Those infected reported they had eaten food from La California restaurant, a Mexican eatery located at 1685 Peoria Street in Aurora.
A friend told Denver7 that on the day that Castaneda died, her mother was hospitalized.
Further investigation from the health department later revealed a total of 33 people were sickened after eating at La California restaurant with 13 of those cases confirmed and 10 others listed as "probable." Of those sickened, the report found, 32 were restaurant customers and only one was an employee.
The report states that 25 of those cases – or 76 percent of all total cases – had been exposed to the bacteria within a five-day period from November 10 to November 14.
A health department official stated in the report the employee who tested positive for salmonella was barred from working at the restaurant until the employee was well. Investigators did not know if the sick employee contributed to the outbreak or was simply sickened by it after coming into contact with the bacterium.
Health department officials also said in their report that the “only food exposure that yielded a statistically significant odds ratio” was a menu item called the “family combo,” which consists of carnitas, buche (pork stomach), cueritos (pork rind), rice, beans, tortillas, salsa, chopped onion, cilantro and lime wedges.
Following a disease-focused inspection at La California in Aurora on November 22, 2017, health department officials found four “critical” violations: cross-contamination, improper or lack of hand washing, improper hot-holding of foods, improper cooling of foods and lack of hot water at a hand sink.
La California earned an ‘F’ in FOX31’s Restaurant Report Card two years ago for 30 critical violations in its March 2015 health inspection.
A retail food inspection report obtained by Denver7 states that in one of the instances of cross-contamination, raw eggs were stored above ready to eat vegetables and tortillas in the walk-in refrigerator. It also details how an employee in the food prep area failed to use soap while washing her hands. Other findings state a large pot of menudo was stored on the kitchen flat top grill at 122 degrees Fahrenheit, when it should have remained at 135 degrees Fahrenheit or greater. Lastly, the inspection report states that salsa, milk, cheese crumbles and sliced cheese were exposed to temperatures that were higher than they should have been.
The report states those violations were corrected on Nov. 27, 2017. A food inspector wrote in the overall inspection notes that “food safety training is strongly recommended.”
The health department says the outbreak affected people who ate at La California from November 4 to November 26, 2017.
The health department noted it also identified a lack of written policies regarding hand washing and excluding ill employees.
The report also states health officials conducted six follow-up visits between November 27, 207 and December 26, 2017 to determine whether their recommendations were followed. Follow-up inspections, however, found there were “continued problems” with cross-contamination, improper washing of the hands, improper hot-holding of foods, improper cooling of foods, and a lack of hot water at a hand sink.
The health department says lab tests show the family combo meal may have led to the poisoning.
On Dec. 11, “the facility was given a recommendation to disinfect the facility,” according to health department officials. That was followed by an enforcement review hearing on January 16, 2018.
Several recommendations were made to La California restaurant owners to prevent further instances of foodborne illness, mostly focusing on establishing written policies for “excluding ill employees” from working if they’re sick, hand washing, proper food handling and the monitoring of hot and cold temperatures of foods.
Jennifer Chase, the Tri-County Communicable Disease Epidemiology Manager, told Denver7 La California restaurant will face increased inspections for several months “until they show they’re compliant with all the food safety requirements.”
Failure to comply with health regulations could lead to La California being stripped of its license and forced to close, Chase said.
Salmonella is a bacterium that causes gastrointestinal illness. Symptoms include diarrhea (which can be bloody), stomach cramps, fever, nausea, and occasionally vomiting, according to health department officials.
Symptoms typically begin 12 to 36 hours (range of approximately 6 hours to 1 week) after exposure. For healthy people, these symptoms will disappear within several days, but serious complications can occur, “such as blood or bone infection,” which requires antibiotic treatment, according to officials.
Salmonella are naturally found in a variety of animals, including livestock (e.g., cows, pigs), poultry, domestic pets, birds, reptiles, and amphibians.
Humans are exposed to Salmonella through the fecal-oral route, usually by ingesting contaminated food or water.
One person died and more than 30 were infected in November 2017 in a Salmonella outbreak among customers of a Colorado restaurant, but the public wasn’t notified at the time and the restaurant remains open for business.
A Nov. 27 inspection report for the implicated restaurant, La California on Peoria Street in Aurora, CO, shows the Tri-County Health Department did not find any violations at that time. However, reports for inspections on Dec. 6, 8, 15 and 19 show multiple critical violations.
A number of those violations, such as holding foods at the wrong temperatures and not keeping raw chicken separate from other foods, are known to allow Salmonella bacteria to grow rapidly and to cause cross contamination of other foods.
Thursday the health department confirmed details about the outbreak for reporter Erika Gonzalez of the KDVR-TV Channel 31 news department. It was not clear Thursday evening why public health officials did not alert the public of the outbreak at the time.
Laboratory tests showed the restaurant’s family meal combo was likely the source of the Salmonella. However, health officials told multiple Denver area media outlets that they had not been able to isolate which food or foods in the meal combo were specifically contaminated.
One restaurant employee tested positive for Salmonella infection, according to the CBS News affiliate in Denver. All of the other outbreak victims were customers of La California. All of the illnesses began between Nov. 4 and Nov. 26, 2017, the health department reported.
The department reported 13 of the 33 cases are confirmed. Twenty of the sick people are probable cases. Twenty-five of the sick people ate at the restaurant within a five-day period from Nov. 10 to 14, 2017.
Violations observed during the Dec. 6 health department inspection of La California restaurant included:
The U.S. Food and Drug Administration, the Centers for Disease Control and Prevention and the U.S. Department of Agriculture warn that foods should not be held at temperatures between 40 degrees and 140 degrees.
Violations observed by public health inspectors during the Dec. 8 follow-up visit included:
One violation was observed by public health inspectors during the Dec. 15 follow-up visit: Hand washing — Paper towels were not available at the hand sink by the food preparation sink.
One violation was observed by public health inspectors during the Dec. 19 follow-up visit: Personnel hygienic practices — A red plastic basket was observed in the basin of the hand washing sink located on the cook line.
Symptoms of Salmonella infection usually include diarrhea, fever and abdominal cramps, beginning from 12 to 72 hours following exposure, according to the U.S. Centers for Disease Control and Prevention.
In most cases, symptoms last for four to seven days, and most victims recover without treatment. However young children, the elderly, and people with weakened immune systems may be prone to more serious illness, including severe diarrhea, which can result in severe dehydration.