Health inspection·May 4, 2023

F 0801 Level of Harm - Minimal harm or potential for actual harm 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 observation, interview, and record review the facility failed to ensure qualified leadership staff when Residents Affected - Many 1. There was no qualified, dedicated full time staff to oversee food services for the Skilled Nursing Facility (SNF) kitchen and residents since at least November 2022. 2. The department was short staffed by 23 out of 65 budgeted positions, including eight leadership/supervisorial positions, and no food service manager since November 2022, resulting in closure of the SNF kitchen. 3. There was not an adequate or effective system in place to ensure that position-specific staff training and competency in skills and knowledge essential for food safety and sanitation occurred. These failures had the potential to result in foodborne illness, and to negatively affect overall health for residents living in the facility. Findings: Review of an undated document titled Duty Statement, Class: Dietetics Director showed the Food Services Director (FSD) was responsible for the day-to-day operation of the Food and Nutrition Services Department. Essential functions included coordinate recruitment, selection interviews and hiring of department staff, provide training and in-services to staff, and conduct management sanitation rounds. 1. There was no qualified, dedicated full time staff to oversee food services for the Skilled Nursing Facility (SNF) kitchen and residents since November 2022. Review of California Health and Safety Code 1265.4 showed (a) A licensed health facility .shall employ a full-time, part-time or consulting dietitian. A health facility that employs a registered dietitian less than full time, shall also employ a full-time dietetic services supervisor who meets the requirements of subdivision (b) to supervise dietetic service operations. The dietetic services supervisor shall receive frequently scheduled consultation from a qualified dietitian. During an interview with the FSD on 5/3/23 at 11:52 a.m. she stated they had not had a Food Service Manager since 11/5/22. When asked what was being done for recruitment, she stated they were working on hiring an office technician first as that position was key. Then they would start to work on hiring a Food Service Manager. When asked how the responsibilities of the position were being covered, the FSD stated she, the cook supervisors, and the food service supervisor worked together and did their best. She stated none of the supervisors had Dietary Services Supervisor or Certified Dietary Manager credentials, but they all had years of experience. 2. The department was short staffed by 23 out of 65 budgeted positions, including eight leadership/supervisorial positions, and no food service manager since November 2022, resulting in closure of the SNF kitchen. Review of Title 22 §72103 showed dietary (Food and Nutrition Services) is a required service (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 2 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0801 in skilled nursing facilities. Level of Harm - Minimal harm or potential for actual harm During an interview with the Food Service Director (FSD) on 5/1/23 at 11:32 a.m. she stated she was a Registered Dietitian (RD) and had worked there for about a year and a half. She stated she had responsibility over all food services as well as the clinical dietitians. The FSD shared their department's staffing was down by about 1/3, due to the COVID-19 pandemic, some retirements, and from staff finding other opportunities for advancement. The department currently had 42 staff but was budgeted for 65 staff, and they currently did not have a Food Service Manager nor an Office Technician (clerical staff). Residents Affected - Many Review of an organizational chart titled Kitchen/Dietetic Counseling/ Food Services, dated May 2, 2023, and signed by the Administrator 12/31/22, showed seven out of 12 leadership/ supervisorial positions in the Food and Nutrition Services Department (FANS) were vacant, including the Office Technician position, a SNF Administrator, a Dietetics Assistant Director, a Food Manager, a Food Service Supervisor II, and two Food Service Supervisors I. During an interview with Registered Dietitian A (RD A), RD B, and RD C on 5/3/23 at 11:21 a.m. they stated their roles in the kitchen involved communication about residents care, creating resident tray tickets including food preferences, conducting test trays. RD B stated We were hired as clinical dietitians. RD A stated they also assisted with the Office Technician position duties since that position was vacant. They also helped with the menus and nutrient analysis. During an interview with the Food Service Director (FSD) on 5/3/23 at 11:52 a.m. she stated their staffing shortage resulted in the closure of the facility's Skilled Nursing Facility kitchen, so the SNF resident's meals were being served from the RCFE (Resident Care Facility for the Elderly) communal living kitchen. While RCFE residents had returned to eating together in the communal dining room, the SNF residents continued to eat their meals in their rooms. 3. There was not an adequate or effective system in place to ensure that position-specific staff training and competency in skills and knowledge essential for food safety and sanitation occurred (Cross Reference

F802, F805, F812). Review of a document titled Food & Nutrition Services - Staff Operations and Training (All Homes) 6325 v.5, dated 4/11/23 showed The Food & Nutrition Services Department will provide sufficient staff to be employed, oriented and trained .Department staff will be trained on and will follow sanitation and infection prevention procedures for the health and safety of Residents at the home .Food & Nutrition Services personnel will be trained in basic food safety and sanitation techniques, prevention of foodborne illness, wear clean clothing, and a cap or hair net .Orientation and in-service training is provided at time of employment and as needed. In-service training sessions are performed by qualified, assigned personnel .Employees will follow the hand wash policy and procedure of the Home and use gloves as appropriate. During multiple observations in the kitchen beginning 5/1/23 at 9:05 a.m., staff hair was not adequately restrained, staff did not change their gloves and wash their hands when changing tasks, multiple pieces of equipment were not clean (can opener and mount, ovens, floor drains, and the ice machine), and staff did not clean fixed equipment according to professional standards of practice, and did not follow manufacturer's instructions for use of quat (quaternary ammonia) sanitizer (Cross Reference F802, F812). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 3 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During an observation of test trays and concurrent interview with the FSD on 5/2/23 at 11:45 a.m. pureed ham was grainy when it was required to be smooth, and spinach, beans, cornbread and strawberries and cream spread across the dish when they wee supposed to mound with a pudding-like consistency. (Cross Reference F805). During and observation and concurrent interview with FST 2B on 5/3/23 at 7:48 a.m. he showed how he cleaned the kitchen ice machine when assigned by supervisors to do it. The ice machine was not sanitary and a white paper towel wiped across a white tube and also below the cuber returned a black substance resembling mold. Instructions for cleaning posted on the ice machine by Food and Nutrition Services did not match the manufacturer's instructions. During an interview with the Administrator on 5/4/23 at 9:20 a.m. she stated the facility did not have any position-specific training and competency documents for FST 2B. There was no evidence FST 2B had been trained and was competent to clean the ice machine. During an interview with the Food Service Director (FSD) on 5/1/23 at 11:32 a.m. she stated that after facility general orientation new staff were trained into their positions by supervisors and other staff, first observing, then helping, then working on their own. She stated staff in-services had not been done through the pandemic, and they had their first in-service since the pandemic the previous month, on therapeutic diets. On 5/4/23 at 8:20 a.m., training and competency documents were requested for the following staff: Food Service Technician 1-C (FST C), FST E, Food Service Technician II-A (FST 2A), FST 2B, Food Services Supervisor A (FSS A), [NAME] A, [NAME] Supervisor 1 (Cook S1), and [NAME] S2. A review of the staff training and competency documents provided on 5/4/23 at 9:15 a.m. showed Food and Nutrition Services staff FST C, FST E, FST 2A, FST 2B, FSS A, [NAME] A, [NAME] S1, and [NAME] S2 completed the facility's initial, general, New Employee Orientation Checklist used for every staff hired in facility. An additional computer-generated list titled Course Completion History for each staff showed courses were completed on topics such as neglect, abuse, personal protective equipment, fire safety, first aid and ergonomics. Further review showed this training regarding staff: FST C - Three of 181 training events dated 3/2015 to current included FANS position specific topics FST E - Five of 205 training events dated 1/2015 to current included FANS position specific topics FST 2A - Six of 182 training events dated 7/2016 to current included FANS position specific topics FST 2B - Three of 155 training events dated 1/2015 to current included FANS position specific topics FSS A - Five of 143 training events dated 7/2016 to current included FANS position specific topics Cook A - Two of 91 training events dated 6/2020 to current included FANS position specific topics Cook S1 - Six of 220 training events dated 3/2015 to current included FANS position specific topics Cook S2 - Two of 290 training events dated 5/2016 to current included FANS position specific topics (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 4 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0801 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete During an interview with the Administrator (ADMIN) on 5/4/23 at 9:20 a.m. she stated that for food services they only had position specific training and competency checklists for one Food Service Supervisor A (FSS A), and one for [NAME] Specialist A (Cook A). The facility did not have position specific training and competency checklists in place for any of the remaining six Food and Nutrition Staff records requested. Event ID: Facility ID: 555891 If continuation sheet Page 5 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

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 an adequate number of staff with the necessary skills to carry out the functions of the department when Residents Affected - Many 1. The Food and Nutrition Services department had inadequate staffing. 2. There was no evidence that position-specific staff training and competencies were routinely in place to ensure food safety and sanitation in the kitchen and A. Staff did not adequately restrain their hair B. Staff did not wash hands and change gloves between tasks C. Equipment was not sanitary D. Equipment was not cleaned per professional standards of practice E. The ice machine was sanitary F. Foods were not pureed to the proper consistency These failures had the potential to result in foodborne illness and to impact the nutritional status of residents living in the facility. Findings: Review of a document titled Food & Nutrition Services - Staff Operations and Training (All Homes) 6325 v.5, dated 4/11/23 showed The Food & Nutrition Services Department will provide sufficient staff to be employed, oriented and trained .Department staff will be trained on and will follow sanitation and infection prevention procedures for the health and safety of Residents at the home .Food & Nutrition Services personnel will be trained in basic food safety and sanitation techniques, prevention of foodborne illness, wear clean clothing, and a cap or hair net .Orientation and in-service training is provided at time of employment and as needed. In-service training sessions are performed by qualified, assigned personnel .Employees will follow the hand wash policy and procedure of the Home and use gloves as appropriate. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 6 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Review of undated documents titled Duty Statement, [facility] for various positions showed position responsibilities included: Food Service Technician I - serves and assists with the preparation of food and beverages, cleans and maintains food service equipment, utensils, and work areas as required. Safely operate, clean, sanitize and maintain food service equipment; Assist in food service and related work .follow department guidelines and procedures for the proper handling and storage of food and supplies. Attend meetings and required in-service training classes. Food Service Technician II - Leads, instructs, and works with employees in serving or assisting with the preparation of food and beverages; cleans and maintains food service equipment, utensils, and work areas. Act as lead foodservice worker .maintain uniform food-handling practices and standards of safety and sanitation. Attend meetings and required in-service training classes. Food Service Supervisor 1 - Coordinates the work of staff in serving food; cleanliness and maintenance of work areas, equipment and utensils. Provide leadership and direction to food service staff .Select and train staff .Maintain uniform food handling practices .Follow department guidelines and procedures for the proper handling and storage of food and supplies. Ensure required monthly training is completed. Cook Specialist 1 - Assists with the preparation, cooking, and dispensing of a variety of food following standardized recipes and methods of preparation. Works with food service staff. Cleans and maintains culinary utensils, equipment and work areas. Instruct and lead staff in food service and cleaning procedures. Attend in-service training classes and regular monthly staff meetings. Comply with all applicable local, state and federal food handling and food safety regulations. Supervising [NAME] 1 - Supervises cooks and food service staff and assists with the preparation, cooking and service of food. Prepares, cooks and dispenses food and serves as lead cook. Supervise and assist in the maintenance of culinary utensils and equipment and the cleaning of various storage and work areas. Conduct inspections and maintain safe food handling practices and standards for safety and sanitation. Comply with all local, state, and federal regulations. Attend meetings. Attend required in-service training. 1. The Food and Nutrition Services (FANS) Department had inadequate staffing During an interview with the Food Service Director (FSD) on 5/1/23 at 11:32 a.m. she stated their staffing was down by about 1/3 since the COVID-19 pandemic, and with some retirements, and from staff finding other opportunities for advancement. They currently had 42 out of 65 budgeted staff. FSD stated the staffing shortage caused the facility to close the skilled nursing unit's (SNF) kitchen, to serve all SNF and communal living residents from the communal living kitchen, and for SNF residents to dine in their rooms instead of a dining room. Review of the staff schedule for May 2023 showed 21 vacant positions including a food service manager, office technician, three food service supervisors, and 16 other positions. During further interview with the FSD on 5/3/23 at 11:52 a.m. she was asked about her efforts for staff recruitment. She stated they were working on getting an office technician first as that was a key position, then would work on filling the Assistant Food Manager position. She stated there had been no Food Service Manager since November 2022, and she, the two cook supervisors, and one food (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 7 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many service supervisor were managing things in the kitchen as best they could. She added that all of the supervisors had years of experience, but none had the qualifications of a Certified Dietary Manager or Dietary Services Supervisor. 2. Multiple observations and interviews in the kitchen beginning 5/1/23 at 9:00 a.m. showed staff had inadequate position-specific staff training and competencies in place. 2A. Hair Restraints (Cross Reference F812) During observations in the kitchen beginning on 5/2/23 multiple staff did not have hair restrained: At 10:35 a.m. [NAME] A's hair hung down below the hair net in back. At 2:31 p.m. Food Service Technician 1 - H (FST H) had a hair net around her bun, but the rest of her hair was not contained. In a concurrent observation [NAME] B had hair straggling out from the sides of her hair net as she prepared apple pie (Cross Reference F812). Review of a policy titled Food & Nutrition Services - Staff operations and Training (All Homes) 6324 v.5 dated 4/11/23 showed employees shall wear hair restraints that covers body hair and is worn to effectively keep their hair from contacting exposed food, clean equipment, utensils and linens. During an interview with the FSD on 5/3/23 at 11:52 a.m. she was asked about her expectations regarding hair restraints in the kitchen. She stated hair should be restrained, was aware of the hair restraint issues, and agreed several staff often did not have their hair fully covered because of the type of hair nets they chose. 2B. Handwashing and Glove Use (Cross Reference F812) During multiple observations in the kitchen between 5/1/23 at 9:00 a.m. and 5/3/23 at 5:00 p.m. staff wore gloves and touched multiple potentially contaminated surfaces such as doors, refrigerator doors, carts, and equipment from the floor without changing their gloves or without washing their hands between doffing (removing) soiled gloves and donning (putting on) new gloves (Cross Reference F812). During an interview with [NAME] Supervisor 2 (Cook S2) on 5/3/23 at 9:32 a.m., and with the FDS on 5/3/23 at 11:52 a.m. their responses regarding when staff should and should not wear gloves in the kitchen did not match (Cross Reference F812.). During an interview with the Administrator (ADMIN) on 5/4/23 at 11:00 a.m. she provided the facility's general infection control hand hygiene policy that included glove use and stated the facility did not have a glove use policy specific to Food and Nutrition Services. Review of the facility policy titled Hand Hygiene Procedure (All Homes), 7584 v.1, dated 12/24/22 showed Per the Centers for Disease Control (CDC) keeping hands clean through improved hand hygiene is one of the most important steps we can take to avoid getting sick and spreading germs to others. The section titled When Should I Use Soap and Water? included washing hands before and after your shift, before/during/after food preparation, before and during food service, before and after removing gloves. 2C. Equipment was not sanitary (Cross Reference F812). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 8 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Review of a policy titled Food and Nutrition Services - Sanitation (All Homes), 6233 v.2, reviewed 10/7/2022, showed All utensils, counters, shelves, and equipment will be kept clean and maintained in good repair. During observations in the kitchen between 5/1/23 at 9:00 a.m. and 5/3/23 at 5:00 p.m. the can opener had a buildup of food debris and there was black grime around the edge of the can opener mount. Two out of two observed ovens had black grime in the bottom and brown grease baked on the doors. During an observation and concurrent interview on 5/1/23 at 10:07 a.m., [NAME] S1 agreed two out of three observed floor drains in the cook's area were not clean. Review of documents titled RCFE, with various position titles, dated 4/3/23 through 5/3/23 showed the Cooks were responsible to clean the floors in the cook's area. The Weekly AM Clean Side/Caddies position was assigned to clean all can openers thoroughly, take out blue inserts and sanitize around the edge (of the can opener mount) on the table. All positions had assignments to clean some kind of fixed equipment. All of the assigned tasks reviewed were signed off by staff as completed. Specific assignments to clean the ovens or clean the floor drains was not found. 2D. Staff did not follow professional standards of practice or manufacturer's instructions to clean fixed equipment (equipment that cannot go through the dishwasher or be cleaned in a sink) (Cross Reference

F812). During staff interviews on 5/3/23 between 2:00 and 3:00 pm, two (FST D, [NAME] B) out of three (FST E) staff stated they cleaned fixed equipment using only quat (quaternary ammonia) sanitizer solution. [NAME] B stated they never used soapy water to clean equipment, adding They told us to always use the quat water. FST E stated newer staff were being trained to only use quat sanitizer to clean equipment. During an interview with the FSD on 5/3/23 at 11:52 a.m. she stated fixed equipment was on a regular cleaning schedule that supervisors assigned. She stated staff used Quat sanitizer to clean equipment, and used some other cleaning chemicals occasionally. Review of the 2022 FDA Food Code 4-603.15, 4-603.16, 4-701.10 and 4-702.11 showed: equipment that cannot be cleaned in a sink or dishwasher shall be washed using detergents, have a distinct, separate rinse after washing so that abrasives and cleaning chemicals are removed, and then shall be sanitized before use after cleaning. Review of manufacturer's instructions for the department's quat sanitizer product directed for equipment to be washed with a good detergent and rinsed thoroughly with water before being sanitized with the sanitizer solution. They also required an at least 30 second wet time on food contact surfaces, and three minutes wet time on non-food contact surfaces. 2E. Kitchen ice machine was not sanitary (Cross Reference F812) During an observation and concurrent interview with FST 2B on 5/3/23 at 7:45 a.m., he stated he was assigned by supervisors to clean the ice machine. The kitchen ice machine was not clean. The department's instructions to clean it, and FST 2B's process to clean it did not match the manufacturer's instructions. During an interview with the Administrator (ADMIN) on 5/4/23 at 9:20 a.m. she stated she did not (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 9 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many have any position specific training and competency checklists for most FANS staff, including FST 2B. There was no evidence FST 2B had been trained or was competent to clean the ice machine. 2F. Pureed foods did not meet texture/consistency standards. (Cross Reference F805). During an observation of lunch test trays, and concurrent interview with the FSD on 5/4/23 at 11:45 a.m., pureed foods did not meet consistency standards. The FSD agreed the pureed ham was grainy (not smooth). The pureed spinach, beans, and cornbread were thin and spread across the plate. The FSD described the strawberries with cream as almost watery thin .way too thin. Review of the facility specific diet manual, approved by the Registered Dietitians on 3/13/23 showed a description of the Regular Pureed Diet was The Pureed Diet is a regular diet that has been designed for residents who have difficulty chewing and/or swallowing. The texture of the food should be of a smooth and moist consistency and able to hold its shape. During an interview with the Food Service Director (FSD) on 5/1/23 at 11:32 a.m. she stated that after facility general orientation new staff were trained into their positions by supervisors and other staff, first observing, then helping, then working on their own. She stated they had done their first staff in-service since the pandemic the previous month and it was on therapeutic diets. She stated her goal was to get staff competencies in place as they attained full staffing. On 5/4/23 at 8:20 a.m., training and competency documents were requested for the following staff: Food Service Technician 1-C (FST C), FST E, Food Service Technician II-A (FST 2A), FST 2B, Food Services Supervisor A (FSS A), [NAME] A, [NAME] Supervisor 1 (Cook S1), and [NAME] S2. A review of the staff training and competency documents provided on 5/4/23 at 9:15 a.m. showed Food and Nutrition Services staff FST C, FST E, FST 2A, FST 2B, FSS A, [NAME] A, [NAME] S1, and [NAME] S2 completed the facility's initial, general, New Employee Orientation Checklist used for every staff hired in facility. It included Dietary Services which on 5/3/23 at 11:52 a.m. the FSD described was education about emergency food. An additional computer-generated list titled Course Completion History for each staff showed courses were completed on topics such as neglect, abuse, personal protective equipment, fire safety, first aid and ergonomics. Further review showed this training regarding staff: FST C - Three of 181 training events dated 3/2015 to current included position specific topics: Food Safety Fundamentals 5/7/2019, and Meals for All (disaster food/plan) 12/10/21 and 7/19/22. FST E - Five of 205 training events dated 1/2015 to current included FANS position specific topics: Basic Nutrition and Food Safety 8/11/22, Food Safety Fundamentals 7/27/19, Hand Hygiene the Basics 8/15/20, Meals for All (disaster food/plan) 7/28/21, 12/23/22. FST 2A - Six of 182 training events dated 7/2016 to current included FANS position specific topics: Basic Nutrition and Food Safety 1/23/22, Diets: Not Just for Weight Loss 5/1/21, Food Safety Fundamentals 6/1/19, 5/22/22, Meals for All (disaster food/plan) 6/30/21, 2/4/22. FST 2B - Three of 155 training events dated 1/2015 to current included FANS position specific topics: About Specialized Diets and Nutrition 5/18/16, About Renal Disease 5/19/16, Food Safety Fundamentals 5/28/19. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 10 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FSS A - Five of 143 training events dated 7/2016 to current included FANS position specific topics: Basic Nutrition and Food Safety 7/10/22, Food Safety Fundamentals 5/28/19, 7/18/22, Meals for All (disaster food/plan) 10/10/21,7/26/22. Cook A - Two of 91 training events dated 6/2020 to current included FANS position specific topics: Food safety fundamentals 7/28/22, Meals for All (disaster food/plan) 7/28/22. Cook S1 - Six of 220 training events dated 3/2015 to current included FANS position specific topics: Basic Nutrition and Food Safety 1/22/22, Food Safety Fundamentals 5/7/19 and 5/15/22, Hand Hygiene the Basics 7/8/2015, Meals for All (disaster food/plan) 9/6/21, 2/7/22, and 3/15/23, Cook S2 - Two of 290 training events dated 5/2016 to current included FANS position specific topics: Meals for All (disaster food/plan) 6/26/21, 7/10/22. During an interview with the Administrator (ADMIN) on 5/4/23 at 9:20 a.m. she stated that for food services they only had position specific training and competency checklists for Food Service Supervisor A (FSS A), and for [NAME] Specialist A (Cook A). Review of FSS A's packet contained six checklist/competency documents signed off by FSS A and a supervisor on 6/4/22, and included topics surrounding kitchen safety, infection control in the kitchen, food preparation, handwashing, glove use, and correct sanitation, labeling and dating foods, preparing mechanically altered foods correctly, skills to supervise staff, and more. Review of [NAME] A's packet showed one document titled Supervising [NAME] 1 Competency, dated 11/2/22 and signed by [NAME] A and a supervisor. The document listed skills such as planning, organizing and preparing meals in appropriate quantity and quality, understanding therapeutic diets and modified texture diets, ability to supervise cleaning and care of equipment, kitchen sanitation, and more. They facility did not have position specific training and competency checklists in place for any of the remaining six Food and Nutrition Staff records requested. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 11 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

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 record review, the facility failed to provide food that was palatable (refers to the taste and/or flavor of the food) and attractive (refers to the appearance of the food when served to residents) to one of 12 sampled residents (Resident 10). These failures had the potential to result in decreased resident meal intakes, negative impact on resident's nutritional status, and a negative impact on resident's overall health and quality of life. Residents Affected - Few Findings: During an interview on 5/1/23 at 10:10 a.m., Resident 10 complained about the quality of the food provided by the facility and stated, The food does not taste good. During an observation and interview on 5/1/23 at 11:38 a.m. in Resident 10's room, Resident 10 was observed sitting and picking at his lunch. Resident 10 voiced his complaints about the cottage cheese being watery and that his grilled ham and cheese sandwich was burnt. It was observed that the cottage cheese was watery, and the grilled ham and cheese was burnt (the bread had a blackened appearance on both sides). Resident 10 had not eaten any of the cottage cheese and only ate a few bites of the grilled ham and cheese sandwich. When asked if Resident 10 had notified staff about the food quality, Resident 10 stated, I have, and sometimes they will replace the food, but the food quality is still the same. During an interview on 5/3/23 at 1:23 a.m. with Certified Nursing Assistant (CNA1), CNA 1 stated that Resident 10 frequently complained about the quality of the food and did not usually request replacement meals. When asked what staff did to ensure Resident 10 was eating and getting adequate nutrition, CNA1 stated, Resident 10 goes to the general store and buys snacks, such as chips and cookies, so he is eating. When asked if the resident complained about his lunch on this specific day, CNA1 stated Resident 10 requested the soup for lunch and then he complained about it. No alternatives were offered to the resident. During an interview with Resident 10 on 5/3/23 at 1:28 p.m. Resident 10 stated he was unhappy because the soup did not taste good and he did not eat it. When asked if he let staff know about the soup not tasting good, Resident 10 stated he had stopped letting staff know because they never addressed the problem. Resident 10 stated he would get the same type of food quality again, so it was not worth it. During an interview on 5/3/23 at 1:52 p.m. with the [NAME] Supervisor (Cook S1), he stated that they usually do not get many complaints about the quality of residents' food. When asked what the process is if a resident does complain, [NAME] S1 stated that they would remake the meal for the resident. When asked how a grilled cheese sandwich is usually cooked, [NAME] S1 stated, The expectation is that the sandwich will be grilled to a toasty light brown color and should not appear burnt. When asked about the normal consistency of cottage cheese that is served to residents, [NAME] S1 stated, The expectation is, it should not be watery or runny, it should mound. During a review of facility policy and procedure titled Food and Nutrition - General Regulations (All Homes) last reviewed on 5/18/22 indicated, I. A. Food and Nutrition Services will provide food of the quality and quantity to meet each Resident's needs in accordance with the physician's orders . I. D. Resident's food preferences will be adhered to as much as possible . IV. A. Recipes for all items that are prepared for regular and therapeutic diets will be .used to prepare attractive and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 12 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0804 palatable meals, in which nutritive values, flavor and appearance are maintained . IV. B. Food will be served attractively, at appropriate temperatures, with appropriate eating utensils in a form to meet individual needs. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 13 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0805 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. Based on observation, interview, and record review the facility failed to ensure pureed foods provided to residents were of proper consistency when they were not smooth and spread thinly across the plate. These failures had the potential to cause difficulty swallowing for some residents, to look unappetizing and be difficult to self-feed for some residents, and to result in decreased meal intakes and nutritional status. Findings: During an observation in the cook's area on 5/2/23 at 10:35 a.m., [NAME] A pureed ham. In a concurrent interview she stated it was just ham with no pineapple because pineapple would not get smooth. She added milk to the ham puree and then stated she added 2 oz. gravy per serving. [NAME] A stated pureed food needed to be smooth and to mound together, with pudding-like consistency. The meal's spinach, beans, cornbread and strawberries and cream were not pureed until later and the process was not observed. A test tray study including a regular lunch tray and a pureed lunch tray was conducted on 5/4/23 at 11:45 a.m. after the last resident lunch meal was served. In a concurrent observation and interview, the Food Service Director (FSD) took the temperature of the foods with a facility thermometer and then the appearance of the meal, the flavor and consistency was evaluated. During evaluation of the pureed tray, the FSD noted the ham was nicely mounded but grainy and salty. The spinach, beans, and cornbread were thin and spread across the plate and the FSD stated The other pureed foods should be standing up. She described the strawberries with cream as almost watery thin .way too thin. Review of recipes provided by the FSD titled Pureed Ham Glazed with Pineapple, Pureed Beans Seasoned, Pureed Spinach Sauteed w/Garlic (fresh), Pureed Cornbread (scr), and Pureed Strawberries & Cream (fzn) all showed these instructions: Measure desired number of servings in food processor. Blend until smooth. Add (pineapple juice, gravy or broth, water, milk, cream depending on product) if product needs thinning. Add commercial thickener if product needs thickening. Review of the facility specific diet manual showed it was approved and signed by the Registered Dietitians on 3/13/23. It's description of the Regular Pureed Diet was The Pureed Diet is a regular diet that has been designed for residents who have difficulty chewing and/or swallowing. The texture of the food should be of a smooth and moist consistency and able to hold its shape. All foods are prepared in a food processor or blender, with the exception of foods which are normally in a soft and smooth state such as pudding. Additional liquid is added in the form of broth, gravy, vegetable or fruit juices, or milk to achieve the appropriate consistency. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 14 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure food safety and sanitation in the kitchen when: 1. Staff hair was not adequately restrained. 2. Staff did not consistently practice appropriate hand hygiene and glove use. 3. Equipment was not sanitary. 4. Equipment was not cleaned according to professional standards of practice. 5. The Dish Machine did not consistently provide accurate temperatures for staff to monitor and ensure its proper operation for cleaning and sanitizing dishes. 6. Ice machines in the kitchen and the nursing unit kitchenettes were not clean. 7. Nursing unit kitchenettes were not sanitary. These failures had the potential to result in foodborne illness for residents consuming food from the facility kitchen. Findings: 1. Staff Hair was not adequately restrained During observations in the kitchen on 5/2/23 multiple staff did not have hair restrained: At 10:35 a.m. [NAME] A's hair hung down below the hair net in back. At 2:31 p.m. Food Service Technician 1 - H (FST H) had a hair net around her bun, but the rest of her hair was not contained. In a concurrent observation [NAME] B had hair straggling out from her hair net as she prepared apple pie. During an interview with the FSD on 5/3/23 at 11:52 a.m. she was asked about her expectations regarding hair restraints in the kitchen. She replied staff wanted those little brown hair nets and they don't stay on. She was aware and agreed several staff often did not have their hair fully covered. 2. Staff did not consistently practice appropriate hand hygiene and glove use (Cross Reference F802) During an interview with the Administrator (ADMIN) on 5/4/23 at 11:00 a.m. she stated the facility did not have a glove use policy specific to Food and Nutrition Services and she provided the facility's general infection control hand hygiene policy that included glove use. Review of a policy titled Hand Hygiene Procedure (All Homes), 7584 v.1, dated 12/24/22 showed Per the Centers for Disease Control (CDC) keeping hands clean through improved hand hygiene is one of the most important steps we can take to avoid getting sick and spreading germs to others. The section titled When Should I Use Soap and Water? included washing hands before and after your shift, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 15 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 before/during/after food preparation, before and during food service, before and after removing gloves. Level of Harm - Minimal harm or potential for actual harm Review of the 2022 FDA Food Code §3-301.14 showed Food employees shall clean their hands and exposed portions of their arms .after handling soiled equipment or utensils; during food preparation, as often as necessary to remove soil and contamination and to prevent cross contamination when changing tasks; .Before donning (putting on) gloves to initiate a task that involves working with food; and after engaging in other activities that contaminate the hands. FDA Food Code 3-304.15(A) showed Single-use gloves shall be used for only one task such as working with ready-to-eat food or with raw animal food, used for no other purpose, and discarded when damaged or soiled, or when interruptions occur in the operation. Residents Affected - Many During an observation in the dish room on 5/1/23 at 9:05 a.m. FST A removed food debris from resident's soiled breakfast dishes using her bare hands. She stated she was working the clean side of the dish room that day but was just helping the dirty side with silverware for a minute. During multiple observations in the dish room on 5/1/23 at 9:41 a.m., FST A, Food Service Technician 2-A (FST 2A), and FST C worked the clean side of the dish machine and did not wear gloves when removing clean dishes from the dish machine racks. FST 2B wore gloves as he put away clean plates, then removed his gloves and washed his hands. FST A donned gloves and pushed a cart containing clean plates, plate guards and some other equipment through the kitchen. A plate guard fell off the cart and onto the floor. FST A picked up the plate guard from the floor with her gloved hands and placed it in the dirty section of the dish room. She did not change her gloves or wash her hands before continuing to push the cart of dishes through a door. She came back with the cart empty. She did not change her gloves or wash her hands. During an observation on 5/1/23 at 11:03 a.m. FST A wore the same gloves as she put resident meal tray tickets and preference cards on tray line, touched the kitchen doors as she pushed the resident meal cart to the nursing unit, and returned to work in the kitchen without removing or changing her gloves. In a concurrent observation FST C wore the same gloves as she pushed the door coming in from the dining room, put resident meal tray tickets on tray line, and touched the doors again as she traveled again between the kitchen and dining room. During an observation on 5/2/23 at 10:15 a.m. [NAME] A wore gloves from the Cook's food preparation area, touched both the walk-in refrigerator and the dry storage room doors while entering and exiting, then returned to work in the Cook's food preparation area without washing hands or changing gloves. In a concurrent observation, [NAME] Supervisor 1 (Cook S1) wore gloves and touched the walk-in refrigerator door handles when entering and exiting, then went back to food preparation wearing the same gloves. During an observation on 5/2/23 at 10:35 a.m. [NAME] A changed gloves without washing hands during food preparation. During an observation on 5/3/23 at 7:45 a.m. [NAME] A wore gloves while making salads. She entered and exited the walk-in refrigerator, touching the door with her gloves, then went back to making salads with no glove change or handwashing. During an interview with [NAME] S2 on 5/3/23 at 9:32 a.m. he stated staff should wear gloves at all times in the kitchen, during food production, and when handling food or items for residents. He (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 16 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many stated gloves should be worn any time cross contamination would be a concern. [NAME] S2 explained staff would not need to wear gloves when signing in for work or filling out daily logs. He stated wearing gloves was optional for staff working on the dirty side of dish room since the gloves were for their own protection and did not endanger residents. [NAME] S2 stated once an item (food or equipment) was touched it was potentially soiled/contaminated. He stated when staff put away clean dishes their hands should be clean, and they did not need to wear gloves. In addition, if a cart had been sanitized, there was no concern for cross contamination and staff didn't need to wear gloves. [NAME] S2 stated if staff touched a door, they would need to wash their hands and put on new gloves. During an interview with the Food Service Director (FSD) on 5/3/23 at 11:52 a.m. she stated that to avoid cross contamination she would expect her staff to wear hairnets, wash their hands, wear gloves, and ensure surfaces were sanitized timely. She stated if staff went to another area, or if they touched the walk-in refrigerator handle or door, yes, they should change their gloves. She stated staff who worked on either the dirty side or the clean side of the dish room should wear gloves. Everyone in the kitchen should be wearing clean gloves at all times. Any position actively engaged (in the kitchen) should wear clean gloves. The FSD further stated staff should wash their hands when entering the kitchen and before putting on gloves, and staff should change their gloves and wash their hands whenever they touched something that could cross contaminate their gloves. The FSD stated if staff handled trash, picked something up off the floor, or delivered a cart they should change their gloves and wash their hands. 3. Equipment was not Sanitary (Cross Reference F802) Review of a policy titled Food and Nutrition Services - Sanitation (All Homes), 6233 v.2, reviewed 10/7/2022, showed All utensils, counters, shelves, and equipment will be kept clean and maintained in good repair. During an observation in the kitchen on 5/1/23 at 10:07 a.m. the floor drains near the cook's prep sink and the floor drain near the cook's prep area were soiled with brown grime. The basin of the floor drain near the cook's fire extinguisher was clean but the floor around it had an accumulation of black and brown grime. In a concurrent interview, [NAME] S1 confirmed two out of three floor drains were not clean. During an observation in the kitchen on 5/1/23 at 10:10 a.m. the can opener blade had food debris, and its mount had an accumulation of black grime around the edges. During an observation on 5/2/23 at 10:15 a.m. two of two ovens observed had a buildup of black grime in the bottom, and brown grease baked on to the doors. 4. Equipment was not cleaned according to professional standards of practice or per manufacturer's instructions (Cross Reference F802). Review of the 2022 FDA Food Code 4-603.15, 4-603.16, 4-701.10 and 4-702.11 showed: equipment that cannot be cleaned in a sink or dishwasher shall be washed using detergents, have a distinct, separate rinse after washing so that abrasives and cleaning chemicals are removed, and then shall be sanitized before use after cleaning. During an interview with FST D on 5/2/23 at 2:31 p.m. she stated part of her job was to clean up tray line after dinner. She stated the process for cleaning equipment such as the tray line was to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 17 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many wash the counter down with Quat (Quaternary Ammonia) Sanitizer, then use a clean towel to dry it off so it was shiny. When asked if they ever washed the equipment down with soapy water, FST D replied no, but sometimes they cleaned it with white vinegar first and did a double clean that way. During an observation and concurrent interview with [NAME] B on 5/2/23 at 2:31 p.m., she prepared apple pie for the dinner meal. She stated at end of her evening shift she cleaned her stationary equipment using a Quat sanitizer rag. When asked if they ever used soapy water to clean it she stated no, they told us to always use the quat water. During an interview with FST E on 5/2/23 at 2:48 p.m. she stated I like to use hot soapy water to wash things down. Then rinse, then sanitize. She added that newer staff were being trained to only use sanitizer to clean equipment. I was trained different (due to her longevity at the facility). Review of the manufacturer's instructions for Sani-Guard 24-7 Food Contact Surface Sanitizer used by the facility kitchen showed: TO SANITIZE FOOD CONTACT SURFACES: For sanitizing hard non-porous surfaces of food processing equipment .food utensils, dishes, silverware, glasses, sink tops, countertops, refrigerated storage and display equipment and other hard nonporous surfaces. Prior to application, remove gross food particles and soil .Then thoroughly wash or flush objects with a good detergent or compatible cleaner, followed by a potable water rinse before application of the sanitizing solution .Use a solution of .150-400 ppm active quat or equivalent dilution to precleaned hard surfaces thoroughly wetting surfaces .Surfaces must remain wet for at least 60 seconds followed by adequate draining and air drying. Do not rinse. TO SANITIZE NON-FOOD CONTACT SURFACES: Add ¼ oz. of Sanit-Guard 24-7 per gallon of water .To sanitize precleaned hard, non-porous surfaces .apply sanitizer use-solution .thoroughly wetting surfaces .treated surfaces must remain wet for 3 minutes. Wipe dry with a sponge, mop or cloth or allow to air dry. Staff did not wash and rinse stationary equipment prior to sanitizing it, and they did not ensure the required wet time occurred for the sanitizer to work properly (Cross Reference F802). 5. The Dish Machine did not consistently provide accurate temperatures for staff to monitor and ensure its proper operation for cleaning and sanitizing dishes (Cross Reference F908). Review of a policy titled Food & Nutrition Services - Warewashing Manual & Mechanical (All Homes), 6703 v.3, review date 10/7/2022, showed A potential cause of foodborne outbreaks is improper cleaning (washing and sanitizing) of contaminated equipment .Dishwashing machines, operated according to the manufacturer specifications, washed, rinsed, and sanitize dishes and utensils using either heat or chemical sanitation. Dish Machines .wash temperature will be between 150-165°F (degrees Fahrenheit); and hot water at a minimum temperature of 180°F will be maintained at the manifold of the final rinse. During an observation in the dish room on 5/1/23 at 9:55 a.m., FST C worked on the dirty side of the dish machine. In a concurrent interview she stated there was a problem with the dish machine and it had been ongoing for years. She explained the final rinse temperature would hit 180°F (degrees Fahrenheit), and then dropped rapidly. During further observation of the function of the dish machine, the temperature screen showed the final rinse temperature dropped from 180°F to 168°F as (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 18 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm racks continued to move through the machine. FST C stated the dish machine temperatures should be 160°F or greater for the wash and rinse, and 180°F or greater for final rinse. FST C also stated there was a problem with the rinse agent (a chemical that helps water to sheet off dishes, so they dry quickly and have fewer water spots) and it had not been working at all for a week. She stated it had happened before, but the repair vendor was different from the dish machine repair vendor. Residents Affected - Many Review of the Manufacturer's specification plate on the dish machine showed for hot water sanitizing the temperature requirements were wash 160 minimum, and final rinse 180°F minimum to 194°F maximum. During an interview with Food Service Supervisor A (FSS A) on 5/1/23 at 10:15 a.m., she stated the Assistant Administrator (ASADMIN) went to their warehouse to see if there were any temperature test strips that could be run through the dishwasher. She explained that in the past they had run temperature strips through the dish machine when there were issues with the dish machine temperature readings, and they had especially had problems with this and used the strips in January. FSS A added she hadn't noticed any big issue with that again until recently. She stated she thought it was an electronics issue rather than a temperature issue, but there had been a lot of issues with the dish machine. FSS A explained that after the repair vendor came, the electronic temperature reader worked well for a while but then went out again. She stated the rinse agent dispenser problem was from a fuse going out, and the service vendor had come several times to fix it. During an interview with FST F on 5/2/23 at 2:13 p.m. she was asked how she knew if the dish machine was working properly. She stated she knew by the noises it made. Also, the final rinse temperature should be 180°F, middle temp (first rinse) 160 or above, and wash temp should be 165°F or higher. If the temps weren't registering correctly, she would get a supervisor. During an interview with [NAME] S2 on 5/3/23 at 8:10 a.m. he stated that in the past, the dish machine temperatures had dropped from 180°F to 170°F. If the temperature was out of range, staff got a supervisor and they used a temperature test strip to check it. When they were having problems with the temperatures, the supervisor did a test strip daily for QAPI. [NAME] S2 stated the machine was repaired in December or January, and the service vendor repaired the mother board, the lines, and gave it a complete overhaul. He stated the rinse agent vendor came to fix the rinse agent the previous Thursday, yet according to staff it still wasn't working. During an interview with the FSD on 5/3/23 at 11:52 a.m. she was asked about the dish machine temperature issues and what had been done to resolve them. She stated the current dish machine was four years old, and they had ongoing problems with it. One problem they identified was the repair vendor had used inferior, substandard parts to repair it. Review of a policy titled Food & Nutrition Services - Equipment (All Homes), 6227 v.2, review date 4/12/2023, showed Equipment will be provided and maintained in good working order. All equipment will be operated and maintained according to the manufacturer's specifications for cleaning and sanitizing and safe operation. Review of documents titled Dish Machine Temperature & Chemical Record, Main Kitchen, dated 11/1/22 through 4/30/23 showed the wash and final rinse temperatures were checked by staff five times each day. Temperatures were documented within the correct range on all checks and dates except for 15 checks on dates 12/6/22 (x3), 12/10/22 (x1), 12/11/22 (x2), 12/13/22 (x1), 12/16/22 (x3), 12/24/22 (x1), 12/26/22 (x4). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 19 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Review of additional documents titled HACCP Temperature Checks showed temperature strips were run through the machine five out of 15 times when temperatures were documented out of range (12/6/22 x2, 12/13/22 (x1), 12/16 x1, and 12/24 x1). The HACCP Temperature Checks also showed additional temperature strip checks 12/3, 12/15, 12/27 (x2), and 1/23/23. The HACCP Temperature Checks did not reflect temperature strips were run through the dish machine daily during the timeline of out-of-range temperatures to ensure food safety, and there were no temperature strips readily available for supervisors to check the dish machine final rinse temperatures when they were questioned on 5/1/23 at 9:55 a.m. 6. Ice Machines in the kitchen and nursing unit kitchenettes were not sanitary. Review of a policy titled Food and Nutrition Services - Sanitation (All Homes), 6233 v.2, reviewed 10/7/2022, showed Ice used in connection with food or drink will be from a sanitary source, and will be handled and dispensed in a sanitary manner. Ice machines will be cleaned according to manufacturer's guidelines. Review of a policy titled Ice Machine Maintenance and Cleaning 6055 .1, dated 10/18/22 showed The Home's staff will adhere to manufacturer's instructions recommended maintenance, cleaning and sanitizing procedures to ensure trouble free operation of the ice machines. Food Nutrition Services will clean the outside of the Ice-O-Matic ice machines. They will remove the ice from the machine's reservoir and the reservoir will be sanitized on a schedule as recommended by the manufacturer's instructions. Plant Operations will inspect the ice machine every three months. The general maintenance and filter change will be performed every six months. In addition Plant Operations will clean and sanitize the internal parts at least every six months as needed. During an interview with the Plant Operations Director (POD) on 5/3/23 at 8:20 a.m. he stated cleaning ice machines in the facility was a joint effort between Plant Ops, Housekeeping and Nursing. He thought the kitchen ice machine was cleaned daily by the kitchen, and Plant Ops changed the filters and did the descaling PM (preventive maintenance) every 30 to 90 days. When asked how staff in the other departments knew how to clean the ice machines correctly, he stated he didn't know because his department was only responsible for the filters and descaling. He stated responsibility for hard water deposits would fall under daily cleaning (by the other departments). 6A. The kitchen ice machine was not sanitary. Review of the Ice-O-Matic Ice Machine Cleaning and Sanitizing Instructions provided by Plant Operations and dated 11/08 showed Maintenance and Cleaning should be scheduled at a minimum of twice per year. It directed use of approved nickel safe ice machine cleaner to the water trough according to label instructions in the wash cycle .remove the splash curtain and inspecting the evaporator and water spillway to ensure all mineral residue was removed .remove and clean the water distribution tube .clean the water trough thoroughly to remove all scale or slime build-up .if necessary remove the water trough to reach all splash areas and float .use sodium hypochloride food equipment sanitizer with 100-200 ppm .to fill the water trough .switch to wash position and circulate for 10 minutes. Inspect all disassembled fittings for leaks .wipe down all other ice machine splash areas plus the interior surfaces of the bin, deflector and door with the remaining sanitizer solution .flush the sanitizer down the drain, turn machine on to further purge the sanitizing solution .discard the first two ice harvests. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 20 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Review of undated Food and Nutrition Services instructions posted on the ice machine, titled Procedure for monthly Ice Machine Cleaning and Sanitizing directed staff to remove the ice .properly sanitize the inside of the ice machine using a food grade quaternary sanitizer .liberally spray the inside of the cabinet with the sanitizer and clean with a brush .Let the sanitizer sit for a few minutes before rinsing thoroughly with clean warm water. Do not touch or wipe out the inside of the cabinet. Air dry. Turn machine back on. The most important thing is to thoroughly sanitize the machine and return the unit to working status. If any questions arise during this process check with your immediate supervisor. The term cabinet was not defined, or its function described in the instructions. The instructions did not match the manufacturer's. During an observation of the kitchen's Ice-O-Matic ice machine and concurrent interview with FST 2B on 5/3/23 at 7:45 a.m. he stated he cleaned the ice machine when supervisors assigned him to do it, and he was the only kitchen staff ever assigned to do it in a long time. Plant ops would be the other ones who do it (clean the ice machine). Further concurrent interview with FST 2B and observation inside the ice machine showed white mineral deposits over multiple surfaces, and a brownish-black substance on a white tube, and also along the bottom of the cuber. A white paper towel wiped across the white tube, and a second white paper towel wiped across the bottom of the cuber returned a black substance resembling mold. FST 2B stated he last cleaned the ice machine 3/15/23. Review of a Food and Nutrition Services document titled Ice Machine Sanitizing Log 2023 showed it had been cleaned once in 2023 on 3/15/23. The log stated Empty and sanitize with multi-quat sanitizer, let cabinet air dry and included supervisor's initials on 3/15/23. FST 2B described this process he used to clean the ice machine: Turn the machine off. Empty the ice bin, remove the cuber cover, push the purge sump button. He noted the white tube inside the machine leaked a lot of water but was not supposed to leak water. Spray and rinse everything down and sanitize it with Sani-Guard 24-7 Quat sanitizer. Rinse it down with water, push the sump pump purge button again, and hand wash the cuber cover. Push the wash button. Wash the whole outside of the machine by hand with sanitizer. Clean the ice fall catcher and lids with sanitizer. When the upper part is done clean the seals and corners, squeegee water down the drain in the ice bin, and wipe out with sanitizer rag. Air dry. Turn on to run, discard two batches of ice before use. FST 2B stated no other chemicals were used in the machine, but he occasionally used a green scrubby tool on the mineral deposits. He stated the machine should not have any mold because it had an antimicrobial liner. During an interview with [NAME] S2 on 5/3/23 at 8:10 a.m. he stated the ice machine was cleaned inside at the end of each month by FST 2B, the procedures were posted on the machine, and Plant Ops cleaned it quarterly. He stated staff could go to any supervisor on shift to guide them in cleaning the machine, and they just used quat sanitizer to clean it. They did not use bleach or any other chemicals. During an observation of the kitchen Ice-O-Matic Ice Machine and concurrent interview with the plumber ([NAME]) and the ASADMIN on 5/3/23 at 9:09 a.m., [NAME] described this process to clean the kitchen ice machine: Remove Cover. Turn Off. Dump and remove Ice. Add Nickel Safe Ice Machine Cleaner solution to tray. Press button to activate the Cleaning Cycle. It takes about 15 minutes. Use a brush to clean inside the white hose. Repeat with IMS-III Sanitizer. Wipe the whole thing down with Nickel (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 21 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many Safe Machine Cleaner. That's basically it. He stated he last cleaned the kitchen ice machine a couple of weeks ago. The ASADMIN took the ice machine out of service until it could be cleaned. This process did not include ensuring all mineral deposits were removed or cleaning the water trough as described in the manufacturer's instructions. Review of Plant Operations documents posted near the ice machine titled Ice-O-Matic Cleaning & Sanitizing (3 month intervals) Location: Main Kitchen, Year/ 2023, showed instructions to clean the ice machine using nickel safe ice machine cleaner and approved sanitizing solution, and each step was signed off as completed 1/12/23 and 4/15/23. Despite these efforts the ice machine was not clean. During an interview with the Administrator (ADMIN) on 5/4/23 at 9:20 a.m. she stated she did not have any position specific training and competency checklists for most FANS staff, including FST 2B. There was no evidence FST 2B had been trained or was competent to clean the ice machine. 6B. The nursing kitchenette ice machines were not sanitary. During observations of the two skilled nursing unit resident food kitchenettes on 5/1/23 between 3:00 p.m. and 4:00 p.m., each unit contained a [NAME] ice machine with white mineral deposits on ice chutes and other exterior surfaces. In a concurrent interview with the Quality Assurance Nurse (QAN), he stated the CNAs (Certified Nursing Assistants) on NOC (night) shift cleaned the exterior of the ice machines, and Plant Ops cleaned the inside. Documents posted on the ice machines titled [NAME] ICE Machine Cleaning Directions indicated nursing's night shift was to clean the outside of the ice machine with soap and water each night. Environmental Services (EVS) was to disinfect the outside of the ice machine daily including the drain pan and drain line. Plant Operations was to do maintenance every three to six months, including cleaning the inside of the machine. Further instructions directed nursing to remove the covers from the ice tubes (chutes), wash them with soapy water, and rinse them nightly. Then wash and rinse the ice chutes nightly. EVS was directed to use Cell Block 64 (food safe) disinfectant to clean and then rinse the covers daily. The documents further showed The inside of the ice tubes build up white material, which harbors bacteria. Please be sure to clean and/or disinfect the inside of the ice tubes. Replace the covers over the ice tubes after cleaning/disinfecting. Nursing clean the ice tray with soap and water and then rinse. EVS disinfect the drain pan with cell block 64, allow 10-minute dwell time, rinse. Pour 1 gallon of hot tap water into the drain pan and drain line. We must be proactive in cleaning and disinfecting the ice machines of the Home. Ice machines are known for cross contamination so cleaning and maintenance of the ice machine are important. Review of documents titled CNA Monthly NOC Shift Unit Duties & Cleaning Log dated April, 2023 showed CNA's were assigned to clean the kitchenettes, check food dates, discard expired products, clean the ice machine, check the dishwasher temperatures, and were signed off daily by the CNA's. During an observation and concurrent interview in the nursing unit kitchenette on 5/3/23 at 8:25 a.m. Maintenance Engineer A (ME A) stated EVS disinfected the outside of the ice machine daily, including cleaning the drain pan and drain line, and Plant Ops did the interior maintenance every three to six months. During an interview with the Custodian Supervisor (CUST) on 5/3/23 at 8:45 a.m. he stated EVS staff cleaned the area around the exterior of the ice machine using sanitizer and chrome polish on the outside. They used Cell Block Sanitizer. The CNA's do the chute area with Vanguard 24-7 Food Safe (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 22 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 chemical, and Plant Ops cleans the inside. Level of Harm - Minimal harm or potential for actual harm In an additional observation with concurrent interview in the nursing unit kitchenette on 5/3/23 at 8:54 a.m., the plumber ([NAME]) stated he deep cleaned every ice machine in the facility including the kitchenette [NAME] ice machines and the kitchen Ice-O-Matic ice machine. The Follet ice machines were wiped down daily by nursing staff, and he deep cleaned them. He stated he was only responsible for two hoses. He didn't clean them, but instead replaced them with new ones every three months. He described this process for cleaning the [NAME] Ice Machines: He poured water into the cleaning cup, ran it through the machine for 15 minutes, dumped it, then repeated the process with sanitizer. He removed, cleaned, and descaled the chutes, ice tray and drain pan every three months. He stated the cleaner-descaler product didn't remove mineral deposits. He replaced the water filters every 6 months. Residents Affected - Many Review of the undated manufacturer's instructions for cleaning/descaling and sanitizing the Follet ice machines #208595, provided by Plant Ops showed the recommended cleaning procedures should be performed at least as frequently as recommended and more often if environmental conditions dictate, and should be performed by trained maintenance staff or a Follet authorized service agent. Cleaning/descaling and sanitizing of the ice machine and dispenser should be done Semi-Annually (more often if conditions dictate). The PLUMBs process was similar to the manufacturer's process except he replaced two hoses quarterly, and he did not describe soaking the ice compression nozzle and drain lines first in cleaner/descaler solution for up to 45 minutes, and then in sanitizer for approximately 30 minutes. The kitchenette ice machines had an accumulation of white mineral deposits. 7. Nursing Unit kitchenettes were not sanitary. During an observation of the resident food kitchenette on the [NAME] memory care unit on 5/1/23 at 3:00 p.m., the room contained a refrigerator, stove, sink and lots of cabinets. Certified Nursing Assistant A (CNA A) was emptying resident water pitchers into kitchen sink and discarding them. The interior of the resident refrigerator was soiled with spilled food. There was a soiled mug in the sink. The ice machine was unclean with a buildup of white mineral deposits, and a drawer showed dried brown liquid. The refrigerator and freezer were full of food and beverages from the facility and from outside the facility. Only food provided by the facility was labeled and dated. The counter was piled with additional boxes of sodas, cereal bars, popcorn and other resident food. A cabinet held an unlabeled, undated bag of candy. In a concurrent interview with the Quality Assurance Nurse (QAN) he stated the expectation for the kitchenette was that the kitchen stocked the refrigerator, and food from the outside was supposed to be labeled with the resident's name. Review of documents titled CNA Monthly NOC Shift Unit Duties & Cleaning Log dated April, 2023 showed the CNA's were assigned daily to Clean Ice Machine .Kitchenette - Clean the fridge and freezer inside and out. Clean the stove, microwave, dishwasher, dishes in the sink and counter tops etc .Remove outdated items from the freezer and fridge .Nursing is responsible for removing items with expiration dates that the Resident's brings in. Discard any expired items found .Temp check the dishwashers. All of the tasks were signed off by staff on the [NAME] and Klamath Units 29/30 days. During an interview with the ADMIN on 5/4/23 at 11:00 a[TRUNCATED] FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 23 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

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 observation, interview, and record review the facility failed to ensure resident's personal food items were labeled and dated, and the facility was unable to provide evidence of nursing staff training and competency regarding food safety and sanitation requirements in nursing unit kitchenettes. These failures had the potential to result in foodborne illness for residents consuming food from the nursing unit kitchenettes. Residents Affected - Few Findings: Review of a document titled Food & Nutrition Services - Outside Food for Residents 7265 v.2, review date 5/23/22, showed It is essential that any food brought in and served to residents is safe to consume and does not increase the risk of foodborne illness, conflict with dietary restrictions, allergies, sensitivities or increase the risk of choking or aspiration and that food or beverages brought by the resident, family or visitors for resident's use will be labeled with the resident's name and the date the item was stored. During an observation on the memory unit on 5/1/23 at 3:00 pm, the resident food kitchenette was not sanitary (Cross Reference F812). Certified Nursing Assistant A (CNA A) was emptying resident water pitchers into kitchen sink. The refrigerator and freezer were full of food and beverages from the facility and from outside the facility. Only food provided by the facility was labeled and dated. The counter was piled with additional boxes of sodas, cereal bars, popcorn and other resident food. A cabinet held an unlabeled, undated bag of candy. In a concurrent interview, CNA A identified popsicles, food and beverages in the refrigerator, the freezer and on the counter as belonging to one of their residents and confirmed they were not labeled or dated. When asked how staff would know who the items belonged to, CNA A stated staff would ask a co-worker, and that staff updated each other with information during report/team meeting. In an additional concurrent interview, the Quality Assurance Nurse (QAN) stated the expectation in the resident kitchenette was that the facility's kitchen stocked the refrigerator. He stated food brought in from the outside was supposed to be labeled with the resident's name, and if foods and beverages were not labeled with the resident's name, they could be fair game for anyone to consume. During an interview with the Administrator (ADMIN) on 5/4/23 at 11:00 am she stated they did not have any evidence of training and competency for nursing staff regarding their responsibilities in the nursing unit kitchenettes and working with resident food (food safety, sanitation, cleaning ice machine, dishwasher use and temperature monitoring). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 24 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0908 Keep all essential equipment working safely. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review the facility failed to ensure the dish machine consistently provided accurate temperatures so staff could monitor its proper function for cleaning and sanitizing dishes. This failure had the potential to result in foodborne illness for residents consuming food in the facility (Cross Reference F812). Residents Affected - Many Findings: Review of a policy titled Food & Nutrition Services - Warewashing Manual & Mechanical (All Homes), 6703 v.3, review date 10/7/2022, showed A potential cause of foodborne outbreaks is improper cleaning (washing and sanitizing) of contaminated equipment .Dishwashing machines, operated according to the manufacturer specifications, washed, rinsed, and sanitize dishes and utensils using either heat or chemical sanitation. Dish Machines .wash temperature will be between 150-165°F (degrees Fahrenheit); and hot water at a minimum temperature of 180°F will be maintained at the manifold of the final rinse. Review of a policy titled Food & Nutrition Services - Equipment (All Homes), 6227 v.2, review date 4/12/2023, showed Equipment will be provided and maintained in good working order. All equipment will be operated and maintained according to the manufacturer's specifications for cleaning and sanitizing and safe operation. During an observation in the dish room on 5/1/23 at 9:55 a.m., FST C worked on the dirty side of the dish machine. In a concurrent interview she stated there was a problem with the dish machine and it had been ongoing for years. She explained the final rinse temperature would hit 180°F (degrees Fahrenheit), and then dropped rapidly. During further observation of the function of the dish machine, the temperature screen showed the final rinse temperature dropped from 180°F to 168°F as racks continued to move through the machine. FST C stated the dish machine temperatures should be 160°F or greater for the wash and rinse, and 180°F or greater for final rinse. Review of the Manufacturer's specification plate on the dish machine showed for hot water sanitizing the temperature requirements were wash 160 minimum, and final rinse 180°F minimum to 194°F maximum. During an interview with Food Service Supervisor A (FSS A) on 5/1/23 at 10:15 a.m., she explained that in the past they ran temperature strips through the dish machine when there were issues with the dish machine temperature readings, and they had especially had problems with this and used the strips in January. FSS A added she hadn't noticed any big issue with that again until recently. She stated she thought it was an electronics issue rather than a temperature issue, but there had been a lot of issues with the dish machine. During an interview with FST F on 5/2/23 at 2:13 p.m. she was asked how she knew if the dish machine was working properly. She stated she knew by the noises it made. Also, the final rinse temperature should be 180°F, middle temp (first rinse) 160 or above, and wash temp should be 165°F or higher. If the temps weren't registering correctly, she would get a supervisor. During an interview with [NAME] S2 on 5/3/23 at 8:10 a.m. he stated that in the past, the dish machine temperatures had dropped from 180°F to 170°F. If the temperature was out of range, staff got a supervisor, and they used a temperature test strip to check it. When they were having (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 25 of 26 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 555891 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/04/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Veterans Home of California - Redding 3400 Knighton Road Redding, CA 96002 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many problems with the temperatures, the supervisor did a test strip daily for QAPI. [NAME] S2 stated the machine was repaired in December or January, and the service vendor repaired the mother board, the lines, and gave it a complete overhaul. During an interview with the FSD on 5/3/23 at 11:52 a.m. she was asked about the dish machine temperature issues and what had been done to resolve them. She stated the current dish machine was four years old, and they had ongoing problems with it. One problem they identified was the repair vendor had used inferior, substandard parts to repair it. Review of documents titled Dish Machine Temperature & Chemical Record, Main Kitchen, dated 11/1/22 through 4/30/23 showed the wash and final rinse temperatures were checked by staff five times each day. Temperatures were documented within the correct range on all checks and dates except for 15 checks on dates 12/6/22 (x3), 12/10/22 (x1), 12/11/22 (x2), 12/13/22 (x1), 12/16/22 (x3), 12/24/22 (x1), 12/26/22 (x4). Review of additional documents titled HACCP Temperature Checks showed temperature strips were run through the machine five out of 15 times when temperatures were documented out of range (12/6/22 x2, 12/13/22 (x1), 12/16 x1, and 12/24 x1). The HACCP Temperature Checks also showed additional temperature strip checks 12/3, 12/15, 12/27 (x2), and 1/23/23. The HACCP Temperature Checks did not reflect temperature strips were run through the dish machine daily during the timeline of out-of-range temperatures to ensure food safety, and when the final rinse temperatures dropped again on 5/1/23 at 9:55 a.m., there were no temperature strips readily available for supervisors to check the dish machine final rinse temperatures. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555891 If continuation sheet Page 26 of 26