Health inspection·October 31, 2024

F 0761 Level of Harm - Minimal harm or potential for actual harm Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview and record review, the facility failed to ensure: Residents Affected - Few 1. Medications (med) were stored properly. 2. Medication Refrigerator temperatures were documented consistently for one of one medication refrigerator. 3. Medication room temperatures were documented consistently for one of one medication room. These failures had the potential for unsafe storage, contamination of medication and altered efficacy of resident medications. Findings: 1. On 10/30/24 at 4:27 P.M., a joint observation of the med cart in the back hall and an interview was conducted with Licensed Nurse (LN) 1. There were oral medications in liquid forms, tablet, and capsule forms, comingled with eye drops in the second drawer of the med cart. LN 1 stated, There should be no liquid medication form and eye drops there. LN 1 stated the medications should not be mixed up. On 10/31/24 at 7:48 A.M., an interview was conducted with LN 1. LN 1 stated the importance of keeping the med cart organized was to prevent contamination and ease of med identification. On 10/31/24 at 9:43 A.M., an interview was conducted with the Director of Nursing (DON). The DON stated the importance of organizing the med cart was to prevent spillage of liquid medications to the tablet forms. A review of the facility's policy, titled Storage of Medications, revised 10/2018, indicated, .B. External use drugs in liquid, capsule .shall be restored separately .a. Example: Separate oral tablets/ capsules from oral liquids .from ophthalmic drops . 2. On 10/30/24 at 4:27 P.M., an observation of the med refrigerator and review of log for the med refrigerator, and an interview was conducted with Licensed Nurse (LN) 1. Inside the med refrigerator, there were tubersol (solution used for skin testing for tuberculosis [TB, respiratory infection]), flu (respiratory virus) vaccines and a vancomycin (antibiotic) eye ointment for a resident. Page 1 of 5 555906 555906 10/31/2024 Meadowbrook Village Christian Retirement Community 100 Holland Glen Escondido, CA 92026

F 0761 Level of Harm - Minimal harm or potential for actual harm A review of the med temperature log was conducted. There was a missed temperature check on 10/19/24. LN 1 acknowledged there was a missed temperature check on the med refrigerator log. On 10/30/24 at 5:04 P.M., a review of the med refrigerator temperature log from January 2024 to October 2024 and an interview was conducted with the Director of Nursing (DON). Residents Affected - Few The log indicated, there were missed documentation of temperatures of the med refrigerator on the following dates: - Morning shift on 4/8/24, 4/15/24, and 4/16/24. - Afternoon shift on 4/18/24, 5/20/24, 6/1/24, 7/16/24 and 10/19/24. The DON stated it was important to monitor and document the temperatures of the med refrigerator especially when there were vaccines to maintain integrity of the vaccines. A review of the facility's policy, titled Temperature of Medications, revised 10/2018, indicated, Drugs should be stored in appropriate temperatures .B. Drugs requiring refrigeration shall be stored in a refrigerator between .36 degrees Fahrenheit and .46 degrees Fahrenheit .1. If storing vaccines .temperature will be documented on log twice daily (AM & PM) . 3. On 10/30/24, a review of the med room temperature log from January 2024 to October 2024 was conducted. On 10/31/24 at 1:01 P.M., a review of the medication room temperature log and an interview was conducted with the Director of Nursing (DON). There were missing documentation of temperatures of the med room on the following dates: - 4/6/24, 4/8/24, 4/13/24, 4/15/24, and 4/16/24. The DON stated the expectation was for the Licensed Nurses (LNs) to take and document med room temperatures daily to maintain integrity of the medications. A review of the facility's policy, titled Temperature of Medications, revised 10/2018, indicated, Drugs should be stored in appropriate temperatures, A. Drugs required to be stored at room temperature shall be stored at a temperature between .59 degrees Fahrenheit .and 86 degrees Fahrenheit. 1) Recommend a temperature log for daily documentation . 555906 Page 2 of 5 555906 10/31/2024 Meadowbrook Village Christian Retirement Community 100 Holland Glen Escondido, CA 92026

F 0812 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to: Residents Affected - Some 1. Store foods appropriately in the dry storage room and freezer. 2. Cover facial hair while preparing food. These failures had the potential for food contamination and spoilage of residents' food. Findings: 1. On 10/29/24 at 8:47 A.M., an initial tour of the kitchen and an interview was conducted with the [NAME] (C1). During an observation of the dry storage room the following were noted: -Chocolate flavored syrup bottle had brown sticky liquid all over the bottle. -Rice cereals were in an unsealed bag and not labelled with the open date. -Bran cereal bag was sealed, but not labelled with the open date. -Flour, thickener, and panko breadcrumbs were stored in large white bins with a large gaps, approximately 1-2 inches between the container and the lids of all three bins. The label on the thickener was very faded and unreadable. During the observation of the facility's freezer, two small containers of ice cream were found unlabeled with open date. C1 stated that if food containers were not sealed, the product could have been contaminated by pests or not preserved its quality. C1 stated that the gaps between lid and top of container could allow contamination from pests. C1 stated that it was important to label all food clearly with open dates, to provide information when the products were past the expiration date. 2. On 10/29/24 at 8:40 A.M., during the initial tour of the kitchen, [NAME] (C1) and Dietary Aide (DA 1) were observed to have beards, and were not wearing beard nets while preparing food. DA 1 was cutting fruits. An interview was conducted. DA 1 stated he just started to grow his facial hair and forgot to wear his beard net. C1 stated the policy was staff with facial hair were required to wear beard nets while in the kitchen. C1 and DA 1 both applied beard nets. DA 1 stated that he was supposed to wear a beard net when working with food to prevent facial hair from falling into food and contaminating it. C1 stated it's important to wear beard nets to not contaminate the food with their facial hair. On 10/30/24 at 12:30 P.M., an observation of kitchen task related photos and an interview was conducted with the Certified Dietary Manager (CDM). There were photos taken during the initial tour of the kitchen, dry storage room and the freezer. 555906 Page 3 of 5 555906 10/31/2024 Meadowbrook Village Christian Retirement Community 100 Holland Glen Escondido, CA 92026

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some The CDM stated the expectation for the dry food storage was that food should be in a sealed container and labeled. The CDM stated that the importance of proper food storage was to prevent contamination and to ensure the food was not past the expiration date. The CDM stated the expectation for food service staff with facial hair was that when they choose to have facial hair, they were required to wear beard net while working with food. The CDM stated the importance of using beard nets was to prevent contamination of food from the food service worker's facial hair. On 10/31/24 at 10:30 A.M., an observation of kitchen task related photos and an interview was conducted with the Administrator (ADM). The ADM stated his expectation for food storage was that all food should be labelled and in a sealed container. The ADM stated the importance of sealing and labelling was to prevent contamination and spoilage of food. The ADM stated his expectation of food service staff was all hair, including facial hair should be covered while working with food or in the kitchen. The ADM stated the importance of covering hair was to prevent food contamination from the hair. According to the 2017 Federal Food and Drug Administration (FDA) Food Code, Section 3-501.17 (A) (B) (C) (D), .required food labeling and dating .the day the original container is opened in the food establishment shall be counted as Day 1 .The date marked shall not exceed a manufacturer's use-by date .mark the date or day of preparation, with a procedure to discard the food on or before the last date or day by which the food must be consumed on the premises. According to the 2017 Federal Food and Drug Administration (FDA) Food Code, Section 2017 4-601.11) Equipment .Non-food contact surfaces .Non-food contact surfaces of equipment shall be kept free from accumulation of dust, dirt, food residue, and other debris. Additionally, the presence of food debris or dirt on nonfood contact surfaces may provide a suitable environment for the growth of microorganisms which employees may inadvertently transfer to food. Review of facility policy titled FOOD SERVICE MANAGEMENT, dated 2023 indicated .All food and nonfood items purchased for the Food and Nutrition Services Department will be properly stored .All open food items will have an open date and use-by-date per manufacturer's guidelines .1.Food storage areas shall be clean at all times .2 .All packaged food .or food items shall be kept clean and dry at all times . Review of facility policy titled PERSONNEL MANAGEMENT, dated 2023 indicated .5. All Food and Nutrition Services staff are required to wear hairnets or caps or other suitable coverings to confine all hair when required to prevent the contamination of food, equipment, or utensils .7. Beards, sideburns, and mustaches shall be covered . 555906 Page 4 of 5 555906 10/31/2024 Meadowbrook Village Christian Retirement Community 100 Holland Glen Escondido, CA 92026

F 0814 Dispose of garbage and refuse properly. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to adequately clean the area around their kitchen dumpster. Residents Affected - Some This failure had the potential to attract pests and rodents. Findings: On 10/30/24 at 11:40 A.M., an observation of the food dumpster and interview with the [NAME] (C1) was conducted. The kitchen dumpster for food was located behind the main building of the facility campus. • A putrid smell was noticeable around dumpster. • The area around the dumpster had remnants of oily, grimy liquid spills on the concrete near the dumpster and on the side of the dumpster. • Multiple used gloves were observed on the floor around the dumpster. • Two small white bags of garbage were observed under the dumpster. C1 stated the expectation was the area around the dumpster should be cleaned regularly and to not have stray trash below or around outside of the dumpster. C1 stated that the importance of cleaning around the dumpster area was to prevent attracting pests and rodents to the trash. C1 stated he had seen a possum at the dumpster a week ago. On 10/30/24 at 12:30 P.M., an observation of photos of kitchen's dumpster and an interview with Certified Dietary Manager (CDM) was conducted. The CDM stated the expectation was garbage should be contained within the dumpster, and the area around the dumpster should be cleaned. The CDM stated the importance of cleaning the area around the dumpster was to prevent pests and rodents from infesting the area. On 10/31/24 at 10:30 A.M., an observation of photos of the kitchen's dumpster and an interview with the Administrator (ADM) was conducted. The ADM stated his expectation was the area around the dumpster should be kept cleaned, no loose trash around or under the dumpster to prevent pest and rodent infestations. Review of policy title Cleaning Procedure - Garbage cans and lids, dated 2023 indicated 'When to be cleaned: weekly .Maintain high standards of cleanliness . 555906 Page 5 of 5