Based on resident and staff interviews, record review, and review of the facility policy titled Dental, the facility failed to ensure one of 31 sampled residents (R) (R66) received annual oral screenings and timely dental care to treat tooth pain. This failure caused R66 to have untreated oral pain. Findings include: Review of the facility's undated policy titled Dental, revealed the Policy was Dental care shall be offered to all residents. The Policy Interpretation and Implementation section included . 2. The contracted provider or personal dentist will be notified of resident's need for dental treatment or consultation as appropriate . Review of R66's Quarterly Minimum Data Set (MDS) with an Assessment Reference Date (ARD) of 7/24/2024, located in the electronic medical record (EMR) under the MDS tab, revealed R66 had a Brief Interview for Mental Status (BIMS) score of 11 out of 15, which indicated R66 was moderately cognitively impaired. The MDS indicated no mouth or facial pain or discomfort or difficulty with chewing. Review of R66's Medication Administration Record (MAR) dated 4/2024, located in the EMR under the Orders tab, revealed R66 received Amoxicillin (an antibiotic) 500mg (milligrams) three times a day for tooth infection for seven days, with a start date of 4/23/2024 through 5/1/2024. Review of R66's Progress Note, dated 4/23/2024, located in the EMR under the Progress Notes tab, revealed new order for Amoxicillin r/t [related to] tooth infection. An additional note for R66 dated 4/23/2024 revealed, needs referral to oral surgeon. R66's Progress Notes, dated 4/24/2024 through 5/1/2024, revealed that R66 continued to take the antibiotic for oral pain. A Progress Note dated 4/26/2024 revealed, Resident continues antibiotic therapy .Oral surgeon appt (appointment) in progress .Will continue current POC (Plan of Care) and notify provider as needed. There were no further progress notes mentioning tooth pain. Review of R66's comprehensive Care Plan, updated 7/4/2024, provided by the facility, documented R66 had oral/dental problems and, as of 4/23/2024, an oral abscess related to impaired dentition. The goal was for R66 to be free of infection, pain, or bleeding in the oral cavity by the review date. Interventions included consulting with an oral surgeon as ordered, coordinating arrangements for dental care transportation as needed, diet as ordered, monitor/document any signs or symptoms of oral/dental problems needing attention including pain and abscess. Review of the Physician's Orders under the Orders tab in the EMR, revealed R66 was given Amoxicillin 500mg twice daily for seven days, with a start date of 9/12/2024. Review of the admission Record revealed the Payer Information documented the Primary Payer was Medicaid (GA) [Georgia] and there was no other payer source documented. During an interview on 9/10/2024 at 2:04 pm, R66 said he had three lower back teeth that needed to be pulled. He said he had told staff, and they had not done anything. He said his pain was a 10 of 10, with a 10 being extreme pain. During an interview on 9/12/2024 at 11:15 am, the Social Services Director (SSD) and the Business Office Manager (BOM) said they had scheduled R66 for a dental appointment in January 2025, and that was the quickest appointment she could get. She said R66 received Medicaid and did not have a dentist. The SSD said she had called every dentist in the area to see who would accept residents who received Medicaid and was unsuccessful. The SSD said she did not document her attempts to locate a dentist in R66's EMR. The SSD said in April, she remembered the dentist looking at R66's teeth and told the nurse that R66 should be seen by an oral surgeon and should receive an antibiotic. The SSD said the Medical Director ordered the antibiotic. The SSD and the BOM said they did not have a formal system to ensure all Medicaid residents received an annual screening and were unaware this was their responsibility. The BOM said there were 70 residents in the facility who received Medicaid benefits and had not had their annual oral screening. During an interview on 9/12/2024 at 3:02 pm, the Administrator and the Director of Nursing (DON), the Administrator said she would expect any resident who resided in the facility to receive dental care as soon as possible when they expressed tooth pain. The DON agreed that a resident who expressed oral pain should be treated as quickly as possible. The DON said she remembered when R66 had expressed pain before, and he was given an antibiotic. She said it should have been addressed at that time. She said this week was the first time she heard R66 had tooth pain again.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on staff interviews, record review, and review of the facility policy titled Abuse, Neglect, Exploitation and Misappropriation Prevention Program, the facility failed to protect one resident (R), (R1) from physical abuse by a staff member from a sample of three residents. Findings include: Facility policy Abuse, Neglect, Exploitation and Misappropriation Prevention Program, last revised April 2021 revealed Policy Statement: Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual, or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms. Facility Incident Form dated 11/29/2023 revealed staff to resident abuse in which Housekeeper AA punched R1 in the left eye, causing R1 to fall to the floor and hit his head. The local law enforcement, physician, and responsible party were immediately notified. Housekeeper AA left the facility. Review of Annual Minimum Data Set, dated [DATE] revealed a Brief Interview for Mental Status score of 99, indicating severe cognitive decline with short and long-term memory problems. Interview on 12/4/2023 at 10:15 am with the Director of Nursing (DON) revealed the incident between R1 and Housekeeper AA was not witnessed by anyone. Stated several staff members heard resident hit the floor and came out into the corridor to see what happened. R1 was found lying on the floor with Housekeeper AA standing over him. Housekeeper AA immediately left the premises, and the facility notified the local law enforcement. The DON stated staff education was immediately started. Interview on 12/4/2023 at 10:49 am with Registered Nurse (RN) BB revealed upon looking down the hall she could see R1 sitting on the floor holding the back of his head. RN BB stated that Housekeeper AA stated, he hit me first. RN BB stated she called 911 for law enforcement assistance while a nurse and Certified Nursing Assistant assisted the resident. Interview on 12/4/2023 at 12:52 pm with Licensed Practical Nurse (LPN) CC revealed she was standing at the nurse's station when she heard a sound like a hit. Upon turning around, R1 was seen on the floor and Housekeeper AA was walking away. LPN CC stated she asked Housekeeper AA 'did you hit him?' and Housekeeper AA stated, he hit me twice, so I hit him back. LPN CC revealed she told Housekeeper AA to leave, and she assisted R1 after notifying RN BB.

Based on record review, staff interviews, and review of the policy titled Care Plans, Comprehensive Person-Centered, the facility failed to develop a person-centered care plan for one resident (R) (R#251) for pneumonia. The sample size was 40 residents. Findings include: A review of the facility policy, Care Plans, Comprehensive Person-Centered, revised 3/2022, revealed each resident would have a person-centered care plan that reflected any problem areas and conditions. Additionally, the assessment of the residents would be ongoing, and the care plan would be revised as information about the residents' conditions changed. A review of R#251's Minimum Data Set (MDS) OBRA Annual Assessment, dated 7/15/22, Section - I/Active Diagnoses, revealed a diagnosis of pneumonia. A review of R#251's care plan for June 2022 and August 2022 revealed that R#656 was not care planned for pneumonia or respiratory issues. A review of the Medical Doctor (MD) orders revealed that R#251 was administered Augmentin 875-125 mg via G-tube twice a day for five days for a diagnosis of pneumonia from 7/1/22 through 7/6/22. During an interview with the Licensed Practical Nurse (LPN) AA on 10/29/22 at 9:57 a.m., LPN AA stated that R#251 was not verbal, but he grunted when he needed something. She stated when a resident had an infection and was on antibiotics, and she monitored for signs and symptoms of side effects to the medication as well as improvement or decline related to the infection. LPN AA added that if a resident had pneumonia, she would follow the care plan for interventions specific to the resident. She stated she would ensure the head of the bed was elevated, monitor oxygen saturation, and monitor for fever and signs and symptoms of shortness of breath or increased difficulty breathing. She would immediately contact the MD and family if she noted any issues. During an interview with the Infection Control Preventionist (ICP) on 10/29/22 at 1:46 p.m., she stated that she expected residents with infections had a person-centered care plan specific to that infection. She indicated it would be the responsibility of the MDS Coordinator to ensure the care plan was developed. During an interview with the MDS Coordinator on 10/29/22 at 2:13 p.m., she stated that she developed a person-centered care plan for any resident with an infection. She added she checked her box each morning to see if there were any new orders for a resident which required an update to the resident's care plan. The MDS Coordinator acknowledged that R#251 had no care plan for pneumonia. However, she stated it was an oversight and that a care plan should have been developed.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, resident and staff interview, and policy review, the facility failed to enter an order in the record for one resident (R) (R#95) requiring suprapubic catheter care. The sample size was 40. Finding include: Record review revealed that R#95 was admitted to the facility on [DATE] with a diagnosis Paraplegia, Overactive Bladder, and Neurogenic Bladder. Review of admission Summary Note dated 8/15/22 revealed R#95 had a 20 French supra pubic catheter in place with 10 cubic centimeter (cc) bulb filled with normal saline. Review of the Minimum Data Set (MDS) admission assessment dated [DATE] revealed in Section C R#95 Brief Interview for Mental Status (BIMS) score was 7 and Section H he had an Indwelling Catheter. Review of the resident's medical record revealed the facility did not have an order for suprapubic catheter care and there was not any evidence of documentation that catheter care was provided for R#95. Review of the care plan for R#95 revealed he had a suprapubic catheter due to paraplegia and would remain free from catheter related trauma. Care plan indicated signs/symptoms would be monitored and recorded for discomfort or Urinary Tract Infection (UTI), and Findings reported to Medical Director (MD). No catheter care was included in care plan. During an interview on 10/29/22 at 1:11 p.m. with R#95 revealed he admitted to the facility with his suprapubic catheter and goes to the Urologist every six weeks for catheter changes. He reported dressing changes are done by the facility staff. An observation was conducted during this time revealed R#95 had a dry dressing to suprapubic catheter site. Interview on 10/29/22 at 2:17 p.m. with Wound Nurse revealed resident did not have an order for catheter care and she did not document catheter care in the residents' medical record. Interview on 10/29/22 at 2:25 p.m. with the Director of Nursing (DON) confirmed R#95 did not have active orders for suprapubic catheter care. She revealed the facility does not use any form of ADL sheets and document ADL care including catheter care in the electronic medical record. She reported R#95 suprapubic catheter care was completed during routine care but could not provide documentation it was given. Her expectation that residents with catheter's have physician orders for catheter care, staff to complete as order and document. Review of the policy titled Nursing Standards of Practice: Suprapubic Catheter Care date unknown, Policy revealed: Suprapubic catheter care will be provided to alleviate risk of irritation and Infection. Procedure: 1. Wash hands and don gloves. 2. Cleanse the skin around the catheter and catheter with soap and water. 3. Remove all exudates while cleaning. 4. Rinse and dry the area. 5. Apply a dressing if ordered or if drainage is present that would soil clothing. 6. Secure the catheter tubing with a strap, if desired. 7. Remove gloves and wash hands. 8. Document the procedure in the medical record. Note: If drainage is minimal, do not use a dressing. Leaving the area open to air will assist in alleviating drainage.

Based on observation, staff interviews, and facility policy, Handwashing/Hand Hygiene, the facility failed to ensure staff performed hand hygiene during one lunch dining service of two dining services observed. Findings Include: A review of the facility policy, Handwashing/Hand Hygiene, revised 8/2019, revealed that all personnel would follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors. A further review revealed that an alcohol-based hand rub, or alternately, soap and water, would be utilized before and after direct contact with residents, after contact with objects in the immediate vicinity of the resident, and before and after assisting residents with meals. During an observation of the lunch dining service on 10/29/22 at 12:01 p.m., the Registered Nurse (RN) BB assisted the residents with their lunch service. At 12:06 p.m., RN BB placed both hands in her hair, touched the back of R#36's chair, and then assisted R#52 with the lid on her glass of tea. RN BB did not wash her hands or use the hand sanitizer. At 12:08 p.m., RN BB was observed assisting R#59 with fluids and opening his straw. At 12:10 p.m., RN BB touched the left side of her face and then assisted R#252 at 12:12 p.m. by opening and placing straws in his tea and water. At 12:15 p.m., RN BB touched her eyeglasses and face and helped R#25 with her cutlery and straw. Finally, RN BB touched the back of R#36's chair, moved an empty dining room chair, and began feeding R#5 at 12:18 p.m. RN BB never used hand sanitizer or washed her hands during the observation from 12:01 p.m. through 12:49 p.m. During an interview with RN BB on 10/29/22 at 12:49 p.m., she explained that she began working at the facility on 10/10/22. She acknowledged she did not use the hand sanitizer or wash her hands before assisting the residents with dining or feeding R#5. RN BB stated that she usually hand-sanitized before assisting residents during their meals. She could not explain why she did not hand-sanitize or wash her hands during the lunch services. RN BB stated that using hand sanitizer or washing hands during meals and between resident contact was standard infection control practice. During an interview with the Infection Control Preventionist (ICP) on 10/29/22 at 1:43 p.m., she stated it was her expectation for staff to hand wash or hand sanitize between passing out resident trays before and after assisting a resident with dining or meals. In addition, she expected staff to wash their hands or hand sanitize after touching objects or their face. The ICP indicated that all new staff members are given education on handwashing before working with the residents. She added that quarterly education and in-services were provided to all staff.

Based on observation, record review, review of the facility policy titled Oxygen Administration, and staff interviews, the facility failed to obtain a Physician's Order for one resident (R) (#69) reviewed of 21 residents receiving oxygen. Findings include: Review of the Electronic Medical Record (EMR) for R#69 revealed diagnosis of acute and chronic respiratory failure, chronic obstructive pulmonary disease with (acute) exacerbation, and hypercapnia. Observations on 12/10/19 at 8:55 a.m., 12/11/19 at 9:01 a.m., and 12/12/19 at 8:18 a.m. revealed R#69 receiving oxygen therapy per nasal cannula ranging from 3 to 4/LPM (liters per minute). During an interview and observation on 12/12/19 at 8:28 a.m., Licensed Practical Nurse (LPN) BB confirmed that R#69 was currently receiving oxygen. However, LPN BB was unable to find a physician's order for oxygen therapy. During an interview with LPN Supervisor AA on 12/12/19 at 8:35 a.m. it was reported that when R#69 returned from the hospital and there was no order for oxygen the admitting nurse should have contacted the Physician to request an order to resume oxygen. LPN BB confirmed, at this time, that she was the admitting nurse and must not have written the order for oxygen. Review of the facility policy titled Oxygen Administration dated 2010 revealed the following procedure: 1. Verify that there is a Physician's Order for this procedure. Review the Physician's Orders or facility protocol for oxygen administration.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of the Resident Census History for R#33 revealed a hospitalization from 10/3/2019 through 10/7/19. Review of the medical record revealed there was no evidence that written notice of transfer was given to R#33 or the resident's responsible party when he was discharged to the hospital. During an interview with the Assistant Director of Nursing (ADON) on 12/12/19 at 9:46 a.m. it was reported that a transfer form is given to emergency personnel when the resident is sent to the hospital, but no written documentation is provided to residents regarding the transfer to the hospital. It was also reported that the resident's family is notified via telephone of transfers to the hospital. The facility provided a policy titled Transfer or Discharge, Emergency revised August 2018. The policy indicated to notify the representative or other family member of an emergency transfer. The facility had no other policies related to notification of transfer. Based on record review and resident/staff interviews, the facility failed to provide the resident/family with a written explanation of reason for a transfer to an acute care hospital for two residents (#33 and #69) reviewed of 85 residents transferred to the hospital since 7/23/18. Findings include: 1. Review of the electronic medical record (EMR) for R#69 revealed an admission Minimum Data Set (MDS) dated [DATE] with section C indicating a Brief Interview Mental Status score of 15. This indicates intact cognition for R#69. Further review of the EMR revealed hospitalizations from 10/25/19 until 11/1/19 and 11/9/19 until 11/25/19. The EMR did not indicate that a transfer notice was provided to the resident. During an interview on 12/12/19 at 4:28 p.m. R#69 denied being provided any documentation when being transferred to the hospital detailing the reason for the need to go to the hospital.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Review of the Resident Census History for R#33 revealed a hospitalization from 10/3/2019 through 10/7/19. Review of the medical record revealed no evidence that written notice of bed hold policy was given to R#33 or the resident's responsible party when he was discharged to the hospital. The resident had Medicare and Medicaid. An interview conducted on 12/12/19 at 1:14 p.m. with the BOM revealed that the facility did not issue written notification of bed hold policy to the resident or resident representative. Based on record review, resident and staff interviews, and review of the facility policy titled Bed Holds and Returns Policy, the facility failed to ensure that two residents (R) (#33 and #69) were made aware of the facility's bed hold and reserve bed payment policy upon transfer of 85 residents transferred to the hospital since 7/23/18. Findings include: Review of the Bed Holds and Returns Policy revised March 2017 revealed prior to transfer, written information will be given to residents and the representative that explains in detail: the rights and limitations of the resident regarding bed-holds, the facility per diem rate required to hold a bed for non-Medicaid residents or to hold a bed beyond the state bed-hold period for Medicaid residents. 1. Review of the electronic medical record (EMR) for R#69 revealed an admission Minimum Data Set (MDS) dated [DATE] with section C indicating a Brief Interview Mental Status score of 15. This indicates intact cognition for R#69. Further review of the EMR revealed hospitalizations from 10/25/19 until 11/1/19 and 11/9/19 until 11/25/19. The EMR did not indicate that any type of bed hold notification was provided to R#62 who is a Medicare resident. Interview on 12/11/19 at 2:37 p.m. with Licensed Practical Nurse (LPN) Supervisor AA who reported that nursing does not provide any documentation to residents when going to the hospital. It was further reported that the Business Office Manager (BOM) would likely be responsible for notifying residents of bed hold procedures. During an interview with the BOM on 12/11/19 at 4:22 p.m. it was reported that R#69 was a Medicare resident and a bed hold notice was not provided. During interview with BOM on 12/12/19 at 8:23 a.m. it was reported that she has not been providing written documentation to non-Medicaid residents regarding bed hold policy or room rates as stated in the facility policy. During further interview with the BOM on 12/12/19 at 8:47 a.m. it was reported that whenever room rates change residents are notified via a letter and residents are verbally notified of room rates on Admission. It was further disclosed that bed rates are not currently posted anywhere in the facility. BOM confirmed that there is no current process for notifying residents in writing whenever they are discharged to the hospital of bed rates or of the bed hold policy. During an interview on 12/12/19 at 4:28 p.m. with R# 69 it was confirmed that no documentation had been provided detailing rates for holding her bed when she went out to the hospital.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, review of the facility policy titled Dating and Labeling Policy, and staff interviews, the facility failed to assure that items were labeled/dated and used before the expiration date in the kitchen, emergency food storage, and in one food pantry. The facility failed to assure that equipment in the kitchen was clean, hairnets were worn to cover all hair, and items in the dry food storage area were without dents and rust. This deficient practice affected 88 of 91 residents receiving an oral diet. Findings include: A brief kitchen tour began on 12/9/19 at 10:35 a.m. and revealed the following: The following was observed unlabeled and undated in the reach in cooler: 1. There was a one-gallon bag with sausage meat that was not labeled or dated. 2. There was a bag of scrambled eggs with seven boiled eggs that was not labeled or dated. 3. There was a peanut butter and jelly sandwich that was not labeled or dated. 4. There was a one-gallon sized bag of cornbread that was not labeled or dated. 5. There was a bag with sliced cheese with an open date of 11/28/19 but there was no expiration date. 6. There were 4 trays of glasses with water in them that were not dated. 7. There was a bag of shredded cheese with an open date of 12/2/19 but there was no expiration date. 8. There were individualized cups of apple juice that did not have an open date or an expiration date. The following was observed expired in the walk-in cooler: 1. There were nine packs of 12 count hamburger buns with best by dates of 10/31/19, 11/6/19, 11/13/19, 11/24/19, and 12/4/19. The following was observed unlabeled and undated in the reach in freezer #1: 1. There was a box of tater rounds with an in date of 11/11 but no expiration date. 2. There were two boxes of chopped collards with no in date or expiration date. DM reported delivered on last week. 3. There was a partially used box of [NAME] sticks that did not have an expiration date. The following was observed unlabeled and undated in the reach in freezer #2: 1. There was a bag of carrots with an in date of 11/4/19 but no use by date. 2. There were three bags of red skinned potato wedges that did not have an expiration date. 3. There was a bag of onion rings that did not have an expiration. During an interview with the Dietary Manager (DM) on 12/9/19 at 11:00 a.m., it was reported that the bread in the refrigerator is checked daily and if it looks fine, they will continue to use the bread beyond the best by date. The DM further reported that items in the refrigerator should be labeled/dated and confirmed that items in the refrigerator were not labeled or dated. She further reported that canned goods are kept no longer than six months before they are thrown away. The resident pantry tour began on 12/11/19 at 2:51 p.m. and revealed the following: Freezer 1. There was one package of pizza rolls with a best by date of 12/4/19. 2. There was one popsicle that was not labeled and did not have an expiration date. Refrigerator 1. There was one cup not dated. 2. There were three eight fluid ounce (fl. oz) chocolate Boost with an expiration date of 4/19/19. 3. There were two staff members observed getting ice and water from ice/water machine in pantry that is noted to have a white buildup. 4. There was one 20 oz Coke Zero with an expiration date of 12/2/19. 5. There were nine four fl. oz apple juices with no expiration date. During an interview and observation on 12/11/19 at 3:12 p.m. with the Licensed Practical Nurse (LPN) Supervisor AA it was reported that the night shift nurses are responsible for cleaning the refrigerator in the resident pantry as well as checking for expired items in the refrigerator. LPN Supervisor AA confirmed the expired juices, Coke, pizza rolls, and unlabeled cup in the freezer and refrigerator of the resident pantry. It was further reported that housekeeping staff are responsible for the cleaning of the ice/water machine in the resident pantry. During interview with the Housekeeping Supervisor on 12/11/19 at 3:23 p.m. it was reported that housekeeping staff cleans the ice machine/water machine daily. When the Housekeeping Supervisor used a white paper on the water dispenser a pinkish brown substance was noted on the paper after wiping. He also reported that the white buildup noted on the machine was from calcium buildup. The Housekeeping Supervisor further reported that there is no policy for cleaning the machine because the machine is wiped down daily. During an interview with the Maintenance Director on 12/12/19 at 7:42 a.m. it was reported that the ice/water machine in the pantry is a leased machine. Further reporting that if there are issues the company is called and someone comes out to resolve the issue. A follow up kitchen tour began on 12/12/19 at 12:33 p.m. and revealed the following: 1. There was an expired 5.44 pound can of mashed potatoes with an expiration date of 5/30/19 with an in date 11/11/18 in the emergency food supply. 2. The can opener in the kitchen has black buildup on the base. 3. There was one kitchen staff noted serving on the tray line with hair not fully covered by hairnet. 4. There were dented and rusted cans in the emergency food storage area. During an interview on 12/12/19 at 12:48 p.m. the DM reported that the can opener blade is washed daily, and Maintenance will have to remove the base to be washed. DM reported that this last took place a few months ago. DM also reported that some of the cans may be dented due to the rack falling on yesterday. She acknowledged that staff in the kitchen did not have hair fully covered by the hairnet but should have and reported that a larger hairnet is needed. DM reported that apple juice typically does not stay in the resident refrigerator in the pantry for residents. It was confirmed that the directions on the box for the apple juice said to use within 10 days of thawing. She confirmed that she is not able to determine when the apple juice was sent to the pantry and going forward apple juice will not be sent unless it is specifically asked for. During an interview with the ice machine Tech DD on 12/19/19 at 1:03 p.m. it was reported that he was called in today to clean the machine. He explained that he is contracted to clean and service the machine every six months. The servicing of the machine includes removing the cover and removable parts, emptying the ice bin, and cleaning of the ice shooter. He stated that routinely the machine can be maintained by using hot water to clean it. When Tech DD removed the ice shooter there was a black and white buildup noted at the mouth of the shoot in which the ice traveled. When touched by Tech DD some of the buildup moved from the shoot. He reported that most of what was being seen was calcium buildup. He also reported that the calcium buildup is on the outside and not on the inside of the tube from which the water comes. An observation on 12/12/19 at 1:07 p.m. of the resident refrigerator in the pantry revealed three bottles of Boost with an expiration date of April 2019. Review of the facility policy titled Dating and Labeling Policy revised 1/24/17 revealed: kitchen will assure food safety by maintaining proper dates and labels to all goods and ready to eat food products. Procedure: 4. Ready to eat foods must be dated with a 72 hour use by date and discarded when expired. 5. Foods marked with manufactures use by date may be used and stored until expiration date. 10. Discard all foods that expire immediately.