Health inspection·November 21, 2024

F812 Code of Federal Regulations, Title 42, Section 483.60(i) Food safety requirements. The facility must – §483.60(i)(2) - Store, prepare, distribute, and serve food in accordance with professional standards for food service safety. California Code of Regulations, Title 22, Section 72345. Dietetic -Sanitation. (d) Ice which is used in connection with food or drink shall be from a sanitary source and shall be handled and dispensed in a sanitary manner. On 10/22/2024, the California Department of Public Health (CDPH) conducted an unannounced annual recertification survey. As a result of the investigation, the facility failed to ensure ice was stored in a sanitary manner for one facility ice machine (IM) by failing to: a. Follow the manufacturer's recommendations for interior cleaning and sanitizing of the IM when moderate amounts of black and yellow substances were observed in the internal components of the IM around the sides of the ice dicer and on the water outlet. The contaminated ice was distributed to 40 residents before breakfast on 10/22/2024. b. Ensure the IM was deeply cleaned weekly and cleaned monthly as indicated by the cleaning log. These violations resulted in 40 residents received contaminated ice for breakfast and had the potential for all 40 residents who received contaminated ice to develop water borne illnesses. During a concurrent observation and interview on 10/22/2024 at 9:30 AM with the Dietary Supervisor (DS) in the facility kitchen, the IM had yellow liquid when a napkin test was performed on the IM. Upon closer inspection, black substances were observed on the sides of the ice dicer and in the water outlet. The DS stated there was an unknown yellow substance on the napkin and unknown black substances around the ice dicer. The DS stated the black and yellow substances in the ice machine should not be there. The DS stated the unknown substances could get into the ice and cause a health hazard for the residents. During a concurrent in interview and record review on 10/22/2024 at 10:28 AM with Dietary Aide 1 (DA 1), the facility's Weekly Ice-O-Matic Deep Cleaning Log (WIDC) dated 7/23/2024 to 10/19/2024 was reviewed. The WIDC indicated staff members signed off on deeply cleaning the IM. DA 1 stated DA 1 cleaned the exterior of the IM but did not clean the inside of the IM. DA 1 stated DA 1 was instructed by DS to only clean the outside of the IM. DA 1 stated deep cleaning the IM would include cleaning the inside and outside of the IM. DA 1 stated DA 1 would not consider the cleaning to be deep cleaning if only the exterior of the IM was cleaned. DA 1 stated DA 1 was not instructed by DS to inspect the inside of the IM because Maintenance Department was responsible for cleaning the interior compartment of the IM. DA 1 stated it was important to clean the interior and exterior of the IM to ensure the ice was kept in a clean compartment. DA 1 stated, serving contaminated ice would get the residents sick. DA 1 stated the black substance in the IM looked like mold and stated if residents ingested the black substance, the residents would get diarrhea. During an interview on 10/22/2024 at 10:40 AM with the DS, the DS stated staff should not be signing off on the WIDC form for deep cleaning if the IM was not deeply cleaned. The DS stated deep cleaning the IM would require cleaning the internal components of the IM. The DS stated if the IM was not cleaned, mold, bacteria, and fungus can grow. The DS stated it was important to clean the IM because the residents could ingest the unknown yellow and black substances in the IM. The DS stated food and water should be served in a sanitary condition and if it not served in a sanitary condition, residents would develop diarrhea, stomach cramps, nausea, vomiting and develop waterborne illnesses. During a concurrent interview and record review on 10/22/2024 at 11:06 AM with Maintenance Worker 1 (MW 1), the facility's Ice Machine Cleaning Log (IMCL) dated 1/2024 to 9/2024 and the Manitowoc IM Technician's Handbook (MTH) were reviewed. The IMCL indicated the IM was last cleaned on 9/16/2024. The MTH indicated to use approved Manitowoc Ice Machine Cleaner and Sanitizer to clean and sanitize the IM. MW 1 stated MW 1 has not cleaned the IM for the month of 10/2024. MW1 stated the IM needed to be cleaned every month. MW 1 stated MW 1 cleaned the IM with one gallon of water to one tablespoon of bleach. MW 1 stated MW 1 was unaware MW 1 had to use a specific cleaner and sanitizer to clean the IM. MW 1 stated MW 1 did not read the IM manual because MW 1 was using the same process to clean the IM at MW 1's previous job. MW 1 stated the IM manual was not followed and should have been followed. MW 1 stated the black substances inside the IM looked "slimy" and stated if the residents ingested the black substance, it could cause nausea and diarrhea. During an interview on 10/22/2024 at 1:40 PM with the DS, the DS stated Certified Nursing Assistant 1 (CNA 1) passed out 40 pitchers of water with contaminated ice to the residents on 10/22/2024 at 6:00 AM. During an interview on 10/22/2024 at 2:47 PM with the Assistant Administrator (AADM), the AADM stated the AADM saw CNA 1 passed out water with ice to the residents in the morning on 10/22/2024. During an interview on 10/22/2024 at 2:50 PM with the Administrator (ADM), the ADM stated two solutions (Manitowoc IM descaler to cleanse the IM and the Manitowoc IM sanitizer to sanitize the machine) were needed to clean the Manitowoc IM. During an interview on 10/25/2024 at 1:51 PM with the Director of Nursing (DON), the DON stated the black and yellow substances should not be in the IM. The DON stated the IM did not keep the ice in a sanitary condition. The DON stated residents would get sick and develop symptoms of nausea, vomiting, and diarrhea because the IM was not cleaned properly. A review of the facility's Policy and Procedure (P&P) titled "Sanitation" indicated a cleaning schedule will list all cleaning tasks and specifies the frequency of the task and the person responsible for completion of the task. A review of an article titled, "Ice Machines and Food Safety (plus, How to Sanitize)”, dated 5/5/2024, indicated to keep ice safe, ensure there are no cross-connections present with the ice machine, handle ice safely using an ice scoop, and regularly clean and sanitize the machine. https://foodsafepal.com/ice-machines-food-safety The facility failed to ensure ice was stored in a sanitary manner for one facility IM by failing to: a. Follow the manufacturer's recommendations for interior cleaning and sanitizing of the IM when moderate amounts of black and yellow substances were observed in the internal components of the IM around the sides of the ice dicer and on the water outlet. The contaminated ice was distributed to 40 residents before breakfast on 10/22/2024. b. Ensure the IM was deeply cleaned weekly and cleaned monthly as indicated by the cleaning log. These violations resulted in 40 residents received contaminated ice for breakfast and had the potential for all 40 residents who received contaminated ice to develop water borne illnesses. These violations, jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of the 40 residents in the facility.