Loma Linda Post Acute

In the surveyor’s words

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

• No harm, potential for more than minimal, widespreadF812Jul 3, 2025

  Based on observation, interview, and record review, the facility failed to ensure dishwashing equipment and food serving utensils were kept in a sanitary condition when:1. The dish drying racks were found to be unsanitary.2. Three scoops stored in a clean storage drawer were found to have dry food particles sticking on the inside part of the scoops.3. Four (4) bags of wheat tortilla were found in the refrigerator past expiration date of June 25, 2025.These failures had the potential to cause cross-contamination of food prepared in the kitchen which can cause severe illness and even be fatal for the 77 vulnerable residents who resided at the facility.Findings:1. […]

• No harm, potential for more than minimal, widespreadF803Jan 10, 2023

  Based on observations, interviews, and record reviews the facility failed to follow the menu when: 1.The incorrect portion of the alternate starch was served to seven residents on a renal (special diet for those with kidney failure) diet and three residents who preferred mashed potatoes instead of rice. They were served with a #12 scoop (2.8 ounces) but should have been served with a #8 scoop (4 ounces), for lunch on January 3, 2023. 2.The cook used a slotted spoon (large plastic or metal spoon with holes in it) instead of a standardized portion server or scoop (Level scoops, ladles, and portion servers provide more accurate portion control than serving spoons that are not volume-standardized measure) to portion the ground meatballs and vegetables (zucchini) according to the Daily… […]

• No harm, potential for more than minimal, widespreadF812Jan 10, 2023

  Based on observations, interviews, and record reviews, the facility failed to maintain professional standards for food service safety when: 1.The walk-in freezer floor had food crumbs and trash under the shelves and under the crates that were storing food. This had the potential for microorganism growth that could be inadvertently transferred to food and may also provide an environment for attraction of pests. 2.The microwave had yellow food crumbs and build-up on the inside, this had the potential to contaminate food heated in the microwave. 3.The stainless-steel wall behind the food preparation area, where the microwave was, had yellow food stains on the wall. This had the potential to attract pests and for microorganism growth that could be inadvertently transferred to food. […]

• No harm, potential for more than minimal, patternF641Jan 10, 2023

  Based on interview and record review the facility failed to accurately reflect the resident's status in the Minimum Data Set (MDS - computerized resident assessment completed by a licensed nurse) Assessments for 12 sampled residents when: 1. The facility did not complete MDS Discharge Assessments for 11 residents (Residents 79, 88, 84, 89, 58, 85, 6, 42, 87, 86, and 77) who were reviewed for MDS data completion. 2. The facility did not accurately code Section N: Medications of the MDS for antibiotics (medication given to treat bacterial infections) for Resident 83. […]

• No harm, potential for more than minimal, patternF761Jan 10, 2023

  Based on observation, interview, and record review the facility failed to properly store medications when: 1. One bottle of liquid oral Pantoprazole (a medication given to reduce acidity in the stomach and esophagus) was left unsupervised on top of a medication cart and was accessible to others. This failure had to potential to allow medication access to residents, staff, and others passing by who do not have the authority to handle medications. 2. One bottle of liquid oral Gabapentin (a medication given for nerve pain) which required refrigeration was found stored in the bottom drawer of a medication cart. This failure had the potential to negatively affect the medication's effectiveness when administered. 3. […]