Bayshire Carlsbad

In the surveyor’s words

From the most serious findings on record at Bayshire Carlsbad, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF802Feb 29, 2024

  Based on observation, interview, and record review, the facility failed to ensure the kitchen staff competently carried out the functions of the food and nutrition services department according to facility policy and standards of practice when: 1. A Kitchen manager took a thermometer and dipped it in a sanitizer bucket with food debris before checking the temperature of a food item. 2. Two Dietary Aides did not use proper food safety and sanitation practices to prevent cross-contamination. 3. A Cook (CK 1) did not properly verbalize the correct cool down process. 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 census was 41. Cross reference F812 Findings: 1. […]

• No harm, potential for more than minimal, patternF812Feb 29, 2024

  Based on observation, interview and record review, the facility failed to ensure safe and sanitary conditions were maintained in the kitchen for food storage methods and food sanitation equipment, according to standards of practice and facility policy when: 1. Food was not dated or stored correctly at the appropriate temperature, 2. The high temperature dish machine did not reach appropriate internal temperature, 3. The sanitizer in the satellite kitchen was not at the appropriate strength, 4. The floor around the dining room refrigerator had a thick layer of sticky dirt at the outside bottom, 5. Two kitchen cutting boards were observed discolored and overworn with several cuts and groves on them, 6. […]

• No harm, potential for more than minimal, patternF880Oct 26, 2021

  Based on observation, interview, and record review the facility failed to fully implement infection control standards of practice for residents on transmission-based precautions (isolation precautions to reduce the spread of infection) during 2 of 4 staff observations. These failures had the potential to expose other residents and staff to potential infection. Findings: During an interview with the infection preventionist (IP) and the director of nursing (DON) on 10/26/21 at 11:45 A.M., the DON stated one licensed nurse (LN) developed symptoms of COVID-19 and tested positive on 10/22/21. […]

• No harm, potential for more than minimal, isolatedF686Mar 12, 2026

  Based on observation, interview and record review, the facility failed to implement interventions to prevent the formation of pressure injuries (wounds caused by sustained pressure to bony areas of the body) for one of three residents (Resident 1) reviewed for wounds.This failure resulted in Resident 1 sustaining pressure injuries to both heels.Findings:During a record review, Resident 1 was admitted on [DATE] with diagnoses which included a fracture of left femur (a large bone extending from the hip to the knee), and need for assistance with personal care.During a record review, Resident 1's Minimum Data Set (MDS- a federally mandated assessment tool) dated 11/22/25 indicated Resident 1 had a Brief Interview for Mental Status (BIMS- a tool to measure cognitive, or thinking, skills) of 10… […]

• No harm, potential for more than minimal, isolatedF697Mar 21, 2025

  Based on interview and record review, the facility failed to follow a physician's order for pain management for one of three residents (Resident 1), for pain when: 1. Non-pharmalogical interventions (NPI- any intervention intended to improve the health or the well-being of individuals that do not involve the use of any drugs or medicine) were not consistently provided prior to pain medication being administered; and 2. Pain medication doses were not administered according to the pain scale ranges level (scale to indicate level of pain 0=no pain, 10 =greatest pain), indicated by the physician. These failures had the potential for pain medication to not necessarily be required and for pain medication doses to be over or under administered. […]