San Francisco Towers

F-F007. Date issued: 5/95. Date revised: 1/20. Policies: In the Food & Nutrition Services Department: All associates associated with the handling of food shall wash hands. Hands are washed with soap and water at the following times: #5. After taking break when returning to the kitchen, #6. After touching hair, skin, beard, or clothing.

Review of Employee Health and Personal Hygiene Handbook indicates the 2017 FDA Food Code, U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration on page 4, indicates Proper handwashing reduces the spread of fecal-oral pathogens from the hands of a food employee to foods. Handwashing can also help reduce the transmission of other pathogens from environmental sources. Effective handwashing includes scrubbing, rinsing, and complete drying of hands and is essential for minimizing the likelihood of cross-contamination. The fingernails and surrounding areas are often the most contaminated parts of the hand and are also the most difficult part of the hand to get clean. Every stage of handwashing is equally important and has an effect in reducing contamination of the hands.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 6 of 6 555728

F-F017. Date issued: 5/95. Date revised:1/23. Level of Harm - Minimal harm or Policies: Pots, dishes and flatware are stored in such a way as to prevent contamination by splash, dusts, potential for actual harm pests, or other means. Procedures: Dish handlers, tray line area associates: *Air dry all food contact surfaces including pots, dishes, flatware, and utensils before storage.Do not stack or store when wet. Residents Affected - Many 3. During a concurrent observation and interview on 6/4/24 at around 10 AM in the kitchen with the Director of Dining Services (DDS), the Corporate Chef (CC), and the Executive Sous Chef (ESC), the following were found:

a) An undated large square plastic container of yellow brownish jelly in the refrigerator. Observed the ESC pulled it out and looked on each side of the container and stated this is apricot jelly. There is no date on it.

We will toss this out. Observed the ESC closing the lid of the container but the lid opens on the other side when closed on the opposite side.

b) An undated half full large plastic original container of light brown sticky looking stuff with tiny black spots was on a shelf of the dry storage room. When asked, the ESC picked-it up and stated, this is mustard. There is no open date on it. Observed the ESC brought the container of mustard out of the storage room.

c) An undated almost half full plastic container of tan looking doughy stuff was on one shelf of a walk-in refrigerator room. When asked, the ESC stated, this is muffin butter. There is no open date on it. I will take

this out.

During a review of the facility's policy and procedure section: Production, purchasing, storage. Subject: Food and supply storage. Policy # B003. Date issued: 5/95. Date Revised: 1/24 indicated. Policies: All food, non-food items and supplies used in food preparation shall be stored in such a manner as to prevent contamination to maintain the safety and wholesomeness of the food for human consumption. Procedures: 1. Most, but not all, products contain an expiration date. The words sell by, best-by, enjoy-by, or use-by should precede the date. The sell-by date is the last date that food can be sold or consumed, do not sell products Foods past the use-by date, sell-by, best-by, or enjoy-by date should be discarded. 2. Cover, label and date unused portions and open packages. Complete all sections on a [NAME] orange label or use the Prep & Print labeling system. Products are good through the close of business on the date noted on the label. 3. Refer to Food Storage Chart in this policy to determine the discard dates for food items. 7. Date and rotate items; first in first out (FIFO). Discard food past the use-by or expiration date. Dry storage: 4. Store foods in their original packages. Foods that must be opened must be stored in NSF (National Sanitation foundation - develops strict standards for public health and safety. NSF officials use the organization's safety standards to test and certify a wide range of food, water, and consumer products.) approved containers that have tight fitting lid.

Refrigerated storage: See policy B004: Cold storage: 1. Temperature for appropriate temperatures for refrigerated and frozen foods areas. 5. Unused portions of canned fruits and vegetables must be transferred to clean, approved storage containers. Do not store in open cans. 6. Store bulk materials in NSF approved containers that have tight fitting lids. Label both the bin and the lid.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 5 of 6 555728 Department of Health & Human Services Printed: 09/24/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 555728 B. Wing 06/07/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

San Francisco Towers 1661 Pine Street San Francisco, CA 94109

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.

(X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 4. During a concurrent observation and interview on 6/5/24 at 10:12 AM in the kitchen, observed one staff carrying while hugging against his chest multiple clean plates from the washing area to the tray line area. Level of Harm - Minimal harm or Informed the CC. During an interview with the CC he asked, did you tell him. This surveyor said no because potential for actual harm the staff was at a distance when observed. This surveyor and the CC approached the staff. The CC spoke to

the staff. The staff was observed nodding his head and responding. The CC explained to this surveyor that Residents Affected - Many the staff understood he was not supposed to carry clean plates and eating utensils hugging, touching his skin or clothes. During interview with the staff and the CC, the staff acknowledged his error and said yes.

5. During a concurrent observation and interview with the Corporate Chef (CC) on 6/5/24 at 10:12 AM, in the kitchen, observed a staff (server) enter the kitchen pushing a service cart with a pitcher and utensils on the cart. He has gloves on his hand. Observed the server stopped in front of us, opened the lid of a garbage bin with his gloved hands behind us and throw something in the garbage bin. After closing the lid of the bin with

the same gloves on his hand he came back and about to continue pushing the cart when he was stopped by

the CC and was told to wash his hands and change his gloves. The staff (server) removed his gloves, threw them in the garbage bin and went to the sink to wash his hands. After washing his hands with a paper towel

in his hands he stopped to talk to another kitchen staff in front of us. While talking to his co-worker, observed him wipe his face with the paper towel, and inserted part of the paper towel inside his nose. The CC was directed to see the server wipe his face and nose with the paper towel after washing his hands. The CC approached the server and instructed him to wash his hands again. The CC stated, we will give them an in-service on handwashing. During an interview with the server, he stated, ok, I will remember that.

During a review of the facility's file section: Sanitation and infection prevention/control, Subject: Hand hygiene. Policy #