Health inspection·November 4, 2021

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. 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 document review, the facility failed to manage the nutritional needs for one (Resident 2) of 4 sampled residents with kidney failure receiving dialysis treatment (process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally) and transferred from the hospital for a leg fracture and management of wounds. This failure had the potential for Resident 21 to not receive the right amount of nutrients to help build muscle, repair wounds and fight infection. Residents Affected - Few Findings: During an observation and concurrent interview on 11/3/, at 2:20 p.m., Resident 21 stated he had a broken left leg and did not get out of bed unless it was for his dialysis treatments scheduled three days a week. At the bedside, Resident 21 was drinking orange juice from a cup. During a review of the meal card for Resident 21, dated 11/3/21, indicated a diet order of Regular. Review of the hospital Discharge summary dated [DATE], indicated Resident 21 had a left tibia-fibula fracture, was cleared for a regular diet with 2 gram potassium by his kidney doctor. During a review of the medical record note, Nutritional Screen and Assessment, dated 9/29/21, indicated the Registered Dietician (RD 1) noted Resident 21 ate well with preferences honored, awaiting return call from hemodialysis to coordinate care, and the resident prefers a potassium restricted regular diet at this time. During an interview on 11/4/2,1 at 1:55 p.m., the Registered Dietician (RD 1) stated he had not heard from the dialysis clinic dietician to coordinate nutritional care for Resident 21. RD 1 further stated he did not follow-up with the dialysis facility because laboratory results were within the normal range and Resident 21 was okay to be on a Regular diet. RD 1 reviewed the medical record and verified that the physician order was for a Regular diet with 2 gram potassium. RD 1 stated oh, he is on a 2 gram potassium. Review of the facility's Diet Order, dated 9/24/21, indicated Regular diet. Potassium 2 gram for dietary. Review of the care plan dated 9/24/21, for impaired nutritional and hydration status related to End Stage Renal Disease with hemodialysis indicated Diet as ordered: Regular. Review of the Renal [kidney] Progress Note, dated 9/24/21 indicated to change diet to cardiac low salt low potassium with 1 liter per day fluids. During an interview on 11/4/21, at 2:35 p.m., the dialysis RD 2, stated Resident 21 was on a Page 1 of 5 555570 555570 11/04/2021 Oakland Heights Nursing and Rehabilitation 2361 East 29th Street Oakland, CA 94606

F 0698 regular diet with 2 gram potassium limit. RD 2 further stated orange juice is not ideal for Resident 21 because it has high potassium content. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 555570 Page 2 of 5 555570 11/04/2021 Oakland Heights Nursing and Rehabilitation 2361 East 29th Street Oakland, CA 94606

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 label and store food under sanitary conditions when: Residents Affected - Few 1. Refrigerated food without month, date, and year available for use: a. Mayonnaise and salad dressing. b. Green and white substance on a lemon found in a box of lemons. 2. Open container of soy sauce 3. Spices were not labeled with date received, opened or expiration date. This failure had the potential to place the residents at risk for developing foodborne illness. Findings: 1. During an observation on 11/1/21 at 9:18, of the walk-in refrigerator a gallon size jar of mayonnaise, a gallon size container of salad dressing both which was two thirds full, had no date to show when it was opened or when the contents expired. The salad dressing had visible residue on the outside of the container. In addition, a box of lemons contained a lemon with a green and white substance on it. 2. During an initial observation on 11/1/21 at 9:45, of the dry storage room, one gallon plastic jug of soy sauce was open. One quarter of the container had dark liquid with black dried residue drippings on the outside of the container and it did not have an open date. 3. During an observation on 11/3/21, at 12:52, six 32-ounce dry spice containers of meat tenderizer, white sesame seeds, ground cayenne pepper, ground cumin, powdered onion and ground coriander were opened, partially used, and did not have a received date. 555570 Page 3 of 5 555570 11/04/2021 Oakland Heights Nursing and Rehabilitation 2361 East 29th Street Oakland, CA 94606

F 0812 Level of Harm - Minimal harm or potential for actual harm During an interview on 11/4/21, at 11:50 a.m., the Diet Services Manager (DSM) stated the staff should put received dates on spices, not the use by dates. The DSM also stated staff were expected to check the facility's food storage guidance to ensure the food items were not expired before using. Residents Affected - Few 555570 Page 4 of 5 555570 11/04/2021 Oakland Heights Nursing and Rehabilitation 2361 East 29th Street Oakland, CA 94606

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and document review, Registered Nurse (RN 1) did not disinfect the blood pressure cuff, thermometer, and pulse oximeter between resident use for four ( Resident 1, 22, 41 and 91) of 7 sampled residents. This failure had the potential for the transmission of communicable diseases and infection. Residents Affected - Some Findings: . During medication pass observations on 11/3/21, at 10:57 a.m. to 11:39 a.m., RN 1 checked each resident's blood pressure, oxygen saturations, and temperatures prior to administering their prescribed medications. RN 1 used a blood pressure cuff, pulse oximeter and temporal thermometer that RN 1 placed on each of the resident's side tables and beddings. After using these equipment on the residents, RN 1 stored them on the nursing cart without disinfection and no disinfection before using them for the next residents. During an interview on 11/3/21, at 11:56 a.m., RN 1 stated the blood pressure cuff, pulse oximeter and temporal thermometer needed cleaning and disinfection prior to returning items to the medication cart due to the risk of spread of infection. RN 1 stated she thought she disinfected the supplies before and after each use on the residents. During an interview on 11/4/21, at 10:30 a.m., the Director of Staff Development (DSD) stated equipment should be disinfected between patient use to avoid the spread of infection. 555570 Page 5 of 5