Other·December 8, 2021

F812 §483.60(i) Food safety requirements. The facility must - §483.60(i)(1) - Procure food from sources approved or considered satisfactory by federal, state or local authorities. (i) This may include food items obtained directly from local producers, subject to applicable State and local laws or regulations. (ii) This provision does not prohibit or prevent facilities from using produce grown in facility gardens, subject to compliance with applicable safe growing and food-handling practices. (iii) This provision does not preclude residents from consuming foods not procured by the facility. §483.60(i)(2) - Store, prepare, distribute and serve food in accordance with professional standards for food service safety.

F880 §483.80 Infection Control The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections. §483.80(a) Infection prevention and control program. The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements: §483.80(a)(1) A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to §483.70(e) and following accepted national standards; §483.80(a)(2) Written standards, policies, and procedures for the program, which must include, but are not limited to: (i) A system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility; (ii) When and to whom possible incidents of communicable disease or infections should be reported; (iii) Standard and transmission-based precautions to be followed to prevent spread of infections. On 11/4/2021, an unannounced visit was made to the facility to investigate a complaint about the environment. The facility failed to have an effective pest control program to maintain the kitchen in a clean, safe, and sanitary condition and prevent the spread of infection potentially affecting the total census of 72 residents, who received food from the kitchen and/or used dishware provided by the kitchen. There were 23 German cockroaches (a small species of cockroach), of various stages of development, crawling on the kitchen walls, under the dishwasher machine, and near the water fountain on the wall separating the walls from the activity room and the kitchen. As a result, there was an increased potential to cross-contaminate food and food contact surfaces that could cause food borne illness (food infection from ingesting live bacteria or food intoxication from ingesting food containing toxins from bacteria) and vector-borne diseases (illnesses that results from infections transmitted to humans by insects, such as cockroaches) for the total of 72 residents. During an observation inside the facility’s kitchen on 11/4/2021 at 3:30 pm, the Surveyor and the Registered Environmental Health Specialist (REHS, a health inspector who inspects various facilities and properties to determine conformance with applicable State laws and County Ordinance Code sections), observed 16 live cockroaches throughout the kitchen and 10 dead cockroaches under the dish washing machine. During the concurrent observation, surveyors observed nine live cockroaches on the wall under the dish washing machine, five cockroaches under the two-compartment sink (deep sink basin made for washing, rinsing or sanitizing dinnerware) and three live cockroaches observed near the water fountain on the wall separating the walls from the activity room and the kitchen. A review of the facility’s Resident Roster, dated 11/4/2021, indicated the facility had 72 residents residing in the facility. During an interview on 11/4/2021 at 5:38 pm, the Administrator (ADM) stated the housekeeping staff (unidentified) would spray the kitchen and bathrooms with an ant, roach, and spider spray bottle as needed with no specified day, time, or frequency. In addition, the ADM stated he did not have an ongoing contract with a pest control company to maintain a pest control program. A review of the facility’s Pest Control form dated 11/4/2021, timed at 5:47 pm, indicated the pest control company did an initial assessment to the facility and reinstatement of service. The form indicated the pest control technician (unidentified) killed multiple (unidentified number) roaches and vacuumed roaches as they came out. The invoice indicated the technician applied German roach intensive treatment to the facility’s kitchen areas and found multiple areas and cracks and crevices that needed to be sealed. A review of the facility’s Pest Control policy and procedure with a revised date of August 2008, indicated the facility should maintain an effective pest control program to ensure the building was kept free of insects and rodents. The policy did not indicate the frequency of pest control maintenance. A review of the undated article from the County of Los Angeles, Department of Public Health, Effective Management of Cockroach Infestation, at http://publichealth.lacounty.gov/eh/docs/specialized/vector_management/cockroachmgmt.pdf, indicated that cockroaches may become pests in any structure that has food preparation or storage areas. The article indicated cockroaches contaminate food and kitchen utensils, occasionally damage fabric and paper products, leave stains on surfaces, and produce unpleasant odors when present in high numbers. Cockroaches that live outdoors could come into contact with human excrement (waste matter/feces) in sewers or with animal fecal matter and had the potential to transmit bacteria that cause food poisoning when they entered the facility's kitchen. A review of the Centers for Disease Control and Prevention, Guidelines for Environmental Infection Control in Health Care Facilities, updated July 1, 2019 https://www.cdc.gov/infectioncontrol/guidelines/environmental/index.html, indicated the guidelines were recommendations for the prevention and control of infectious diseases that are associated with healthcare environments. The guidelines indicated pest included cockroaches from inside the health care facilities that can serve as agents for the mechanical transmission of microorganisms (small living thing/cell), or as active participants in the disease transmissions process by serving as a vector (a live carrier that transfers infectious pathogens/germs) to animal and or human. The facility failed to have an effective pest control program to maintain the kitchen in a clean, safe, and sanitary condition and prevent the spread of infection potentially affecting the total census of 72 residents, who received food from the kitchen and/or used dishware provided by the kitchen. There were 23 German cockroaches, of various stages of development, crawling on the kitchen walls, under the dishwasher machine, and near the water fountain on the wall separating the walls from the activity room and the kitchen. As a result, there was an increased potential to cross-contaminate food and food contact surfaces that could cause food borne illness and vector-borne diseases for the total of 72 residents. The above violations jointly or separately had a direct or immediate relationship to the health, safety, or security of all the residents in the facility