**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, review of Resident Identifier (RI) #64's medical record, the facility's WEEKLY SKIN REPORT FOR THE TIME PERIOD ENDING, 24 HOUR SHIFT REPORT and the policy titled Abuse, Neglect, Misappropriation of Resident Property, Exploitation, and Injuries of Unknown Source, the facility failed to investigate a suspicious injury of unknown source. On 7/17/2019, RI #64 was observed to have a red and blue/green large bruise that was rectangular and covered most of the breast area from the nipple up and the chest wall. This deficient practice affected RI #64, one of one sampled resident identified by the facility as having an injury of unknown source. Findings include: The facility's policy titled Abuse, Neglect, Misappropriation of Resident Property, Exploitation, and Injuries of Unknown Source with an effective date of 11/28/2016, documented . PURPOSE: To ensure the safety and well-being of each resident, the facility will promote and protect the rights of each resident. POLICY: . INJURIES OF UNKNOWN SOURCE an injury should be classified as an injury of unknown source when both of the following conditions are met: (1) The source of the injury was not observed by any person or the source of the injury could not be explained by the resident; and (2) the injury is suspicious because of the extent of the injury or the location of the injury . V. INVESTIGATION . C. The Abuse Coordinator or designee is responsible for conducting a thorough investigation and obtaining witness statements . RI #64 was readmitted to the facility on [DATE]. RI #64 has a medical history to include diagnosis of Dementia. RI #64's PHYSICIAN ORDERS dated 4/23/2019 included an order for Eliquis 2.5 milligrams by mouth twice a day. According to www.webmd.com, Eliquis is an anticoagulant medication used to treat and prevent blood clots. Nausea, easy bruising or minor bleeding may occur while taking Eliquis. RI #64's Quarterly Minimum Data Set with an assessment reference date of 5/19/2019, indicated the resident was severely impaired in cognitive skills for daily decision making with a Brief Interview for Mental Status score of four. RI #64 was assessed as being independent with most Activities of Daily Living. During this assessment period, RI #64 received an anticoagulant medication. RI #64's PHYSICIAN ORDERS dated 7/17/2019 transcribed by Employee Identifier (EI) #11, a Registered Nurse (RN), documented Monitor Bruising on (L) (left) breast q (every) shift until healed. In an interview on 1/17/2020 at 5:12 PM, EI #11, a RN stated on 7/17/2019, she was called to look at the bruise on RI #64's left breast by EI #8, a Certified Nursing Assistant. When asked to describe the bruising, EI #11 stated the bruise was red and blue/green in color, it was large, rectangular and covered most of the breast area from the nipple up and the chest wall. When asked how she had investigated to determine what happened, EI #11 said, she asked the CNA, EI #8, but the CNA did not know what happened. During an interview on 1/17/2020 at 10:30 AM, EI #2, the Director of Nursing (DON) was asked when she became aware of the bruising to RI #64's left breast. EI #2 stated she read it on the shift report. When asked what she had done to investigate how the bruise occurred, EI #2 said she had not investigated it. When asked if the facility had determined the cause of RI #64's bruising to the left breast, EI #2 said she was sure they talked about it, but she could not remember. The facility's 24 Hour Shift Report for 7/17/2019 and 7/18/2019 indicated RI #64 had a large bruise to the left breast and left forearm. The facility's WEEKLY SKIN REPORT FOR THE TIME PERIOD ENDING 7/28/2019, 8/10/2019, 8/18/2019, 9/1/2019, 9/7/2019, 9/15/2019, and 10/5/2019 indicated the facility monitored the bruising to RI #64's left breast until healed on 10/5/2019. On 1/18/2020 at 11:51 AM, an interview was conducted with EI #1, the Administrator/Abuse Coordinator. EI #1 was asked if the bruising to RI #64's left breast was considered an injury of unknown source. EI #1 said yes. EI #1 acknowledged there was not an investigation to determine what caused the suspicious bruising to RI #64's left breast. In an interview with RI #64's responsible party on 1/20/2020 at 10:15 AM, she acknowledged that she had been notified of the bruising to RI #64's breast. RI #64's responsible party stated the facility notified her weekly the status of bruising and that it was getting better. When asked what concerns she had regarding the bruising, RI #64's responsible party stated she did not think RI #64 had been mistreated and she was never afraid the resident has been harmed.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, review of Resident Identifier (RI) #64's medical record and the facility's policy titled Abuse, Neglect, Misappropriation of Resident Property, Exploitation, and Injuries of Unknown Source, the facility failed to timely report an injury of unknown source to the State Agency. On 7/17/2019, RI #64 was observed to have a red and blue/green large bruise that was rectangular and covered most of the breast area from the nipple up and the chest wall. This injury of unknown source was not reported to the State Agency until 1/21/2020. This deficient practice affected RI #64, one of one sampled resident identified by the facility as having an injury of unknown source. Findings include: The facility's policy titled Abuse, Neglect, Misappropriation of Resident Property, Exploitation, and Injuries of Unknown Source with an effective date of 11/28/2016, documented . PURPOSE: To ensure the safety and well-being of each resident, the facility will promote and protect the rights of each resident. POLICY: . INJURIES OF UNKNOWN SOURCE an injury should be classified as an injury of unknown source when both of the following conditions are met: (1) The source of the injury was not observed by any person or the source of the injury could not be explained by the resident; and (2) the injury is suspicious because of the extent of the injury or the location of the injury . VII. REPORTING/RESPONSE A. the Abuse Coordinator or designee will ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source . are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency .) in accordance with State law through established procedures . RI #64 was readmitted to the facility on [DATE]. RI #64 has a medical history to include diagnosis of Dementia. RI #64's PHYSICIAN ORDERS dated 4/23/2019 included an order for Eliquis 2.5 milligrams by mouth twice a day. According to www.webmd.com, Eliquis is an anticoagulant medication used to treat and prevent blood clots. Nausea, easy bruising or minor bleeding may occur while taking Eliquis. RI #64's Quarterly Minimum Data Set with an assessment reference date of 5/19/2019, indicated the resident was severely impaired in cognitive skills for daily decision making with a Brief Interview for Mental Status score of four. RI #64 was assessed as being independent with most Activities of Daily Living. During this assessment period, RI #64 received an anticoagulant medication. RI #64's PHYSICIAN ORDERS dated 7/17/2019 transcribed by Employee Identifier (EI) #11, a Registered Nurse (RN), documented Monitor Bruising on (L) (left) breast q (every) shift until healed. In an interview on 1/17/2020 at 5:12 PM, EI #11, a RN stated on 7/17/2019, she was called to look at the bruise on RI #64's left breast by EI #8, a Certified Nursing Assistant. When asked to describe the bruising, EI #11 stated the bruise was red and blue/green in color, it was large, rectangular and covered most of the breast area from the nipple up and the chest wall. In an interview on 1/17/2020 at 4:21 PM, EI #1, the Administrator/Abuse Coordinator, was asked what types of incidents are reported to the State Agency. EI #1 said any abuse, neglect, misappropriation of property, and injuries of unknown origin. During a follow-up interview on 1/18/2020 at 11:51 AM, EI #1, the Administrator/Abuse Coordinator was asked what the facility policy directed the staff to when an injury of unknown source had been identified. EI #1 replied, to report it. When asked if the bruise to RI #64's left breast was injury of unknown source, EI #1 said yes. EI #1 acknowledged RI #64's injury of unknown source had not been reported to the State Agency. On 1/21/2020 at 2:41 PM, the facility reported to the State Agency an injury of unknown source. The injury was listed as bruising to RI #64's left breast.

Based on interviews and review of Resident Identifier (RI) #43's medical record, the facility failed to ensure RI #43 was not ordered and administered a PRN (as needed) antipsychotic medication, Haldol, for greater than 14 days, without documented rationale in the resident's medical record for the continued use of the PRN antipsychotic medication. This deficient practice affected RI #43, one of five sampled residents reviewed for unnecessary medications. Findings include: RI #43 was readmitted to the facility 8/27/2019. RI #43 has a medical history to include diagnoses of: Dementia with behavioral disturbance, Mood Disorder, Psychotic Disorder with delusions and Unspecified Psychosis. RI #43's PHYSICIAN ORDERS dated 8/28/2019, documented Haldol 2 mg (milligram) po (by mouth) prn (as needed) q6hrs (every six hours) for agitation. In an interview on 1/16/2020 at 4:42 PM, Employee Identifier (EI) #2, the Director of Nursing acknowledged RI #43's order for Haldol had not been renewed since it was ordered on 8/28/2019. When asked if the physician gave a rationale to continue use beyond 14 days, EI #2 said no. When asked if the facility had re-evaluated RI #43's use of as needed Haldol, EI #2 said no. During a telephone interview on 1/16/2020 at 5:12 PM, EI #5, the facility's Medical Director and RI #43's Primary Physician was asked if RI #43 had been re-evaluated for the extended use of the antipsychotic medication, Haldol, that was ordered to be administered on an as needed basis. EI #5 replied no and it should have been done within 14 days of the order. RI #43's August 2019 MEDICATION SHEET revealed the resident was administered Haldol once during the month. RI #43's September 2019 Medication Administration Record revealed the resident was administered Haldol 15 times during the month. RI #43's October 2019 Medication Administration Record revealed the resident was administered Haldol 16 times during the month. RI #43's November 2019 Medication Administration Record revealed the resident was administered Haldol twice during the month. RI #43's December 2019 Medication Administration Record revealed the resident was administered Haldol twice during the month. RI #43's January 2020 Medication Administration Record revealed the resident was administered Haldol once during the month. RI #43's Physician Orders for January 2020 had a handwritten order dated 1/16/2020 that read May D/C (discontinue) Haldol.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and record review, the facility failed to ensure Resident Identifier (RI) #22's suprapubic urinary catheter and tubing was shielded from the view of other residents and visitors. This effected one of two residents with suprapubic catheter. Findings include: RI #22 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses of Cervical Spinal Cord injury. A review of the December 2018 Physician's Orders with an order date 11/28/18 stated, . CHANGE SUPRA PUBIC CATH (CATHETER) Q (EVERY) MONTH ON THE 13TH (20 FRENCH (FR) CATH W(WITH)/30 ML (milliliters) H2O (water) BULB) . A review of RI #22's Care Plan for FOLEY CATHETER dated 12/31/16 revealed the presence of a suprapubic catheter. On 12/19/18 at 1:29 p.m. the surveyor observed RI #22's suprapubic catheter hanging on the bed frame without a covered bag to shield it from the view of other residents or visitors. On 12/19/18 at 3:06 p.m. an interview was conducted with Employee Identifier (EI) #4, Certified Nursing Assistance (CNA). The surveyor asked EI #4 what was that (referring to the resident's catheter). EI #4 said it was RI #22's catheter. The surveyor asked EI #4 how was the catheter supposed to be. EI #4 said it was supposed to hang below RI #22's body and be in a bag to cover it. The surveryor asked EI #4 what concerns there were with the catheter not being covered. EI #4 said it was sealed so it was not going to leak unless it was bumped really hard. The surveyor asked EI #4 why should the facility put the catheter inside of a bag. EI #4 said, it was for privacy first and then for protection of the catheter bag. On 12/19/18 at 3:07 p.m. the surveyor conducted an interview with RI #5, License Practical Nurse (LPN). The surveyor asked EI #5 what was that (referring to the resident's catheter bag). EI #5 said that was RI #22's catheter bag. The surveyor asked EI #5 how it was supposed to be. EI #5 said, it was supposed to have a drainage bag holder over it. The surveyor asked EI #5 what issues there were with that. EI #5 said it was a dignity issue. On 12/19/18 at 4:17 p.m. the surveyor conducted an interview with RI #22. The surveyor asked RI #22 how it made him/her feel for the catheter to be on the side of the bed, exposed with urine, without a cover. RI #22 said, he/she was so used to it, he/ she did not think about it anymore. RI #22 said, if he/she was going out he/she would want it covered. The surveyor asked RI #22 how often the catheter was covered. RI #22 said, is was the first time that bag had been on the catheter in awhile.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure Resident Identifier (RI) #31's prescribed diet was followed. This affected one of four residents whose diets were reviewed. Findings Include: RI # 31 was admitted to the facility on [DATE] and readmitted on [DATE], with diagnoses including Type 2 Diabetes with Diabetic Autonomic (poly) Neuropathy, Gastroparesis, and Dependence on Renal Dialysis. A review of RI #3's December 2018 Physician Orders dated 12/7/2018, revealed a regular diet with double eggs and cheese with breakfast and no tomatoes, no potatoes and no bananas. An observation was made on 12/18/2018 at 6:00 p.m. RI #31's meal tray was observed for intake amount. RI #31's meal tray was noted to have hashbrowns. RI #31 said she/he did not eat them because they told her/him she/he could not have them. Employee Identifier (EI) #2, Director of Nursing (DON) was present and also observed RI #31's tray. On 12/19/2018 at 1:53 p.m., the surveyor conducted an interview with EI #2. The surveyor asked EI #2 what was on RI #31's supper tray the evening before. EI #2 said hash browns. The surveyor asked EI #2 who was responsible for ensuring meals on the trays were correct. EI #2 said dietary and nursing staff that put out trays. The surveyor asked EI #2 what would be some issues with RI #31 receiving potatoes. EI #2 said, RI #31 could have abnormal labs.

Based on observation, interview, and review of the facility policy titled Labeling and Dating Foods . the facility failed to ensure all frozen items were sealed, labeled and dated in the walk in freezer. During the entrance tour of the kitchen on 12/18/18, an unlabeled and undated clear plastic bag of breaded okra was open and exposed the okra to the air in the walk in freezer. This had the potential to affect 65 residents who received meals from the kitchen. Findings include: Review of a facility policy titled Labeling and Dating Foods . and dated 2016 revealed the following: Guideline: All foods stored will be properly labeled according to the following guidelines. Procedure: . 3. * Date marking for freezer storage food items . Once a package is opened, it will be re-dated with the date the package was opened and shall be used by the safe food storage guidelines . During the entrance observation of the facility kitchen on 12/18/18 at 9:15 AM, the walk-in freezer was observed with the Certified Dietary Manager, Employee Identifier (EI) #3. In the walk-in freezer was an unlabeled and undated, open, clear, plastic bag of breaded okra. EI #3 removed the bag of okra from the freezer and stated, it should not be stored without a label, a date and it should have been sealed. On 12/19/18 at 1:45 PM, EI #3, CDM was asked what the facility policy was for food items stored in bags in the freezer. EI #3 said, they should be secured, dated, labeled and put away. EI #3 was asked what dates should have been on the okra. EI #3 said, the date it came in, the date it was opened and the use by date. EI #3 was asked how it should have been put away. EI #3 said, if something is left over it would be labeled and dated and closed up. When asked how to close or secure an open bag of okra in the freezer, EI #3 said, roll it down tight, in a dated zip-lock bag. When asked how long the okra had been in the freezer open, EI #3 replied, she could not say for sure how long. When asked why frozen food items should not be in the freezer in an open bag, EI #3 said, it could be freezer burned and could make someone sick if it got contaminated.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** (2) RI #15 was admitted to the facility on [DATE], with the diagnosis of Dysphagia, Oropharyngeal Phase. On 01/31/18 at 8:57 a.m., the surveyor observed a no straws please sign posted over RI #15's bed. On 02/01/18 at 12:00 p.m., the surveyor observed a straw in RI #15's water pitcher. On 02/01/18 at 3:57 p.m., RI #15's assigned Licensed Practical Nurse (LPN) on the 3-11 PM shift, EI #7, and the surveyor entered RI #15's room. The straw remained in RI #15's water pitcher. The surveyor asked EI #7 could RI #15 reach the water pitcher and drink from it. EI #7 said if RI #15 was in the room, yes. When asked why RI #15 had the sign above the bed that the resident was not to have a straw, EI #7 said she did not know. On 02/01/18 at 4:12 p.m., the surveyor conducted an interview with EI #4, a LPN Rehabilitation Nurse. The surveyor asked EI #4 was RI #15 cared planned for the use of no straw. EI #4 looked in RI #15's medical records and said she did see one. The surveyor asked EI #4 should there be a care plan for RI #15's no usage of straws. EI #4 said she did not write one and there probably should have been one. Based on observations, record review and interviews, the facility failed to ensure: (1) the amount of fluid allowed for Resident Identifier (RI) #35, a resident on dialysis and fluid restriction, was documented on the care plan; and (2) a care plan was developed for RI #15's no use of straws. These deficient practices affected RI #15 and #35, two of 19 sampled residents whose plans of care were reviewed. Findings Include: (1) RI #35 was readmitted to the facility on [DATE], with diagnosis to include End Stage Renal Disease and Chronic Kidney Disease. The Quarterly Minimum Data Set (MDS) assessment, with an Assessment Reference Date (ARD) of 09/03/17, revealed RI #35 had a Brief Interview for Mental Status score of 3 indicating severely impaired cognition. A review of RI #35's careplan titled Risk for complications related to Renal Failure requiring Dialysis did not specify the amount of fluids allowed for each discipline. The care plan failed to designate the amount of fluid restriction allowed. A review of RI #35's February 2018 Physician Orders revealed an order for 1500 cc (centimeter) fluid restriction. RI #35 is receiving hemodialysis Monday, Wednesday and Friday. The Plan of Care [NAME] for the CNAs (Certified Nursing Assistants) did not address the fact RI #35 was on fluid restriction or the amount of the restriction. A review of the MAR (Medication Administration Record ) did not specify the amount of fluids to be given with medications or that RI #35 was on a fluid restriction. On 02/02/18 at 3:10 p.m., the Registered Nurse (RN) supervisor, Employee Identifier (EI) #2 was asked if the care plan for a resident on fluid restriction should have the amounts allowed. EI #2 stated yes, it should also be on the meal card. When asked how the CNAs would know the amount of the fluid restriction, EI #2 stated it should be on their ADL (Activity of Daily living) card.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interview and record review, the facility failed to ensure the Physician's Orders for Resident Identifier (RI) #15 to not have a straw was followed. This deficient practice affected RI #15, one of 19 residents whose Physician Orders were reviewed. RI #15 was admitted to the facility on [DATE], with the diagnosis of Dysphagia, Oropharyngeal Phase. A review of RI #15's Plan of Treatment for Outpatient Rehabilitation, with an onset date of 04/23/16, documents: . 20. INITIAL ASSESSMENT . 0 (No) straws c (with) orders for Glucerna c meals . RI #15's Weekly Progress Note, with summary dates from 04/29/16 - 05/05/16, documented: . GOAL: . (2). Patient will tolerate thin liquids c 0 s/s (signs/symptoms) aspiration . Current: . via (by way of) cup rim - NO STRAWS . RI #15's February 2018 Physician Orders documented: . NO STRAWS. ALL THIN LIQUID FROM CUP RIM . On 01/31/18 at 8:57 a.m., the surveyor observed a no straws please sign posted over RI #15's bed. On 02/01/18 at 12:00 p.m., the surveyor observed a straw in RI #15's water pitcher. 02/01/18 at 4:12 p.m. the surveyor conducted an interview with a Licensed Practical Nurse/Rehabilitation Nurse, Employee Identifier (EI) #4. The surveyor asked EI #4 why was RI #15 given a Physician's Order for no straws. EI #4 said from her understanding it was related to RI #15's dysphagia. The surveyor asked EI #4 what could possibly happed if RI #15 used the straw. EI #4 said RI #15 could possible choke if the liquid went down to fast.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and interviews, the facility failed to monitor the amount of fluid for Resident Identifier (RI) #35, a resident receiving Dialysis and on a 1500 cc (centimeter) fluid restriction. This affected RI # 35, one of three residents sampled for dialysis. Findings Include: RI #35 was readmitted to the facility on [DATE], with diagnosis to include End Stage Renal Disease, Chronic Kidney Disease and Vascular Dementia. The Quarterly Minimum Data Set (MDS) assessment, with an Assessment Reference Date (ARD) of 09/03/17, revealed RI #35 had a Brief Interview for Mental Status score of 3 indicating severely impaired cognition. RI #35's February 2018 Physician Orders reveals an order for a 1500 cc (centimeter) fluid restriction. RI #35 was receiving hemodialysis Monday, Wednesday and Friday. A review of RI #35's chart, MAR (Medication Administration Record), care plan nor the CNA (Certified Nursing Assistant) [NAME] revealed documentation of the daily amount of fluids RI #35 was receiving. On 02/02/18 at 11:30 a.m., the Dietary Manager, Employee Identifier (EI) #3 was asked who is responsible for dividing the amount of fluids nursing and dietary is to provide to RI #35. EI #3 stated it was the nursing staffs duty. On 02/02/18 at 3:10 p.m., EI #2 the RN (Registered Nurse) Supervisor was asked how the CNAs know when a resident is on fluid restriction. EI #2 stated it was on the ADL (Activity of Daily Living) sheet. When asked if the fluid amounts were added up to prevent giving too much fluid, EI #2 stated she didn't think so. When asked why it is important to monitor fluid intake, EI #2 stated to prevent fluid overload. 02/01/18 at 1:45 p.m., the LPN (Licensed Practical Nurse) EI #6 was asked where the amount of fluids given to RI #35 with the medications was documented. EI #6 stated there was no place to document the amount. When EI #6 was asked whose responsibility it was to divide the amount of fluid for the staff to provide, EI #6 stated she did not know.

Based on observation and interviews, the facility failed to ensure 62 stock Bisacodyl Suppositories, with the expired date of 12/2017, were not stored in the refrigerator in the medication room. This deficient practice had the potential to affect all residents in the facility with a Physician's Order for Bisacodyl Suppositories. Findings Include: On 02/01/18 at 2:49 p.m., the surveyor made an observation of the medication room on the South Unit with Employee Identifier (EI) #7, a Licensed Practical Nurse. The surveyor observed a box of 62 stock Bisacodyl suppositories with an expiration date of 12/2017. The surveyor asked EI #7 should the expired suppositories be in the refrigerator. EI #7 said no. The surveyor asked EI #7 who was responsible for ensuring expired medications were not stored in the refrigerator. EI #7 said all of the nurses. The surveyor asked EI #7 what could be the result of a resident receiving an expired medication. EI #7 said they could have a reaction to or not get the full benefits of the medication. On 02/01/18 at 5:46 p.m., the surveyor conducted an interview with EI #4, the Registered Nurse/Quality Assurance/Infection Control Nurse. The surveyor asked EI #4 who was responsible for ensuring expired medications were disposed of. EI #4 said the nurses that work should check for expired medications and the pharmacist comes monthly and checks too. The surveyor asked EI #4 what should happened to expired medications. EI #4 replied, they should be destroyed. The surveyor asked EI #4 should the expired suppositories have been left in the refrigerator. EI #4 said no. When asked what were some of the consequences of administering an expired medication to a resident, EI #4 said the medication could not be as effective when it is expired.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews the facility failed to ensure: (1) Resident Identifier (RI) #20's nebulizer mask was stored properly; and (2) a Certified Nursing Assistant, Employee Identifier (EI) #8, did not touch Resident Identifier (RI) #56's cornbread with her bare hands while assisting RI #56 with the lunch meal 01/31/18. These deficient practices affected RI #20, one of two residents observed with a nebulizer mask, and RI #56 one of two residents observed being assisted with meals. Findings Include: (1) RI #20 was admitted to the facility on [DATE], and readmitted on [DATE], with a diagnosis of Chronic Obstructive Pulmonary Disease. RI #20's February 2018 Physician Orders documented: . ALBUTEROL - IPRATROPIUM 2.5 MG (milligram) - 0.5 MG 3 ML (milliliters) INHALATION SOLUTION. TID (three times a day) PRN (as needed) SOB (shortness of breath) . On 01/31/18 at 9:37 a.m., the surveyor observed RI #20's nebulizer mask lying on top of dresser drawer. The nebulizer mask was not in a covering at this time. On 01/31/18 at 2:07 p.m., RI #20's nebulizer mask remained uncovered lying on top of the dresser drawer. On 02/01/18 at 10:02 a.m., the surveyor once again observed RI #20's nebulizer mask lying on top of the dresser drawer not in a covering. On 02/01/18 at 1:30 p.m., the surveyor conducted an interview with the Licensed Practical Nurse assigned to care for RI #20 on 02/01/18, on the 3 - 11 PM shift, EI #7. The surveyor asked EI #7 did RI #20 receive nebulizer treatments. EI #7 said yes. The surveyor asked EI #7 how should RI #20's nebulizer mask be stored when not in use. EI #7 said the mask should be stored in a Ziploc or plastic bag. The surveyor asked EI #7 what was there a potential for when the nebulizer mask was not stored properly. EI #7 replied the mask could hit the floor and be contaminated from being on the floor. (2) RI #56 was admitted to the facility on [DATE], and readmitted on [DATE], with a diagnosis of Dementia. A Quarterly Minimum Data Set assessment, with an Assessment Reference Date of 10/01/17, assessed RI #56 as being totally dependant on staff for feeding. On 01/31/18 at 11:25 a.m., the surveyor observed EI #8, the CNA assisting RI #56 with the lunch meal, pick up the resident's cornbread with her bare hands and hand it to resident. On 02/01/18 at 2:00 p.m., the surveyor conducted an interview with EI #8. The surveyor asked EI #8 should the resident's food be handled by staff with their bare hands. EI #8 said no. The surveyor asked EI #8 what would it be considered if you touched a resident's food with your bare hands. EI #8 said cross-contamination. The surveyor asked EI #8, if staff needed to touch a resident's food, what should they do first. EI #8 replied, grab a napkin first or put on gloves.