Arroyo Grande Care Center

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to appropriately label and store drugs when three cartons of Med Pass 2.0 fortified nutritional shake were found to be expired in the medication room of nursing station two.This failure had the potential to result in residents possibly receiving expired and ineffective medication.During a concurrent observation and interview on [DATE] at 10:12 A.M. with licensed nurse (LN 3), while checking medications in Station 2 medication room, found three cartons of Med Pass 2.0 fortified nutritional shake, (drink to add additional dietary calories and protein Fortified with vitamins and minerals), expired. Two expired [DATE] and one expired [DATE]. LN 3 confirmed they are expired and stated, Those need to go. It's all med nurses responsibility to check them.During a review of the facility's policy and procedure titled Medication Storage dated [DATE], indicated, . N. Outdated .medications .are immediately removed from stock, disposed of according to…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review, the facility failed to follow the nutritional needs of a residents in accordance with recommended guidelines diet prescription for a renal diet for one of one resident (Resident 72) when Certified Nurse Assistant (CNA) 4 added salt to the resident's meal. This failure has the potential of not meeting the nutritional goal of the resident as prescribed diet. During an observation on 7/22/25 at 7:48 am at the dining room, Resident 72 was observed for her meal intake. Certified Nurse Assistant (CNA) 4 was overheard offering Resident 72 if she wanted to have salt and pepper on her meal with the resident responding with a nod. CNA 4 opened the salt packet and sprinkled salt into resident 72's meal.During a concurrent interview and record review on 7/22/25 at 7:48 am with CNA 4, the meal ticket of Resident 72 was reviewed. The meal ticket indicated in part, Minced Meat, Renal, Nectar Thick Large Minces /LS. CNA 4 stated that she reviewed the meal ticket and is aware that it is a renal diet and states that the LS means low salt that is why…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure food safety standards were followed when an expired milk, brought in by family, was found in the snack refrigerator in nursing station 2.This failure had the potential to cause food- borne illness to a vulnerable resident.During a concurrent observation and interview on 7/22/2025 at 10:35 A.M., with licensed nurse (LN 2), while checking the snack refrigerator in Station 2, found an Alta Dena reduced fat milk (brought in by family) was expired on 6/17/2025. LN 2 confirmed the milk was expired and stated, We usually check items brought in by family. We should check it daily.During a review of the facility's policy and procedure titled, Resource: Food Safety for Your Loved Ones, dated 2022, indicated in part ., Food or beverages should be labeled and dated to monitor for food safety: . Foods and beverages that have passed the manufacturer's expiration date will be discarded.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview, and record review, the facility failed to complete an accurate nursing assessment for one of two sampled residents (Resident 1). This failure resulted in the receiving facility not having sufficient information necessary to develop and implement a care plan to meet Resident 1's needs. Findings: During a review of Resident 1's Care Plan (CP) (a document that outlines a patient's health needs and the care they will receive) dated, 1/24/25, the CP indicated, Resident 1 had impaired skin integrity, erythema (skin redness) to sacrococcygeal (the area at the base of the spine) and groin. During an interview on 2/10/25 at 3:05 p.m. with Licensed Nurse (LN 4), LN 4 verbalized they did the assessment, they saw some redness on Resident 1's bottom, got busy and did not document the redness. During a review of Resident 1's Needs upon discharge assessment, dated 1/27/25, the Needs upon discharge assessment indicated, Resident 1's skin was intact. Review of [NAME] and [NAME], Tenth Edition, Fundamentals of…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure a proper system was in place to safeguard one of three sampled residents (Resident 1) personal funds when the facility's billing department deposited Resident 1's personal check for rent payment into the facility's bank account. This failure resulted in the misappropriation of Resident 1's personal funds which had the potential to cause emotional distress and anxiety to the resident. Findings: During a review of Resident 1's Face Sheet (FS), dated 8/9/23, the FS indicated in part, Resident 1 was a [AGE] year-old female, who was admitted to the facility on [DATE] with admitting diagnoses including, pneumonia (infection of the lungs) and acute kidney failure (rapid loss of kidney function). The FS also indicated, Resident 1 was discharged from the facility on 10/20/22. During a phone interview on 8/9/23 at 5:25 p.m. with Resident 1, Resident 1 verbalized, asking a facility staff to mail out a personal check as payment for a leased residential…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure: 1. Expired medications were not stored and available for staff use, in two of two first aid kits, and in one of two treatment carts. These failures had the potential for unsafe and ineffective medication administration that can cause harm to the residents. 2. A licensed nurse followed the facility's policy and procedures (P&P) on medication administration. Findings: 1. During a concurrent interview, and inspection of the facility's two Disaster Kits (D-Kit), on 8/9/21 at 9:45 a.m., with Assistant Director of Nursing (ADON), items observed in a D-Kit, included, a heavy-duty extension cord, flashlight, floor plans, a typed list of area hospitals and nursing homes, a First Aid Kit (FA-Kit) with manual, and other supplies. The two FA-Kits, one in each D-Kit, had a stamped expiration date of 2/18. The labels on the FA-Kits indicated, the kits contained items such as gauze dressing pads, tweezers, scissors, adhesive bandages, tape, and other supplies. In addition, the labels also indicated, the kits…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview and record review, the facility failed to ensure food was stored, prepared, distributed and served in accordance with professional standards for food service safety when: 1) kitchen staff did not have all their hair restrained, and 2) food items were past their best buy date in the reach-in refrigerator. This had the potential for food to be contaminated by hair and the quality of the food may change past the use by date. The census of the facility was 74. Findings: 1. During an observation on 8/09/21, at 10:57 a.m., in the kitchen, Kitchen Staff (KS) 1, was making peanut butter and jelly sandwiches with hair under hat but hair in back not restrained while making sandwiches. During an observation on 8/10/21, at 10:37 a.m., in the kitchen, KS 1 was scooping fruit cocktail with 4 ounce slotted ladle into bowls. KS 1 had a hat on head and hair in back not restrained and sides hair coming out of hat down the side of her face. During an observation on 8/10/21 at 11:53 a.m., in the kitchen, KS 2 had hair out the back of hair restraint and down her back. KS…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure the menu was followed for: 1) Two of two residents (Residents 4 and 36) on the small portion minced and moist diet, and 2) Two of two residents (Residents 6 and 16) on the small portion soft and bite sized diets for the lunch meal on 8/9/21. This failure had the potential to result in not meeting the nutritional needs of the residents and further compromising their medical status. Findings: During a review of the lunch menu for day 23 (8/9/21), the menu indicated, for MM5 (minced and moist) diet: three ounces chicken baked, #8 scoop (1/2 cup or 4 ounces) MM pasta and sauce, #8 scoop MM zucchini. The lunch menu indicated, SB6 SM (small and bite sized, small portion) chicken baked - 2 ounces, SB pasta and sauce #10 scoop (2.75 ounces), #8 scoop SB zucchini. There was no menu column that indicated what the small portion, minced and moist diet should receive. During an observation on 8/9/21, at 11:57 a.m, of the lunch meal service, the following was observed, a #16 scoop (1/4 cup or 2 ounces) and a #8…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on Observation, interview, and record review, the facility failed to use appropriate alternatives prior to installing bed rails (adjustable metal or rigid plastic bars that attach to the bed) for five of 5 sampled residents (Resident 35, 41, 54, 61, and 62). This facility failure had the potential to result in an increased risk for entrapment (strangulation, suffocation, bodily injury or death when a resident or part of their body is caught between the bed rail and mattress) or falls. Findings: During a review of the facility's policy and procedure (P&P) titled, Bedrails/Siderails, dated 3/1/18, the P&P referenced the regulation, F700, and indicated, Alternative interventions should always be considered prior to use of Side Rails or in combination with Side Rail use. According to Fundamentals of Nursing ([NAME] et al.; Elsevier: 2017, p. 392), . many deaths and injuries related to entrapment and falls for both adult portable bedrail products and hospital bed rails have been reported . The FDA [U.S. Food…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

The facility failed to ensure that one resident was free from unnecessary drugs. Resident #15 Unnecessary Meds, Psychotropic Meds, and Med Regimen Review Based on resident interview, clinical record review, and review of the drug manufacturer's specifications, the facility failed to ensure that, each resident's drug regimen was free from unnecessary drugs, including medications used for an excessive duration. This medication used in this manner, could have prevented this resident from reaching her highest functional capacity. Findings: Review of the clinical record for sampled Resident 15 on 8/12/2021 at 10:15 am with the Director of Nurses (DON), confirmed that this resident had been taking Zolpidem (Ambien) a sleeping medication 5 mg as needed during her hour of sleep. This medication was ordered by the resident's physician on 6/11/2021 (one day after the resident's admission to the facility). Interview with Resident 15 on 8/12/2021 at 9:20 am Resident 15 stated that she was unable to sleep at night because of the light in her eyes from the hallway and the room light above her…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.