Based on observations, interviews, record review, and facility policy review, the facility failed to maintain a urinary catheter bag in a manner to prevent potential contamination and urinary tract infections when Resident 86's urinary catheter bag was observed on the floor on five occasions on three of the four days of the survey. This affected Resident #86, one of three residents reviewed with catheters. Findings included: Review of a facility policy titled, Urinary Catheter Care, dated 07/02/2007, revealed, . PURPOSE: Urinary catheter care helps prevent urinary tract infections . PROCESS: . Catheter tubing and drainage bags are kept off the floor to prevent contamination . Review of a Face Sheet revealed the facility admitted Resident #86 on 10/28/2021 and readmitted the resident on 03/03/2022 with diagnoses that included Urinary Retention and Gross Hematuria (visible blood in the urine). Review of a quarterly Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 04/27/2023, revealed Resident #86 had a Brief Interview for Mental Status (BIMS) score of seven, which indicated Resident #86 had severe cognitive impairment. The MDS indicated Resident #86 was totally dependent on staff for toilet use and had an indwelling catheter. Review of Resident #86's Care Plan, initiated 01/30/2023, revealed Resident #86 required a suprapubic catheter due to urinary retention. The Care Plan directed staff to secure the resident's urinary catheter bag to their thigh and maintain the drainage bag below the level of the bladder. The Care Plan also indicated Resident #86 liked to keep their urinary catheter bag in the garbage can. Review of Resident #86's June 2023 Physician Orders revealed an order, dated 10/04/2022, that indicated the resident utilized a suprapubic catheter for a diagnosis of Urinary Retention. On 07/10/2023 at 10:25 AM, the surveyor observed Resident #86's urinary catheter bag on the floor. On 07/11/2023 at 2:56 PM, the surveyor observed Resident #86's urinary catheter bag on the floor. On 07/11/2023 at 3:43 PM, the surveyor observed Resident #86's urinary catheter bag hanging from the side of the trash can with the bag touching the floor. On 07/12/2023 at 10:21 AM, the surveyor observed Resident #86's urinary catheter bag hanging from the side of the trash can with the bag touching the floor. On 07/12/2023 at 2:47 PM, Resident #86's urinary catheter bag was observed on the floor. In an interview with Licensed Practical Nurse (LPN) #2 on 07/12/2023 at 2:52 PM, she revealed the urinary catheter bag should never be on the floor. In an interview with Registered Nurse (RN) #3 on 07/12/2023 at 2:53 PM, she revealed the urinary catheter bag should not be on the floor. In an interview with LPN #5 on 07/13/2023 at 8:59 AM, she revealed urinary catheter bags should be hanging off the side of the bed and the bag should not touch the floor. In an interview with the Director of Nursing (DON) on 07/13/2023 at 9:14 AM, she stated urinary catheter bags should not be on the floor. She went on to add the staff acknowledged this issue should have been taken care of a while ago. In an interview with the Administrator on 07/13/2023 at 10:52 AM, she revealed the urinary catheter bag should not be on the floor.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, a review of a facility policy Perineal Care, and a facility Laboratory Report, the facility failed to ensure the Certified Nursing Assistant (CNA) did not use the same soiled gloves she had on to place a clean brief on Resident Identifier (RI) #54, a resident with a history of Urinary Tract Infections (UTI). This was observed on 11/13/19 and affected one of two residents observed for incontinent care. Findings Include: A review of a facility policy titled Perineal Care with a revised date of October 2010 revealed Purpose The purposes of this procedure are to provide cleanliness and comfort to the resident, to prevent infections . RI #54 was admitted to the facility on [DATE]. A diagnosis included Urinary Tract Infection. A review of a facility Laboratory Report revealed PROCEDURE CULTURE URINE . COLLECTED 10/30/19 . Organisms Identified Escherichia coli 11/01/19 . A review of a Physician Order for RI #54 dated 11/1/19 revealed Amoxicillin 500 mg (milligrams) PO (by) mouth TID (three) X (times a day) for 5 days DT (due to) UTI . On 11/13/19 at 4:14 PM, the surveyor observed incontinent care for RI #54 provided by Employee Identifier (EI) #2, CNA and EI #3, CNA. Both CNAs gathered the needed supplies, washed their hands, and put on gloves. EI #3 placed the barrier on the over the bed table and the supplies on top of the table. Both CNAs prepared RI #54. EI #2 cleaned the front area of RI #54 wiping four times using a clean wipe each time. EI #3 assisted to turn RI #54 to the left side. EI #2 removed her gloves, sanitized her hands, and put on a clean pair of gloves. EI #2 wiped the buttock area three times using a clean wipe each time. EI #2 picked up the clean brief and placed it under RI #54 with the same gloves she had on to clean the buttocks area. On 11/13/19 at 4:23 PM, during an interview, the surveyor asked EI #2 to recap how she performed the incontinent care. EI #2 replied, she cleaned the front, changed gloves after sanitizing her hands, turned the resident, wiped the buttock area, and then placed the clean brief. EI #2 was asked when should you wash or sanitize your hands. EI #2 replied, between cleaning the buttock and placing the clean brief. EI #2 was asked if she washed or sanitized her hands after cleaning the buttock area before placing the clean brief. EI #2 replied, no. EI #2 was asked why she did not wash her hands and put on clean gloves before placing the clean brief. EI #2 replied, she kind of forgot to. EI #2 was asked what was the harm in her using the same gloves to place a clean brief after cleaning a resident's buttock area. EI #2 replied, spreading germs and infection control. On 11/14/19 at 10:27 AM, an interview was conducted with EI #1, the Staff Development and Infection Control Registered Nurse. EI #1 was asked when should staff change gloves during incontinent care. EI #1 replied, they should wash their hands and put on gloves when starting; after cleaning they should wash their hands and put on clean gloves; then before placing anything clean like the brief. EI #1 was asked when should the CNA use the same gloves she had on to clean a resident, then place the clean brief. EI #1 replied, the CNA should not use the same gloves she had on to clean a resident; she should remove her gloves wash her hands, put on clean gloves, and then place the clean brief. EI #1 was asked what would the harm be in the CNA using the same soiled gloves to place a clean brief on a resident. EI #1 replied, possible spread of infection.

Based on observations, interviews, and a review of facility policies titled FOOD TEMP LOG POLICY & PROCEDURE, and Cleaning Dishes / Dish Machine, the facility failed to ensure: 1.) the holding temperature of all foods on the steam table were measure before beginning tray-line service and the holding temperature of fried chicken was at least 135 degrees Fahrenheit and 2.) four pans were not wet and stacked in a manner that prevented air-drying. This was observed on 11/13/19 during the supper meal and had the potential to affected 127 of 127 residents receiving meals from the kitchen. Findings Include: 1.) A facility policy titled: FOOD TEMP LOG POLICY & PROCEDURE dated 09/18/12 revealed Food temperatures will be taken . when placed on the serving line for all meal service . On 11/13/19 at 4:38 PM during a kitchen observation, the Surveyor noted that no holding temperatures were measured before the beginning of the supper meal plating. At 5:26 PM, 45 meals were plated and had left the kitchen. The Surveyor intervened and asked Employee Identifier (EI) #4, Dietary Manager who was performing cook duties, how did he know the food on steam table was held at the correct temperature before the tray line started. EI #4 replied, staff checked the temperature of all foods immediately after cooking and before transfer to the steam table. EI #4 measured temperatures of all foods on the steam table at that time. The holding temperature of the fried chicken was 125 degrees Fahrenheit. Food service resumed without the fried chicken being removed or re-heated. On 11/13/19 at 5:32 PM, an interview was conducted with EI #5, Dietary Manager. EI #5 was asked, when should the temperature of foods be measured. EI #5 replied, food temperatures should be measured once when the food was finished cooking to ensure it reached appropriate temperature; and then again on the steam table prior to beginning food service line. EI #5 was asked, who was responsible for checking the temperatures. EI #5 replied, the cook. EI #5 was asked, what was the potential harm to residents when food holding temperatures were not measured before beginning tray service line. EI #5 replied, bacteria grew more rapidly when foods were held below 135 degrees Fahrenheit, measuring the temperature ensured foods were held above 135 degrees Fahrenheit. EI #5 added, not measuring holding temperatures could also affect the palatability of foods. On 11/14/19 at 12:37 PM, an interview was conducted with EI #4. EI #4 was asked, who was responsible for measuring temperatures of foods. EI #4 replied, the cook and himself, the Dietary Manager. EI #4 was asked, when were temperatures measured. EI #4 replied, food temperatures were measured after staff cooked the food and before the tray-line started. EI #4 was asked, why were food temperatures measured before starting the tray-line. EI #4 replied, holding temperatures were measured to ensure food was at the correct temperature. EI #4 was asked, when should foods prepared in the kitchen be served from the steam table before the holding temperatures of foods were measured. EI #4 replied, never. EI #4 was asked, what was the potential harm to residents when holding temperatures were not measured before serving. EI #4 replied, bacteria could grow when foods were not held at temperatures greater than 135 degrees Fahrenheit and it could affect the temperature of food when it reached resident. 2.) A facility policy titled: Cleaning Dishes / Dish Machine with a year date of 2013 revealed . Procedure: . 9. Allow the dishes to air dry on the dish racks. On 11/13/19 at 4:15 PM, two small metal pans and two large pans were observed on a shelf stacked in a manner that prevented air-drying. The two pair of pans were separated by the Surveyor and wetness was noted on the inside and outside of the pans. On 11/13/19 at 5:32 PM, EI #5, Dietary Manager was asked to check the metal pans stacked on the shelf. EI #5 was asked, were the pans stacked in a manner that prevented air-drying. EI #5 replied, yes, they were stacked together. EI #5 was asked, were those pans visibly wet. EI #5 replied, yes. EI #5 was asked, what was the potential harm to residents when metal food service pans were wet and stacked in a manner that prevented air-drying. EI #5 replied, bacteria grew more rapidly in moist conditions and increased the risk of food-borne illness. On 11/14/19 at 12:37 PM an interview was conducted with EI #4. EI #4 was asked, how was cookware dried and stored. EI #4 replied, pans should be tilted to the side to allow air-drying. EI #4 was asked, when should pans be moist and stacked together. EI #4 replied, never, that was wet nesting. EI #4 was asked, what was the harm to residents when pans were moist and stacked together. EI #4 replied, bacteria could grow.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, interview, review of a facility abuse reportable to the State Agency and review of the facility policy titled Abuse, Neglect and Exploitation, Misappropriation of Resident Property, the facility failed to ensure two allegations of abuse were reported to the State Agency within the required two hour reporting time frame. This affected two of three allegations reported to the state agency. Findings Include: A review of a facility policy titled Abuse, Neglect and Exploitation, Misappropriation of Resident Property with an implementation date of 11/28/17 revealed . Policy Explanation and Compliance Guidelines: .The components of the facility abuse prohibition plan . :VII. Response and Reporting of Abuse . The DON, Administrator or designee will contact the State Agency to report any alleged abuse, this will be done immediately but no later than 2 hours after allegation of abuse, . 1) A review of an Online Incident Reporting System Report revealed An incident report has been submitted at 10/15/2018 5:49 PM . resident involved . Date and Time of incident 10/13/18 7:00 PM . Resident Identifier (RI) #123 was admitted to the facility on [DATE] and readmitted on [DATE] with a diagnosis of Anxiety Disorder. On 11/14/18 03:20 PM an interview was conducted with Employee Identifier (EI) #1, Director Of Nursing, referring to the incident reported to the State Agency. EI #1 was asked what type of incident was this. EI #1 replied, physical abuse. EI #1 was asked what was the time and the date the alleged abuse occurred. EI #1 replied, 10/13/18 at 7:00 PM. EI #1 was asked when was the incident reported to the State Agency. EI #1 replied, on 10/15/18 at 5:49 PM. EI #1 was asked what was the policy for the time frame for reporting abuse. EI #1 replied, within 2 hours. EI #1 was asked if the policy for reporting an allegation of abuse was followed. EI #1 replied, no. EI #1 was asked what was the potential for harm in not reporting an allegation of abuse in the required time frame. EI #1 replied, there really was no harm, actions were taken it was only not reported timely. 2 ) A review of an Online Incident Reporting System Report revealed, Name(s) of resident (s) involved .Date and Time of incident 10/29/18 at 6:15 PM . An incident report has been submitted .10/30/18 at 9:19:41 AM . RI # 89 was admitted to facility on 2/26/97 with a diagnosis of Deaf nonspeaking. RI #180 was readmitted to the facility on [DATE] with a diagnosis of Mood Disorder. On 11/14/18 at 3:30 PM, an interview was conducted with EI #1, DON. EI #1 was asked what type of incident was this, referring to the incident reported to the State Agency. EI #1 replied, physical. EI #1 was asked what was the time and date the incident occurred. EI #1 replied, 10/29/18 at 6:15 PM. EI #1 was asked when was the incident reported to the State Agency. EI #1 replied, 10/30/18 at 9:19 AM. EI #1 was asked what was the policy for the time frame for reporting abuse. EI #1 replied, within 2 hours. EI #1 was asked if the incident was abuse. EI #1 replied, yes physical. EI #1 was asked if the policy for reporting an allegation of abuse followed. EI #1 replied, no. EI #1 was asked what was the potential for harm in not reporting an allegation of abuse in the required time frame. EI #1 replied, there was no potential for harm; they took appropriate actions, but just did not follow the policy in reporting.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews the facility failed to ensure the Quarterly Minimum Data Set (MDS) dated [DATE] for Resident Identifier (RI) #123 accurately reflected RI #123 transfer status. This affected one of 32 residents who were reviewed for MDS accuracy. Findings Include: A review of RI #123's Quarterly MDS assessment, with Assessment Review Date (ARD) of 11/08/2018 revealed that his/her transfer status was supervision on self-performance and setup help only on support provided. RI #123 was admitted to the facility on [DATE] and readmitted on [DATE], with diagnoses of Repeated Falls and Obesity. On 11/15/2018 at 10:10 AM, an interview was conducted with Employee Identifier (EI) # 11, Certified Nursing Assistant. EI #11 was asked what were her duties. EI #11 stated, activity of daily living, feeding, and general assistance to residents. EI #11 was asked how often she was assigned to care for RI #123. EI #11 stated that it varied but she was familiar with RI #123. EI #11 was asked if RI #123 could transfer to the wheelchair from the bed without assistance. EI #11 replied, no. EI #11 was asked what was the transfer status in regards to assistance for RI #123. EI #11 replied, 2-person assist. EI #11 was asked why was it necessary to be a 2-person assist for RI #123. EI #11 replied, safety. On 11/15/2018 at 10:20 AM an interview was conducted with RI #123. RI #123 was asked how did he/she transfer from the bed to the wheelchair. RI #123 stated, Very slowly and asked for help. RI #123 was asked how many staff members were required to assist with transferring from the bed to the wheelchair. RI #123 replied that it was usually two. RI #123 stated that his/her legs would give out if he/she put any weight on them. On 11/15/2018 at 1:15 PM, an interview was conducted with EI #12, Registered Nurse, MDS Coordinator. EI #12 was asked what was the general purpose of Minimum Data Set (MDS) assessments. EI #12 replied, to give an overview of the residents' care and needs. EI #12 was asked when was the last MDS assessment completed for RI #123. EI #12 replied, 11/8/18. EI #12 was asked what was coded for RI #123's transfer status. EI #12 replied, self performance was coded as supervision. EI # 12 was asked did the MDS accurately reflect the assistance that RI #123 required in getting from the bed to the wheelchair during the observation period for the MDS. EI #12 replied, no sir, she did not believe so. EI #12 was asked what was the possible negative consequence of the MDS being coded inaccurately. EI #12 replied that if the MDS was the only thing to go by then it could lead to an injury.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2) A Review of a revised date October 2010, facility policy titled Instillation of Eye Drops revealed: . The purpose of this procedure is to provide guidelines for instillation of eye drops to treat medical conditions, eye infections and dry eyes . Steps in the Procedure 2. Perform hand hygiene. 3. Put on gloves . RI#52 was admitted to the facility on [DATE] with a diagnosis of unspecified macular degeneration. A review of RI #52's November 2018 Physician orders revealed: .OLOPATADINE HCL 0.2% Eye Drop instill 2 drops in both eyes Twice Daily . On 11/14/18 at 8:09 AM, EI #5 Licensed Practical Nurse (LPN) was observed giving RI #52's morning medication. EI #5 gave the by mouth medications. EI #5 put on gloves without washing her hands and administered the eye drop medication. EI #5 removed the gloves and washed her hands and put eye drops back into the medication cart. On 11/14/18 at 3:17 PM, an interview was conducted with EI #5. EI #5 was asked, what was the policy on washing hands before instilling eye drops, EI#5 stated, she was suppose to wash her hands or use hand sanitizer before and after putting on gloves, make sure to put the drops on clean surface and make sure you don't touch eye the. EI #5 was asked if she washed her hands before putting on gloves. EI#5 replied, no. EI #5 was asked why did she not wash her hands. EI#5 replied, I forgot. EI#5 was asked what was the potential harm in not washing her hands before putting on gloves and instilling eye drops. EI #5 replied, it could cause infection. RI #71 was admitted to the facility on [DATE] with a diagnosis of Hypertensive heart disease with heart failure and type 2 diabetes mellitus. A review of RI #71's 2018 November Physician Orders revealed, Refresh Celluvisc 1% Eye drops- instill one drop into both eyes every 4 hours as needed . On 11/14/18 at 4:24 PM, the surveyor observed EI #4 LPN knock on the door and explained to RI #71 what she would be given. EI #4 washed her hands and instilled eye drop x 1 and removed the gloves. RI #71 was taking the by mouth medication while EI#4 waited for next eye drop. EI #4 did not wash hands before putting on a clean pair of gloves. EI#4 put on gloves, loaded the Albuterol treatment and removed the gloves. EI #4 did not wash her hands. EI#4 put on clean gloves and instilled the second eye drop in the other eye and then started the breathing treatment. EI#4 removed her gloves and did not wash her hands. On 11/14/18 at 4:45 PM, an interview was conducted with EI #4. EI #4 was asked what was the policy on washing hands after removing gloves. EI#4 replied to sing the song happy birthday for 30 seconds. EI #4 was asked if she washed her hands after she removed her gloves. EI #4 replied,I don't recall. EI #4 was asked, why did she not wash her hands. EI# 4 replied, I forgot. EI #4 was asked what was the potential harm in not washing her hands, EI#4 replied, It can cause contamination and transfer infections. On 11/15/18 09:44 AM, an interview was conducted with EI#2 Infection Control Nurse. EI#2 was asked what was the policy on administering eye drops. EI #2 replied, do hand hygiene, put on gloves, administer the eye drops and wash hands after completing. EI#2 was asked when should a nurse give by mouth medication, then without washing their hands put on gloves and administer the eye drops. EI#2 replied, Never. EI # 2 was asked, what was the potential for harm with putting on gloves without washing hands and administering the eye drops. EI#2 replied, Transmission of infections. Based on observation, interview, record review and review of the facility policies titled, Handwashing/Hand Hygiene, Personal Protection Equipment - Gloves and Instillation of Eye Drops, the facility failed to ensure: 1. a Certified Nursing Assistant (CNA) washed her hands between glove changing while assisting with incontinent care for Resident Identifier (RI) #41 and 2. two licensed staff washed their hands after giving by mouth medication to RI #52 and RI #71, before putting on gloves to administer eye drop medication. This affected one of one resident's observed for incontinent care and two of four nurses observed for medication pass. Findings Include: 1) A review of a facility policy titled Hand Hygiene, revised date August 2015, revealed: Policy Statement This facility considers hand hygiene the primary means to prevent the spread of infections. 9. The use of gloves does not replace hand washing/hand hygiene. Integration of glove use along with routine hand hygiene is recognized as the best practice for preventing healthcare-associated infections. The facility policy titled, Personal Protection Equipment - Gloves revised date July 2008, revealed, . 8. Wash your hands after removing gloves. RI #41 was admitted to the facility on [DATE] with diagnoses of Dementia and Cerebrovascular Accident. On 11/13/18 at 2:26 PM Employee Identifier (EI) #13 and EI #3, CNAs were observed providing incontinent care for RI#41. Both CNAs washed their hands and put on gloves. EI #13 removed the brief, wiped the front area of RI # 41. EI #13 turned RI #41 to the side and wiped the buttock area. EI #13 removed her gloves and washed her hands and placed a clean brief then turned RI #41 to the back position. EI #3 removed the soiled brief. EI #3 changed her gloves without washing her hands then continued to place and secure the clean brief. On 11/14/18 at 2:00 PM, an interview was conducted with EI #3, CNA. EI #3 was asked what was the policy for washing hands with glove changes, while performing incontinent care for residents. EI #3 replied, they were supposed to wash their hands before they start then put on gloves. EI #3 continued saying to wash hands every time they changed gloves and when the task was completed. EI #3 was asked if she washed her hands between the glove change. EI #3 replied, no. EI #3 was asked what was the potential for harm in not washing hands between glove changes. EI #3 replied, infection control and they could spread germs. On 11/14/18 at 4:41 PM an interview was conducted with EI #2, Registered Nurse, Infection Control. EI #2 was asked what was the policy on washing hands when changing gloves during incontinent care. EI #2 replied, wash hands put on gloves, then wash before and after each glove change. EI #2 was asked when should staff change gloves without washing their hands. EI #2 replied, never. EI #2 was asked what would the harm be in not washing hands between glove changes. EI #2 replied, spread of infection.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews and a review of facility policies and a document titled, Dishware and Glassware Safety, Tray Line Temp Log, and FOOD TEMPT LOG POLICY & (and) PROCEDURE, the facility failed to ensure : 1. residents were not served food on chipped plates and 2. a second temperature was taken for the egg rolls, a temperature was taken of the orient vegetables and the second batch of chicken. This had the potential to affect 125 of 125 residents who received meals from the kitchen. Findings Include: 1) A review of a policy titled, Dishware and Glassware Safety, with a date of 2013 revealed: .Procedure: 1. Chipped or cracked .or china are discarded immediately. On 11/14/2018 at 11:56 a.m., the surveyor observed EI #9, the cook putting food in a chipped plate. The survyor observed 14 chip plates under a table in the dish room with utensils on top of the table. On 11/14/18 at 12:33 p.m., EI #6 brought 8 plates from the dishroom. The surveyor observed 5 chipped plates in the stack. On 11/15/2018 at 9:39, an interview was conducted with EI #6. EI #6 was asked why were plates chipped at the tray line. EI #6 replied, a failure to ensure all chipped items was removed before service. EI #6 was asked why should residents not be served food on chipped plates. EI #6 replied, they could become further chipped, food can become contaminated with foreign material and the resident can become injured. EI #6 was asked what was the facility policy on chipped plates at the tray line. EI #6 replied, they should be removed from service and not used. EI #6 was asked where were the chips located on the plates. EI #6 replied, around the rims of the plates. EI #6 was asked who was responsible for making sure residents were not served food on chipped plates. EI #6 replied, dietary staff. On 11/15/2018 at 9:55 a.m., the surveyor conducted an interview with EI #9. EI #9 was asked why were plates chipped at the tray line. EI #9 replied, she had no idea. EI #9 stated from being handle rough when coming out of the dish machine. EI#9 was asked why should residents not be served food on chipped plates. EI #9 replied, it was a danger, pieces could get in their food and if they handle their own plate they could get scratch. EI #6 was aked where were the chips located on the plate. EI #9 replied, on the back and side of the plate at the rim 2) A review of a facility policy titled, FOOD TEMPT LOG POLICY & PROCEDURE, with a date of 9/18/12 revealed: Food temperatures will be taken before the meal is placed on the serving line to insure the food is cooked and has reached the appropriate temperature .each time the tempts are taken they are to be documented on the Daily Food Temp Log Sheet .All temperatures will be recorded immediately onto the temp log. A review of a document titled, Tray Line Temp Log, with a date of [DATE], at the lunch meal revealed no temperature for the alternate egg rolls, and orient vegetable. The second batch of chicken was not recorded on the log. Only the first batch of chicken was recorded on November 14, 2018 temperature log. The first batch of chicken was recorded at 180 degrees. On 11/14/2018 at 11:13 a.m. during the lunch meal, EI (Employee Identifier) EI #9, the cook was taking temperatures of the foods on the tray line. EI #9 took the temperature of the alternate egg rolls and the temperature was not hot enough. EI #9 stated that she would get back with the surveyor regarding the temperature. EI #9 did not go back and take a second temperature of the Egg Rolls. EI #9 did not take the temperature of the alternate Orient Vegetables/Broccoli and EI #9 did not take the temperature of the second batch of chicken. At 11:46 a.m. ,the second batch of chicken was in two baskets up in the fryer. At 11:49, EI # 8, kitchen manager, dropped more chicken in the fryer. EI #8 took the chicken from the fryer basket and put it in a medium square pan and placed it in the stove oven. EI #8 did not take the temperature before putting the chicken in the stove. At 12:30 the cook took the second batch of chicken which was in a medium square pan from the oven and placed it in the pan on the steam table. EI #9 did not take the temperature of the chicken. On 11/15/2018 at 10:02 a.m., an interview was conducted with EI #9. EI #9 was asked what was the temperature of the orient vegetable/broccoli and egg rolls at the tray line. EI #9 replied, the egg rolls were not up to temperature and she should have taken them off the line. EI #9 further stated the first temperature of the egg rolls was around 110 degree. EI #9 was asked did she take the temperature of the egg rolls the second time. EI #9 replied, no ma'am. EI #9 was asked what was the temperature of the orient vegetable /broccoli. EI #9 stated she did not recall. EI #9 was asked did she take the temperature of the vegetable /broccoli. EI #9 replied, she could not remember. EI #9 was asked who was responsible for taking the temperatures of food at the tray line. EI #9 replied, the cook. EI #9 was asked why was it important that all food temperatures were taken at the tray line. EI #9 replied, so it would be at the correct temperature before serving the food. EI #9 was asked when should food temperatures be taken at the tray line. EI #9 replied, right as they put them on the line or before putting them on the line. EI #9 was asked what was the temperature of the second batch of chicken. EI #9 replied, she could not tell the surveyor. EI #9 stated that the surveyor would need to talk with EI #8, kitchen manager. EI #9 was asked did she take the temperature of the second batch of chicken. EI #9 replied, no ma'am. EI #9 was asked did she take the temperature of the second batch of chicken before putting it in a pan on the tray line. EI #9 replied, no ma'am. EI #9 was asked what was the potential harm to the residents when food temperatures were not taken at the tray line. EI #9 replied, they (residents) could get sick and the temperature not being up was not the proper procedures. On 11/15/2018 at 9:51 a.m., the surveyor conducted an interview with EI #8. EI #8 was asked what was the temperature of the second batch of chicken. EI #8 replied, he did not take the temperature of the chicken. EI #8 was asked what was the potential harm to the residents when food temperatures were not taken at the tray line. EI #8 replied, it was a potential for them to get sick, and bacteria grow on the foods not held at the proper temperature.

Based on observation, interview and a review of a facility policy titled, Waste Disposal, the facility failed to ensure: the dumpster doors were closed on two of three dumpster's on site. This had the potential to affect all resident residing at the facility. Findings Included: A review of a facility policy titled, Waste Disposal, with a date of 2013 revealed, .Procedure: .2. Trash will be deposited into a sealed container outside the premise. On 11/13/18 at 10:52 a.m., the surveyor observed three dumpster's on site. Dumpster number two doors was opened at the front side and back side of the dumpster. Dumpster number three door was opened at the back side of the dumpster. There was food debris on the front side of dumpster number three. On 11/15/18 at 9:50 a.m., the surveyor conducted an interview with (Employee Identifier) EI #6, Dietary Manager. EI #6 was asked what was the facility policy regarding keeping the dumpster doors closed. EI #6 replied, the dumpster should be closed at all times. EI #6 was asked what dumpster doors were opened. EI #6 replied, the center dumpster doors had two doors opened which was number two, and the last dumpster number three had one door opened. EI #6 was asked why were the dumpster doors open. EI #6 replied, the nursing home and dietary staff failure to ensure dumpster doors were closed. EI #6 was asked who was responsible for keeping the doors closed. EI #6 replied, dietary. EI #6 was asked why was it important to keep the dumpster doors closed. EI #6 replied, to help keep down on rodents, pest control and offensive odors.