Creekside Post Acute

In the surveyor’s words

From the most serious findings on record at Creekside Post Acute, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF801Jul 18, 2025

  Based on interview and record review, the facility failed to ensure staff who had appropriate competencies and skill set completed the resident's Quarterly Nutrition Assessment (a detailed evaluation of eating habits, weight and overall health related to food, done every 3 months). This failure had the potential to place 52 highly vulnerable residents' health at risk due to not receiving an adequate nutritional assessment.During a review of Residents 5, 8, 25 and 26's Quarterly Nutrition Assessments (comprehensive evaluation of an individual's nutritional status, aiming to identify any nutritional deficiencies or risks, and guide personalized interventions) between November 2024, through June 2025, it indicated the assessments were completed and signed by the Dietary Service Supervisor… […]

• No harm, potential for more than minimal, widespreadF812Jul 18, 2025

  Based on observation, interview, and record review, the facility failed to store resident food safely when:1.The resident refrigerator had multiple food items that were not labeled or dated. 2. The temperature of the refrigerator had not been monitored in June 2025 and July 2025. These failures had the potential for food borne illness (any illness resulting from eating contaminated/spoiled foods) in 25 medically compromised residents who were able to store food in this refrigerator.During a concurrent observation and interview on July 16, 2025, at 9:57 AM, with the Social Worker (SW), in the dining room, the resident refrigerator was found to have multiple food items that were not labeled or dated. Two thermometers were located outside of the fridge. […]

• No harm, potential for more than minimal, widespreadF812Mar 17, 2022

  Based on observation, staff interview, and record review, the facility failed to prevent entry of outside contaminants into the bulk container of thickener (a starch added to liquids and foods to make it firmer). This failure had the potential to cause contamination of food prepared with thickener, and possible foodborne illness in 47 of 48 medically compromised residents who received food from the kitchen. Findings: During a concurrent observation and interview on March 14, 2022, at 8:26 AM, with the Dietetic Services Supervisor (DSS), in the kitchen, the bulk container of thickener had multiple dark crumbs mixed in with the white thickener. […]

• No harm, potential for more than minimal, widespreadF814Mar 17, 2022

  Based on observation, interview, and record review, the facility did not properly dispose of trash when the outside garbage bin for trash was overflowing, and the lid was not closed for one of one dumpster. This failure had the potential to attract vermin (pests or nuisance animals that spread diseases) in a facility that cares for 48 medically compromised residents. Findings: During a concurrent observation and interview on March 14, 2022, at 10:43 AM, with the Dietetic Services Supervisor (DSS), in the outdoor garbage storage area, the trash dumpster was overflowing with garbage, and the lids were not closed. The DSS stated that the trash should not be overflowing, and the lids should be closed. […]

• No harm, potential for more than minimal, widespreadF886Jan 13, 2021

  Based on interview and record review, the facility failed to properly prevent and/or contain COVID-19 when three out of three sampled staff members (LVN 1, CNA 1, & CNA 2) were not subjected to routine COVID-19 testing, according to the facility's residing County of San Bernardino's COVID-19 positivity rate. This failure had the potential for resident harm and/or death for 36 out of 48 vulnerable residents in the facility not previously affected by COVID-19, as the non-adherence to routine COVID-19 testing of facility staff members, per San Bernardino County's COVID-19 positivity rate, failed to ensure consistent infection surveillance to prevent and/or mitigate incidences of COVID-19 outbreaks in the facility. […]