Arbol Healthcare Center of Santa Rosa

In the surveyor’s words

From the most serious findings on record at Arbol Healthcare Center of Santa Rosa, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812May 30, 2024

  Based observation, interview and record review, the facility failed to store, prepare, distribute, and serve food in accordance with professional standards of food service safety when: 1) the facility failed to store dry foods (staples; mixes and packaged foods; canned and dried foods; spices, herbs, condiments, and other foods not requiring refrigeration) in the optimum temperature between 50 and 70 Fahrenheit (F); and 2) the facility failed to prevent cross-contamination of kitchen dishes when dietary staff operating the dishwasher handled dirty and clean dishes without changing gloves or performing hand hygiene. These failures had the potential for residents to consume degraded food and had the potential to expose residents to gastro-intestinal diseases. […]

• No harm, potential for more than minimal, widespreadF609Jan 19, 2024

  Based on observation, interview, and record review, the facility failed to report one incident of resident abuse to authorities within the required two-hour time frame after the allegation was made. This failure to report an allegation of abuse within the Federally mandated requirement of two hours, had the potential to result in ongoing resident abuse and physical, mental, and /or emotional harm, and prevented the State Agency from conducting a timely investigation into the allegation. Findings: During a review of a report titled State of California Report of Suspected Dependent/Elder Abuse (SOC 341) dated 1/1/24, the SOC 341 indicated alleged abuse occurred on 12/30/23 with exact time unknown. […]

• No harm, potential for more than minimal, widespreadF802Oct 27, 2023

  Based on dietary staff observations, dietary staff interviews and dietary document review, the facility failed to ensure staff competency in relationship to dietary staff position as evidence by dietary staff not 1) knowing how to test the quaternary (quat ammonium compounds designed to kill germs) sanitizer solution used to sanitize the kitchen countertops and sanitize the pots and pans in the manual three-compartment sink process (wash, rinse, and sanitize), 2) using the correct Cool Down Process for hot foods, 3) follow therapeutic diets when portion sizes were not plated correctly and meat needing to be pureed (texture-modified diet with the consistence of pudding for people who have difficulties with chewing and swallowing) was not weighed prior to being pureed, 4) serving pasteurized… […]

• No harm, potential for more than minimal, widespreadF812Oct 27, 2023

  Based on kitchen observations, dietary staff interview, and dietary document review, the facility failed to ensure safe dietetic services as evidence by 1) meat not thawed according to the facility's policy and procedure, 2) the correct Cool Down Process for cooked meats was not followed per the facility's policy and procedure, 3) dietary staff did not know how to test the quaternary (quat ammonium compounds designed to kill germs) sanitizer solutions, 4) non-pasteurized eggs were being used, 5) the kitchen floors and counter appliances looked dirty, 6) garbage cans in the prep food areas were not covered with lids and the garage bens outside were open and there was garbage surrounding the garbage bins, 7) opened dried food products were not labeled with an open date and use by date, 8)… […]

• No harm, potential for more than minimal, widespreadF880Oct 27, 2023

  Based on observations, interviews and record reviews, the facility failed to maintain an effective infection prevention and control program when: 1. Staff were not following the facility's guidelines for Contact Precautions, donning and doffing of Personal Protective Equipment (PPE, equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses), and appropriate hand hygiene with a resident who was positive for Clostridium Difficile infection (C. diff, also known as Clostridioides difficile or C. difficile, is a bacteria that causes diarrhea and inflammation of the colon. It is a contagious infection that is estimated to cause almost half a million infections in the United States each year. - Centers for Disease Control and Prevention), 2. […]