Health inspection·May 15, 2025

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record reviews the facility failed to ensure sanitary practices in the kitchen were maintained for floor sink drains and the ice machine to prevent debris, slime, mold and other potentially contaminated substances to prevent exposure to unsafe and unsanitary practices that affect foods. These failures had the potential to place residents at risk of developing foodborne illnesses. The facility census was 238. Cross reference F925 Findings: During a record review of the County of San Diego, Department of Environmental Health and Quality, Food Inspection Report dated 5/14/25, the report indicated .Risk Factor/Violation: 23. No rodents, insects, birds or animals Observation: Multiple evidence of rodent infestation (rodent droppings) .behind the oven in the food preparation area. Behind cabinet .Facility using .Pest control company. Last pest control receipt was 5/1/2025 .Corrective Action: Eliminate all rodent activity and harborage immediately. Thoroughly clean and sanitize all food contact surfaces and impacted areas. Facility ordered to cease and desist operating until all evidence of vermin has been eliminated and approval to re-open has been granted by this department . 1. During a concurrent kitchen observation and interview on 5/15/25 at 12:26 P.M., the Registered Dietitian (RD) and Director of Food and Nutrition Services (DFNS) acknowledged an unsealed/uncovered floor drain at the back wall sink area behind the ice machine, and an unsealed/uncovered large floor hole inside the dry storage room. The large hole had a gray rubber bucket on top of it that could be easily lifted. The RD lifted the large bucket to view the hole and stated, that should be sealed and covered. During a record review of the facility vendor's Pest Control Company reports from January 2025 to May 2025 for the Kitchen area, the report recommendations indicate to repair Loose/Broken tiles for rodent control: 1/2/25- observation of loose/broken tiles, location: kitchen area(s) date entered: 1/2/25 recommendation: seal or replace status: pending 2/6/25- observation of cracks and crevices, location: kitchen area(s) date entered: 2/6/25 recommendation: seal gap status: pending Page 1 of 6 555659 555659 05/15/2025 San Diego Post-Acute Center 1201 South Orange Ave. El Cajon, CA 92020

F 0812 Level of Harm - Minimal harm or potential for actual harm 2/6/25- observation of cracks and crevices, location: kitchen area(s) date entered: 2/20/25 recommendation: seal gap status: pending 4/17/25- observation of cracks and crevices, location: kitchen area(s) date entered: 4/17/25 recommendation: seal gap status: pending Residents Affected - Many 5/15/25- observation of cracks and crevices, location: kitchen area(s) date entered: 5/15/25 recommendation: seal gap status: pending During an interview on 5/15/25 at 2:30 P.M with the County Environmental Health Inspector (CEHI), the CEHI stated during his annual routine facility kitchen inspection on 5/14/25 and he found vermin rodent droppings behind the large oven in the food preparation area and one in the entry room to the dry storage area. The CEHI stated he closed the kitchen for food preparation and storage on 5/14/25 due to the rodent droppings but re-opened the kitchen on 5/15/25 because the Pest Control Company placed bait boxes throughout the kitchen and kitchen staff cleaned and sanitized the kitchen the evening of 5/14/25. During an interview on 5/15/25 at 4:19 P.M. with the Maintenance Director (MTD), the MTD stated he schedules the pest control company visits biweekly and the company provides him a report with recommendations after each visit. The MTD stated he has not been able to complete all the repair recommendations made by the previous pest control company, but he acknowledged the open holes and floor sink drains did make it easier for rodents to enter the kitchen area. The MTD further indicated the cluttered equipment and items at the back garbage dumpster needed to be removed because they may help rodents come towards the facility building. During an interview on 5/15/25 at 4:30 P.M. with the Administrator (ADM), Director of Nursing (DON), Assistant Director of Nursing (ADON), Executive Assist to Administrator (EAA), RD, DFNS and MTD, the ADM, DON and RD all acknowledged the kitchen unsanitary conditions regarding uncovered floor drains and openings should have been addressed by the facility staff to prevent the presence of rodents in the kitchen. According to the 2022 Federal Food and Drug Administration (FDA) Food Code, section 6-202.15 titled Outer Openings, Protected.(A) Except as specified in (B), (C), and (E) and under (D) of this section, outer openings of a FOOD ESTABLISHMENT shall be protected against the entry of insects and rodents by: (1) Filling or closing holes and other gaps along floors, walls, and ceilings; (2) Closed, tight-fitting windows; and (3) Solid, self-closing, tight-fitting doors . According to the 2022 Federal Food and Drug Administration (FDA) Food Code, Insects and rodents carry disease-causing microorganisms which may be transmitted to humans by contamination of food and food-contact surfaces. The presence of insects and rodents is minimized by protecting outer openings to the food establishment. (FDA 2022 Annex 3 - Public Health Reasons/Administrative Guidelines, 6-202.15 Outer Openings, Protected) The facility's Kitchen Sanitation policy was requested but not provided. During a review of the facility policy titled Pest Control dated 2001, the policy indicated .1. This facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents .5. Garbage and trash are not permitted to accumulate and are removed from the facility daily . 555659 Page 2 of 6 555659 05/15/2025 San Diego Post-Acute Center 1201 South Orange Ave. El Cajon, CA 92020

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 2. During a kitchen observation and interview on 5/15/2025 at 12:45 P.M., the Maintenance Director (MTD) opened the ice machine for the Surveyors to view the inside ice making section. There were black, brown and grayish colored spots and grime inside the ice machine grid curtain, water tray, and both sides of the ice chute. The MTD stated he cleaned inside the ice machine every month using a descaler and sanitizer chemical. The MTD, RD, and DFNS acknowledged the black, brown and gray colored debris inside the internal ice machine parts. The MTD stated during the monthly cleaning, he turned off the machine, emptied the ice from the bin, then poured the descaler solution inside the tubing to flow throughout the machine. Then followed up with the sanitizer solution to flow through the machine parts. The MTD stated he did not use a scrub brush to clean between the metal flaps in the ice machine curtain, but acknowledged he should use one to clean the black, brown and gray slime substances on the ice machine parts. The RD and DFNS stated it was important for the residents to have clean ice for drinking and for the kitchen to use ice to keep foods cold and the ice machine should be visibly clean. During a record review of the facility's Ice Machine Manufacturer's Guidelines titled B. Cleaning and Sanitizing Instructions indicated, .1. Cleaning procedure 1) Dilute [Manufacturer's name] Scale Away with warm water .7) .c. Wipe down the .shaft .retainer rod .with cleaning solution .8) Pour the cleaning solution into the water tank .2. Sanitizing Procedure . During a concurrent interview and record review on 5/15/25 at 4:00 P.M., with the RD, the RD stated the Food & Nutrition - RDN Monthly Inspection Checklists dated 4/10/24 through 4/15/25 completed by the facility RD, indicated no identified issues with uncovered floor holes and drains or ice machine cleaning. The RD acknowledged these concerns may have been overlooked during the kitchen inspections but should have been identified so they could be addressed. According to the 2022 US FDA Food Code, Section 3-303.11, titled Ice Used as Exterior Coolant, Prohibited as Ingredient, Ice that has been in contact with unsanitized surfaces .may contain pathogens and other contaminants if this ice is then used as a food ingredient, it could be contaminated . According to the 2022 US FDA Food Code, Section 4-204.17, titled Ice Units, Separation of Drains, Liquid waste drain lines passing through ice machines and storage bins present a risk of contamination due to potential leakage of the waste lines and the possibility that contaminants will gain access to the ice through condensate migrating along the exterior of the lines .The potential for mold and algal growth in this area is very likely due to the high moisture environment. Molds and algae that form on the drain lines are difficult to remove and present a risk of contamination to the ice stored in the bin. During a review of the facility's policy and procedure (P&P) titled Ice Machine Cleaning Procedures, dated 2018, the P&P indicated .The ice machine (bin and internal components), needs to be cleaned .3. The ice machine will be cleaned .per the manufacturer's guidelines .4. Registered Dietitian will monitor the cleanliness of the ice machine . 555659 Page 3 of 6 555659 05/15/2025 San Diego Post-Acute Center 1201 South Orange Ave. El Cajon, CA 92020

F 0925 Make sure there is a pest control program to prevent/deal with mice, insects, or other pests. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to ensure the facility's kitchen was free of pests when: Residents Affected - Many 1) the pest control company recommendations were not carried out to prevent rodents, and 2) unsanitary practices with large uncovered openings and holes were found in the kitchen. This failure led to a kitchen closure by the local health department due to sightings of rodent droppings and had the potential to contaminate the residents' food prepared and stored in the kitchen and dining areas. The facility census was 238. Cross reference F812 Findings: During a record review of the County of San Diego, Department of Environmental Health and Quality, Food Inspection Report dated 5/14/25, the report indicated .Risk Factor/Violation: 23. No rodents, insects, birds or animals Observation: Multiple evidence of rodent infestation (rodent droppings) .behind the oven in the food preparation area. Behind cabinet .Facility using .Pest control company. Last pest control receipt was 5/1/2025 .Corrective Action: Eliminate all rodent activity and harborage immediately. Thoroughly clean and sanitize all food contact surfaces and impacted areas. Facility ordered to cease and desist operating until all evidence of vermin has been eliminated and approval to re-open has been granted by this department . During an interview on 5/15/25 at 11:50 A.M. with the Maintenance Director (MTD), the MTD stated he had not seen any pests in the kitchen, but kitchen staff reported they saw one back in January 2025 near the floor drain behind the kitchen ice machine. The MTD stated he had the pest control company place bait traps in the area, and he placed a metal netted drain cover over the floor sink drain hole. During an interview on 5/15/25 at 12:15 PM with the evening [NAME] (CK) in the kitchen, CK stated they were told the rats and mice were getting in the kitchen through the produce company deliveries. CK stated their coworker said they saw one at the floor sink drain behind the wall of the ice machine a while ago too. During a concurrent kitchen observation and interview on 5/15/25 at 12:26 P.M., the Registered Dietitian (RD) and Director of Food and Nutrition Services (DFNS) acknowledged an unsealed/uncovered floor drain at the back wall sink area behind the ice machine, and an unsealed/uncovered large floor hole inside the dry storage room. The large hole had a gray rubber bucket on top of it that could be easily lifted. The RD lifted the large bucket to view the hole and stated, that should be sealed and covered. During an observation on 5/15/25 at 1:36 P.M. of the facility's garbage area outside the back of the building, the garbage area was filled with clutter including cardboard boxes, worn appliances, equipment, linens, bins and crates. During an interview on 5/15/25 at 2:30 P.M with the County Environmental Health Inspector (CEHI), 555659 Page 4 of 6 555659 05/15/2025 San Diego Post-Acute Center 1201 South Orange Ave. El Cajon, CA 92020

F 0925 Level of Harm - Minimal harm or potential for actual harm the CEHI stated during his annual routine facility kitchen inspection on 5/14/25 and he found vermin rodent droppings behind the large oven in the food preparation area and one in the entry room to the dry storage area. The CEHI stated he closed the kitchen for food preparation and storage on 5/14/25 due to the rodent droppings but re-opened the kitchen on 5/15/25 because the Pest Control Company placed bait boxes throughout the kitchen and kitchen staff cleaned and sanitized the kitchen the evening of 5/14/25. Residents Affected - Many During an interview on 5/15/25 at 4:19 P.M. with the Maintenance Director (MTD), the MTD stated he schedules the pest control company visits biweekly and the company provides him a report with recommendations after each visit. The MTD stated he has not been able to complete all the repair recommendations made by the previous pest control company, but he acknowledged the open holes and floor sink drains did make it easier for rodents to enter the kitchen area. The MTD further indicated the cluttered equipment and items at the back garbage dumpster needed to be removed because they may help rodents come towards the facility building. During an interview on 5/15/25 at 4:30 P.M. with the Administrator (ADM), Director of Nursing (DON), Assistant Director of Nursing (ADON), Executive Assist to Administrator (EAA), RD, DFNS and MTD, the ADM, DON and RD all acknowledged the kitchen unsanitary conditions regarding uncovered floor drains and openings should have been addressed by the facility staff to prevent the presence of rodents in the kitchen. During a record review of the facility vendor's Pest Control Company reports from January 2025 to May 2025 for the Kitchen area, the report recommendations indicate to repair Loose/Broken tiles for rodent control: 1/2/25- observation of loose/broken tiles, location: kitchen area(s) date entered: 1/2/25 recommendation: seal or replace status: pending 2/6/25- observation of cracks and crevices, location: kitchen area(s) date entered: 2/6/25 recommendation: seal gap status: pending 2/6/25- observation of cracks and crevices, location: kitchen area(s) date entered: 2/20/25 recommendation: seal gap status: pending 4/17/25- observation of cracks and crevices, location: kitchen area(s) date entered: 4/17/25 recommendation: seal gap status: pending 5/15/25- observation of cracks and crevices, location: kitchen area(s) date entered: 5/15/25 recommendation: seal gap status: pending During a further record review of the facility Vendor's Pest Control reports beginning 11/7/24 to 4/17/25 the report recommendations indicated .replaced bait unit . for rodent control. According to the 2022 Federal Food and Drug Administration (FDA) Food Code, Insects and rodents carry disease-causing microorganisms which may be transmitted to humans by contamination of food and food-contact surfaces. The presence of insects and rodents is minimized by protecting outer openings to the food establishment. (FDA 2022 Annex 3 - Public Health Reasons/Administrative Guidelines, 6-202.15 Outer Openings, Protected) 555659 Page 5 of 6 555659 05/15/2025 San Diego Post-Acute Center 1201 South Orange Ave. El Cajon, CA 92020

F 0925 Level of Harm - Minimal harm or potential for actual harm According to the United States Centers for Disease Control and Prevention (CDC), a rat is a known vector for diseases including: .Hantavirus- A family of viruses which can cause serious illnesses and death. These viruses cause diseases like .fever with renal (kidney) dysfunction .that are spread mainly by rodents and are not spread from person-to-person . Residents Affected - Many https://www.cdc.gov/hantavirus/about/index.html During a review of the facility policy titled Pest Control dated 2001, the policy indicated .1. This facility maintains an on-going pest control program to ensure that the building is kept free of insects and rodents .5. Garbage and trash are not permitted to accumulate and are removed from the facility daily . 555659 Page 6 of 6