Health inspection·March 7, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on interview and record review, this requirement was not met when a Certified Nursing Assistant (CNA 1) yelled, Don't yell at me to one of 16 sampled residents (Resident 6), and was loud enough that Resident 75, Resident 20, and visiting family members (FAM 1) overheard it. This had the potential to compromise Resident 6's dignity and negatively impact other resident's emotional and psychosocial well-being and create an environment of fear. Findings: Resident 6's admission Record was reviewed and indicated that Resident 6 was admitted to the facility for conditions including dementia (a disease that causes memory and thought processes to deteriorate). Review of the facility's policy titled, Promoting/Maintaining Resident Dignity, dated January, 2023 indicated, It is the practice of [the facility] to protect and promote resident rights and treat each resident with respect and dignity . The policy further stated, 1. All staff members are involved in providing care to residents to promote and maintain resident dignity and respect resident rights; and, 10. Speak respectfully to residents; avoid discussions about residents that may be overheard. Review of the facility's document titled, Allegation of Abuse, dated 3/6/24, indicated that CNA 1 was witnessed yelling aggressively and loudly at a patient with dementia [Resident 6], witnessed by the charge nurse, Registered Nurse (RN) 2 and other visitors and had made the visitors, jump. The record further indicated that CNA 1 had violated hospital policies pertaining to Professional Code of Conduct and Promoting/Maintaining Resident Dignity. In an interview on 3/4/24 at 10:55 AM, Resident 75 stated that her FAM 1 overheard staff and a resident yelling across the hall. The man across the hall is very noisy all the time, always yelling at people. Resident 75 stated that she had heard staff yelling back. In an interview on 3/4/24 at 11:55 AM, Resident 20, whose room is next to Resident 6's, stated, The gentleman next door is very loud, yells every day at staff. CNAs yell back, it's very loud here. In an interview on 3/5/24 at 1:04 PM, CNA 1 stated that on 3/1/24, she was helping Resident 6 put on his foot braces. He had been yelling at me all day long, and when he yelled at me again, I used my 'mom voice' and yelled back at him. I apologized, I was frustrated. In an interview on 3/05/24 at 2:12 PM, Interim Director of Nursing (IDON) stated that she was the Page 1 of 15 555588 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few first supervisor to receive a call from Licensed Vocational Nurse (LVN) 1 who was charge nurse that afternoon. IDON stated that LVN 1 reported that she heard CNA 1 speaking loud and yelling at resident across the hall. They argued back and forth. IDON stated that in all such instances, the staff member had to be taken off of the nursing floor while the incident was investigated. In an interview on 3/5/24 at 1:37 PM, Resident 75's FAM 1 stated that on 3/1/24, she was visiting her mother, whose room is directly across the hall from Resident 6. FAM 1 stated that she overheard a CNA across the room raising her voice and yelling at a resident in a loud tone, and was then overheard swearing in the hall. In an interview on 3/6/24 at 9:05 AM, LVN 1 stated that she was with a resident's family across the hall and heard CNA 1 yelling at Resident 6, I don't care, don't yell at me! this was loud enough that two family members overheard it and were startled by it. LVN 1 further stated that she was alarmed by the tone of voice used by CNA 1 to Resident 6, and that she reported this because the manner in which CNA 1 spoke to Resident 6 violated the facility's Code of Conduct. 555588 Page 2 of 15 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician. Based on interview and record review, the facility failed to ensure federal regulations related to the education qualification requirements of the Certified Dietary Manager (CDM), were followed as outlined in the California Health and Safety Code (HSC 1265.4). This failure had the potential to result in inadequate oversight of the food and nutrition services department associated with meal distribution accuracy, safe food handling and sanitation guidelines. Findings: According to the HSC 1265.4 a CDM, (4) Is a graduate of a dietetic services training program approved by the Dietary Managers Association and is a certified dietary manager credentialed by the Certifying Board of the Dietary Managers Association, maintains this certification, and has received at least six hours of in-service training on the specific California dietary service requirements contained in Title 22 of the California Code of Regulations prior to assuming full-time duties as a dietetic services supervisor at the health facility. On 3/5/24 at 8:34 AM, an interview was conducted with the CDM. The CDM stated that he completed the CDM course through an online university from North Dakota. The CDM stated he was not aware of the requirement of six hours of training on specific California dietary service requirements contained in Title 22 of the California Code of Regulations as specified in the HSC 1265.4, and that he had not met this requirement. On 3/6/24 at 8:25 AM, an interview was conducted with the Facility Administrator (FA). The FA stated she was not aware of the requirement of six hours of training on specific California dietary service requirements contained in Title 22 of the California Code of Regulations as specified in the HSC 1265.4. 555588 Page 3 of 15 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

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 record review, the facility failed to ensure that their facility cooks (FC), were trained to safely prepare food and adhere to sanitation requirements in the kitchen when: Residents Affected - Some 1. FC3 did not thaw chicken in accordance with their food safety policy; and 2. FC1 did not perform hand hygiene after removing gloves; and 3.FC1 did not have knowledge of how to properly conduct manual dishwashing procedures, (when dishes are washed in a sink by hand, instead of in a dishwasher). These failures had the potential to increase the risk of food contamination with bacteria and subject the residents to food borne illness such as stomach cramps, nausea, vomiting and diarrhea. Findings: 1. Review of a facility provided record titled, Performance & Goal Review Form dated 2/28/24, indicated that the facility's Certified Dietary Manager (CDM), determined FC3 was compliant with all facility policies. Review of a facility provided record titled, Job Description and Competencies indicated facility cooks would complete a California approved food handling course, maintain high standards of food quality, prevent cross contamination, and be knowledgeable in sanitation practices. Review of a facility policy titled, Employee Sanitation Practices last reviewed on 1/1/2023, and in effect, indicated that fish and poultry would be thawed in the refrigerator below 40 degrees Fahrenheit (F). And any meat thawed under running water would be fully submerged and completely thawed in less than two hours. Additionally, the policy indicated that meats thawed under running water would be fully prepared and cooked within four hours of removal from the freezer. During an interview with FC3 on 3/4/2024 at 10:39 AM, it was observed that there were two plastic tubs of completely frozen chicken (approximately 20 -30 pounds) thawing in a sink. FC3 confirmed that it was chicken, and it was going to be cooked the next day, Tuesday 3/5/24. FC3 indicated it was alright to thaw chicken under running water and stated, there is no log used to record when the meat was removed from the freezer or how long it was left under running water. FC3 indicated that the meat would be left under the running water until it was completely thawed, and then it would be stored in the refrigerator until it was cooked. FC3 stated, I do not know how long it will take to thaw the meat, and indicated she checked on the chicken every 30 to 45 minutes until thawed. During a kitchen tour on 3/4/2024 at 2:38 PM, it was observed that the chicken thawing at 10:39AM, was still thawing under running water in the sink. FC3 confirmed the chicken was placed in the sink around 10:30 AM (about 4 hours prior), and that it was going to be stored in the refrigerator, until the next day, when it was going to be cooked and served. During an interview on 3/4/24 at 2:40 PM, Registered Dietitian (RD) 1 confirmed that meat can only thaw under running water for a maximum of two hours and all meats thawed under running water should 555588 Page 4 of 15 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some be prepared within four hours of removal from the freezer. RD1 indicated that meat thawed under running water cannot be stored in the refrigerator for future use and indicated the chicken observed thawing under running water would be disposed of. During an interview on 3/5/24 at 8:40 AM, the Certified Dietary Manager (CDM) confirmed that the facility preference is for meat to be thawed in the refrigerator and indicated that chicken should not be thawed in the sink under running water. And stated, we only thaw meat under running water when we need to thaw it fast, and indicated was only done occasionally when staff was not available to remove the meat from the freezer. The CDM confirmed that meat thawed under running water needed to be prepared within four hours of removing it from the freezer, and that the thawing process must be completed within two hours. The CDM confirmed that the chicken should not be thawed under running water and indicated it should only be thawed in the refrigerator. The CDM indicated that the chicken thawed in the sink on 3/4/24 was discarded due to unsafe handling. 2. Review of a facility provided record titled, Job Description and Competencies indicated facility cooks would apply handwashing principles, complete a California approved food handling course, maintain high standards of food quality, prevent cross contamination, and be knowledgeable in sanitation practices. Review of a facility policy titled, Employee Sanitation Practices last reviewed on 1/1/2023, and in effect, indicated staff would wash hands with soap and hot water for a minimum of 20 seconds after handling soiled equipment, before handling any clean equipment and utensils (silverware), and before donning gloves. Review of a facility policy titled, Dishwashing and Pot washing last reviewed 1/1/23 and in effect, indicated all staff must perform hand hygiene before handling any clean dishware. Review of a facility provided document titled, Core Competency Demonstration Cook indicated that FC1 was competent at performing hand hygiene and followed approved procedures. During a kitchen tour on 3/4/24 between 10:21 AM and 10:41 AM, FC1 was observed handling dirty dishes, removing soiled gloves, and then donning clean gloves without performing hand hygiene prior to handling clean dishware three separate times, at 10:21 AM, 10:29 AM and 10:41AM. During an interview on 3/4/24 at 10:41 AM, RD1 confirmed that FC1 should perform hand hygiene after removing soiled gloves, before donning clean gloves, and before handling clean dishware. During an interview on 3/4/24 at 10:42 AM, FC1 indicated he did not know he should wash his hands after removing dirty gloves, before donning clean gloves, and before handling clean dishes and silverware. During an interview on 3/5/24 at 11:22 AM, the CDM confirmed that staff should perform hand hygiene after touching dirty items or surfaces, removing dirty gloves, before donning clean gloves, before touching any clean dishes or silverware, working with any food prep items, and before handling food. 3. According to USDA Food Code 2022, Section 4-501.19 Manual Ware washing Equipment, Wash Solution Temperature. The temperature of the wash solution in manual shall WARE WASHING EQUIPMENT, be maintained at not less than 43 degrees Celcius (C, a unit of measuring temperature), or 110 degrees 555588 Page 5 of 15 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Fahrenheit (F, a unit of measuring temperature), or the temperature specified on the cleaning agent manufacturer's label instructions. Review of facility provided records titled, Job Description and Competencies indicated facility cooks would compete a California approved food handling course, would maintain high standards of food quality, prevent cross contamination, and be knowledgeable in sanitation practices. Review of a facility provided document titled, Core Competency Demonstration, Cook indicated that FC1 was competent at cleaning and sanitizing dishware, utensils, and work areas. And indicated that FC1 was competent in the dish room and able to effectively clean and sanitize all dishware used for tray line (where food is placed on trays for the residents). Review of a facility provided document titled, Dietary In-Service Notes, on 8/9/23 indicated that the facility CDM provided education on manual dishware washing to FC1. And the printed handout included with the education indicated that the dishware washing solution only needed to be 100 degrees F or the temperature on the cleaning agent manufactures label. And that the dishware should soak in the sanitizing solution for at least 30 seconds. Review of an undated facility posting in the manual ware washing room titled, Three Compartment Sink Procedures indicated that the wash water temperature needed to be a minimum of 110 degrees F, and that the dishware must be completely submerged in the sanitizing solution for a minimum of one minute. During a kitchen tour and concurrent interview on 3/5/24 at 2:02 PM, FC1 indicated he did not know what the water temperature should be when manually washing dishware and was referred to the poster on the wall that indicated the wash water needed to be maintained at a minimum of 110 degrees F. FC1 stated, the dishware should soak in the sanitizer for about 30 seconds. FC1 demonstrated the process used to test the dishware sanitizing solution. It was observed that FC1 submerged the test strip into the dishware sanitizing solution, then removed it immediately, and did not follow the test strip manufactures instructions (printed on the package). FC1 was referred to the test strip package that indicated that test strip should be submerged in the sanitizing solution for five seconds, removed form the solution and then analyzed. FC1 was observed resubmerging the same test strip into the sanitizing solution for more than five seconds, and then indicated the sanitizing solution was the appropriate concentration. 555588 Page 6 of 15 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

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 that Food and Nutritional Services staff followed food safety and sanitation guidelines when: Residents Affected - Many 1. Meat was not thawed properly. 2. Hand hygiene was not consistently performed. 3. The dish machine water temperature did not meet the manufacturer specified guidelines. 4. One hand washing sink in the food service area, did not have hot water. 5. Two of three ice machines were not clean. 6. The sanitizing storage process used for wiping cloths was not followed. 7. Hair restraints were not consistently used by kitchen and maintenance staff. 8. Food preparation equipment was not in good working order. 9. Food was stored in a used non-approved storage container. 10. Clean dishware was stored in soiled containers. 11. Two knife holders were not clean. These failures had the potential to increase the risk of food contamination and food borne illnesses, and subject the residents who ate food from the kitchen, to stomach cramps, nausea, vomiting and diarrhea. Findings: 1. Review of a facility policy titled, Employee Sanitation Practices, last reviewed on 1/1/2023 and in effect, indicated that meat would be thawed in the refrigerator below 40 degrees Fahrenheit (F a unit of measuring temperatures). And any meat thawed under running water would be fully submerged and completely thawed in less than two hours. Additionally, the policy indicated that meats thawed under running water would be fully prepared and cooked within four hours of removal from the freezer. During an interview and concurrent kitchen tour with Registered Dietitian (RD) 1 on 3/4/24 at 9:57 AM, it was observed that there was meat thawing in a sink under running water. RD1 confirmed that there was a pork shoulder (approximately 30-40 pounds), thawing under running water and indicated the meat had been removed from the freezer at approximately 8:57 AM. RD1 indicated that the pork will not be cooked for two days, which will be on Wednesday 3/6/24. During an interview with a Facility [NAME] (FC) 3 on 3/4/2024 at 10:39 AM, it was observed that there was chicken thawing in a sink. FC3 confirmed that the meat was chicken, and it was going to be cooked the next day, Tuesday 3/5/24. FC3 indicated it was alright to thaw the chicken under running 555588 Page 7 of 15 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0812 Level of Harm - Minimal harm or potential for actual harm water and stated, there is no log used to record when the meat was removed from the freezer or how long it was left under running water. FC3 indicated that the meat would be left under the running water until it was completely thawed, and then it would be stored in the refrigerator until it was cooked. FC3 stated, I do not know how long it will take to thaw the meat, and indicated the meat was checked on every 30 to 45 minutes, until thawed. Residents Affected - Many During a kitchen tour on 3/4/2024 at 2:38 PM, it was observed that the chicken thawing since 10:39AM, was still thawing under running water in the sink. FC3 confirmed the chicken was placed in the sink around 10:30 AM (about 4 hours prior), and that it was going to be stored in the refrigerator until the next day when it was going to be cooked and served. During an interview on 3/4/24 at 2:40 PM, RD1 confirmed that meat can only thaw under running water for a maximum of two hours and all meats thawed under running water should be prepared within 4 hours of removal from the freezer. RD1 indicated that meat thawed under running water can not be stored in the refrigerator for future use and indicated the pork and chicken observed thawing under running water would be disposed of. During an interview on 3/5/24 at 8:40 AM, the Certified Dietary Manager (CDM), confirmed that the facility preference is for meat to be thawed in the refrigerator and indicated that chicken should not be thawed in the sink under running water. And stated, we only thaw meat under running water when we need to thaw it fast, and indicated was only done occasionally when staff was not available to remove the meat from the freezer. The CDM confirmed that meat thawed under running water needed to be prepared within four hours of removing it from the freezer, and that the thawing process must be completed within 2 hours. The CDM confirmed that the pork and chicken previously observed thawing under running water on 3/4/24, should have been under the running water for no more than 2 hours. The CDM indicated that the meat needed to be cooked within four hours and should not have been placed back into the refrigerator after the thawing process. The CDM indicated that the chicken and pork that was thawed in the sink on 3/4/24, was discarded due to the unsafe handling of the meat. 2. Review of a facility policy titled, Employee Sanitation Practices last reviewed on 1/1/2023 and in effect, indicated staff would wash hands with soap and hot water for a minimum of 20 seconds after handling soiled equipment, before handling any clean equipment and utensils (silverware), and before putting on gloves. Review of a facility policy titled, Dishwashing and Pot washing last reviewed 1/1/23 and in effect, indicated all staff must perform hand hygiene before handling any clean dishware. During a kitchen tour on 3/4/24 between 10:21 AM and 10:41 AM, FC1, was observed handling dirty dishes, removing soiled gloves, and then putting on clean gloves without performing hand hygiene, prior to handling clean dishware three at separate times, 10:21 AM, 10:29 AM and at 10:41AM. During an interview on 3/4/24 at 10:41 AM, RD1 confirmed that FC1 should have performed hand hygiene after removing soiled gloves, before putting on clean gloves, and before handling clean dishware. During an interview on 3/4/24 at 10:42 AM, FC1 indicated that he did not know he should wash his hands after removing dirty gloves, before putting on clean gloves, or before handling clean dishware. During an interview on 3/5/24 at 11:22 AM, the CDM confirmed that staff should perform hand hygiene after touching dirty items or surfaces, removing dirty gloves, before putting on clean gloves, 555588 Page 8 of 15 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0812 before touching any clean dishware, working with any food prep items, and before handling food. Level of Harm - Minimal harm or potential for actual harm 3. The National Sanitation Foundation (NSF) guidelines (instructions) posted on the facility's dishwashing machine indicated that the minimum temperatures for both washing and rinsing dishes, must be at least 130 degrees F. Residents Affected - Many Review of a facility policy titled, Physical Plant and Equipment Department Security last reviewed 1/1/23 and in effect, indicated that equipment is operated according to manufacturer's instructions. Review of a facility's policy titled, Dishwashing and Pot washing last reviewed 1/1/23 and in effect, indicated that the water temperature should be 120 degrees F or higher, to clean and sanitize dishes using a chemical (cleaning solutions), sanitization process. During a kitchen tour and concurrent interview with FC1 on 3/4/2024 at 10:29 AM, it was observed that the dishwasher water washing temperature reached 102 degrees F, and the rinse water temperature reached 115 degrees F. FC1 indicated that the water temperature only needed to reach 120 degrees F and stated, sometimes it needs to run a few cycles to get to 120 degrees. FC1 confirmed that the dishes he had just processed only reached 118 degrees F and stated, it could be an issue with the fuse. FC1 ran the dishwashing machine through four cycles and the water temperature was observed reaching a maximum temperature of 120 degrees F. During a kitchen tour observation, review of dishwashing temperature logs, and concurrent interview on 3/4/2024 at 10:43 AM, RD1 confirmed that the facility uses a chemical sanitization dishwashing process and indicated that the water temperature was monitored and recorded in a logbook each shift. A review of the logbook contained printed guidance indicating that the dish machine minimum wash water temperature must be between 120 and 140 degrees F, and that the rinse cycle should reach 130 degrees F. The log dated March 2024, reflected that there were three days where the dish machine's washing and rinsing water temperatures recorded, only reached 125 degrees F. It had been observed during the kitchen tour, that the actual wash and rinse temperatures did not reach 120 degrees F during several wash and rinse cycles when FC1 processed soiled dishes. RD1 confirmed by observation that the dishwashing machine water was not reaching 120 degrees F. RD1 confirmed that the manufacturer's instructions for the dishwashing maching specified that wash and rinse water temperatures should be 130 degrees F, whereas their logbook guidance indicated temperatures between 120 and 140 degrees F, were acceptable. RD1 indicated she was not sure why the water temperature directions were different. FC1 indicated that she would place a maintenance request and inform the facility's CDM. A record review of the facility's, Dish Machine Temperature logbook from October 1, 2023 through February 29, 2024, indicated that on 139 of 152 days, the water temperatures recorded by staff, fell below the manufacturer's specified temperature of 130 degrees F. During an interview on 3/5/24 at 8:47 AM the CDM indicated that the dishwashing machine is a low temperature machine, and it uses chemicals to clean and sanitize the dishware. The CDM confirmed that the logbook used to record the dishwashing machine water temperatures indicated that a range of 120° to 140° is acceptable, and indicated he was aware that the manufacturer specifications for this dishwashing machine required a water temperature no less than 130°F. 4. According to the United States Department of Agriculture (USDA) Food Code 2022, Section 5-202.12 Handwashing Sink, Installation (A) A HANDWASHING SINK shall be equipped to provide water at a 555588 Page 9 of 15 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0812 temperature of at least 85 degrees F. Level of Harm - Minimal harm or potential for actual harm Review of a facility policy titled. Physical Plant and Equipment Department Security last reviewed 1/1/23 and in effect, indicated that handwashing stations would have hot water. Residents Affected - Many During a tour of the facility's kitchen on 3/4/24 at 9:30 AM, it was observed that one of three handwashing sinks (the sink near the resident meal tray line preparation area), did not have functioning hot water. During an interview on 3/4/24 at 9:50 AM, RD1 confirmed that the handwashing sink near the tray line preparation area did not have functioning hot water and confirmed that staff had not reported the nonfunctioning hot water. 5. According to the USDA Food Code 2022 Section 4-601.11 Equipment, Food-Contact Surfaces, Nonfood-Contact Surfaces, and Utensils, (A) Equipment, food-contact surfaces and utensils shall be clean to sight and touch. During an observation of the ice machine cleaning process with the Regional Director of Plant Operations (RPO), on 3/4/24 at 3:12 PM, it was observed that there was calcification build-up (minerals cause the surface to become rough which makes it easy for germs to stick to that surface), in contact with the ice in two of three facility ice machines, one in the dining room and one in the nourishment room. The plastic ice chute and drip tray on the ice machine in the nourishment room was observed to be worn and had white calcified mineral deposits built up on the surfaces. The RPO confirmed that the ice machines in the dining and nourishment rooms were not clean and had calcified deposits in contact with the ice. The RPO and indicated the plastic chute and drip tray needed to be replaced, I routinely clean the ice machines every six months. 6. According to the USDA Food Code 2022 Annex Section 3-304.14 Wiping Cloths, Use Limitation: Soiled wiping cloths, especially when moist, can become breeding grounds for pathogens that could be transferred to food. Any wiping cloths that are not dry (except those used once and then laundered) must be stored in a sanitizer solution of adequate concentration between uses. Wiping cloths soiled with organic material can overcome the effectiveness of, and neutralize, the sanitizer. The sanitizing solution must be changed as needed to minimize the accumulation of organic material and sustain proper concentration. Proper sanitizer concentration should be ensured by checking the solution periodically with an appropriate chemical test kit. During a facility kitchen tour on 3/5/24 at 10:44 AM, it was observed that the red sanitizing bucket in the food preparation sink had large amounts of food debris (organic material) in the sanitizing solution and the cloth in the sanitizing solution was visibly soiled and not completely submerged in the sanitizing solution. During an interview on 3/5/24 at 10:44 AM, FC4 confirmed that the sanitizing solution in the red bucket had food debris in it and that the sanitizing solution needed to be changed. During an interview on 3/5/24 at 10:50 AM, the RDM confirmed that the facility did not have a log to keep track of when the sanitizing solution was changed and indicated that it should be changed every two hours. 7. According to the USDA Food Code 2022 Section 2-402.11 Hair Restraints, effectiveness. 555588 Page 10 of 15 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Food employees shall wear hair restraints such as hats, hair coverings or nets, beard restraints, and clothing that covers body hair, that are designed and worn to effectively keep their hair from contacting exposed food, clean equipment, and utensils. Review of a facility policy titled, Employee Sanitation Practices, reviewed 1/1/23 and in effect, indicated that hair would be kept clean and covered with a cap or hair net and beards and mustaches will be covered. During a kitchen tour and observation with RD1 on 3/4/24 at 10:45 AM, FC4 was observed preparing food without a hairnet and instead was wearing a ball cap which exposed his hair and the hair on his arms was not covered. RD1 confirmed that FC4 was not wearing a hair net and should be. During an ice machine maintenance demonstration in the kitchen on 3/4/24 at 2:57 PM, with RD1 it was observed that RPO had facial hair and did not have a facial hair covering on. RD1 confirmed that RPO should have worn a facial hair cover while in the kitchen and when maintaining the ice machine. During an interview on 3/5/24 at 10:56 AM, the CDM indicated that he was not aware kitchen staff needed to cover body hair on the arms and stated, long sleaves are not sanitary. 8. According to the USDA Food Code 2022 Section 4-201.11 Equipment and Utensils: Equipment and utensils must be designed and constructed to be durable and capable of retaining their original characteristics so that such items can continue to fulfill their intended purpose for the duration of their life expectancy and to maintain their easy cleanability. If they cannot maintain their original characteristics, they may become difficult to clean, allowing for the harborage of pathogenic microorganisms, insects, and rodents. Equipment and utensils must be designed and constructed so that parts do not break and end up in food. During a facility kitchen tour on 3/4/24 at 9:43 AM, it was observed that three cooking pans had visible wear and chipping to the surface coating, two cutting boards had wear, grooves, and material that easily chipped away, and a can opener blade was worn and a had thick dried dark substance accumulated at the base of the blade. RD1 confirmed that the can opener blade was not clean and should be replaced, that the pans were worn and should be replaced, and indicated that cutting boards with deep grooves or loose material that can easily dislodge needed to be replaced. 9. The USDA Food Code 2022 defines single use articles such as plastic tubs or buckets which do not meet the materials, durability, strength, and cleanability as specified under sections 4-101.11, 4-202.11 for multi-use utensils. During a facility kitchen tour on 3/5/24 at 10:55 AM, a plastic container labeled, baking powder was observed. The CDM indicated that the plastic container now labeled baking powder, was originally a mashed potato container and that thought it was alright to reuse the mashed potato container to store other dry foods. 10. According to the USDA Food Code 2022 Section 4-601.11 Equipment, Food-Contact Surfaces, Nonfood-Contact Surfaces, and Utensils, (A) Equipment, food-contact surfaces and utensils shall be clean to sight and touch. Review of a facility policy titled, Dishwashing and Pot washing reviewed 1/1/23 and in effect, indicated that food storage equipment must be washed and sanitized before clean dishes are stored. 555588 Page 11 of 15 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During a kitchen tour on 3/5/24 at 10:50 AM, it was observed that there were four bins containing dishware on the clean side of the dish room. Debris and fluid were in the bottom of four out of four bins. The CDM confirmed that the four bins contained clean dishes, that there was debris and fluid accumulated in all four bins, and confirmed that the clean dishware had not been stored properly. 11. According to the USDA Food Code 2022 Section 4-601.11 Equipment, Food-Contact Surfaces, Nonfood-Contact Surfaces, and Utensils, (A) Equipment, food-contact surfaces and utensils shall be clean to sight and touch and the objective of cleaning focuses on the need to remove organic matter from food-contact surfaces so that sanitization can occur and to remove soil from nonfood contact surfaces so that pathogenic microorganisms will not be allowed to accumulate. During a facility kitchen tour on 3/4/24 at 10 AM, it was observed that debris had accumulated on top of two of two knife holders in the food preparation area. RD1 confirmed that there was debris on top of two of two knife holders in the food preparation area and that the two knife holders should be cleaned. 555588 Page 12 of 15 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0813 Have a policy regarding use and storage of foods brought to residents by family and other visitors. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure that their, Food from Outside Sources policy (outside sources are food from any other source than the facility's kitchen), included procedures on how to heat or reheat resident food that had been brought in from the outside or contained education for staff and visitors on safe food handling practices and potentially hazardous foods, (PHF-food that allows for rapid progression and growth of bacteria; such as food that consists in whole or part of milk, milk products, eggs, meat, poultry, rice, fish shellfish, edible crustaceans, raw-seed sprouts, and vegetables including heat-treated vegetables). Residents Affected - Few This failure had the potential for residents who received food from a source to be subjected to contaminated food and food borne illnesses such as stomach cramps, nausea, vomiting, diarrhea and food poisoning. Findings: Review of the facility's policy titled, Food from Outside Sources reviewed 1/22, indicated patients are encouraged to consume facility meals, snacks and supplements to assure adequate nutrition and reduce the risk of contamination. To support patient's nutrient intake, foods from outside sources may be provided to patients with appropriate storage and handling. Procedure: 3. Potentially hazardous foods may not be stored in patient rooms and should be eaten upon receipt. Review of the facility's document titled, Outside Food Storage undated, indicated, Staff cannot reheat your food for you. Review of the facility's document titled, Patient Foods Brought From Outside Facility written by the facility's Certified Dietary Manager, indicated hot items brought into the facility for residents, should be consumed within one hour to ensure food safety and cannot be kept and reheated. On 3/4/24 at 11:54 AM, an interview was conducted with Licensed Vocational Nurse (LVN) 1 regarding food brought to the facility from outside sources. When asked if LVN 1 had received education on safe food handling, LVN 1 stated, For the most part, yes. When asked how visitors were educated on safe food handling, LVN 1 stated the facility provided visitors with a copy of the policy on food from outside sources upon admission. On 3/5/24 at 9:30 AM, an interview was conducted with LVN 1. LVN 1 stated the facility did not heat or reheat food from outside sources because they could not regulate the temperature of the food. On 3/5/24 at 2:21 PM, an interview was conducted with the Director of Staff Development (DSD). When asked if facility staff had been educated on safe food handling, the DSD indicated that she went over the policy on food from outside sources and that the education on safe food handling was the Registered Dietitian's (RD) responsibility. On 3/5/24 at 2:43 PM, an interview was conducted with the RD. When asked how visitors were educated on safe food handling, the RD stated visitors were provided a copy of the facility's policy on food brought from outside sources. The RD stated she tried to review safe food handling with visitors verbally, but visitors were not provided anything in writing regarding safe food handling. The RD added the facility did not reheat food brought from outside sources because the facility staff had not been trained to check food temperatures. 555588 Page 13 of 15 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0908 Keep all essential equipment working safely. 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 record review, the facility failed to maintain essential foodservice equipment in safe operating condition when: Residents Affected - Many 1. The dish machine water temperature did not meet the manufacturer specified guidelines. 2. One hand washing sink in the food service area did not have hot water. 3. One of three ice machine storage bins was not cleaned per manufacturer specification. These failures had the potential to increase the risk of food and ice contamination, and subject the residents who ate food or used ice from the facility's kichen, to food borne illnesses such as stomach cramps, nausea, vomiting and diarrhea. Findings: 1. The National Sanitation Foundation (NSF) guidelines (instructions) posted on the facility dishwashing machine indicated that the minimum wash water temperature must be 130 degrees Fahrenheit (F, a unit of measuring temperatures), and the minimum rinse water temperature must be a minimum of 130 degrees F. Review of a facility policy titled, Physical Plant and Equipment Department Security reviewed 1/1/23 and in effect, indicated that equipment is operated according to manufacture instructions. Review of a facility policy titled, Dishwashing and Pot washing reviewed 1/1/23 and in effect, indicated that the water temperature needed to be 120 degrees F or higher, to clean and sanitize dishes using a chemical sanitization process (a process of using chemical cleaning solutions instead of very hot, over 160 degrees F, water temperatures). During a kitchen tour and concurrent interview with Facility [NAME] (FC) 1)on 3/4/24 at 10:29 AM, it was observed that the wash water temperature only reached 102 degrees F, and the rinse water temperature only reached 115 degrees F. FC1 indicated that the water temperature only needed to reach 120 degrees F, and stated, sometimes it needs to run a few cycles to get to 120 degrees. FC1 confirmed that the dishes he had just processed only reached 118 degrees F, and stated, it could be an issue with the fuse. FC1 ran the dishwashing machine through four cycles and the water temperature was observed reaching a maximum temperature of 120 degrees F. During a kitchen tour and concurrent interview on 3/4/24 at 10:43 AM, Registered Dietitian (RD) 1 confirmed that the facility uses a chemical sanitization dishwashing process and indicated water temperature was monitored and recorded in a logbook each shift. It was observed that the facility logbook contained printed guidance indicating that the dish machine minimum wash water temperature must be between 120 and 140 degrees F, and the rinse cycle should reach 130 degrees F. It was observed that on three out of three days with water temperature measurements recorded for the month of March 2024, indicated that the wash and rinse temperature only reached 125 degrees F when checked. It was observed during the kitchen tour that the actual wash and rinse temperature did not reach 120 degrees F during several wash and rinse cycles while FC1 was processing soiled dishes. RD1 confirmed by observation, that the dishwashing machine water was not reaching 120 degrees F, and that the manufacturer 555588 Page 14 of 15 555588 03/07/2024 Vibra Hospital of Northern California D/P Snf 2801 Eureka Way Redding, CA 96001

F 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many specified wash and rinse water temperature of 130 degrees F was different than the facility's logbook which specified wash and rinse water temperatures, and indicated she was not sure why the water temperatures were different. FC1 indicated that she would place a maintenance request and inform the Certified Dietary Manager (CDM). A record review of the facility's, Dish Machine Temperature logbook from 10/1/23 through 2/29/24, indicated that on 139 out of 152 days, water temperatures below the manufacturer's specified temperature of 130 degrees F were recorded by kitchen staff. During an interview on 3/5/24 at 8:47 AM, the CDM indicated that the dishwashing machine is a low temperature machine, and it uses chemicals to clean and sanitize the dishware. The CDM confirmed that the logbook used to record the dishwashing machine water temperatures indicated that a range of 120° to 140° is acceptable, and indicated he was aware that the manufacturer specifications for this dishwashing machine required a water temperature no less than 130°F. 2. According to USDA Food Code 2022, Section 5-202.12 Handwashing Sink, Installation (A) A HANDWASHING SINK shall be equipped to provide water at a temperature of at least 85 degrees F. Review of a facility policy titled, Physical Plant and Equipment Department Security reviewed 1/1/23 and in effect, indicated that handwashing stations would have hot water. During a tour of the facility kitchen on 3/4/24 at 9:30 AM, it was observed that one of three handwashing sinks (the sink near the resident meal tray line preparation area), did not have functioning hot water. During an interview on 3/4/24 at 9:50 AM, RD1 confirmed that the handwashing sink near the tray line preparation area did not have functioning hot water and confirmed that staff had not reported the nonfunctioning hot water. 3. Review of a facility policy titled, Physical Plant and Equipment Department Security reviewed 1/1/23 and in effect, indicated that equipment is operated according to manufacture instructions. Review of [NAME] ice machine manufacturer instructions provided by the facility on 3/5/24 at 2:15 PM, indicated that cleaning and sanitizing the ice machine required the use of Safe Clean (a chemical cleaning solution) for cleaning, and Calgon IMII (a chemical sanitizing solution) for sanitizing the ice storage bin. During an interview on 3/5/24 at 2:15 PM, the CDM indicated that the ice machine ice storage bin in the kitchen was cleaned monthly. CDM explained the process to turn off the machine, empty out the ice, remove the diverter plate, mix the sanitizing solution with water, clean the inside of the bin with the sanitizing solution (Calgon IMSII), rinse the bin and allow to air dry. CDM indicated that he used the dishwashing machine to clean the diverter plate, air dried the diverter plate and then reassembled the machine before turning it back on. CDM confirmed that he was only using the sanitizing solution (Calgon IMSII) and that he did not use the manufacture specified cleaning solution (SafeCLEAN) when cleaning the ice storage bin monthly and was not aware that the cleaning solution was needed. 555588 Page 15 of 15