Based on observation, interview and records review the facility failed to store, prepare, distribute and serve food in accordance with professional standards for food service safety for 18 out of 18 sample selected residents (Resident 234, 22, 30, 8, 237, 236, 10, 235, 21, 27, 17, 134, 137, 11, 135, 136, 31 and 138) who were residing at the facility and receiving food from the facility's kitchen when: 1. Facility did not ensure food temperatures were checked before serving to all 18 residents (IJ). 2. Multiple Dietary staff did not wear hair nets and beard nets while working in the kitchen. 3. A Dietary staff did not wash hands upon entering the kitchen. 4. 24 plated foods were stored in the refrigerator without covers and three of three-gallon tub ice creams with no lids were stored in the freezer. 5. Ice Cream freezer had frost around the rim and inside the freezer. 6. Multiple items in the walk-in freezer were undated and unlabeled. 7. [NAME] used water instead of nutrient fluids for making pureed food. These failures had the potential to result in the outbreak of foodborne illness that affected the 18 residents who resided in the facility. On 10/24/23, at 1:16 p.m., the facility Administrator (ADM), Director of Nursing (DON) and Operation Director (OD) were informed of an Immediate Jeopardy situation (IJ - a situation in which the provider's noncompliance with requirements has caused or is likely to cause serious injury, harm, impairment, or death to a resident), for failure to ensure adequate cooking and proper holding temperatures. (Poorly cooked food or food that is not held at appropriate temperatures may promote the growth of pathogens that cause food-borne illness). The IJ lifted on 10/25/23 at 10:30 a.m., when the facility submitted an acceptable plan of action; Dietary manager finished in-servicing kitchen staff on checking food temperature before serving and set up the system in place to record the food temperature for each meal in the kitchen. Findings: A review of the facility's Diet Type Report, dated 10/25/23, indicated 18 residents received food from the facility's kitchen. 1. During a concurrent observation and interview on 10/24/23, at 11:00 a.m., the Head [NAME] (HC) prepared food on plates to pass to staff for serving to residents, and HC did not check the food's temperature before putting the food on the plates. HC stated, we don't check the food temperature, and the facility did not have a temperature log to record the food temperature. During an interview on 10/24/23, at 11:00 a.m., with [NAME] 2, [NAME] 2 stated the facility did not check the food's temperature and did not have a temperature log to record the food temperature. During an interview on 10/24/23, at 11:00 a.m., with the Dietary Manager (DM), DM confirmed that HC did not check the food temperature before serving, the facility did not have a food temperature log and checking the food temperature before serving was important to prevent foodborne illnesses in the residents. During a concurrent observation and interview on 10/24/23, at 11:30 a.m., with DM, surveyor checked the food temperature inside the chafing dishes and the following food items with the following temperatures were observed: the temperature of cooked chicken for chicken sandwiches was 110 degrees Fahrenheit (F-a scale of temperature), the temperature of cooked shrimp for shrimp sandwiches was 85 degrees F, the temperature of cooked sweet potatoes was 100 degrees F, the temperature of cooked spinach was 150 degrees F, and the temperature of the soup was 140 degrees F. A review of the facility menu titled, Lake Park Healthcare Center Weekly Menu: Fall/Winter 2023 Week 2, indicated the menu for the date of 10/24/23 for lunch was Ham and bean soup, Coleslaw, Grilled shrimp po boy or chicken patty sandwiches, sweet potato rounds, southern style spinach, southern fudge pie. A review of the facility's policy and procedure P&P titled, Food Temperatures, undated, indicated . 6. the following range of temperatures is recommended for food at point of tray assembly. a. Broth, soup, hot beverages: 180-190 degrees F, b. Meat, portioned for service: 160 degrees F, Casserole dishes, creamed items, creamed soups: 160 degrees F, Potatoes and vegetables: 160 degrees F, . 2. During an observation on 10/23/23, at 10:14 a.m., [NAME] 1, [NAME] 2 and Chef were not wearing a hairnet/beard net while preparing lunch in the kitchen, and on 10/24/23, at 10:30 a.m., HC was working in the kitchen with a long beard and without wearing a beard net. During an interview on 10/24/23, at 10:30 a.m., with HC, HC stated wearing a beard net and hairnet is important for infection control. A review of the facility policy and procedure (P&P) titled, Personal Hygiene, undated, indicated . if hair is long and not covered properly with the cap, a hair net must be worn . 3. During a concurrent observation and interview on 10/23/23, at 10:14 a.m., Chef entered the kitchen and started to move food out of a shopping bag without washing his hands. Chef confirmed he had not washed his hands prior to moving food out of the shopping bag. A review of the facility policy and procedure (P&P) titled, Personal Hygiene, undated, indicated . Hands must always be washed prior to beginning work . 4. During a concurrent observation and interview on 10/23/23, at 10:14 a.m., 24 plated foods (including: boiled eggs, cheese, ham and vegetables) were stored in the refrigerator without covers, and three-three gallon ice cream tubs had no lids and were stored in the freezer. Chef confirmed the food items were not covered and stated those items needed to be covered for infection control. A review of the facility (P&P) titled, Lake Park Healthcare Center Weekly Menu: Fall/Winter 2023 Week 2, indicated the menu for the date of 10/23/23 for breakfast was scrambled egg or boiled egg, bacon, cream of wheat, breakfast bread, seasonal fruit and Jelly/Margarine. A review of the facility policy and procedure (P&P) titled, Food Storage, undated, indicated . 15. Leftover food is stored in covered containers or wrapped carefully and securely . A review of the facility policy and procedure (P&P) titled, Procedure for Refrigerated Storage, dated 2018, indicated . 5. Food should be covered and stored loosely to permit circulation of air . 5. During a concurrent observation and interview on 10/23/23, at 10:14 a.m., with Chef, ice cream freezer had frost around the rim and inside the freezer. Chef confirmed there was frost around the rim and inside the freezer and stated there should not be any frost in the freezer. DM was not able to provide any policy related to freezer with frost. 6. During a concurrent observation and interview on 10/23/23, at 10:14 a.m., with Chef, three packages of pork and two bags of bread were found undated and unlabeled in the walk-in freezer. Chef confirmed the pork and two bags of bread were undated and unlabeled and stated they should have dates and labels. A review of the facility's policy and procedure (P&P) titled, Procedure for Refrigerated Storage dated 2018, indicated . 9. Food items should be arranged so that older items will be used first. Dating the packages or containers will facilitate this practice . 7. During a consecutive interview and observation on 10/24/23, at 11:00 a.m., with HC, HC added water instead of nutritive fluid such as milk or broth to shrimp sandwiches to make puree. HC stated he did not know that he could not add water to make puree. A review of the facility recipe titled, Shrimp Grilled Po Boy-4484, Recipe Summary card, indicated . Puree steps: Remove desired number of servings and add nutritive liquid, milk, broth . A review of the facility policy and procedure (P&P) titled, Pureed Food Preparation, undated, indicated . never use water. Only use nutritive liquids such as broth, milk .