Based on observations, staff interviews, record reviews, and review of the facility policy titled, Medication Administration-General, the facility failed to ensure the medication error rate was less than 5 percent (%). A total of 28 opportunities were observed, with four errors for two residents (R) (R6 and R11), resulting in an error rate of 14.2 %. This failure had the potential to result in medication not being given in accordance with the physician's orders and had the potential to adversely affect R6 and R11's clinical condition. Findings include: Review of the facility policy titled, Medication Administration-General, dated 2024, revealed the policy guidelines included that medications are to be administered in accordance with a valid prescriber order. The guidelines also instructed the Nurse or Certified Medication Aide (CMA) to read the administration directions on the Medication Administration Record (MAR) and verify the correct medication, dose, and directions for use, prior to medication administration. 1. A review of the clinical record revealed R6 had a physician's order, dated 7/4/2024, for one 81 milligram (mg) tablet of delayed-release aspirin to be administered once per day for a diagnosis of aphasia following cerebral infarction. A review of the electronic Medication Administration Record (eMAR) revealed the aspirin was scheduled to be administered at 9:00 am. Further review of R6's clinical record revealed a physician's order, dated 7/10/2024, for one drop of Artificial Tears 0.5%-0.6% eye drops to be administered to both eyes two times per day for an unspecified disorder of the eye and adnexa. A review of the eMAR revealed the eye drops were scheduled to be administered at 9:00 am and 5:00 pm. There was also a physician's order, dated 8/2/2024, for one 500 mg tablet of divalproex extended release (ER) to be administered orally every 24 hours for a diagnosis of mood disorder. A review of the eMAR revealed the medication was scheduled to be administered at 9:00 am. During an observation of medication pass on 9/4/2024 at 8:32 am, CMA BB failed to administer the delayed-release aspirin as ordered. CMA BB administered a chewable aspirin in error. Observation also revealed CMA BB failed to administer the Artificial Tears eye drops and divalproex oral tablet to R6. During an interview on 9/4/2024 at 10:10 am, CMA BB confirmed she had not administered the eye drops or divalproex medication. 2. A review of the clinical record revealed that R11 had a physician's order, dated 9/2/2024, for one 8.6 mg tablet of senna to be administered every 12 hours for constipation. A review of the eMAR revealed the medication was scheduled to be administered at 9:00 am and 9:00 pm. During an observation of medication pass on 9/4/2024 at 9:15 pm, CMA DD failed to administer the senna as ordered to R11. During an interview on 9/4/2024 at 10:06 am, CMA DD confirmed that R11 should have received the senna during the medication pass.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to ensure that pressure ulcer treatments were provided as ordered by the physician for two residents (R1 and R5), and that pressure ulcers were accurately assessed and monitored for two residents (R4 and R5) from a total sample of eight residents. Findings include: 1. Review of the clinical record revealed that R1 was admitted to the facility on [DATE] and had diagnoses that included, but were not limited to, type 2 diabetes mellitus, hypertension, cerebral infarction, and peripheral vascular disease. Review of the care plan revealed that R1 had cognitive impairment, limited mobility, a self-care deficit, and skin breakdown. Further review of the clinical record revealed that R1 was hospitalized from [DATE] through 9/11/2023. Review of the electronic August 2023 Treatment Administration Records (TAR's) revealed that prior to the 8/27/2023 hospital admission, R1 had physician ordered wound treatments for a left heel ulcer, left anterior lower leg wound, and excoriated area to the sacrum and buttocks. The left heel ulcer treatment order, dated 8/10/2023, was to cleanse the ulcer and periwound area with normal saline and pat dry. Apply skin barrier protective wipe to the periwound area, apply moist-to-moist gauze dressing to the ulcer, and wrap with roll gauze every Tuesday, Thursday, and Saturday on the day shift. The left anterior lower leg wound treatment order, dated 8/10/2023, was to clean the leg wound and periwound area with normal saline and pat dry. Apply skin barrier protective wipe to the periwound area, apply non-adherent dressing to the wound, and wrap with roll gauze every Tuesday, Thursday, and Saturday on the day shift. The treatment order for the excoriated area to the sacrum and buttocks, dated 8/18/23, was to clean the excoriated area with wound cleanser and normal saline and pat dry. Apply Triad hydrophilic wound dressing every Monday, Wednesday, and Friday on the day shift. Review of R1's Weekly Wound report for July and August 2023 revealed that the left heel ulcer and left leg ulcers were listed as stage 3 pressure ulcers on 7/27/2023. Further review of R1's clinical record, including the electronic August 2023 TAR's revealed that after 8/22/2023, there was no evidence that the wound treatments for the left heel ulcer and left anterior lower leg ulcer were completed as ordered and scheduled on 8/24/2023 and 8/26/2023, prior to the hospital stay on 8/27/2023. There was no evidence that the treatment for the excoriated area to the sacrum and buttocks was completed as ordered and scheduled on 8/23/2023 and 8/25/2023, prior to the hospital stay on 8/27/2023. During an interview on 11/1/2023 at 5:00 pm, Nurse Consultant GG stated that the facility's electronic clinical record system was down from 8/23/2023 through 8/28/2023 and paper TAR's were printed out and used. However, the facility was unable to locate R1's August 2023 printed paper TAR's that would show wound treatments completed prior to R1 going to the hospital on 8/27/23. Nurse Consultant GG also stated that the facility's treatment nurse was out during the time the electronic clinical record system was down, and the charge nurses would have been responsible for providing wound treatments for the residents. During an interview on 11/2/23 at 1:55 pm, Assistant Director of Nursing (ADON) AA stated that she had completed a wound treatment to R1's sacrum before, but she could not remember the exact date and that she might have done a treatment to the sacrum at some point between Monday and Friday (8/21/2023-8/25/23) but could not recall. ADON AA did state that she had never provided wound treatments to R1's legs or feet. During an interview on 11/2/2023 at 2:45 pm, Licensed Practical Nurse (LPN) BB, who was assigned to R1 on the day shift on 8/25/2023 and 8/26/23, stated that he did not provide wound treatments to R1. Further review of R1's clinical record, including the November 2023 electronic TAR's revealed a 11/1/2023 physician's order to clean a wound to the left medial foot with normal saline, apply skin prep to the periwound, and cover the wound with foam dressing every Monday, Wednesday, Friday and as needed on the day shift. Review of the Weekly Wound report for R1 revealed that the left medial foot wound was listed as a stage 2 pressure ulcer on 10/30/2023. During an observation of wound care for R1 on 11/1/2023 at 1:00 pm, a dressing was observed intact to the left medial foot. The treatment nurse stated that she completed the dressing change earlier that morning because the bandage was coming off. During the observation, when R1 was turned and repositioned in bed, and her bed linens changed, the dressing came off the left medial foot ulcer. After the dressing came off, the treatment nurse applied Triad paste to the wound bed and skin prep to the wound edges. She then covered the wound with a foam dressing. However, the physician's ordered treatment for the left medial foot ulcer did not include the use of Triad paste. In addition, the treatment nurse did not clean the wound with normal saline prior to applying the Triad paste, and skin prep, and covering with a foam dressing. 2. Review of the Weekly Wound report for R4 revealed documentation on 7/17/2023 that the resident developed a Stage II pressure ulcer to the left and right buttocks and to the sacrum. Documentation on 8/10/2023 noted the pressure ulcer to the left buttock and the sacrum healed. There was no further documentation of the pressure ulcer to the right buttock since 7/27/2023 when it was described as a Stage II pressure ulcer. On 9/6/2023 the sacrum re-opened as a Stage II that measured 1.6 centimeter (cm) x 2.8 cm x 0.2 cm. However, during an observation of wound care on 11/15/2023 at 10:40 am with the Treatment Nurse, the resident was observed to have two separate Stage II pressure ulcers to the left upper buttock and the right upper buttock. During an interview with the Treatment Nurse on 11/15/2023 at 12:15 pm, she stated the wound measurements on the Weekly Wound report were from the wound on the right buttock. She stated there were no measurements for the left buttock and the wound to the left buttock had been present since October 2023. She also confirmed these wounds were never one wound that had separated into two separate wounds. 3. Review of the Weekly Wound report for R5 indicated the resident developed a Stage II pressure ulcer to the left heel on 8/4/23. Staff continued to document the wound as a Stage II each week through 11/14/2023. However, during an observation of wound care on 11/15/2023 at 11:50 am, the pressure ulcer on the resident's left heel was observed to be an unstageable Pressure Ulcer that was covered with black/gray soft eschar. When the Treatment Nurse was asked if she was staging the wound, she stated the wound was a Stage II. She also stated at that time she thought the dark tissue was the Medi-Honey dressing as she was cleaning the wound and attempted to remove what she thought was the Medi-Honey dressing but was in fact necrotic tissue. During a subsequent interview with the Treatment Nurse on 11/15/2023 at 12:45 pm, she stated that on 11/10/2023 the tissue on the left heel started to look dark. On 11/14/2023 when she measured the wound, she thought the dark tissue was the Medi-Honey dressing. During an interview with the Corporate Wound Nurse on 11/15/2023 at 12:43 pm, she stated the pressure ulcer on the resident's left heel would be considered an unstageable pressure ulcer. Review of the August 2023 Electronic Treatment Record (eTAR) revealed physician's orders on 8/18/2023 to cleanse left heel wound and periwound with normal saline and pat dry, apply skin barrier protective wipe to periwound area, cover with adhesive foam dressing on Monday, Wednesday and Friday. However, there was no documentation that the treatment was done as ordered to the left heel on 8/21/2023, 8/23/2023 and 8/25/2023. Review of the September 2023 eTAR revealed physician's orders for treatment to a pressure ulcer of the sacral region. The order read to clean wound with normal saline, pat dry, clean periwound with skin barrier wipes, apply non-adhesive foam gauze Monday, Wednesday and Friday. However, review of the September eTAR revealed there was no documentation treatment was done as ordered between 9/6/2023 and 9/20/2023 for six of thirteen scheduled days. Review of the October 2023 eTAR revealed the resident had received treatment to the left heel with Di-Dak-Sol 0.0125% topical solution every day from 10/2/2023 through 10/16/2023. There was no documentation treatment was done to the left heel between 10/16/2023 to 10/23/2023. The eTAR indicated a physician's order to cleanse the left heel with normal saline, pat dry, apply skin barrier to periwound, cover with adhesive foam Monday, Wednesday and Friday. During an interview and review of the eTARs with the Treatment Nurse on 11/30/2023 at 10:30 am, she stated that she out sick from 8/19/2023 to 8/30/2023 and the backup Treatment Nurse was out sick during that time as well. She stated the floor nurses would have been responsible for the treatments. She also stated the electronic charting system was down during those dates and they were not able to locate the paper eTARs. She could not give an explanation for the gap in time for the treatment to the sacrum between 9/6/2023 and 9/20/2023. In regards to the lack of documentation for the left heel between 10/16/2023 to 10/23/2023, she was out sick again during that time and the backup Treatment Nurse worked 12 hour shifts and would not be in the facility Monday through Friday. Therefore, the floor nurses would have been responsible for doing the treatments when the backup nurse was not there.

Based on observation, staff interview, record review, and a review of the facility's policy titled, Intravenous Antibiotic, the facility failed to ensure all nursing staff had the competencies and skill set necessary to provide care for residents receiving intravenous therapy through an Intravenous Infusion Pump for one of two residents (R) (#4) reviewed for intravenous therapy. This failure had the potential for residents to have a decline in health status. Findings include: Review of the undated policy titled, Intravenous Antibiotic, intravenous antibiotics may be administered via a variety of modes, such as: small volume minibags administered intermittently, programmable infusion pumps allowing intermittently intervals, and a keep-vein-open rate between intervals and prefilled disposable antibiotic infusion device. A review of the facility provided Facility Assessment reviewed date 05/22/2023 revealed the facility accepts residents with special treatments - intravenous (IV) medications: Number/Average or Range of Residents - 2. A review of the facility's Skill Checklist - Core Competency form revealed that initials will indicate that the following skills have been successfully demonstrated during peer orientation. These skills represent core nursing competencies and should not be performed until demonstrated to an appropriately trained person. These skills represent those needed for the annual review as well. Intravenous is included on the checklist. A review of the facility's job description for LPN Charge Nurse for Impatient Services revised 3/2022 revealed: Essential Duties and Responsibilities - IV implementation and administration. A review of the facility's job description for RN Nurse Supervisor for Inpatient Services revised 3/2022 revealed: Summary - Responsible for directing nursing care of the patients. Essential Duties and Responsibilities - Monitors the work of other nursing staff care to the unit for thoroughness, makes rounds to provide care to and cleanliness of patients, and implements the educational program. Record review in the Electronic Medical Record (EMR) of the admission Record for R#4 revealed multiple diagnoses to include infection and inflammatory reaction due to internal right knee prosthesis and Methicillin-resistant Staphylococcus aureus (MRSA) to the right knee. Record review of the admission Minimum Data Set (MDS) for R#4 dated (ARD) of 06/15/2023 revealed a Brief Interview for Mental Status (BIMS) score was 12 out of 15, indicating she was cognitively intact, and she had IV medications administered while a resident with a diagnosis as infection and inflammatory reaction due to internal right knee prosthesis. Record review of the care plan in the EMR for R#4 revealed the resident has an infection, new or recently diagnosed administer medications and/or treatment as ordered. Diagnostics as ordered, monitor vital signs, and notify MD. Record review of the Physician's Orders for R#4 revealed an order for R#4 to receive vancomycin 1 gram (gm)/200 milliliters (mL) in dextrose 5 % intravenous piggyback (vancomycin in 5 % dextrose in water) 100 ml intravenously every 24 hours on at 6 a.m. for 37 days. Please allow for the trough to be collected prior to administering medication if the trough is scheduled. Please check the trough schedule prior to administering. Order start date 6/15/2023. A review of the educational in-services provided revealed that the licensed staff did not receive formal training related to the operation/use of intravenous infusion pumps. A review of the Electronic Medication Administration Record (EMAR) revealed that vancomycin 1gm was documented as administered on 7/01/2023 at 6 a.m. Observation and interview on 7/1/2023 at 8:13 a.m. revealed R#4 lying in bed. There was an undated full IV bag of vancomycin 1gm observed hanging on the IV pole. Further observation revealed that the infusion pump was off, and the IV tubing was connected to the resident's Peripherally Inserted Central Catheter (PICC) on the left arm. R#4 stated that the nurse came in and informed her she was starting her IV antibiotic and hung the medicine before the day shift this morning. R#4 further stated that she had surgery on her right knee and now had an infection in the knee, as the reason for the IV medicine she is currently receiving. Interview and observation on 7/1/2023 at 8:30 a.m. with Licensed Practical Nurse (LPN) CC observed LPN CC enter R#4's room, assess her pain level, administer pain medication by mouth, and exit the room. LPN CC returned to R#4's room at 8:41 a.m. and began to disconnect the IV Vancomycin from the PICC line. LPN CC verified that the dose had not been infused, the pump was off, and the IV bag was not dated or timed prior to being hung for administration. LPN CC revealed that the medication was scheduled to be administered at 6 a.m., and she had no idea as to the reason the medication was not infused. LPN CC stated she relieved the night nurse (agency nurse) at 7:15 a.m., but the nurse did not inform her that the medicine was not infused as ordered. LPN CC continues to state she entered R#4's room at approximately 7:45 a.m. but did not notice the antibiotic was not infused and connected to the resident. LPN CC stated that she had received orders on 6/30/2023 from the pharmacy to resume the vancomycin 1gm on 7/1/2023. Interview and observation on 7/1/2023 at 8:44 a.m. with Assistant Director of Nursing (ADON) verified that the vancomycin 1gm still hanging and had not been infused. The ADON reviewed the EMAR and stated that the 6 a.m. dose of vancomycin for 7/1/2023 was documented as administered. The ADON also stated that there was not a progress note to reflect that the medication was not administered and/or that the medical provider was not notified according to the documentation. The ADON revealed that the medication was scheduled to be administered at 6 a.m., and the nurse had one hour before and one hour after the time to administer the dose. The ADON further revealed that the agency night nurse did report to her prior to leaving that she was unable to get the infusion pump to work to administer the dose of IV medication. The ADON stated she was supposed to have checked off on the pump, but she had not done so. ADON stated that she was not sure if the agency nurse knew how to operate the IV pump or had any training in the operation of the infusion pump. In addition, ADON stated that she had worked at the facility since January 2023 and did not have formal training on the use of the IV infusion pump. Interview on 7/1/2023 at 8:54 a.m. with Registered Nurse (RN) EE revealed that she is new to the facility and is shadowing another nurse today. She further stated that she had completed the classroom portion of orientation but had not received any training related to the IV infusion pump at the time of this interview. RN EE stated that she had been a nurse for a long time and was sure she would be able to figure out the operation of the pump. Interview and observation on 7/1/2023 at 9:10 a.m. with Director of Nursing (DON) verified that the IV antibiotic (vancomycin), which was scheduled to be administered at 6 a.m., was still hanging and had not been infused. The DON revealed that the dose should have been dated and timed at the time of being hung for infusion. The DON explained that on 6/29/2023, when the infusion was started, the resident complained of pain at the IV site. The infusion was stopped, and R#4 was sent out to the hospital for further evaluation. The DON revealed that upon return early morning on 6/30/2023, R#4 had a new PICC line in the opposite arm (left), and it was determined the resident had a blood clot in the right arm. The DON further stated that the infusion pump was supplied by the pharmacy, and the nurse had not been trained in the operation of the infusion pump. The DON was unable to program the correct infusion time into the infusion pump for the administration of the medication. After several failed attempts to program the IV infusion pump, DON stated she does not use the pump every day but could Google it or get someone to show her how to operate it. The DON further stated that she had only worked at the facility since October 2022 and was not sure if the nurse had been trained on the operation of the infusion pump. A follow-up interview on 7/01/2023 at 1:04 p.m. with DON revealed that she was not able to locate any documentation of the staff being educated on the usage of the IV infusion pump. The DON provided all the education she had for the night agency nurse and verified that there was no education for the use of the IV infusion pump. The DON also stated that it was her expectation that medications, including intravenous medications, be administered as ordered by the physician. The DON revealed that if the medication was not administered as ordered, the physician should have been notified, and the dose should not have been documented as administered. The DON further revealed that R#4 had MRSA in the right knee, and getting her medication should have been a priority this morning. Interview on 7/2/2023 at 10:54 a.m. with LPN DD revealed that she had worked at the facility for over a year through an agency. LPN DD stated that she had administered IV antibiotics to residents previously at the facility, but the facility did not provide her with any formal education/training for the use of the pump. LPN DD stated that her orientation at the facility consisted of training on electronic records only. Telephone interview on 7/2/2023 at 12:39 p.m. with RN II revealed that she serves as the Educational Coordinator for the facility. She stated that the licensed staff at the facility are nurses who have been hired since she had been at the facility. RN II stated that the licensed staff had been competent in the use of the IV infusion pump by verbalizing the use of the pump. She further stated that there is not always a pump available at the facility to train the staff on its operation physically. RN II revealed there had not been a need to have a representative from the pharmacy conduct an in-service on the use of the pump because there are one-two-three instructions attached to the infusion pump. In addition, RN II stated that she had not observed nurses load the IV tubing or program the infusion pump to ensure compliance with the infusion pump operation. The agency night nurse who worked the night of 6/30/2023 was not available for an interview during this survey.

Based on observations, staff interviews, and a review of the facility's policies titled Medication Storage in the Care Center, and Insulin Administration, a review of latanoprost ophthalmic solutions manufacturer packet insert, the facility failed to ensure drugs and biologicals used in the facility were labeled and stored properly for four of five medication carts (South Hall Certified Medication Aide (CMA) cart one, South Hall Nurse cart, South Hall CMA cart two, and North Hall Nurse cart). Findings include: A review of the policy titled Medication Storage in the Care Center, revealed the intent was to ensure medications and biologicals are stored safely, securely, and properly following manufacturer's recommendations or those of the supplier. Guidelines included for medications requiring refrigeration or temperatures between two degrees Celcius (C) (36 degrees Fahrenheit (F) and eight degrees C (46 degrees F) are kept in a refrigerator with a thermometer to allow temperature monitoring. A review of the undated policy titled Insulin Administration, revealed the intent was to ensure insulin is administered correctly and safely. The guidelines included to date all insulin bottles and pens with date of first puncture or date removed from refrigerator and depending on manufacturer's recommendations insulin must be replaced 10 to 56 days after first use. Review of the manufacturer's packet insert for latanoprost ophthalmic solutions revealed that storage instructions were to protect the solution from light and store unopened bottle(s) under refrigeration at two degrees to eight degrees Celsius (C) (36 degrees to 46 degrees Fahrenheit (F)). Once a bottle is opened for use, it may be stored at room temperature up to 25°C (77°F) for 6 weeks. Observation on 7/1/2023 at 9:00 a.m. of South Hall Certified Medication Aide (CMA) medication cart one with CMA FF revealed one open container of latanoprost ophthalmic solution 0.005% 2.5 milliliters (ml) (a medication used to treat glaucoma and ocular hypertension) to be stored in the cart without an open or discard date. CMA FF verified there was not an open or discard date on the box or container and revealed she was unsure why the medication was not dated. CMA FF revealed that the nurse who opens the container normally labeled it. She further revealed that all nurses and CMAs should look at the ophthalmic solutions to ensure there was an open or discard date on them prior to administration. Observation on 7/1/2023 at 9:05 a.m. of South Hall Nurse medication cart with Licensed Practical Nurse (LPN) GG revealed one open Novolog Flex Pen 100units/ml (a medication used to treat diabetes mellitus) with an open date of 6/2/2023 and a discard date of 6/30/2023. LPN GG verified the open and discard dates on the Novolog Flex Pen. She revealed she was unsure why the insulin pen was not discarded on the discard date. She revealed that the nurse should check the discard date prior to administering the insulin. Observation on 7/1/2023 at 9:35 a.m. of South Hall CMA medication cart two with CMA AA revealed two containers of unopened latanoprost ophthalmic solution 0.005% 2.5ml to be stored in the medication cart. The label on the box stated to store under refrigeration until opened. CMA AA verified that the ophthalmic drops were not stored under refrigeration according to the manufacturer's recommendations. She revealed that night shift nurses received medications from the pharmacy delivery and stocked the medication carts. Observation on 7/1/2023 at 10:45 a.m. of North Hall Nurse medication cart with LPN HH revealed one open Levemir Flex Touch 300 units/3ml (a medication used to treat diabetes mellitus) to be stored in the cart without an open or discard date. LPN HH verified there was not an open or discard date on the insulin pen. Further observation revealed one open Novolog Flex Pen 100 units/1ml insulin pen with an open date of 5/31/23 and a discard date of 6/29/23. LPN HH verified the open and discard dates on the Novolog Flex Pen. She revealed she was unsure why the Levemir insulin pen did not have an open and discard date on it or why the Novolog insulin pen was not discarded on the discard date. LPN HH further revealed that insulin pens should be dated with an open and discard date when opened and should be discarded on the discard date. She stated that when an insulin pen was opened, the nurse opening the pen should label it. Interview on 7/2/2023 at 9:53 a.m. with the Director of Nursing (DON) revealed her expectations were for medications requiring refrigeration to be stored in the refrigerator as recommended by the manufacturer. She further revealed that her expectations were for ophthalmic medications to be labeled with an open date when opened and discarded on the manufacturer recommended discard date. She revealed her expectations were for insulin to be labeled with an open and a discard date when opened and discarded on the discard date. The DON stated she expected each nurse and CMA to routinely check their assigned medication cart to ensure ophthalmic medications and insulin were labeled appropriately. She further stated that she planned to provide education to nurses and CMAs to ensure ophthalmic medications and insulin were labeled and stored according to the manufacturer's recommendations and were discarded on the discard date. She further revealed that she planned to place identified concerns in the Quality Assurance and Performance Improvement (QAPI).

Based on observation, staff interviews, and a review of the facility's policy titled, Cleaning and Sanitizing, the facility failed to demonstrate the proper procedure to wash dishware in the three compartment sink to prevent food borne illness. The facility census was 69, with 67 residents consuming an oral diet. Findings include: Review of the facility policy titled Cleaning and Sanitizing revealed that for three compartment sink, items should be fully submerged in the sanitizer solution per manufacturer guidelines. Review of EcoLab Oasis 146 Multi-Quat Sanitizer Product Specification Document revealed: Expose all surfaces to the sanitizing solution for a period of not less than one minute. Observation on 7/1/2023 at 10:40 a.m. of Dietary [NAME] BB washing the food processor bowl, blade, and lid in the three compartment sink revealed that she washed the items with soapy water, rinsed and placed all the items in the sanitizing sink for 15 seconds then placed on shelf area to dry. Continued observation revealed a poster hung on the wall in front of the wash sink. The post was labeled EcoLab Wash Procedure, and step five stated to submerge in sanitizer for one minute or as specified by the product label. Interview on 7/1/2023 at 10:40 a.m. with Dietary [NAME] BB verified that she placed the dishware items in the sanitizing solution for 15 seconds. The cook stated that items are to only be in the solution for 10 seconds. The cook confirmed that the poster hung on the wall for three compartment sink sanitizing indicated submerge for one minute. Interview on 7/1/2023 at 11:00 a.m. with Certified Dietary Manager (CDM) revealed that dishware items should be submerged in the sanitizing solution for 10 seconds. The CDM confirmed that the facility is using EcoLab quaternary sanitizing solution. The CDM did not realize that the manufacturer's recommendation for usage is to submerge items in the sanitizing solution for one minute/60 seconds.