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Complaint Investigation

Courtyard Health Care Center

Inspection Date: September 8, 2025
Total Violations 1
Facility ID 055922
Location DAVIS, CA
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Inspection Findings

F-Tag F0812

Nutrition and Dietary Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Based on observation, interview, and record review, the facility failed to serve food in a sanitary manner for

a census of 108 residents, when:Clean Utensils were found with food particles and water residuals and utensil holders had multiple small black particles; andDietary Aide 3 (DA 3) did not wash hands before handling clean kitchenware.These failures had the potential to result in foodborne illness among vulnerable residents.Findings:1. During a concurrent observation and interview on 9/8/25 at 11:05 a.m. with the Dietary Manager (DM) and Registered Dietician (RD), the kitchen's utensils and utensil holders were observed. Multiple small black particles were observed on the utensil holders. Three forks and three spoons had food particles and water residuals. DM and RD confirmed six utensils were dirty and stated clean utensils should have no food particles on it. DM further stated it was unsafe to use uncleaned utensils for residents.2. During a concurrent observation and interview on 9/8/25 at 12:28 p.m. with DA 3, DA 3 was manually washing the kitchenware (containers) with soap and water. Next, DM removed the cleaned kitchenware from the dishwasher. DA 3 continued to wash more kitchenware from the dirty side. There was no hand hygiene observed before touching the cleaned kitchen containers. DA 3 confirmed he was the only one doing dishwashing and should have washed hands before touching the cleaned side of the dishwashing area.During an interview on 9/8/25 at 12:33 p.m. with the RD, RD stated there should be two people doing dishwashing at a time and DA 3 should have washed his hands before touching the clean side of the dishwashing area to prevent contamination. A review of the facility's undated policy and procedure titled, Dishwashing, indicated, All dishes will be properly sanitized through the dishwasher. Gross food particles shall be removed by careful scraping and pre-rinsing in running water. Flatware is to be pre-soaked in a solution of water and detergent per manufacturer's instructions. Pay close attention to prevent cross-contamination of workers going from handling dirty dishes and then clean . Wash hands and change gloves whenever cross-contamination occurs.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

FORM CMS-2567 (02/99) Previous Versions Obsolete

Facility ID:

If continuation sheet

Event ID:

📋 Inspection Summary

COURTYARD HEALTH CARE CENTER in DAVIS, CA inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in DAVIS, CA, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from COURTYARD HEALTH CARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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