface is to remain wet. Use enough sanitizer to meet this time period. Do not rinse. A facility document review was conducted. The document titled Equipment and Supplies dated 2018 indicated, . Have the correct detergent for cleaning assignment .thoroughly rinse the .surface after cleaning .A sanitizer is recommended for .surfaces which have direct contact with food .Recommend bucket with separate compartments labeled for wash and rinse solutions .two separate containers are necessary . According to the 2017 Federal Food and Drug Administration (FDA) Food Code, Section 4-601.11, Equipment .Food-contact surfaces (C ) .food-contact surfaces shall be effectively washed to remove or completely loosen soils by using .manual .means necessary such as the application of detergents .rinsed .and sanitized after cleaning .; Inability to effectively wash, rinse, and sanitize the surfaces of food equipment and food contact surfaces may lead to buildup of pathogenic organisms transmissible through food . 6. On 12/06/21 at 7:56 A.M., a kitchen observation was conducted. Next to the juice machine there was a large plastic bin with 4 oz. cups stacked wet on top of each other with water dripping down inside the cups. 555545 Page 9 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some On 12/06/21 at 8:04 A.M., an interview and observation were conducted during the dish washing process with [NAME] 1. Observed [NAME] 1 unloading wet dishes from dish racks after they came out of the dish washing machine and stacked the dishes on top of each other wet on a storage shelf next to the dishwashing machine counter. [NAME] 1 stated they did not have room in the kitchen to air dry dishes before putting them away. [NAME] 1 stated the staff normally just stacks dishes on the racks wet because there was no room in kitchen. On 12/06/21 at 9:06 A.M., an interview and observation were conducted during the dishwashing process with the facility's Food and Nutrition Services Director (FANSD). The FANSD observed [NAME] 1 stacking wet dishes from dishwashing machine rack to the storage shelf next to the dishwashing machine counter. The FANSD interjected and explained to [NAME] 1 that the dishes must air dry before they are put away. The FANSD stated the dishes shouldn't be stored wet because that could produce bacterial growth on the dishes. The FANSD stated the dishes should be air dried before they are put away. A facility document review was conducted on 12/8/21. The document titled Dish Washing dated 2018 indicated, .5. Dishes are to be air dried in racks before stacking and storing . According to the 2017 Federal Food and Drug Administration (FDA) Food Code, Section 4-901.11 Equipment and Utensils, Air-Drying Required, After cleaning and sanitizing, equipment and utensils: shall be air-dried . 7. On 12/07/21 at 9:16 A.M., an observation was done in the presence of the Food and Nutrition Services Director (FANSD). Observed CNA 1 enter the kitchen through a door from the patient care area, place her personal cup into the clean hand washing sink, then removed ice from the kitchen's ice machine to fill her cup in the hand washing since. CNA 1 did not complete hand hygiene after entering the kitchen or before removing ice from the kitchen's ice machine. On 12/07/21 at 9:33 A.M., an observation and interview were conducted in the kitchen with the facility's Food and Nutrition Services Director (FANSD). Observed a staff member enter the kitchen from the facility's break room door, removed ice directly from the kitchen's ice machine and placed the ice in a white cup. Staff member did not complete hand hygiene after entering the kitchen or before removing ice from the kitchen's ice machine. The FANSD stated the staff member should have washed their hands before removing the ice from the ice machine. The FANSD stated the facility does not have a policy for the ice machine. On 12/07/21 at 11:17 A.M., an interview was conducted with CNA 1 in the kitchen. CNA 1 stated it was not okay to put her personal cup in the clean hand washing sink in the kitchen to fill it up with ice. CNA 1 stated the kitchen hand washing sink is to be kept clean. CNA 1 stated she was educated that she must wash her hands in the kitchen's handwashing sink before removing ice from the ice machine. CNA 1 stated she did not do hand hygiene or wash her hands in the hand washing sink before she removed the ice to fill her personal cup. A facility document review was conducted 12/14/21. The document titled Hand Washing Procedure dated 2018 indicated, .When Hands Need To Be Washed: 1. Before starting work in the kitchen . A facility document review was conducted 12/14/21. The document titled Food Handling dated 2018 indicted, .All Food & Nutrition service personnel will wash their hands prior to handling food . 555545 Page 10 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0812 Level of Harm - Minimal harm or potential for actual harm A facility document review was conducted 12/14/21. The undated document titled Policy/Procedure-Nursing Clinical indicated, .It is the policy of this facility to cleanse hands to prevent transmission of possible infectious material and to provide clean, healthy environment for residents and staff . 8. Residents Affected - Some On 12/06/21 at 7:56 A.M., a kitchen observation was conducted. Observed a side-by-side freezer and refrigerator that had food debris and large food pieces on the bottom shelves. Observed a large amount of tan colored caked on substance on the outside of the dairy refrigerator. On 12/06/21 at 9:06 A.M., an observation and interview were conducted in the kitchen with the facility's Food and Nutrition Services Director (FANSD ). The FANSD stated the outside of the refrigerators and freezers are cleaned daily and the inside is cleaned once a week by the dietary staff. The FANSD stated the outside of the dairy refrigerator does not look clean. The FANSD stated the refrigerator and freezer did not look clean inside and acknowledged that there was food debris on the bottom shelves. The FANSD stated It looks like they have not been deep cleaned. when observing the refrigerator and freezer. On 12/06/21 at 12:04 P.M., an observation and interview were conducted in the break room where the resident refrigerator is located with the facility's Food and Nutrition Services Director (FANSD ). Observed the inside of the refrigerator that did not look clean and had food particles on shelves and crisper drawers. The FANSD stated the kitchen staff cleans the refrigerator weekly and the last time it was cleaned per the cleaning log was Thursday. The FANSD stated the refrigerator currently does not look clean. The FANSD stated he will have the kitchen staff clean the refrigerator now. A facility document review was conducted. The document titled Shelves Counter and Other Surfaces Including Hand Washing Sink dated 2018 indicated, 1. Wash surface with warm detergent solution following manufacturers instructions .2. Rinse with clear water using a clean sponge or cloth. Wipe dry with a clean cloth. 3. Spray with a sanitizer. Read sanitizer directions to learn how long surface is to remain wet. Use enough sanitizer to meet this time period. Do not rinse. A facility document review was conducted. The document titled Equipment and Supplies dated 2018 indicated, . Have the correct detergent for cleaning assignment .thoroughly rinse the .surface after cleaning .A sanitizer is recommended for .surfaces which have direct contact with food .Recommend bucket with separate compartments labeled for wash and rinse solutions .two separate containers are necessary . According to the 2017 Federal Food and Drug Administration (FDA) Food Code, Section 4-601.11 Equipment .Food-Contact Surfaces . (A) EQUIPMENT FOOD-CONTACT SURFACES .shall be clean .sight and touch . 9. On 12/06/21 at 8:04 A.M., an observation in the kitchen was conducted. Observed black debris over floor repair work and over various areas of the laminate floor that was uneven. Observed large amount of caked on black debris on burners and burner racks on stove top. Observed gas line going to stove from wall had caked on greasy tan and brown debris over them. On 12/06/21 at 9:06 A.M., an observation and interview were conducted in the kitchen with the facility's Food and Nutrition Services Director (FANSD) ). The FANSD stated the kitchen floors are swept 555545 Page 11 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some and mopped daily and the maintenance department deep cleans the floors in the kitchen monthly. The FANSD stated the top of the stove gets cleaned once a week by the kitchen staff. The FANSD acknowledged there was black debris over floor repair work and over various areas of the laminate floor. The FANSD acknowledged there was caked on black debris on burners and burner racks on stove top. The FANSD acknowledged the gas lines going to stove from wall had caked on greasy tan and brown debris over them. According to the 2017 Federal Food and Drug Administration (FDA) Food Code, Section, 2017 4-601.11 Equipment .Non-food contact surfaces .Non-food contact surfaces of equipment shall be kept free from accumulation of dust, dirt, food residue, and other debris. Additionally, 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 . A facility document review was conducted. The document titled Shelves Counter and Other Surfaces Including Hand Washing Sink dated 2018 indicated, 1. Wash surface with warm detergent solution following manufacturers instructions .2. Rinse with clear water using a clean sponge or cloth. Wipe dry with a clean cloth. 3. Spray with a sanitizer. Read sanitizer directions to learn how long surface is to remain wet. Use enough sanitizer to meet this time period. Do not rinse. A facility document review was conducted. The document titled Equipment and Supplies dated 2018 indicated, . Have the correct detergent for cleaning assignment .thoroughly rinse the .surface after cleaning .A sanitizer is recommended for .surfaces which have direct contact with food .Recommend bucket with separate compartments labeled for wash and rinse solutions .two separate containers are necessary . 10. On 12/06/21 at 8:04 A.M., an interview and observation were conducted during the dish washing process with [NAME] 1. Observed counter on the clean side of dishwasher had food debris under clean dishes and clean dish racks. [NAME] 1 stated the food must be coming off dishes after they have been washed. On 12/07/21 8:51 A.M., an observation and interview were conducted with the facility's Registered Dietitian (RD) and the Food and Nutrition Services Director (FANSD). Observed food particles (a cube of meat, pieces of what appeared to be carrots) again on the clean side of dishwasher counter under gray dish racks that contain clean dishes in them. The FANSD stated there should not be any food on the clean side of the dishwasher counter. The FANSD and RD acknowledged that the food particles on clean side of counter underneath the clean racks of clean dishes could pose a health risk to the residents if the dishes became contaminated. According to the 2017 Federal Food and Drug Administration (FDA) Food Code, Section 4-501.14 Warewashing Equipment, Cleaning Frequency A warewashing machine; the compartments of .basins, or other receptacles .and drainboards .shall be clean . A facility document review was conducted. The document titled Shelves Counter and Other Surfaces Including Hand Washing Sink dated 2018 indicated, 1. Wash surface with warm detergent solution following manufacturers instructions .2. Rinse with clear water using a clean sponge or cloth. Wipe dry with a clean cloth. 3. Spray with a sanitizer. Read sanitizer directions to learn how long surface is to remain wet. Use enough sanitizer to meet this time period. Do not rinse. 555545 Page 12 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A facility document review was conducted. The document titled Equipment and Supplies dated 2018 indicated, . Have the correct detergent for cleaning assignment .thoroughly rinse the .surface after cleaning .A sanitizer is recommended for .surfaces which have direct contact with food .Recommend bucket with separate compartments labeled for wash and rinse solutions .two separate containers are necessary . According to the 2017 Federal Food and Drug Administration (FDA) Food Code, Section, 2017 4-601.11) Equipment .Non-food contact surfaces .Non-food contact surfaces of equipment shall be kept free from accumulation of dust, dirt, food residue, and other debris. Additionally, 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 . 11. On 12/06/21 at 8:04 A.M., an observation of the dishwashing process was conducted. Observed [NAME] 1 unloading wet dishes from dish racks after they came out of the dish washing machine and stacked the dishes on top of each other wet on a storage shelf next to the dishwashing machine counter. On 12/06/21 at 8:04 A.M., an interview and observation were conducted in the kitchen with [NAME] 1. [NAME] 1 stated they do not have room in the kitchen to air dry dishes before putting them away. [NAME] 1 stated the staff normally just stacks dishes on the racks wet because there is no room in kitchen. [NAME] 1 stated the dishwashing machine temperature needs to reach a temperature of 110 degrees to clean the dishes properly. Observation of temperature gauge on dishwasher while running read 115 degrees. On 12/06/21 at 9:06 A.M., an interview and observation were conducted during the dishwashing process with the facility's Food and Nutrtion Services Director (FANSD). The FANSD stated the dishwashing machine temperature requirement for proper cleaning of the dishes was 120 degrees. The FANSD stated they have been told by maintenance that they must run dishwashing machine two or three times in the beginning of washing to get the dishwasher temperature up to 120 degrees. Observed the dishwashing machine go through 3 cycles and the temperature gauge only reached 118 degrees. On 12/08/21 at 2:24 P.M., an interview was conducted with the facility's Administrator (ADM). The ADM stated it was her expectation that the kitchen staff will report all equipment failures to the maintenance department and that all repairs will be carried out by either the maintenance department or the appropriate contracted company. The ADM stated that it was also her expectation that any equipment repairs done in the kitchen would be verified for completion to ensure the equipment is functioning properly after the repairs. According to the 2017 Federal Food and Drug Administration (FDA) Food Code, Section 4-501.110 titled Mechanical Warewashing Equipment, Wash Solution Temperature, .(B) The temperature of the wash solution in spray-type warewashers that use chemicals to sanitize may not be less than .120 degrees F. According to the 2017 Federal FDA Food Code, Section 4-501.11, titled Equipment, Good Repair and Proper Adjustment .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 of properly cooling or holding time/temperature control for safety foods at safe temperatures. 555545 Page 13 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0812 A facility document review was conducted on 12/8/21. The document titled Dish Washing dated 2018 indicated, . Low-temperature machine: Use the machine at a range of 120-140 (degree symbol) F . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 555545 Page 14 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observations, interviews, and record reviews the facility failed to ensure essential kitchen equipment was maintained for the dish machine and a reach-in freezer according to food safety and sanitation standards of practice and facility policy. Residents Affected - Many This failure had the potential to expose residents to contaminants that could cause foodborne illness. Cross reference F802 and F812 Findings: 1. On 12/6/21 at 8:04 A.M., an observation of the dish machine and interview with a [NAME] (CK 1) was conducted. CK 1 stated the dishmachine was a low-temperature machine and the wash temperature needed to reach a temperature of 110 degrees to clean the dishes properly. An observation of the temperature gauge on dishwasher while running read 115 degrees. CK 1 stated the dish machine had to run a few times before it reached right temperature of 120 degrees Fahrenheit (F). On 12/06/21 at 9:06 A.M., an observation and interview were conducted at the dishmachine with the Food and Nutrition Services Director (FANSD). The FANSD stated the wash temperature requirement for proper dishmachine cleaning was 120 degrees F. The FANSD stated the machine had to run at least three times before it reached the 120 degrees F temperature. The dish machine ran through 3 cycles and the temperature gauge only reached 118 degrees F. The FANSD acknowledged the temperature gauge reached 118 degrees on the third time. On 12/7/21 at 9:24 A.M., an observation and interview were conducted with CK 2. CK 2 stated he had to run the dish machine a few cycles before he used it to make sure it reached 120 degrees F. CK 2 stated the dish machine has been like this for a while. On 12/8/21, a document review of the 2021 monthly kitchen Sanitation and Food Safety reports completed by the RD was conducted. The September 2021 report indicated the dish machine had to be ran 3 times before it reached 120 degrees F. According to the 2017 Federal FDA Food Code, section 4-501.110, titled Mechanical Warewashing Equipment, Wash Solution Temperature, .The temperature of the wash solution in .ware washers that use chemicals to sanitize may not be less than .120 degrees F. A facility document review was conducted on 12/8/21. The document titled Dish Washing dated 2018 indicated, . Low-temperature machine: Use the machine at a range of 120-140 degrees F . 2. During the initial kitchen tour on 12/6/21 at 7:59 A.M., an observation of reach-in freezer #2 was conducted. The freezer had condensation ice build-up on the door handle, frost collection inside the left corner of the door handle, and ice droplets in the ceiling. On 12/6/21 at 8:02 A.M., an interview was conducted with the FANSD. The FANSD acknowledged the condensation build-up and ice droplets and stated it should not be present. On 12/7/21 at 3:40 P.M., an interview was conducted with the RD. The RD stated the freezer should 555545 Page 15 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0908 not have condensation because it could affect the food stored in it. Level of Harm - Minimal harm or potential for actual harm On 12/8/21 at 8:55 A.M., an interview was conducted with the maintenance director (MTD). The MTD stated he was not informed the freezer had condensation but it was important for equipment to work correctly. Residents Affected - Many On 12/8/21 at 2:24 P.M., during an interview with the ADM, the ADM stated the expectation was for maintenence repairs to be completed and important for facility equipment to work correctly. On 12/8/21, a facility policy for maintenance repairs was requested but not provided. According to the 2017 Federal FDA Food Code, Section 4-501.111, titled Equipment, Good Repair and Proper Adjustment .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 of properly cooling or holding time/temperature control for safety foods at safe temperatures. 555545 Page 16 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0920 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide at least one room set aside to use as a resident dining room and for activities, that is a good size, with good lighting, air flow and furniture. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure the dining room space was able to safely accommodate non-feeding assistance residents who wanted to consume meals in the designated dining room space. This failure had the potential to lead to poor food intake among residents who want to eat meals in a communal dining room. Cross reference F804 Findings: On 12/6/21 at 12:16 P.M., an observation of the lunch meal service was conducted in the dining room. Four residents were seated two per table to eat their meal. There was one empty table in the dining room without any residents seated. On 12/7/21 at 12:48 P.M., an observation was conducted of the dining room. Five residents were seated in the dining room with two at one table and three at another table. There were two Rehabilitative Nursing Assistants (RNA) at each table to assist with feeding their assigned resident. There was one empty table without any residents seated. On 12/7/21, a review of Resident 48's admission Record face sheet was conducted. Per the facility's admission record, Resident 48 was admitted on [DATE] with diagnoses to include difficulty walking, type 2 diabetes mellitus (poor management of blood sugar), and protein calorie malnutrition (not enough protein to meet the body's needs). On 12/7/21 at 12:46 P.M., during the dining room observation, Resident 48 was seen in the hallway being pushed by her family member responsible party (RP) to the dining room to eat lunch. Resident 48 was stopped by the facility staff who told her to return to her room to eat lunch because the dining room was full. On 12/7/21 at 12:52 P.M., an interview was conducted with Resident 48's RP. The RP stated her mother wanted to eat in the dining room, but the facility staff told her she had to eat in her room because she was not on the list to eat in the dining room. On 12/8/21 at 9:53 A.M., an interview was conducted with the RD about resident dining. The RD stated residents could eat in the dining room if they choose or wanted too. The RD stated she was unaware of a dining list the residents had to sign up on. On 12/8/21 at 10:10 A.M., an interview was conducted with the RNA. The RNA stated the residents who ate in the dining room were on the feeding assistance list which came from physician and speech therapist referrals. The RNA stated residents who don't require feeding assistance sometime eat outside in the courtyard area and some eat in their rooms. However, the RNA stated they can all eat in the dining room if they choose to, if there is space due to covid-19 precautions. The RNA stated the room could safely seat five to six residents during meals. 555545 Page 17 of 18 555545 12/09/2021 The Cove at LA Jolla 7160 Fay Avenue LA Jolla, CA 92037

F 0920 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 12/8/21, a review of Resident 43's admission Record face sheet was conducted. Per the facility's admission Record, Resident 43 was admitted on [DATE] with diagnoses to include Gastro-esophageal reflux disease (GERD) and protein-calorie malnutrition (not enough protein to meet the body's needs). On 12/8/21 at 10:30 A.M., an interview was conduceted with Resident 43. Resident 43 stated she eats her meals in her room and sometimes outside. She stated she does not need assistance with feeding and did not know she had to be on a list to eat in the dining room. On 12/8/21 at 2:25 P.M., an interview was conducted with the ADM. The ADM stated all residents can eat in the dining room if they choose to because they follow covid-19 prevention safety precautions for the residents. The ADM further stated it was important for residents to have an enjoyable eating experience while at the facility. Per the Centers for Disease Control and Prevention (CDC) SARS-CoV-2, guidance document dated September 10, 2021, titled Interim Infection Prevention and Control Recommendations to Prevent SARS-CoV-2 Spread in Nursing Homes in Nursing Homes & Long-Term Care Facilities and revised Quality Services Organization (QSO) 20-39 NH indicated .fully vaccinated residents who are not in isolation or quarantine may eat in the same room without physical distancing .if any unvaccinated residents are dining in a communal area (e.g., dining room) all residents should use source control when not eating and unvaccinated patients/residents should continue to remain at least 6 feet from others (e.g., limited number of people at each table and with at least six feet between each person) . A facility policy on dining was requested but was not provided. 555545 Page 18 of 18