Health inspection·June 12, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to notify the physician promptly when two of four residents (Resident 22 and Resident 31) had significant weight changes (weight loss or gain). As a result of this deficient practice, residents were placed at risk for delayed treatment. Findings: 1. A review of Resident 22's admission record indicated the resident was re-admitted to the facility on [DATE] for diagnosis including Alzheimer's disease (a disease characterized by a progressive decline in mental abilities). A review of Resident 22's Weights and Vitals Summary indicated 13.7 pounds (Lbs) of weight loss between 5/1/25 and 6/3/25: 6/3/25 185.2 Lbs 5/1/25 198.9 Lbs On 6/11/25 at 10:59 A.M., an interview and record review was conducted with Registered Nurse (RN 12). RN 12 reviewed Resident 22's Weight and Vitals Summary dated 5/1/25 and 6/3/25 and stated the resident had a weight loss of 13.7 Lbs (6.9%) over a month. RN 12 stated the resident's weight loss was significant and concerning. RN 12 stated when a resident loses a significant amount of weight, the assigned nurse should reach out to the physician right away and document the notification. RN 12 reviewed Resident 22's clinical record and stated there was no documentation that the physician was notified about resident's 13.7 Lbs weight loss. 2. A review of Resident 31's admission Record, dated 6/12/25, indicated the resident was admitted to the facility on [DATE] with a diagnosis of chronic diastolic (congestive) heart failure. A review of Resident 31's Physician Orders dated 5/26/25, indicated an active order for Daily Weight in the morning If wt [weight]. gains more than 3lbs [pounds], in 48 hours, please notify MD [Medical Doctor]. A review of Resident 31's Weights and Vitals Summary indicated on 6/3/25 resident's weight was recorded as 163.2 Lbs. On 6/4/25, 6/5/25, and 6/6/25 no weight was documented. On 6/7/25 the resident's weight was recorded as 172.7 lbs and showed a weight gain of 9.5 lbs since 6/3/25. Page 1 of 12 555928 555928 06/12/2025 Ridgeview Skilled Nursing Facility 9825 Glen Center Drive San Diego, CA 92131

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 6/10/25 at 1:59 P.M., a concurrent interview and record review was conducted with Licensed Nurse (LN) 4. LN 4 reviewed the Weights and Vitals Summary for Resident 31. LN 4 stated there was no weight charted for 6/4/25, 6/5/25, and 6/6/25 for Resident 31. LN 4 stated Resident 31 had an active order for a daily weight which had started on 5/26/25 the order indicated to call the MD if there was a weight gain of more than three pounds in 48 hours. LN 4 stated the MD should have been notified of Resident 31's weight gain. On 6/10/25 at 3:40 P.M., a concurrent interview and record review was conducted with LN 5. LN 5 reviewed Resident 31's Weights and Vitals Summary and stated there was a weight increase of eight or nine lbs from 6/3/25-6/7/25. LN 5 stated there was no documentation of notification to the MD in Resident 31's clinical record. LN 5 stated we should have notified the MD about Resident 31's significant weight gain of more than three pounds. On 6/12/25 at 12:23 P.M., an interview was conducted with the Director of Nursing (DON). The DON stated the MD should have been notified immediately of Resident 31's weight gain and Resident 22's weight loss. A review of the facility's policy titled Significant Change of Condition Guidelines revised June 2025, indicated, .promptly notify the resident, his or her attending physician .of significant changes in the resident's medical/mental condition and/or status 555928 Page 2 of 12 555928 06/12/2025 Ridgeview Skilled Nursing Facility 9825 Glen Center Drive San Diego, CA 92131

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure one of three residents (Resident 31) with a diagnosis of congestive heart failure (CHF, when the heart cannot pump blood effectively) was provided care and treatment according to acceptable standards of practice when: Residents Affected - Few 1. Resident 31's weight was not taken daily as prescribed by the Medical Doctor (MD). 2. Resident 31 was not assessed for potential fluid overload (a condition where there was too much fluid in the body) after a 9.5 pound (lbs) weight gain. These failures had the potential to exacerbate the resident's congestive heart failure. Cross reference F580 and F726. Findings: A review of Resident 31's admission Record, dated 6/12/25, indicated the resident was admitted to the facility on [DATE]. A review of Resident 31's Minimum Data Set (MDS - a comprehensive assessment tool) Section I, dated 5/30/25, indicated the resident had an active diagnosis of Heart Failure. A review of Resident 31's Physician Orders dated 5/26/25, indicated an active order for Daily Weight in the morning If wt [weight]. gains more than 3 lbs, in 48 hours, please notify MD. A review of Resident 31's Weights and Vitals Summary indicated on 6/3/25 the resident's weight was recorded as 163.2 lbs. On 6/4/25, 6/5/25, and 6/6/25 no weight was documented. On 6/7/25 the resident's weight was recorded as 172.7 lbs and indicated a weight gain of 9.5 lbs since 6/3/25. According to the American Heart Association article titled Lifestyle Changes for Heart Failure dated 6/16/25, indicated, .sudden weight gain .can be a sign .your heart failure is getting worse .Your health care professional needs to know about weight changes. On 6/10/25 at 10:50 A.M., an interview was conducted with Resident 31. Resident 31 stated he liked to be weighed daily so he could keep track of his fluid retention and weight gains. On 6/10/25 at 3:40 P.M., a concurrent interview and record review was conducted with Licensed Nurse (LN) 5. LN 5 reviewed Resident 31's Weights and Vitals Summary and stated the resident had a weight increase of eight or nine lbs from 6/3/25-6/7/25. LN 5 stated there was no documentation of notification to the MD in Resident 31's clinical record. LN 5 stated the LN should have notified the MD about Resident 31's significant change of weight. LN 5 stated the LN should have completed a physical assessment to identify potential fluid overload. On 6/11/25 at 12:27 P.M., an interview was conducted with the Director of Nursing (DON). The DON stated the facility did not have a policy to guide the nursing care for residents with CHF. On 6/12/25 at 12:23 P.M., an interview was conducted with the DON. The DON stated that Resident 31's daily weights should have been taken and documented. The DON stated the MD should have been 555928 Page 3 of 12 555928 06/12/2025 Ridgeview Skilled Nursing Facility 9825 Glen Center Drive San Diego, CA 92131

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few notified immediately of Resident 31's weight gain. The DON stated the LN should have done a physical assessment to ensure that the resident was not experiencing fluid overload. According to the nursing textbook titled Nursing Fundamentals, dated 2021, .Chapter 15 Fluids and Electrolytes .Symptoms of fluid overload include pitting edema, ascites, and dyspnea and crackles from fluid in the lungs. Edema is swelling in dependent tissues due to fluid accumulation in the interstitial spaces Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK591820/ on 6/19/25. A review of the facility's RN (Registered Nurse) Job Description, issued August 2020, indicated .Principle Duties: .The RN supervisor is responsible for contacting resident's attending physicians for change of condition .accurate and timely documentation of all physician, resident, family member/surrogate decision maker communication .Critical thinking skills to assess and triage accordingly . 555928 Page 4 of 12 555928 06/12/2025 Ridgeview Skilled Nursing Facility 9825 Glen Center Drive San Diego, CA 92131

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the intake of a nutrition intervention was measured for one of 19 sampled residents (Resident 20) with significant weight loss. Residents Affected - Few The facility did not ensure a nutritional supplement for a resident who triggered for significant weight loss was accurately measured. This failure had the potential to cause more weight loss and further impair the resident's nutritional status. Findings: Resident 20's admission Record dated 6/10/25 was reviewed. The Resident admission initial date was 4/12/25 and was readmitted on [DATE] with a diagnosis of Chronic Diastolic (Congestive) Heart Failure (CHF-a heart disorder which causes the heart to not pump the blood efficiently), Iron Deficiency Anemia (a condition where the body does not have enough healthy red blood cells) and muscle weakness. A review of Resident 20's Nutrition Evaluation dated 4/17/25 completed by RD, indicated, Heart Healthy, low fat, low cholesterol, 2-2.5 grams Sodium diet with a 2-liter fluid restriction.Ideal body weight: 56.82 kg (125 pounds) .usual weight: 56.82 kilograms (125 pounds) .MNA (mini nutritional assessment) score of 11 indicates risk for malnutrition Nutrition Evaluation dated 5/21/25 completed by RD, indicated Most recent weight of 53.13 Kilograms (116.9 pounds) variance in weight loss. No fluid restrictions diet intake of 50 percent, Skin integrity of a Stage 1 pressure ulcer to the left buttocks and right buttocks and left heel. Pertinent labs dated 5/10/25 Hgb (hemoglobin) 15.6, Hct(hematocrit) 46.8 H, Glucose (simple sugar- the body's primary source of energy from food) 218 H, Na (Sodium)134 L, K+ (a mineral that your body needs to work properly). Adequacy of intake needs not met. Hydration needs met: na/not always. Calories needed 1590 Kcals,(30 Kcals/kg), percentage needed 65 percent, Protein needed 69 grams (1.3 g/kg) percent needed 76 percent, needs met: No Recommendations: weekly weights, provide diet of choice/offer preference, MVI with minerals (multivitamin) Supplement: magic cup (a frozen dessert, contains 9 grams of protein) BID (twice a day) Prostat (liquid protein medical food providing 15 grams of enzyme-hydrolyzed protein and 100 calories per 1 fluid oz) 30ml QD (four times a day). Monitor food intake, skin and weekly weight. Additional comments: MNA score of 8 indicates risk for malnutrition. On 6/10/25 at 8:07 A.M., an interview and observation were conducted with Resident 20. Resident 20 was in her room, sitting up in bed with tray in front. Resident 20's meal tray had scrambled eggs, toast, yogurt, fruit bowl, orange juice, water, resident had no concerns regarding her breakfast. On 6/10/25 at 8:20 A.M., an interview was conducted with Certified Nursing Assistant (CNA 1). CNA 1 stated she had been working at the facility for two years PRN (per diem). CNA 1 stated she often encouraged Resident 20 to eat and that Resident 20's meal intake was approximately 75-100%. CNA 1 stated she sets up the meal tray for Resident 20. CNA 1 stated she would calculate Resident 20's meal intake and chart the amount in the medical record. CNA 1 stated she does not count the magic cup separately in the total meal intake percentage. 555928 Page 5 of 12 555928 06/12/2025 Ridgeview Skilled Nursing Facility 9825 Glen Center Drive San Diego, CA 92131

F 0692 Level of Harm - Minimal harm or potential for actual harm On 6/10/25 at 12 P.M., an interview and observation were conducted with Resident 20 in her room. The resident was sitting up in bed with meal tray in front. Resident 20's meal tray had 2 bowls of chicken broth, 1 cup of mix fruit and a 1 magic cup. Resident 20 had consumed both bowls of chicken broth. Resident 20 did not consume the magic cup. Resident stated she was not going to eat it (magic cup) because she didn't like it (magic cup) and does not usually eat it (magic cup). Residents Affected - Few A review of the facility's Medical Administration Record (MAR) from May 2025-June 2025, the MAR indicated the nursing staff documented yes or no which represented the magic cup was served to resident 20 on her tray or not. The MAR did not indicate the percentage of consumption Resident 20 consumed. On 6/11/25 at 10:54 A.M., an interview and record review with Director of Nursing (DON). The DON stated the magic cup is provided by the kitchen and is on the meal tray. The DON stated CNA counts the meal tray and does not count the magic cup separately. The DON stated licensed nurses would chart on the Medication Administration Record (MAR). The DON stated licensed nurses do not document percentages on intake of the magic cup. The DON stated there is no policy regarding documentation of a supplement. The DON stated it is important to document interventions to do an appropriate assessment and to show if an intervention is effective or not. On 6/11/25 at11:50 A.M., an interview was conducted with RD. The RD stated she would ask the nurse how much Resident 20 had consumed of the magic cup. The RD stated she had no documentation regarding magic cup intake. The RD stated her expectation is for her to know the amount of magic cup has been consumed to be able to provide and accurate assessment to provide the nutrients to help with the resident's overall health. Per the facility policy titled Residents at Nutritional Risk, revised 9/22/21, indicated .The high-risk resident should receive interventions that should promote optimum quality of life .4. CDM, DTR or other clinically qualified nutrition professional and RD should evaluate the resident's condition with the input from nursing to determine the plan of action if needed and monitor the resident's problem until the problem is resolved 555928 Page 6 of 12 555928 06/12/2025 Ridgeview Skilled Nursing Facility 9825 Glen Center Drive San Diego, CA 92131

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure that two of four licensed nurses (LN 4 and RN 12) were competent to provide care for a resident (Resident 31) with a diagnosis of congestive heart failure (CHF, a condition where the heart does not pump blood as well as it should). This failure had the potential for Resident 31 and other residents with CHF to experience negative outcomes related to fluid overload (a condition where fluid builds up in the body). Cross reference F580 and

F684. Findings: A review of the Facility Assessment updated 6/9/2025, indicated .Most common Diagnoses: Over Past 12 Months Details: Heart Disease with various complications A review of Resident 31's admission Record, dated 6/12/25, indicated the resident was admitted to the facility on [DATE] with a diagnosis of chronic diastolic (congestive) heart failure. A review of Resident 31's Physician Orders dated 5/26/25, indicated an active order for Daily Weight in the morning If wt [weight]. gains more than 3lbs [pounds], in 48 hours, please notify MD [Medical Doctor]. A review of Resident 31's Weights and Vitals Summary indicated on 6/3/25 the resident's weight was recorded as 163.2 lbs. On 6/4/25, 6/5/25, and 6/6/25 no weigh for Resident 31 was documented. On 6/7/25 Resident 31's weight was recorded as 172.7 lbs and indicated a weight gain of 9.5 lbs since 6/3/25. According to the American Heart Association article titled Lifestyle Changes for Heart Failure dated 6/16/25, indicated, .sudden weight gain .can be a sign .your heart failure is getting worse .Your health care professional needs to know about weight changes. On 6/10/25 at 1:59 P.M., a concurrent interview and record review was conducted with Licensed Nurse (LN) 4. LN 4 was a Registered Nurse. LN 4 reviewed Resident 31's Weights and Vitals Summary and stated there was no weight documented for 6/4/25, 6/5/25, and 6/6/25. LN 4 stated Resident 31 had a weight gain over three pounds on 6/7/25. LN 4 stated Resident 31 needed to be weighed daily to ensure adequate nutrition. LN 4 did not know Resident 31 had CHF. LN 4 did not know how to assess for and identify signs and symptoms of fluid overload. On 6/10/25 at 3:40 P.M., a concurrent interview and record review was conducted with LN 5. LN 5 reviewed Resident 31's Weights and Vitals Summary and stated the resident had a weight increase of eight or nine lbs from 6/3/25-6/7/25. LN 5 stated the LN should have done a physical assessment such as listening to lung sounds and an edema (swelling in the body) check. LN 5 stated it was important to monitor weight changes to ensure the resident did not experience fluid overload. On 6/11/25 at 11:34 A.M., a concurrent interview and record review was conducted with RN (Registered Nurse) 12. RN 12 reviewed Resident 31's Weights and Vitals Summary and stated the resident was not weighed on 6/4/25, 6/5/25, and 6/6/25. RN 12 stated on 6/7/25 she weighed Resident 31 and did not 555928 Page 7 of 12 555928 06/12/2025 Ridgeview Skilled Nursing Facility 9825 Glen Center Drive San Diego, CA 92131

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few notice that there had been a significant increase of weight. RN 12 stated, I would be more concerned if it was a weight loss. RN 12 stated that if she had noticed the weight gain, she would have done a bladder assessment on Resident 31 and notified the Director of Nursing (DON). RN 12 knew that Resident 31 had CHF and did not know how to assess for and identify signs and symptoms of fluid overload. On 6/11/25 at 12:27 P.M., an interview was conducted with the DON. The DON stated the facility did not have a specific competency evaluation for nurses related to CHF. The DON stated the facility did not have a policy to guide the nursing care for residents with CHF. The DON further stated the facility did not have a policy for nurse competency. On 6/12/25 at 12:23 P.M., an interview was conducted with the DON. The DON stated the facility admitted a high volume of CHF residents. The DON stated residents with CHF and weight gain should be assessed by the LN. The DON stated LNs should assess for lung sounds, edema, and shortness of breath. The DON stated it was her expectation for the LNs to be competent in providing care for CHF residents. According to the nursing textbook titled Nursing Fundamentals, dated 2021, .Chapter 15 Fluids and Electrolytes .Symptoms of fluid overload include pitting edema, ascites, and dyspnea and crackles from fluid in the lungs. Edema is swelling in dependent tissues due to fluid accumulation in the interstitial spaces Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK591820/ on 6/19/25. A review of the facility's RN (Registered Nurse) Job Description, issued August 2020, indicated .Principle Duties: .The RN supervisor is responsible for contacting resident's attending physicians for change of condition .accurate and timely documentation of all physician, resident, family member/surrogate decision maker communication .Critical thinking skills to assess and triage accordingly . 555928 Page 8 of 12 555928 06/12/2025 Ridgeview Skilled Nursing Facility 9825 Glen Center Drive San Diego, CA 92131

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to provide medication as ordered by the prescriber for three weeks for one of five residents (Resident 20) reviewed for pharmacy services. This deficiency resulted in the facility's failure to provide a medication to meet the needs of the resident according to the prescribed orders. Findings: A review of Resident 20's admission Record indicated the resident was readmitted to the facility on [DATE]. On 6/12/25 at 8:11 A.M., a medication administration observation was conducted with Registered Nurse (RN) 12. RN 12 was observed preparing medications to administer to Resident 20. Vitamin B-12 was not administered to Resident 20. A review of Resident 20's physician orders dated 5/17/25, indicated the resident was to receive Vitamin B-12 Oral Tablet Extended Release 1000 mcg (micrograms) once a day in the morning. A review of Resident 20's medication administration record (MAR) indicated Vitamin B-12 1000 mcg was not given to Resident 20 from 5/24/25 through 6/12/25. On 6/12/25 at 10:30 A.M., an interview and record review was conducted with RN 12. RN 12 stated Vitamin B-12 oral tablet had not been given to Resident 20 for approximately one month. RN 12 stated Resident 20's family member had been called multiple times to bring in Resident 20's medication. RN 12 stated the facility should provide medications if the family did not bring in the medications. On 6/12/25 at 10:49 A.M., an interview and record review was conducted with RN 13. RN 13 stated Resident 20's family wanted to bring in the medication for the resident and that the medication should have been brought to the facility in a timely manner. RN 13 stated when the medication was not brought in, the facility should have provided Resident 20's Vitamin B-12. On 6/12/25 at 12:10 P.M., an interview was conducted with the Director of Nursing (DON). The DON stated that the family of Resident 20 had requested to bring in their own supply of Vitamin B-12 Oral Tablets for administration to their family member and the physician wrote orders for the medication. The DON stated after three days of a resident not receiving a medication the physician should have been informed. The DON stated that the facility is responsible to provide the medication to the resident. Per facility's policy and procedure titled Handling Meds admitted with Residents revised [DATE], did not provide guidance related to the delivery, receipt and administration of non-narcotic, family-provided medication. 555928 Page 9 of 12 555928 06/12/2025 Ridgeview Skilled Nursing Facility 9825 Glen Center Drive San Diego, CA 92131

F 0802 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 the kitchen staff received appropriate training in food sanitation and food safety according to standards of practice and facility policy when: 1. One cook did not demonstrate the proper method of testing the sanitizer solution used for sanitization (the process of safely removing waste to prevent disease transmission and improve hygiene) on equipment and food prep surfaces to prevent cross contamination. 2. One cook did not demonstrate proper method on thickening for a puree soup for one resident. These failures had the potential to expose residents to bacterial contamination, that could result in food borne illnesses for all residents who consume food from the kitchen. The facility census was 19. Cross references F812 Findings: 1. During a kitchen observation and interview on 6/11/25 at 3:35 P.M. with [NAME] (CK 2), CK 2 demonstrated how he tested the sanitizer concentration level in the red buckets. CK 2 filled a red bucket with water and sanitizer. CK 2 dipped an ammonia test strip into a red bucket with ammonia sanitizing solution for 30 seconds, then pulled the strip out and stated the reading was 300-400 ppm (parts per million). CK 2 stated the test strip readings should be 200 ppm. CK 2 dumped the water and filled the red bucket back up with water and added solution to repeat steps to test the bucket again. CK 2 stated he used the red buckets with sanitizer to wipe food prep counter surfaces, food carts, and the food production sink. CK 2 stated he was not sure how many seconds he had to dip the strip in the red bucket with the solution. CK 2 was observed reading a chart on the wall that had instructions on sanitizing red buckets and stated he needed to dip the strip for 30 seconds. A review of the Hydrion sanitizer test strip with CK 2 instructed to dip strip in solution for ten seconds. CK 2 stated he should have dipped the sanitizer strip for ten seconds per instructions on the label. On 6/11/24 at 3:45 P.M., an interview was conducted with the Director of Food and Nutrition Services (DFNS). The DNFS stated that there was an in-service with the kitchen staff on the use of test strips for testing the sanitizer solution. The DFNS stated that the kitchen staff were instructed how to use the appropriate process when testing sanitizer levels in the red buckets. The DFNS stated her expectations for the kitchen staff was to follow the correct process for testing the sanitizer levels in the red sanitizer buckets. According to the 2022 Federal Food and Drug Administration (FDA) Food Code, section 4-601.11 Equipment, titled Food-Contact Surfaces, Nonfood-Contact Surfaces, and Utensils.cleaning focuses on the need to remove organic matter from food-contact surfaces so that sanitization can occur and to remove soil from nonfood contact surfaces so that pathogenic microorganisms will not be allowed to accumulate . Per facility's policy titled Sanitizing Food Contact Surfaces, revised date 3/1/2025, indicates .Use chemical sanitizers in accordance with the EPA-registered label (Environmental Protection Agency) use directions included on the labeling. 3. Sanitation buckets must be established with appropriate solution. Quaternary solution, 200 ppm or 150-400 ppm depending on the product used and 555928 Page 10 of 12 555928 06/12/2025 Ridgeview Skilled Nursing Facility 9825 Glen Center Drive San Diego, CA 92131

F 0802 manufactures guidelines Level of Harm - Minimal harm or potential for actual harm 2. During a kitchen interview and observation on 6/10/25 at 11:20 A.M. of the lunch tray line service, there was a bowl of pureed tortilla soup sitting on top of a counter with a lid on it. The soup had a liquid texture and appeared thin and fluid-like. CK 1 described how he prepared a bowl of pureed Spinach Tortellini soup, which was by taking a portion of the regular soup and adding a tablespoon or two of powder thickener to it, then stirring it to create a mixture. CK 1 stated he would check the pureed food with a spoon for its thickness and consistency by determining if it coats the spoon. Residents Affected - Few On 6/10/25 at 12:10 PM, an interview with the Speech Language Therapist (SLT) was conducted. The SLT stated she expected the texture of pureed foods to be at a nectar-thick or pudding like texture. The SLT stated it was important for foods to be at the correct texture for residents with difficulty swallowing. On 6/10/25 at 1:17 P.M., an interview was conducted via video call with the Registered Dietitian (RD). The RD stated she has done in-service texture of foods but had not done a demonstration on different types of liquid textures. The RD stated her expectation was for all cooks to know how to prepare the correct textured diet foods, including pureed, to meet the resident's needs. A copy of the pureed Spinach Tortellini Soup recipe was requested but not provided. According to the International Dysphagia Diet Standardization Initiative (IDDSI) 2024, a pureed texture indicates .prescribed to people who have pain when chewing or swallowing or are unable to bite or chew foods. This diet requires a texture modification so that foods are smooth and lump-free, and foods should not be firm or sticky. Foods should fall off spoon as an intact spoonful, hold its shape on a plate, and liquid must not separate from solid. Foods do not require chewing or bolus formation .(IDDSI, 2019a; IDDSI, 2019b); and a Level 2- Mildly thick liquid included . dietary management of dysphagia with liquid thickness modification described as liquids that are sippable, flow off a spoon at a slower rate than thin liquid, requires effort to suck through a standard straw, and further meet the complete descriptive and testing specifications of International Dysphagia Diet Standardisation Initiative (IDDSI, 2019a; IDDSI, 2019b) . 555928 Page 11 of 12 555928 06/12/2025 Ridgeview Skilled Nursing Facility 9825 Glen Center Drive San Diego, CA 92131

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure food safety and sanitation practices in dietary services were maintained for food storage according to standards of practice when: Residents Affected - Few 1. The facility did not ensure dry food storage room temperatures were monitored. 2. The facility did not ensure trash bins were stored next to clean dishware. These failures had the potential to cause widespread food borne illness among all 19 residents who receive food from the kitchen. Findings: 1. During the initial kitchen tour on 6/9/25 at 10:30 A.M., an interview and observation was conducted with the Director of Food and Nutrition Services (DFNS) and Executive Chef (EC) about the dry food storage room temperature. The DFNS stated the dry food storeroom temperature was not monitored. The DFNS further stated the room was not too close to the kitchen, so she did not think the temperatures in that room would be too hot. A Surveyor used their thermometer to measure the dry storage room's ambient (the temperature of the surrounding air in a particular environment) temperature, and it was 88 degrees F (Fahrenheit). The DFNS stated temperatures in the dry food storage may need to be monitored to ensure the quality and safety of the food. According to the 2022 Federal Food and Drug Administration (FDA) Food Code, section, 4-204.112, titled Temperature Measuring Devices, .A permanent temperature measuring device is required in any unit storing time/temperature control for safety food because of the potential growth of pathogenic microorganisms 2. During an observation and interview on 6/11/25 at 3:20 P.M., a kitchen Utility Worker (UW) was observed taking out 2 large gray garbage bins of trash to the outside dumpster. After the UW rinsed out the garbage bins with water, he brought them back to the kitchen and turned upside down on the floor in the main walkway next to the dry dish storage rack with clean dishware. Water was observed coming out of the trash bins onto the floor. The UW stated this was what he always did after he removed the trash, and this was how he was trained. On 6/11/25 at 3:30 P.M., an interview and observation were conducted with EC. EC stated trash bins should not be placed near clean dishware and with water spilling onto the floor. Per the facility's undated policy titled Floor Safety, the policy indicated .1. Floors should be kept clean and dry 8. Any spills occurring should be cleaned immediately. 555928 Page 12 of 12