San Diego Nursing Home Cited for Multiple Food Safety and Emergency Preparedness Violations
SAN DIEGO, CA - Casa De Las Campanas, a skilled nursing facility located at 18655 W. Bernardo Drive, faced multiple citations during a state health inspection in June 2024, with inspectors identifying serious deficiencies in emergency preparedness, food quality, and sanitation practices that affected the facility's 50 residents.
Emergency Food Supply Failed to Meet Regulatory Requirements
During a June 6, 2024 inspection, state surveyors discovered that Casa De Las Campanas lacked adequate emergency food supplies specifically designated for its 50 skilled nursing residents. The facility's emergency provisions were pooled together with supplies for the entire senior residential care community rather than maintaining separate reserves for residents with specific medical and dietary needs.
When inspectors examined the facility's emergency stockpile with the Acting Administrator, Safety and Transportation Director, and dietary staff, they found 11 pallets containing 60 cases of one-liter water containers and boxes of dehydrated meals requiring water for preparation. However, the facility had not performed basic calculations to determine whether these supplies would adequately serve residents requiring therapeutic diets during a three-day emergency.
The dietary supervisor acknowledged that 873 meals would be needed to feed 97 residents three meals daily for three days, but the facility's emergency menu planning document failed to address how residents on modified texture diets or those requiring therapeutic nutrition would be accommodated during a crisis.
Therapeutic diets are medically prescribed nutrition plans that modify specific nutrients or food textures to manage chronic conditions such as diabetes, kidney disease, heart disease, or swallowing disorders. During emergencies when regular kitchen operations may be compromised, facilities must have predetermined plans to continue providing these specialized diets to prevent serious medical complications.
The facility's Registered Dietitian and Dietary Supervisor confirmed during interviews that the emergency menu plan lacked clear instructions for feeding residents on therapeutic and texture-modified diets. This oversight represented a significant gap in emergency preparedness, as many nursing home residents depend on specialized nutrition to manage their medical conditions and maintain their health status.
According to the facility's own policy documents from 2013 and 2015, all menus should be approved by the consultant dietitian and therapeutic diets must be planned according to the state-approved diet manual. The policies also specifically required that preplanned emergency menus be available and stored separately with annual rotation. However, the inspection revealed these standards were not being met in practice.
Residents Reported Persistent Food Quality Concerns
Multiple residents and facility council meeting minutes documented ongoing complaints about food palatability, flavor, and preparation quality. During a dining observation on June 4, 2024, inspectors witnessed residents expressing dissatisfaction with meals being served, with one resident describing the salad as unacceptable and another stating the food was dry.
A review of Resident Council meeting minutes from February through April 2024 revealed a pattern of dietary concerns, including complaints that beef and pork served at dinner were too tough to eat, soup quality was poor with meat either overcooked or undercooked, and food lacked adequate flavor. The resident council president, identified as Resident 3, told inspectors during a June 5 interview that meat items often seemed overcooked and difficult to eat, and that menus featured confusing terminology and unfamiliar foods.
Food palatability directly impacts nutritional intake among older adults, particularly those in long-term care facilities. Research indicates that unappetizing food contributes to inadequate consumption, which can lead to malnutrition, unintended weight loss, and increased mortality risk. When residents consistently find meals unpalatable, they may eat less than their nutritional requirements, compromising their overall health status and recovery from illness.
To assess these concerns, inspectors conducted a test tray evaluation on June 5. The barbecued chicken served on the regular diet tasted dry, appeared slightly overcooked, and lacked flavor. The Food and Beverage Director and Dietary Supervisor agreed the chicken was dry and could have used more seasoning.
During a subsequent interview on June 6, the Registered Dietitian acknowledged that residents had expressed mixed reviews about facility foods and described meals as boring. She confirmed hearing concerns that meat was sometimes tough and verified that at least one resident had specifically complained about dry chicken. The Dietary Supervisor stated she was unaware of the resident council's dietary concerns and acknowledged that kitchen staff should have received training on methods to improve menu palatability.
The inspection also revealed that residents receiving pureed texture-modified diets did not always receive nutritionally equivalent meals compared to those on regular diets. On June 5, residents on pureed diets received mashed potatoes instead of the garlic paprika chickpeas served to other residents, resulting in different nutritional content. The Registered Dietitian agreed that all residents should receive the same nutritional value in their meals regardless of texture modification.
Finger Food Diet Not Properly Implemented for Resident at Risk
Inspectors identified a specific case where dietary modifications intended to improve food intake were not properly executed. Resident 60, who experienced significant weight loss and required substantial assistance with eating, had been identified by the Dietary Supervisor on May 13 as someone who "eats well when meals are finger food," with a note to update preferences to encourage better intake.
However, when inspectors observed Resident 60's lunch tray on June 5, the meal included a half sandwich with lettuce, two chicken legs, split pea and mint soup, a banana, and milk. A Certified Nursing Assistant stated the resident could eat some foods independently but required assistance with items like sandwiches.
Finger foods are specifically designed for residents with cognitive impairment or difficulty using utensils, allowing them to maintain independence during meals and potentially increase overall food intake. The facility's own 2009 policy stated that meats should be sliced and placed between bread to serve as sandwiches cut into fourths prior to meal service.
The Registered Dietitian and Dietary Supervisor acknowledged during a June 6 interview that the sandwich served to Resident 60 was not cut into fourths as specified by facility policy. The Registered Dietitian confirmed that residents should receive food in the correct form to encourage intake and prevent weight loss.
This deviation from the prescribed diet format was particularly concerning given Resident 60's nutritional risk profile. A May 9 nutritional evaluation by the facility's Registered Dietitian indicated the resident consumed only approximately 25 percent of meals, posed high nutritional risk for continued weight loss after already losing 3.8 pounds over six days, and showed laboratory results reflecting anemia.
Unintended weight loss among older adults in long-term care facilities is associated with increased mortality rates. Weight loss of 5 percent or more within 30 days is linked to a tenfold increase in the likelihood of death according to the Academy of Nutrition and Dietetics. Proper implementation of dietary modifications designed to improve intake becomes critical for residents already experiencing nutritional decline.
Food Safety and Sanitation Deficiencies Identified
The inspection revealed multiple food safety and sanitation issues in the facility's dietary operations that could potentially lead to foodborne illness. Inspectors documented problems with equipment maintenance, food storage practices, and contamination prevention measures.
Two ice machines were not properly cleaned and maintained according to manufacturer specifications. Three ice machines and one dishwashing machine lacked proper air gap systems to adequately prevent backflow of contaminated fluids. An air gap is a physical separation between the water supply outlet and potentially contaminated water sources, serving as a critical barrier against contamination of potable water used in food preparation.
Food storage equipment showed evidence of inadequate cleaning and maintenance. Two reach-in refrigerators used for resident food storage contained brownish sticky debris on door gaskets, while one refrigerator door had multiple black and grayish spots on the inside panel. Door gaskets create the air-tight seal necessary to maintain proper refrigeration temperatures, and contamination in these areas can compromise both food safety and equipment function.
Proper refrigeration is essential to prevent bacterial growth that causes foodborne illness. Contaminated gaskets and interior surfaces can harbor pathogenic bacteria that may transfer to stored foods, particularly ready-to-eat items that will not undergo further cooking to eliminate pathogens.
The facility's cutting boards showed significant wear that compromised food safety. Four green, three white, and three red rubber cutting boards displayed white discoloration and were severely worn with large cuts and grooves in the center. These deep grooves and cuts create harboring sites for bacteria that cannot be adequately cleaned and sanitized, potentially cross-contaminating foods prepared on these surfaces.
Inspectors also observed multiple food items, including individual desserts, being transported uncovered from the production kitchen to the health center kitchen. Uncovered food during transport is exposed to potential airborne contaminants, dust, and other sources of contamination that could introduce pathogens or foreign objects into resident meals.
Additional Issues Identified
The inspection documented other deficiencies in the facility's dietary operations and emergency preparedness systems. The emergency water supply calculations appeared inadequate for both drinking water needs and the water required to rehydrate emergency meals. Facility documents indicated 124 cans of meals ready to eat requiring 48 ounces of water per can, totaling approximately 46.5 gallons, but the overall calculation of emergency water needs did not clearly account for all residents' hydration requirements over a three-day period.
The facility's menu planning policies from 2013 and 2015 required therapeutic diet menus to be planned according to the state-approved diet manual and prescribed by attending physicians, with all menus requiring dietitian approval. However, the absence of therapeutic diet considerations in emergency menu planning represented a gap between policy requirements and actual implementation.
The facility's 2013 policy on test trays and meal rounds specified that food should be served in a palatable and attractive manner, with food complaints addressed on an individual basis as they arise. However, the pattern of recurring complaints documented in resident council minutes and the Dietary Supervisor's lack of awareness about these concerns suggested that the system for addressing food quality issues was not functioning effectively.
The facility's scope of service policy from 2013 indicated that staff should be adequately trained and educated in food preparation and service, yet the inspection findings regarding improperly prepared finger foods, dry and overcooked meats, and nutritionally non-equivalent pureed meals suggested gaps in staff training or oversight of food production standards.
These violations represented a comprehensive failure to maintain the food service and emergency preparedness standards required for skilled nursing facilities caring for medically complex residents who depend on the facility to meet their nutritional and dietary needs safely and appropriately.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Casa De Las Campanas from 2024-06-07 including all violations, facility responses, and corrective action plans.
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