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Complaint Investigation

Grass Valley Healthcare Center

Inspection Date: December 30, 2025
Total Violations 1
Facility ID 055640
Location GRASS VALLEY, CA
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Inspection Findings

F-Tag F0880

Infection Control Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0880

Provide and implement an infection prevention and control program.

Level of Harm - Minimal harm or potential for actual harm

Based on observation, interview, and record review the facility failed to store items in a sanitary manner for two of six sampled residents (Resident 1 and Resident 2) when used urinals were stored uncovered in a drawer that contained the residents' personal items.This failure increased the risk of contamination and infection for the residents.Findings:Resident 1 admitted to the facility in late 2025 with diagnoses which included urinary tract infection and weakness.Resident 2 admitted to the facility in mid 2024 with diagnoses which included urinary tract infection and bacteria in the bloodstream.During an interview on 12/30/25 at 12:53 p.m. with Certified Nursing Assistant (CNA1), CNA 1 stated urinals should be stored in a drawer without other items.During a concurrent observation and interview on 12/30/25 at 1:28 p.m. with the Infection Preventionist (IP) of Resident 1's closet, Resident 1's bottom drawer of the closet contained an uncovered urinal, a clear drinking cup which held an uncovered toothbrush, and a bottle of cologne. The IP confirmed the findings and stated the urinal should not be stored with personal care items for infection control reasons.During a concurrent observation and interview on 12/30/25 at 1:32 p.m. with the IP of Resident 2's closet, Resident 2's bottom drawer of the closet contained an uncovered urinal, a blood pressure cuff, a red plastic dining place mat and a seat cushion. The IP confirmed the findings and stated

she expected the urinal to be stored separately from other items.During an interview on 12/30/25 at 3:40 p.m. with the Director of Nursing (DON), the DON stated she expected urinals to be stored separate from personal items to prevent contamination and infection.During a review of the facility policy and procedure (P&P) titled, ADL [activities of daily living] PERSONAL SUPPLIES, CLEANING, AND DISPOSAL, dated 10/15, the P&P indicated, Purpose: To provide Adl [Activities of Daily Living] supplies for individual residents and prevent infections .Toileting items, including urinals, will be stored separately from other personal items.

Residents Affected - Few

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

GRASS VALLEY HEALTHCARE CENTER in GRASS VALLEY, 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 GRASS VALLEY, 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 GRASS VALLEY HEALTHCARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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