Other·May 3, 2022

F925 CFR §483.90(i)(4) Maintain an effective pest control program so that the facility is free of pests and rodents. On 2/17/2022, the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate a complaint related to physical environment. The facility failed to maintain the kitchen in a clean, safe, and sanitary condition in which food was stored, prepared, and served in accordance with professional standards of food service safety. For all residents receiving food and / or using tableware from the kitchen, the facility did not: 1. Eradicate (destroy/kill) active rat (a rodent that resembles a large mouse, typically having a pointed snout and a long, sparsely haired tail; rats can carry many diseases and are responsible for transmitting diseases; rats communicate and mark their territory by urinating everywhere they go, representing a significant public health risk) infestation (presence of an unusually large number of rat population) in the kitchen as evidenced by actual live bodies, droppings (feces) or vomitus, urine stain or gnaw marks that could result in contamination of food, equipment, packaging, or utensils. Between 12-15 rat droppings were observed in the kitchen floor underneath the food preparation sink area. 2. Eliminate harborage conditions (locations and conditions where pests can live, thrive [grow strong], reproduce, and feed) such as gaps, cracks, crevices (narrow openings) in the walls and floors and on different surfaces throughout the kitchen. As a result, all residents in the facility, were placed at risk of developing food-borne illness (eating live microorganisms, food containing toxins from bacteria), and vector-borne diseases (diseases that result from an infection transmitted to human by vermin [noxious, objectionable, or disgusting animals collectively, especially those of small size that appear commonly and are difficult to control, as flies, lice, bedbugs, cockroaches, mice, and rats]) from ingesting (drinking / eating) contaminated food and unsanitary food preparation and storage that could lead to life-threatening complications and death. On 3/24/2022 at 2:19 p.m., the SA received an email notification from Los Angeles County Department of Environmental Health (LAC DEH, the agency that approves operation of kitchens [licensing] and conduct periodic kitchen inspections [restaurants, health facilities, and any public venue that serves food]) of the facility’s kitchen condition. A review of the facility’s census report, dated 3/24/2022, indicated there were 98 residents residing in the facility. On 3/24/2022 at 3:55 pm., an observation tour of the kitchen was conducted, 12-15 rat droppings were on the kitchen floor under the two-compartment food preparation sink area; the grout was missing throughout the kitchen floor; there was grime, grease, and food debris on the floor, walls and beneath all food equipment; there were missing tiles and damaged surfaces, which served as harborage of pest. On 3/24/2022 at 4:55 pm., during an interview, the Infection Preventionist (IP) stated she was scheduled to do a kitchen inspection with the Registered Dietitian (RD) the next day. The IP provided the Evaluator with the Kitchen Sanitation Audit, dated 1/4/2022 and 2/1/2022, conducted by the RD and IP. Both audit reports indicated the kitchen was free of pest and the section (Section # 15) for gaps/holes/cracks was marked out of compliance because some tiles in the kitchen were noted with cracks. There was no plan of action to correct the non-compliance or deadline to make the necessary corrections. On 3/24/2022 at 5:25 pm., during an interview, RD confirmed she and IP were responsible for conducting monthly kitchen sanitation report which was due this week. RD stated vermin droppings can contaminate foods and utensils served or used with the residents causing them diseases. RD was unable to explain the unsanitary and unsafe kitchen condition but acknowledged being responsible for the safe operation of the kitchen. On 3/26/2022 at 12:49 pm., during an interview, Licensed Vocational Nurse 1 (LVN 1), who was administering medications to the assigned section of the facility, stated she gave oral medications and for residents who could not eat by mouth and were fed through enteral tube (soft tubing surgically inserted into the gastric tract through the abdominal wall for medication and feeding formula administration) she flushed the enteral tube with water served in water pitchers from the facility’s kitchen. There were five residents on enteral feeding in the facility. On 3/26/2022 at 1:15 pm., during an interview, Kitchen Supervisor stated it was the responsibility of the RD and himself to maintain the kitchen in a clean, safe, and sanitary condition but was unable to explain the unsanitary condition the kitchen was preparing, and handling foods served to residents. On 3/26/2022 at 1:35 pm., during an interview, Director of Nursing (DON) confirmed rat droppings could lead to food contamination placing all residents at risk of diseases. On 3/27/2022 at 10:20 am., during an interview, Cook 1 could not explain the kitchen unsanitary condition. A review of facility’s pest control reports for the past six months, titled “Customer Service Report & Invoice” dated 9/27/2021, 10/27/2021, 11/23/2021, 12/29/2021, 1/26/2022, and 2/23/2022, all indicated “serviced for elimination of pests. No activity note.” The pest control report did not address evaluating harborage conditions and the areas of the facility serviced. A review of the facility’s Dietetic Service Contract date 5/15/2021, indicated the RD Consultant will provide management tools as needed to the KS to enhance the operation of the dietary department. Sanitation inspection done to the kitchen weekly. A review of the facility’s policy and procedures titled, “Kitchen Sanitization”, with subtitle “Policy Interpretation and Implementation”, revised in 2008, indicated all kitchen areas and dining areas shall be kept clean, free from litter and rubbish and protected from rodents, roaches, flies, and other insects. All utensils, counters, shelves, and equipment shall be kept clean, maintained in good repair and shall be free from breaks, corrosions, open seams, cracks, and chipped areas that may affect their use or proper cleaning. A review of the facility’s policy and procedures titled, “Infection control”, revised on 7/2014, with subtitle “Policy Interpretation and Implementation” indicated, the objectives of our infection control policies and practices are to: a. Prevent, detect, investigate, and control infections in the facility b. Maintains a safe, sanitary, and comfortable environment for personnel, residents, visitors and the general public. A review of an undated document part of the contract agreement titled, Scope of Service, indicated each regular service visit included a sanitation and structural inspection of the covered service areas and inform the customer of existing sanitation or structural conditions found which can contribute to pest activity or infestation. A review of the facility’s policy and procedures titled, “Pest Control" with subtitle “Policy Interpretation and Implementation” revised on 2/2008, indicated, this facility maintains an on-going pest control program to ensure the building is free of insects and rodents. A review of the facility’s policy and procedures titled, “Preventing and Managing pest infestations” revised on 12/2011, indicated in the procedures: 1. Monitoring a. Maintain vigilance if there is an outbreak reported in the geographic region. b. Be aware of the distinctive signs of infestation (droppings, sighting of pest) 2. Identification c. Inspect areas in the facility for any signs of infestation. 1. Check areas for the presence of pest activity. Use a flashlight to check for signs of pest activity. 2.Use contact and standard precaution. 3.Eradication of infestation a. Remove and treat/or treat all infested materials 4. Follow up c. Seal cracks and cervices to remove hiding places. A review of the 2017 U.S. Food and Drug Administration Food Code 4-402.11 indicated, the inability to adequately or effectively clean areas under equipment could create a situation that may attract insects and rodents and accumulate pathogenic (disease-causing) microorganisms that are transmissible through food. A review of the 2017 U.S. Food and Drug Administration Food Code 6-202.15 indicated, insects and rodents are vectors of disease-causing microorganisms (living thing that is too small to be seen with the naked eye) which may be transmitted to humans by contamination of food and food contact surfaces. Food establishment shall be protected against the entry of insects and rodents by filling or closing holes and other gaps along floors, walls, and ceilings; closed, tight fitting windows and solid self-closing tight fitting doors. The facility failed to maintain the kitchen in a clean, safe, and sanitary condition in which food was stored, prepared, and served in accordance with professional standards of food service safety. For all residents receiving food and / or using tableware from the kitchen, the facility did not: 1. Eradicate active rat infestation in the kitchen as evidenced by actual live bodies, droppings or vomitus, urine stain or gnaw marks that could result in contamination of food, equipment, packaging, or utensils. Between 12-15 rat droppings were observed in the kitchen floor underneath the food preparation sink area. 2. Eliminate harborage conditions such as gaps, cracks, crevices in the walls and floors and on different surfaces throughout the kitchen. As a result, all residents in the facility, were placed at risk of developing food-borne illness, and vector-borne diseases from ingesting contaminated food and unsanitary food preparation and storage that could lead to life-threatening complications and death. The above violations had a direct relationship to the health, safety, and security of all residents.