Grossmont Post Acute Care

In the surveyor’s words

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

• Actual harm, isolatedF600Aug 1, 2024

  Based on observation, interview, and record review, the facility failed to ensure one resident (Resident 1), who was cognitively impaired and dependent on staff for care, was free from abuse when certified nursing assistant (CNA) 2 called the resident an ass then smacked the side of his head with an open hand while telling the resident, That's for hitting me last week. As a result, Resident 1 became agitated and attempted to hit staff back. In addition, Resident 1 had seemed guarded following the incident, per staff interview. […]

• No harm, potential for more than minimal, widespreadF800Jul 27, 2023

  Based on observations, interviews, and record reviews the facility failed to ensure effective dietetic systems related to food and nutrition services were executed according to facility policy and standards of practice when: 1. A resident's (Resident 6), nutrition care plan was not carried out, and experienced unintentional weight loss. 2. Kitchen staff were not trained in day-to-day food safety and sanitation practices. 3. Residents' meals were not served at palatable temperatures according to policy. 4. Expired foods, dirty dishes, and dirty equipment were found in the kitchen. 5. […]

• No harm, potential for more than minimal, widespreadF802Jul 27, 2023

  Based on observation, interview and record review, the facility failed to ensure kitchen staff received the competencies and training needed to perform their job duties when: 1. A Cook could describe the cool down process for cooked foods, and 2. A Diet Aide could not describe the correct temperatures of the three-compartment sink for manual dish washing These failures placed residents at risk of cross contamination and acquiring food-borne illnesses. Findings: 1. During an interview on 7/24/23 at 9:40 A.M. with Cook (CK 1) and the Director of Dietary (DD), CK 1 stated there was no cool down process for foods, but only for meats. CK 1 stated if they cooled meats to serve later, they would cool it for a couple of hours, label it, date it then place it in the refrigerator. […]

• No harm, potential for more than minimal, widespreadF812Jul 27, 2023

  Based on observation, interview and record review, the facility failed to ensure food safety and sanitation practices were met in the kitchen according to standard of practice when: 1. A tray with fourteen small glasses of milk and four glasses of juice each dated 7/14/23, were on the shelf for use in the walk-in refrigerator. 2. The kitchen's clean dish storage area had dirty serving utensils and food items stored on them. 3. The ceiling vent was full of grayish-black dust. 4. The facility did not use a cool down process for ambient temperature prepared foods. 5. […]

• No harm, potential for more than minimal, isolatedF694May 14, 2026

  Based on observation, interview and record review, the facility failed to ensure a peripherally inserted central catheter (PICC, a long, thin and flexible tube [catheter] that is inserted into a vein in the upper arm for medication administration) was measured weekly for one of two residents reviewed (Resident 1).This failure resulted in Resident 1 returning to the hospital with chest pain, removal of the PICC, and replacement with another catheter to complete medication administration. Findings:A consumer complaint was filed with the California Department of Public Health regarding Resident 1's catheter. […]