ALBUQUERQUE, NM-SKIES HEALTHCARE AND REHABILIATION CENTER

The Department of Health & Human Services conducted an inspection of the facility. The following highlighted decencies listed below were found in a public survey.

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
45426

Based on observation, interview, and record review, the facility failed to ensure food was stored in a manner that prevented foods in dry storage from becoming contaminated from rodent activity. This deficient practice could lead to foodborne illnesses that could affect all 115 residents identified on the alphabetical census list provided by the Administrator on 10/23/23 who eat food prepared in the kitchen. The findings are:

A. On 10/20/23 at 3:09 pm during an interview, the Complainant stated, he was concerned about mice at the facility. He stated that due to the mice problem, food had to be thrown away because the mice would eat the food in dry storage. The mice continued to be drawn to the dry storage room, so the bread rack was moved out of dry storage. The complainant expressed concerns that the residents could become sick if the food was served to the residents.

B. On 10/23/23 at 5:23 am, during a tour of the facility’s kitchen, an observation was made of the dry food storage room. Rodent activity and droppings were in the following areas:
-A shallow, clear plastic pan (rectangular tray-like container or bin that is not enclosed or sealed), located on the bottom shelf of a baker’s rack with eight, unopened packages of five pounds, five ounces of La Banderita brand corn tortillas dated 09/12/13. The tortillas were eaten through the packaging by rodents and rodent droppings were in the pan.
-On the top rack of the same shelving unit, an opened package of cacao powder, dated 08/12/23 stored in a zipped/sealed plastic storage bag had rodent chew marks through the outer and inner packaging.
-On the shelving rack next to the cacao powder, a dropping was observed in a cardboard box (part of the original bulk packaging) containing 11 cardboard canisters of Quaker brand Grits dated 09/23/23.
-Rodent droppings were underneath the baker’s rack, in front of and around the two mice traps set there.

C. On 10/23/23 at 5:33 am, during an observation of the kitchen and interview, the Dietary Manager (DM) stated he had been at the facility about a month and a half. He was aware of mice traps in the kitchen but had not seen any mice. The Dietary Manager then observed the tortilla pan and confirmed that there were rodent droppings in the pan and that the tortilla packages had been chewed through. The Dietary Manager pulled the tortilla pan from the shelf. More rodent droppings were observed along the tops of the packages of tortillas and throughout the open tortilla pan/bin. The plastic shelf liner where the pan was contained droppings also. The Dietary Manager confirmed there were rodent droppings in the box of Grits and underneath the canned goods rack. He did not know how often the traps were checked by the exterminator.

D. On 10/23/23 at 1:18 pm, during an interview with the Administrator (ADMIN) and the Director of Nursing (DON), they stated that they had a problem with mice back in July/August this year in and around the dietary area. Contaminated food or food that could have been affected was thrown out. To protect the food from future infestation, ADMIN stated they have things off the floor and liners on the shelves. She stated that We have different types of bins (to store food in), and seal off any penetrations (gaps or holes) in the building.

E. Record review of exterminator invoices revealed the following:
-12/12/22 Set mouse traps in admin (administration) office
-01/18/22 Kitchen treated no problems found. Set mouse traps in admin office.
-02/14/23 Kitchen treated for mice, 4 caught in mop room. Mop room needs to have the walls fixed; mice are in the holes in the wall.
-03/13/23 Kitchen treated for mice non(e) caught this period. Mop room needs to have walls fixed; mice are in the holes in the wall.
-07/13/23 Rebaited (to put more food on a hook or in a special device used to attract and catch a fish or animal, after the first food you put there has been eaten) 4 mice traps in kitchen. No mice found.
-08/07/23 Rebaited 4 mouse traps in kitchen. No mice found. Placed 4 new traps in kitchen.
-09/07/23 Rebaited 7 mouse traps in kitchen. One mouse caught a week ago. Placed 3 new traps in kitchen.
-10/12/23 Rebaited 7 mouse traps in kitchen.
F. Record review of facility’s policy titled [Name of Facility Provider] Policy 029 Pest Control revised 09/2017 stated under procedures:
3. Where applicable, bulk foods will be removed from their original packaging and stored in containers with tight fighting lids.
G. Record review of facility policy titled FNS 408 Pest Controlunder the heading Process stated the following:
7. Food is stored in closed and sealed containers.

Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
45426

Based on observations, record review and interviews, the facility failed to maintain an effective pest control program by not ensuring the facility was free of rodents. This deficient practice is likely to affect all 115 residents listed on the resident census list provided by the Administrator on 10/23/23 and could likely lead to contamination of food prepared in the kitchen causing illness in the residents. The findings are:

A. On 10/20/23 at 3:09 pm during an interview, the Complainant stated, he was aware of a mouse problem at the facility. He stated that he did not believe that the pest management system was effective and that large quantities of food had to be thrown out on a regular basis due to the mice eating the food in storage. The complainant also stated that the mice droppings had to be cleaned daily due to the presence of the mice. The complainant had concerns that there were many places the mice could be hiding in the facility around the kitchen, storage areas, dining area, and within the walls. The complainant stated that the kitchen also had many areas mice could be drawn to such as the toaster, the dishwashing area, and food left under the bottom shelves of the steel tables/counters.

B. On 10/23/23 at 5:23 am, during a tour of the facility’s kitchen, the following observations were made:
-A tray rack with several resident, meal trays with leftover food from meals and dirty dishes stored outside of kitchen door in maintenance hallway. The tray was located on the opposite side of the wall for dry good storage.
-In the dry goods storage room: Rodent droppings were observed in several locations within the room:
-Several droppings were in a shallow, clear plastic pan (rectangular tray-like container or bin that is not enclosed or sealed), located on the bottom shelf of a baker’s rack. In the pan were eight, unopened packages of five pounds, five ounces of La Banderita brand corn tortillas. The tortillas had been eaten through the plastic wrapping and several bits of chewed wrapping were visible in the clear plastic pan. The tortillas were dated 09/12/23.
-On the top rack of the same shelving unit, an opened package of cacao powder, dated 08/12/23 stored in a zipped/sealed plastic storage bag was observed to have had rodents’ gnaw and chew marks through both the original cacao packaging and the ziplock bag it was stored in.
-On the shelving rack next to the cacao powder, a large dropping was in a cardboard box (part of the original bulk packaging) that contained 11 cardboard canisters of Quaker brand Grits, dated 9/23/23 .
-Several droppings were found underneath the bottom shelf of the canned goods rack behind the storage room door. The droppings were in front of the two metal box traps, which were also located beneath the canned goods rack.

-Two large droppings were in front of the canned goods rack, along the bottom track of the propped open, storage room door (door was held open with a bungee cord to the baker’s rack). The droppings were visible once the door was moved to close the door.
-In the dining room: Several items of litter on the floor in several areas that consisted of opened cocoa packages, paper wrappers and spilled cocoa powder.

C. On 10/23/23 at 5:33 am, during an observation of the kitchen and interview, the Dietary Manager (DM) stated he had been at the facility about a month and a half and was in the position temporarily. He had not seen evidence of mice in the facility. He was aware of some mice traps in the kitchen but had not seen any mice. He had not seen the exterminator pick up the traps. The Dietary Manager then observed the tortilla pan and confirmed that there were rodent droppings in the pan and that the tortilla packages had been chewed through. The Dietary Manager stated he would throw the tortillas out now and pulled the tortilla pan from the shelf. Once the pan was pulled off the shelf, droppings were along all the tops of the eight packages of tortillas. There were a larger quantity of sized droppings that were around all the packages of tortillas in the pan. More droppings were on the plastic shelf liner where the pan previously set. He stated he did not
understand how there were fresh droppings. The Dietary Manager confirmed that there were rodent droppings in the box of grits. The Dietary Manager confirmed there were droppings underneath the canned goods rack, in front of the mouse traps there. He stated the dry goods room was swept and mopped daily but that the door is not closed or moved to sweep and clean behind.

D. On 10/23/23 at 5:50 am, during an observation of the kitchen and interview with DM, the mop closet in the kitchen area had debris (plastic wrappers, containers, cups) on the floor in the corners and along the walls. The Dietary Manager stated that the closet should not be like that. During a tour of the kitchen area, the kitchen floor near the sinks and ice machine and food prep line near the steam tables, in front of the stove had large quantity of food debris. The Dietary Manager stated the floor should be clean and swept.

E. On 10/23/23 at 7:48 am, during an interview with the Housekeeping Manager (HKM) and observation of the janitor room, the Housekeeping Manager (HKM) opened the locked janitor room, located across from the maintenance office. He stated he was new to the position of Housekeeping Manager and had only been in it approximately a month and a half. He had not seen any evidence of vermin (a catch-all term used for any small animals or insects that are considered pests, ie roaches, mice, ants). He stated that the janitor room was to be cleaned out once a day and mopped. Once the mop buckets and loose, plastic wrapper trash had been removed, piles of rodent droppings were observed in the two furthest corners of the room, around the mop basin and along the walls. HKM confirmed that the piles did appear to be rodent droppings but stated he did not know how long those had been there. He stated that the janitor’s room had not been cleaned or
mopped. Clear plastic tubing was observed in the room, coming from the ceiling, which entered the side wall of the janitor’s room. A quarter inch gap was observed around the tubing where it entered the wall. HKM confirmed that the piles did appear to be rodent droppings but stated he did not know how long those had
been there.

F. Record review of exterminator invoices revealed the following:
-12/12/22 Set mouse traps in admin (administration) office
-01/18/23 Kitchen treated no problems found. Set mouse traps in admin office.

-02/14/23 Kitchen treated for mice, 4 caught in mop room. Mop room needs to have the walls fixed; mice are in the holes in the wall.
-03/13/23 Kitchen treated for mice non(e) caught this period. Mop room needs to have walls fixed; mice are in the holes in the wall.
-07/13/23 Rebaited (to put more food on a hook or in a special device used to attract and catch a fish or animal, after the first food you put there has been eaten) 4 mice traps in kitchen. No mice found.
-08/07/23 Rebaited 4 mouse traps in kitchen. No mice found. Placed 4 new traps in kitchen.
-09/07/23 Rebaited 7 mouse traps in kitchen. One mouse caught a week ago. Placed 3 new traps in kitchen.
-10/12/23 Rebaited 7 mouse traps in kitchen.

G. Record review of facility’s policy titled [Name of Facility Provider] Policy 029 Pest Control revised 09/2017 stated under procedures
2. All food preparation, service, and storage areas will be monitored regularly for any signs of pest/vermin

H. On 10/23/23 at 1:18 pm, during an interview with the Administrator (ADMIN) and the Director of Nursing (DON), they stated they did not have an active pest problem and have not seen any activity. They stated that they had a problem with mice back in July/August of the current year around the dietary area. ADMIN stated she was made aware of the problem by the interim district dietary manager, who saw small black debris that we believed to be droppings. They stated that mice traps were set out by the exterminator and penetrations (gaps or holes) in the building were sealed by maintenance. The exterminator emails the invoices with his findings to her or the receptionist if there are any concerns. Contaminated food or food that could have been
affected was thrown out. To protect the food from future infestation, ADMIN stated they have things off the floor and liners on the shelves. She stated that we have different types of bins (to store food in), and seal off any penetrations.

I. Record review of the facility’s policy titled Record review of facility policy titled FNS 408 Pest Control with effective date of 05/01/23 under the heading Process stated the following:
2. Director of Dining Services/Director of Culinary Services or designee interacts on a regular basis with the exterminator to pinpoint problem areas and pest sightings.
3. Pest sighting are recorded in a log book.
4. Food service areas are to be maintained in a clean and sanitary condition at all times. Special attention is given to areas around food production equipment, warm or moist areas, trash storage containers, and areas with discarded cartons.

Personal Note from NHA – Advocates: NHAA shares with all the families of loved ones who are confined to nursing homes the pain and anguish of putting them in the care of someone else. We expect our loved ones to be treated with dignity and honor in the homes we place them. We cannot emphasize enough to family members of nursing home residents; frequent visits are essential to our loved ones’ well-being and safety. This nursing home and many others across the country are cited for abuse and neglect.

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