Based on observations, interviews and the facility's policy titled, Labeling and Dating Foods (Date Marking), the facility failed to ensure out of date food was discarded on 06/30/2024 during the initial kitchen observation. This had the potential to affect 57 of 57 residents receiving food from the kitchen. Findings include: A facility's policy titled, Labeling and Dating Foods (Date Marking), documented, . Procedure: . 2. Date marking for refrigerated storage food items . *Once opened, all ready to eat, potentially hazardous food will be re-dated with a use by date according to current safe food storage guidelines . 4. Prepared food or opened food items should be discarded when: *The food items does not have a specific manufactured expiration date and has been refrigerated for 7 days *The food items is leftover for more than 3 days *The food item is older than expiration date . On 06/30/2024 at 4:20 PM, an initial kitchen tour was conducted with the Dietary Manager (DM). An observation was made of a quart of buttermilk with a use by date of 06/29/2024, a Ziploc or re-sealable bag of bologna with a use by date of 06/29/2024, a Ziploc bag of Deli Turkey with a use by date of 06/27/2024 and a Ziploc bag of Deli Smoked Ham with a use by date of 06/29/2024 in the reach in cooler. During the initial kitchen tour conducted on 06/30/2024 at 4:20 PM, an interview was conducted with the DM. The DM stated the quart of buttermilk, Ziploc bags of bologna, Deli Turkey and Deli Smoked Ham, should have been discarded by the used by date on the label. The DM admitted these items should not have been in the cooler. The DM stated the concern of having these items in the cooler after the use by date was the items could be used when they were possibly unsafe.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and review of a facility policy tilted Voting Policy and a facility document titled current registered voters, the facility failed to ensure Resident Identifier (RI) #12 and RI #21 were given the opportunity to vote in the June 5, 2018 State Wide Election. This affected 2 of 8 registered voters in the facility. Findings Include: A review of an undated policy titled Voting Policy documented: .It is the policy of .to encourage all residents to exercise the right to vote while residing in the facility .Procedure: .3. During election periods, the Social Services Director will obtain absentee ballots for the residents interested . A review of a facility document titled current registered voters documented RI #12 and RI #21 were registered voters. On 6/12/18 at 10:00 a.m., a resident council meeting was held. During the meeting, residents reported they did not vote in the last election. 1) RI # 12 was readmitted to the facility on [DATE]. A review of RI # 12's most recent Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 4/12/18 documented a Brief Interview of Mental Status Score (BIMS) of 15, which indicated RI # 12 was cognitively intact. On 6/12/18 at 4:13 p.m., an interview was conducted with RI # 12. RI # 12 stated he/she was not asked if he/she wanted to vote in the June 5, 2018 State Wide Election. RI # 12 stated he/she would have voted in the election if he/she had been asked. 2) RI #21 was readmitted to the facility on [DATE] A review of RI #21's most recent Quarterly MDS with an ARD of 4/22/18 documented a BIMS of 13, which indicated RI #21 was cognitively intact. On 6/12/18 at 4:21 p.m. RI # 21 was asked if he/she was allowed to vote in the June 5, 2018 State Wide Election, he/she responded no. He/she was asked if he/ she would have wanted to vote in the June 5, 2018 election, and he/she responded yes. An interview was conducted with Employee Identifier (EI) # 2, Social Services Director on 6/12/18 at 3:25 p.m. EI #2 stated there were 8 registered voters in the facility. EI # 2 stated the registered voters did not vote in the June 5, 2018 State Wide Election. EI # 2 was asked if the residents were asked if they wanted to vote in the election. EI # 2 responded no, because it is not an election we normally participate in. EI # 2 stated the last election the residents were able to participate in was the November 2017 presidential election. EI # 2 further stated we normally only participate in the presidential election. EI # 2 was asked if the residents should be able to participate in an election other than the presidential election. EI # 2 stated, yes, if they showed an interest. EI #2 was asked if she should ask residents if they want to vote if they are registered voters. EI #2 stated yes, she probably should have asked.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical record review, interview and review of a facility policy titled Comprehensive Care Plans, the facility failed to ensure a care plan was developed for an anticoagulant medication for Resident Identifier (RI) #16 and RI #22. This affected RI #16 and RI #22, two of 15 sampled residents reviewed for care plans. Findings Include: The facility policy, Comprehensive Care Plans dated 11/01/2017 documented: . It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident . that are identified in the resident's comprehensive assessment . 1) RI #16 was admitted to the facility on [DATE] with diagnoses to include, Atherosclerotic Heart Disease. A review of RI #16's Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 04/26/2018, revealed the resident had received an anticoagulant medication in the last seven days or since admission. A review of RI #16's current Physician Orders dated 06/06/2018, documented: .Coumadin 5 milligram (mg) . and 7.5 mg . by mouth at bedtime . On 06/12/2018 at 04:30 p.m., the Surveyor reviewed the care plans for RI #16. No care plan for an anticoagulant medication was found. On 06/12/18 at 05:29 p.m., an interview was conducted with Employee Identifier (EI) #1, a Registered Nurse/MDS and Care Plan Coordinator. EI # 1 was asked if RI #16 was on an anticoagulant medication. EI #1 stated yes. EI # 1 was asked if RI #16 had a care plan for an anticoagulant medication prior to 06/12/2018. EI #1 stated no. EI #1 was asked if RI #16 should have a care plan for an anticoagulant medication. EI #1 stated yes, and explained the care plan is so staff can take care of the residents, and would know what side effects to observe for, such as bleeding and bruising. 2) RI #22 was admitted to the facility on [DATE] with a diagnoses to include Atherosclerotic Heart Disease. A review of RI # 22's most recent Quarterly MDS with an ARD of 4/15/18 revealed the resident had received an anticoagulant medication in the last seven days or since admission. A review of RI #22's June 2018 Physician Orders documented: . (Pradaxa) . 150MG(Milligrams) capsule Dose: (1 capsule/150mg) by mouth twice a day . First Date: 10/27/2017 For: Atherosclerotic heart disease . On 6/12/18 at 4:30 p.m., a review of RI # 22's medical chart revealed no care plan for anticoagulant use. An interview was conducted with Employee Identifier (EI) # 1, RN/MDS Coordinator on 06/12/18 at 5:29 p.m EI # 1 stated RI # 22 was on an anticoagulant medication. EI # 1 stated there was no care plan for anticoagulant medication prior to 6/12/18. EI #1 stated there should have been a care plan for the use of the anticoagulant medication. EI # 1 further stated a care plan is needed so staff who cares for the resident would know what side effects to observe for, such as bleeding or bruising.