Based on observations, interviews, and facility policy review, it was determined that the facility failed to ensure that over-the-counter medications and prescribed medications required for as needed (PRN) basis were removed and not used from the medication/storage rooms and medication carts. Findings include: A review of a facility policy titled, Medication Storage in the Facility, revised January 2018, indicated, that all expired medications will be removed from the active supply and will be destroyed, regardless of the amount of medication that remains in the usual manner. During review of the [NAME] Station Medication Room on 11/06/24 at 8:40 AM, 3 bottles of Vitamin B-6 100 mg were found with the expiration date of 06/2024. During review of the East Station Medication Room, on 11/06/2024 at 8:54 AM, the medication cart used by the Medication Aide Certified (MAC) was found to have six cards of expired as needed medications. Those included: Resident #1 Cyclobenzaprine 10 milligrams (mg)-30 tablets (1 card) with an expiration date of 11/5/24; Resident #39 Benzonatate 100 mg-29 capsules (1 card) with an expiration date of 10/24/24; Resident #57 Clonidine Hydrochloride (HCl) 0.1 mg-24 tablets (1 card) with an expiration date of 10/06/24; Resident #32 Tizanidine 2 mg-16 tablets (1 card) and 7 tablets (1 card) to equal a total of 23 tablets with an expiration date of 10/24; and Resident #62 Ondansetron HCl 4 mg-29 tablets (1 card) with an expiration date of 10/23/24. During an interview on 11/06/2024 at 9:03 AM, LPN stated that the expired medications would be turned in to the Director of Nursing (DON). During an interview on 11/07/24 at 9:30 AM, DON stated that the Vitamin B-6 should have been removed and that all the other Vitamin B-6 had already been removed and those must have been missed. DON confirmed that an in-service with staff had already started regarding checking expiration dates on the over-the-counter medications and the PRN medications that are on the medication carts.

Based on observation and interview the facility failed to maintain a sanitary environment during lunchtime on the secure unit. This failed practice had the potential to affect 15 residents who resided on the secure unit. The findings are. On 10/09/23 at 12:36 PM, CNA #3 opened the food cart and stepped onto the bottom shelf inside the food cart. The resident's meal trays were inside the cart. She reached on top of the cart and grabbed 3 cans of coke from the top of the cart. On 10/12 23 at 8:35 AM, the Surveyor asked the dietary manager, How are the staff supposed to get the drinks, cups and ice from top of the food carts? She stated, I have no clue. On 10/12/23 at 8:42 AM, the Surveyor asked CNA #4, How are staff supposed to get the drinks, cups and ice from top of the food carts? She stated, Reach up and get it. The Surveyor asked are staff supposed to step inside the food cart to reach the items on top of the cart? She stated, No.

Based on interview and record review, the facility failed to ensure 3 (Resident #25, Resident #67, and Resident # 68) of 6 (Resident #10, Resident #19, Resident #25, Resident #32, Resident #67, and Resident #68) sampled residents that were reviewed for unnecessary medication did not receive a PRN (as needed) medication past 14 days without justification, and an evaluation by the doctor. The findings are: Review of Resident #25's Order Summary Report showed a physician order dated 09/15/23 for a Haldol Injection as needed for delirium related to schizophrenia. A review of Resident #25's October 2023 Medication Administration Record revealed that Resident received an as needed injection of Haldol on 10/11/23. A review of the medical records, and the monthly pharmacy reviews did not indicate a justification of why Resident #25 should continue Haldol as needed 14 days. During interview on 10/11/23 at 3:59 PM, the Director of Nurse (DON) confirmed there was no justification for continued use of the as needed Haldol documented, and there was no evaluation by the physician for the continued use. Review of Resident #67's Order Summary Report showed a physician order dated 9/19/23 for Xanax every 6 hours as needed for anxiety for 60 Days. A review of an October 2023 Medication Administration Record revealed Resident #67 received Xanax on 10/09/23. A review of the medical records, and the monthly pharmacy reviews did not indicate a justification of why Resident #67 should continue Xanax as needed past 14 days. During interview on 10/11/23 at 3:47 PM, the Director of Nurse (DON), said it was rare to have someone on as needed antipsychotic medications, and there would be documentation. She said as needed medication should be renewed after 2 weeks, for up to 60 days. She confirmed there was no documentation in the medical record. A review of Resident #68's Order Summary Report showed a physician order for Lorazepam every 6 hours as needed for anxiety for 60 Days on 9/11/23. A review of an October 2023 Medication Administration Record revealed that Resident #68 received Lorazepam on 10/09/23. A review of the medical records and the monthly pharmacy reviews did not indicate a justification of why Resident #68 should continue Lorazepam as needed past 14 days. On 10/11/23 at 4:09 PM, the DON confirmed there was no documentation in the medical record.

Based on observation, record review, and interview, the facility failed to ensure that meals were prepared and served according to the planned written quantified recipe and menus meet the nutritional needs of the residents for 2 of 2 meals observed. 3 The findings are: Review on 10/11/2023, of the Spring/Summer 2023 menu for the breakfast meal showed the residents on pureed diets were to receive 6-ounces of pureed oatmeal, a #16 scoop (1/4 cup) of pureed sausage, a #16 scoop (¼ cup) of pureed biscuit, a #8 scoop (1/2 cup) of pureed pancake. On 10/11/23 at 7:36 AM Dietary Employee (DE) #2 used a #16 scoop (1/4 cup) to serve a single portion of the following food items to the residents on pureed diet; pureed bread, pureed sausage, pureed eggs and 6-ounce spoon to serve cream of wheat. There were no pureed biscuits or pureed pancakes served to the residents on pureed diets. Review of the Spring/Summer 2023 menu noon meal showed the residents on pureed diets were to receive a #10 scoop of pureed buttermilk pie each and residents on mechanical soft diets were to receive 3 ounces of ground pork loins each. On 10/11/23 at 12:00 PM (DE) #1 placed 3 servings of butter milk pies into a blender, instead of 5 servings, added milk and pureed. At 12:06 PM, Dietary Supervisor instructed DE #1 to give pudding to 2 residents on pureed diets who did not get buttermilk pie and stated, We should have made more than 6 pies. On 10/11/23 at 12:11 PM (DE) #2 placed 11 servings of pork loins into a blender and blended. He poured the mixture into a pan and placed it on the steam table to be served to 21 residents who required mechanical soft diets. The Surveyor asked the Dietary Supervisor why is there not enough meat for all residents? She stated, We ordered enough, but they were shrunk after cooking them. I know now to do 3, instead of 2. Review on 10/12/2023 of the Spring/Summer 2023 menu for breakfast meal showed residents on pureed diets were to receive 6 -ounce of pureed oatmeal, a #16 scoop (1/4 cup) of pureed sausage, a #16 scoop (¼ cup) of pureed biscuit, a #8 scoop (1/2 cup) of pureed pancake. On 10/12/23 at 7:50 AM DE #2 used a #16 scoop (1/4 cup) to serve a single portion of the following food items to the residents on pureed diets; pureed bread, pureed sausage, pureed eggs and 6-ounce spoon to serve cream of wheat. There were no pureed biscuits or pureed pancakes served to the residents on pureed diets. 10/12/23 7:51 AM the surveyor asked DE #2 the reason residents on pureed diets did not receive pureed biscuits and pureed pancakes. He stated, I didn't know they were supposed to have pureed biscuits and pureed pancakes.

Based on observation and interview, the facility failed to ensure pureed food items were blended to a smooth, lump-free consistency to minimize the risk of choking or other complications for residents who required pureed diets for 2 of 2 meals observed. The findings are: On 10/11/23 at 11:05 PM, Dietary Employee (DE) #2 used 4 ounces of spoon to place 10 servings of brussels sprouts into a blender and pureed. At 1:07 AM, Dietary Employee #2 poured the pureed brussels sprouts into a pan. He covered the pan with foil and placed it on the steam table. The consistency of the pureed brussels sprouts was not smooth with pieces of brussels sprouts in the mixture. On 10/11/23 at 11:45 AM, Dietary Employee #1 placed 6 dinner rolls into a blender, added warm milk and pureed. He scooped pureed bread with milk into a pan and placed it on the steam table. The consistency was thick, with lumps and not smooth. On 10/11/23 12:00 PM, Dietary Employee #1 placed 3 servings of butter milk pies into a blender, he added milk and pureed. At 12:02 PM, Dietary Employee #1 poured the pureed dessert into a pan. The consistency of the pureed butter milk pie was not smooth or formed, and there were pieces of crumbs in the mixture. On 10/11/23 at 12:13 PM, Dietary Employee #2 placed 5 servings of pork loins into a blender, instead of 6 servings, added its juice and pureed. At 12:15 PM, DE #2 poured the pureed mixture into a pan. He placed the pan on the steam table and covered it with foil. The consistency was gritty, thick, and not smooth. On 10/11/23 at 1:54 PM, the Surveyor asked Dietary Employee #1 to describe the consistency of the pureed butter milk. Dietary Employee #1 stated, It was not smooth and was no pudding like. On 10/11/23 at 1:55 PM, the Surveyor asked Dietary Employee #2 to describe the consistency of the pureed food items served to the residents on pureed diets. He stated, Pureed meat was not smooth. It was gritty. Pureed bread was thick and lumpy.

Based on observation, interview and policy review, the facility failed to store controlled medications securely in 3 of 3 medication rooms. The findings are: On 10/11/2023 at 8:42 AM, the Surveyor toured the North/Northeast Medication Room with Registered Nurse (RN) #1. Inside the refrigerator, on a shelf was a red plastic tub containing what RN #1 identified as (1) unopened 30 milliliter (mL) bottle labeled as Lorazepam, (2) unopened 1 mL vials labeled as Lorazepam, and (4) unopened single-use syringes labeled as Lorazepam. The medications were not stored in a separately locked, permanently affixed compartment. The Surveyor observed the refrigerator was also being used to store nutritional supplements for the residents. On 10/11/2023 at 9:15 AM, the Surveyor toured the [NAME] Medication Room with (Licensed Practical Nurse (LPN) #2. Inside the refrigerator, there were 3 bottles sitting inside the door. LPN #2 identified the bottles as 30 mL bottles of Lorazepam, 2 unopened and 1 opened with 30mL remaining in the container. On 10/11/2023 at 9:44 AM, the Surveyor toured the East Medication Room with LPN #1. Inside the refrigerator, the Surveyor observed a metal container affixed to the roof of the refrigerator. LPN #1 opened the metal container without the use of a key. LPN #1 said they had forgotten to lock it back when they last accessed the controlled medications. LPN #1 identified the contents as 2 boxes labeled as Lorazepam in 30 mL bottles. The Surveyor asked LPN #1 to confirm controlled medications needed to be secured in a locked permanently affixed container. LPN #1 agreed. On 10/11/2023 at 12:02 PM, the Director of Nursing (DON) confirmed the controlled medications were not being stored separately as required, and the East Medication Room-controlled medications were not being stored separately in a locked container. On 10/12/2023 at 9:00 AM the Administrator said the facility had no policy on medication storage.

Based on observation and interview, the facility failed to ensure the ice scoop holder was maintained in clean and sanitary condition, expired dairy products and food items were promptly removed / discarded on or before the expiration or used by date to prevent the growth of bacteria; and dietary staff washed their hands before handling clean equipment or food items to prevent potential food borne illness for residents who received meals from 1 of 1 kitchen. The findings are: On 10/09/23 at 9:33 AM, there were 4 cartons of half and half on a shelf in the walk-in refrigerator with an expiration date of 10/07/2023. On 10/09/23 at 9:40 AM, five 5-lb boxes of carrot cake mix were on a rack in the storage room with an expiration date of 10/05/2023. On 10/09/2023 at 9:46 AM, a wet pink residue was on the scoop holder on the left side of the ice machine. The ice scoop was resting directly in contact with the pink residue. The Surveyor asked the Dietary Supervisor to wipe the area where the pink residue was observed, and the pink residue easily transferred to the paper towel. The Surveyor asked the Dietary Supervisor how often is the ice scoop holder cleaned and who uses the ice from the machine? She stated, The CNAs used it to fill the water pitchers in the resident's rooms, and we use it to fill beverages served to the residents at mealtimes. We clean it daily. On 10/11/23 at 7:35 AM, Dietary Employee #1 was on the tray line assisting with the breakfast meal. He picked up condiments and cartons of supplements, and placed them on the trays. Without washing his hands, he picked up glasses by the rims and placed them on the trays to be served to the residents for lunch. On 10/11/23 at 10:29 AM, Dietary Employee #1 walked into the kitchen with a can of soda and placed it on the table by the door leading to the outside. He went into the walk-in refrigerator, removed a bag of bread, placed it on the counter, picked up packages of peanut butter and jelly, opened them, and placed them on the counter. He untied a bag of bread, removed gloves from the glove box, and placed them on his hands. He removed slices of bread from the bag and placed them on the pan liner. Without changing gloves or washing his hands, he spread peanut butter and jelly on the slices of bread, topped each slice with another slice of bread, and placed them on the plates. He covered them with foil and placed them on a shelf in the walk-in refrigerator to be served to the residents for the lunch meal. On 0/11/23 at 11:03 AM, Dietary Employee #2 removed a pan of vegetables from the oven and placed it on the counter. Without washing his hands, he picked up a clean blade and attached it to the base of the blender to be used in pureeing food items to be served to the residents for lunch. The Surveyor immediately asked Dietary Employee #2 what should you have done after touching dirty objects, and before handling clean equipment? He stated, I should have washed my hands. On 10/11/23 at 11:30 AM, Dietary Employee #3 picked up a menu from the counter, glanced at it and placed it on the counter. He opened the door to the walk-in refrigerator, removed a container of tuna salad and a bag of bread and placed them on the counter. He untied the bag of bread, and then removed gloves from the glove box placing them on his hands. Without washing his hands and changing gloves, he removed slices of bread from the bag and placed them on the plates. He used a scoop and scooped tuna salad, spread tuna salad on the slices of bread and topped each slice with another slice of bread to be served to residents. Review of facility policy titled, Hand washing showed staff will wash hands and exposed portions of arms to remove contamination after entering the kitchen, during food preparation, and when working with ready to eat food. Also, before donning gloves for working with food and after engaging in other activities that contaminate the hands.

Based on observation, record review and interview, the facility failed to ensure meals were prepared and served according to the planned written menu to meet the nutritional needs of the residents for 1 of 1 meal observed. This failed practice had the potential to affect 10 residents who received pureed diets from 1 of 1 kitchen according to a list provided by the Dietary Supervisor on 7/13/2022. The findings are: 1. On 7/13/2022 the menu for the noon meal documented residents who received pureed diets were to receive a #6 scoop (6 oz) of pureed ham and beans. 2. On 7/13/22 at 11:58 PM, Dietary Employee #1 used a 6 oz spoon to place 6 servings of ham and beans into a blender and pureed. At 11:59 PM she poured the pureed ham and beans in a pan and placed it on the steam table to be served to 10 residents who received pureed diets. 3. On 7/13/22 at 12:16 PM. the following observations were made during noon meal service. a. Dietary Employee #1 used 2 oz spoon was equivalent to ¼ cup to serve cornbread to the residents on pureed diets, instead of a #10 scoop which was equivalent 1/3 to ½ cup for each resident. b. Dietary Employee #1 used 6 oz spoon to serve half a portion of pureed ham and bean to the residents on pureed diets. The menu specified for the residents on pureed diets to receive a #6 scoop (6 ounces) of pureed ham and bean each. c. On 7/13/22 at 1:30 PM, Dietary Employee #1 was asked what spoon size did you use to serve pureed cornbread and how many servings of pureed cornbread did you serve to each resident on pureed diets? She stated, I used 2 oz spoon to give a serving of cornbread each. She was asked how much ham and beans did you prepare for the residents on pureed diets? She stated, I used 6 oz spoon to put 6 servings of ham and bean in the blender and pureed She was asked how many residents you have on pureed diets? She stated, We have 10 residents.

Based on observation, record review and interview, the facility failed to ensure food was prepared by methods that maintained appearance to encourage adequate nutritional intake for 1 of 2 meal observed in the kitchen. The failed practice had the potential to affect 45 residents who received regular diets, 24 residents who received mechanical soft diets and 10 residents who received pureed diets from 1 of 1 kitchen, as documented on a list provided by Dietary Supervisor on 7/13/2022 at 12:55 PM. The findings are: 1. On 7/14/22 At 7:50 PM a pan of scrambled eggs was on the steam table. The plastic pan liner used to line the pan was brown in color. The scrambled eggs were over cooked and had brown flaky substance on it. The fried eggs were over cooked and dry. The Dietary Supervisor was asked to describe the appearance of the scrambled eggs. She stated, There were brown flakes in the egg. It was yucky. 2. On 7/14/22 At 7:54 AM, Human resource (HR) Manager who was loading breakfast trays in a food cart was asked to describe the appearance of the scrambled eggs and fried eggs served to the residents for breakfast. She stated, They were brown flaky eggs in the mixture from being over cooked. The plastic liner used to line the pan has brown. Fried eggs were overcooked and dried. 3. On 7/14/22 at 8:50 PM, the Dietary Supervisor was asked to describe the appearance of pureed eggs, regular oatmeal, and cream of wheat. She stated, There were brown flaky eggs in the pureed eggs. Pureed biscuit looked like biscuit and not pureed. Oatmeal was a little thick.

Based on observation and interview, the facility failed to ensure pureed food items were blended to a smooth, lump free consistency to minimize the risk of choking or other complications for residents who required pureed diets for 2 of 2 meal observed. The failed practice had the potential to affect 10 residents who received pureed diets as documented on the Diet List provided by the Food Service Supervisor on 7/13/2022. The findings are: 1. On 7/11/22 at 6:28 PM, Resident # 20 was served pureed macaroni and cheese. The consistency of the pureed macaroni and cheese was clumpy. 2. On 7/13/22 at 11:27 AM, Dietary Employee #1 prepared another pan of mashed potatoes with butter and evaporated milk. The consistency of the mashed potatoes was runny. 3. On 7/13/22 at 11:58 AM, Dietary Employee #1 used a 6 ounce spoon to place 6 servings of ham and beans into a blender and pureed. She poured the pureed ham and beans in a pan and placed it on the steam table to be served to 10 residents who received pureed diets. The consistency of the pureed ham and bean was lumpy and was not smooth. 4. On 7/13/22 at 12:14 PM, the Dietary Supervisor was asked to describe the consistency of the pureed ham and beans and fortified mashed potatoes. She stated, You can see pieces of meat in the mixture and mashed potatoes was runny.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to ensure foods stored in the freezer, refrigerator and dry storage area were covered, sealed, and dated to minimize the potential for food borne illness for residents who received meals from 1 of 1 kitchen: expired dairy products and food items were promptly removed / discarded on or before the expiration or use by Date to prevent the growth of bacteria; dietary staff washed their hands between dirty and clean tasks and before handling clean equipment or food items to prevent potential for cross contamination: and failed to ensure 1 of 2 ice machines was maintained in a clean and sanitary condition to prevent potential contamination of residents' beverages for residents who received meals from 1 of 1 kitchen. These failed practices had the potential to affect 79 residents who receive meals from the kitchen (total census: 80) as documented on a list provided by Dietary Supervisor. The findings are: 1. On 7/11/22 at 11:29 AM, the following observations were made during the initial tour of the kitchen with Dietary Supervisor. a. The following cereal boxes were in a Clear rectangular container stored under the counter, there were no dates when the cereals were received or when opened. 1) Four Raisin Bran. 2) Three [NAME] Krispies. 3) Two Cheerios; one of which was open. b. The following dry food items in a clear rectangular container on shelf in the storage room, the dry food items had no dates were not covered or sealed and had no dates when opened or received. 1) Envelopes of Instant Whey Protein. Surveyor asked Dietary Supervisor how many were in the container. She stated, about 30. She was asked, Should they be dated? She stated, They should have a sticker with the dates on the container like the others do. 2) Plastic jar of Pro Source. 3) Box of tartar sauce packets. 4) Box of yellow cake mix dated received 12/31/21 and expiration date March 3, 2022. 5) Box of Muffin mix dated received 12/14/21 and manufacture date of 6/20/21. No expiration date but is over a year old. 6) Open jar of Rainbow sprinkles. 7) Open jar of Sprinkle Mix. 8) Tube of Black decorative icing not dated and expired [DATE] 9) Three graham cracker crusts. 10) Spice storage shelves near walk-in freezer contained: a) Paprika with flip top lid not closed and not dated. b) Cinnamon with flip top lid not closed and not dated. The Dietary Supervisor was asked, Should these be dated like the other spices? She stated, They have expiration dates, so they don't need to be dated. 11) A bottle of vanilla dated 3/21 with old, smudged label. The Dietary Supervisor was asked, Is this March of 2021? She stated, We don't use vanilla that often, so I am not sure if it is March 21st or March of 2021. 2. On 7/11/2022 at 11:40 AM, the following observations were made in the walk-in freezer shelves: a. An open box of French toast sticks bag not sealed/tied closed b. An open box of Chicken & Cheese in tortilla rolls bag not sealed/tied closed Dietary Supervisor was asked, Should these be tied or in a sealed bag? DM stated, Yes. c. An open box of Cheese, Beef, Bean Burrito bag not sealed/tied closed d. An open box of [NAME] Dean sausage patties bag not sealed/tied closed. e. An open box of Okra bag not sealed/tied closed f. Mint Chip ice cream 3- gallon tub (½ full) no open or received dates. 3. On 7/11/2022 at 11:50 AM, the following observations were made in the walk-in refrigerator: a. Plastic container ½ full of vanilla pudding with use by date of 7/10. Dietary Supervisor was asked, Should this be in here? She stated, No, I started to go through this but got busy. b. Five Bags of green grapes turning brown and soft and 2 bags of red grapes getting soft had use by date of 7/5. Dietary Supervisor was asked, Does the use by date say 7/5/22? She stated, I didn't know how long grapes are good for, so I made them 7/5. She was asked, Would you eat the green grapes that are brown? DM stated, Probably not. c. One zip lock bag of shredded orange colored cheese dated use by 7/ (date not complete) and had no open date. d. Open flat of 22 banana nut muffins received date 6/24, open date 7/7, use by date 7/11. Top of muffins covered in liquid looking film. e. Flat of 24 apple muffins received date 6/24. Tops of muffins covered on a liquid looking film. Dietary Supervisor stated, Those should have already been used. f. One box of red bell peppers dated received 6/24. Bell peppers were wrinkly, soft, and had patches of grayish fuzz on each pepper. g. One 11 lb. pail, 1/2 full of chocolate icing, sitting on a rectangular plastic bin on top shelf of shelving unit with black sticky build-up and brown fuzzy build-up on piece of loose tubing cover sitting on top of pail. Build-up also sticking to brown substance on lid. h. On 7/12/22 at 12:40 PM, the Food storage policy received from DON stated, .Procedure: Containers are to be dated and labeled with the contents .All food not in original containers will be labeled, dated, and stored in NSF approved containers . 4. On 7/13/22 at 10:11 AM, Dietary Employee #1 Removed celery stalks from a bag and placed them on the cutting board on the counter. She diced the celery stalks and when she was ready to put them on ham and beans in a pan on the counter. She immediately was stopped and was asked what should you have done with the celery before using them in food to be cooked and served to the residents for lunch meal? She stated, Washed them. 5. On 713/22 at 10:24 AM, Dietary Employee #1 took out a container of strawberry and a container of blackberry from the walk-in refrigerator and placed them on the counter. She removed strawberries and blackberries from their original containers and placed them in bowls to be served to the residents for lunch. She was asked what should you do before plating strawberries and blackberries to serve to the residents for lunch? She Stated, Rinse them. 6. On 7/13/2022 at 10:34 AM, there were 3 cartons of 2 % milk stored on a shelf in the walk-in refrigerator that had an expiration date of 7/10/2022 7. On 7/13/22 at 10:37 AM, Dietary Employee #2 turned on the three-compartment sink faucet and rinsed strawberries. She then, turned off the faucet and, without washing her hands, she picked strawberries from the original container, placed them on the cutting board and sliced them in half. She then, placed slices of strawberries in bowls to be served to the residents for lunch meal. 8. On 7/13/22 at 11:29 AM, Dietary Employee #2 took out a box of pie crust and placed it on the counter. She removed gloves from the glove box and placed them on her hands, contaminating the gloves. Without changing the gloves and washing her hands, she removed a pie crust from the box and placed it over the slices of apple in a pan and placed in the oven to bake. 9. On 7/13/22 At 11:34 AM, Dietary Employee #1 turned on the 3-compartment sink and washed the blender bowl and blade She then turned off the faucet and, without washing her hands, she picked up the blade and attached it to the base of the blender to be used in pureeing food items to be served to the residents who received pureed diets for the noon meal. At 11:37 AM, she used 4 oz spoon to place 11 servings of turnip greens into a blender. She picked up a bag of bread from the counter and untied the bag. She then removed 2 slices of bread from the bag with her bare hand and placed them on top of the turnip greens inside the blender and pureed to be served to the residents who received pureed diets. On At 11:40 AM, she poured the pureed turnip greens in a pan and placed it in the warmer. 10. On 7/13/22 11:47 AM, Dietary Employee #2 was wearing gloves on her hands, she closed the door to the warmer, opened the microwave door and removed a cup of warm milk and placed it on the counter. Without changing gloves and washing her hands, she picked up a clean blade and attached it to the base of the blender, she used her contaminated gloved hand to pick up 10 servings of cornbread and placed them in the blender, added milk and pureed to be served to the residents on pureed diets. At 12:11 PM Dietary Employee #2 was asked, What should you have done after touching dirty objects and before handling clean equipment? She stated, I should have washed my hands. 11. The facility's policy on hand washing provided by the Dietary Supervisor on 7/13/202 at 1:47 PM documented, To remove contamination after entering the kitchen during food preparation and before donning gloves for working with food, after engaging in other activities that contaminate the hands .