St John's Health Sage Living

In the surveyor’s words

From the most serious findings on record at St John's Health Sage Living, in the surveyor’s own words.

• No harm, potential for more than minimal, patternF812May 8, 2025

  Based on observation, staff interview, review of the dishwasher manufacturer's instructions, and facility policy and procedure review, the facility failed to monitor and record the internal temperature of foods and failed to ensure a sanitary environment in 1 of 1 kitchen. The census was 47. The findings were: 1. Regarding recording food temperatures in the food preparation area: a. Observation on 5/7/25 starting at 9:51 AM showed cook #1 took the temperature of mashed potatoes, and did not log the temperature before he placed the food into the holding cart. […]

• No harm, potential for more than minimal, patternF812Jan 12, 2023

  Based on observation, staff interview, and review of facility policies and the 2022 Food Code, the facility failed to ensure hand hygiene and gloving was done in accordance with accepted standards to minimize cross contamination during 1 of 1 observations of meal preparation in the kitchen. The findings were: 1. Observation in the kitchen on 1/11/23 from 3:45 PM until 4:22 PM showed cook #1 was preparing food for the evening meal. The cook wore the same pair of gloves for the duration of the observation (no hand hygiene or changing of gloves). During the observation, the cook was observed to touch potentially contaminated surfaces, such as a cardboard box, the handles of the refrigerator, the handles of the fryer baskets and handles to drawers with his gloved hands. […]

• No harm, potential for more than minimal, patternF812Oct 21, 2021

  Based on observation, staff interview, and review of the Food Code, the facility failed to ensure staff preparing and assembling food wore hair restraints during 1 of 2 meals observed, in 2 of the 3 units (Wildflower Way and Larkspur Lane). The findings were: 1. Observation on 10/19/21 at 8:20 AM in Larkspur Lane revealed RN #2 was at the steam table in the dining room dishing up food for residents #21 and #24. The RN was not wearing a hair restraint. 2. Observation on 10/19/21 at 9:28 AM in Wildflower Way revealed RN #3 was at the steam table in the dining room dishing up food for resident #1. The RN was not wearing a hair restraint. 3. […]

• No harm, potential for more than minimal, isolatedF602May 8, 2025

  Based on facility incident review, staff interview, resident representative interview, and policy and procedure review, the facility failed to ensure residents were free from misappropriation or exploitation for 1 of 3 sample residents (#16) reviewed for allegations of misappropriation. The findings were: 1. Review of the facility incident report showed resident #16 reported on 1/22/25 s/he was missing four checks and $2,000 from his/her bank account. The resident's POA sent images of the cashed checks to the administrator. The checks had phone numbers written in the endorsement area, which the administrator checked against employee records. One of the phone numbers matched a hospital employee who sometimes worked in the facility. […]

• No harm, potential for more than minimal, isolatedF883Feb 8, 2024

  Based on medical record review, staff interview, and review of facility policies and CDC immunization recommendations, the facility failed to ensure residents were offered pneumococcal immunizations based on CDC recommendations for 2 of 5 sample residents (#2, #21) reviewed for immunizations. The findings were: 1. Review of the medical record showed resident #2 was [AGE] years old. Further review showed the resident received the following pneumococcal vaccines: pneumococcal 23 polyvalent on 10/18/06 and pneumococcal 13 valent conjugate on 9/24/15. There lacked evidence the resident was offered a pneumococcal immunization since the last administration in 2015. 2. Review of the medical record showed resident #21 was [AGE] years old. […]