Based on interview and record review, the facility failed to ensure a resident was able to withdrawal her money on weekends and evenings for 1 of 1 resident reviewed for personal funds. (Resident 31) Finding includes: During an interview, on 9/4/2024 at 3:06 P.M., , Resident 31 indicated she was unable to get her money out of her account on the weekends or evenings. The record for Resident 31 was completed on 9/9/2024 at 11:05 A.M. Diagnoses included, but were not limited to: depression, hemiplegia, diabetes and vascular dementia. During an interview, on 9/10/2024 at 9:57 A.M., the Business office manager indicated the residents could get money out of their personal fund accounts from 7:30 A.M. to 8:00 P.M., when someone was working at the front desk. After 8:00 P.M. the money was locked up in a safe in the office and was not assessable to the residents. During an interview, on 9/10/20 at 10:11 A. M., the Administrator indicated the residents can get their money when the receptionist was at the front desk, between 7:30 A.M. to 8:00 P.M. She indicated they should have been able to get their money out at any time of the day or night. On 9/10/2024 at 11:08 A.M., the Administrator provided a policy titled,Availability of Resident Funds-After Business Office, dated 2018, and indicated the policy was the one currently used by the facility. The policy indicated . It is the policy of this facility to provide residents reasonable access to their personal funds after business office hours 3.1-6(f)(1)

Based on observation, record review, and interview, the facility failed to provide proper storage of oxygen accessories for 1 of 3 residents reviewed for oxygen. (Resident 11) Finding includes: During an observation on 9/6/2024 at 9:10 A.M., Resident 11's nasal cannula tubing, attached to the oxygen concentrator, was wrapped around the bedrail. During an observation on 9/10/2024 at 9:12 A.M., Resident 11's nasal cannula tubing, attached to the oxygen concentrator, was on the floor between the bed and the recliner. During an observation on 9/10/2024 at 11:06 A.M., Resident 11's nasal cannula tubing, attached to the oxygen concentrato,r was draped over the arm of the recliner. A record review for Resident 11 was completed on 9/9/2024 at 10:54 A.M. Diagnoses included, but were not limited to: asthma, acute respiratory failure and congestive heart failure. A Quarterly Minimum Data Set (MDS) assessment, dated 7/17/2024, indicated Resident 11 used oxygen therapy. A Physician's Order, dated 11/23/2024, indicated oxygen was to be used at 2 liters per nasal cannula as needed. A Care Plan, with an effective date of 5/11/2023 to present, indicated Resident 11 was not able to maintain oxygen saturations and received supplemental oxygen. During an interview, on 9/10/2024 at 11:00 A.M., CNA 8 indicated the nasal cannula tubing should be stored in a respiratory bag when not in use. A policy was provided, on 9/10/2024 at 12:59 P.M. by the Director of Nursing. The policy titled, Use of Oxygen, indicated, .The following guidelines will be observed in oxygen administration .II. The tubing should be kept off the floor 3.1-47(a)(6)

Based on interview and record review the facility failed to have a care plan for a skin issue for 1 of 3 residents reviewed for skin. (Resident 18) Finding includes: During an interview, on 9/6/2023 at 1:27 P.M., Resident 18 indicated he had an area to his right toe. A record review was completed on 9/07/2023 at 11:34 A.M. Resident 18's diagnoses included, but were not limited to: fractured left leg, dysphagia, hypertension, diabetes, obstructive and reflux uropathy. A 5-day MDS (Minimum Data Set) assessment, dated 8/17/2023, indicated the resident required extensive assist of one staff for bed mobility, toilet use, dressing and two assist for transfers. A Nurses Note, dated 6/13/2023, indicated a scab was found during weekly skin assessment. Measured 1.2 x 2 cm (centimeters). Family notified and MD notified. No new orders to care for this site. A Nurse's Note, dated 6/16/2023, indicated Resident 18 was receiving therapy when the therapist found the wound to his toe. New order received for skin prep to resident's skin area on the Right 2nd toe. Area is scabbed over and there are no signs/symptoms of infection to this area. A Physician's order, dated 6/27/2023, included skin prep to the right 2nd toe three times a day, and notify the wound nurse if the area worsens or open. A Nurse's Note, dated 8/30/2023, indicated Resident 18 received doxycycline hyalite (antibiotic) 100 mg (milligram) capsule 2 times daily for right 2nd toe infection. A Physician's order, dated 8/30/2023, indicated to cleanse area to the toe with NS (normal saline), apply bacitracin (antibiotic ointment) and a dry dressing every day. The record lacked a care plan for the skin issue to the toe. During an interview, on 9/07/2023 at 2:17 P.M., the Infection Preventionist indicated there should have been a care plan. On 9/11/2023 at 12:45 P.M., the Director of Nursing provided the policy titled, Care Plan, dated November 2017, and indicated the policy was the one currently used by the facility. The policy indicated . 3. Each resident's Comprehensive Person Centered Care Plan has been designed to: a. Incorporate identified problem areas . 6. Care plans are revised as changes in the resident's condition dictate On 9/11/2023 a 12:45 P.M., the Director of Nursing provided the policy titled Wound Care/Treatment Guidelines, undated, and indicated the policy was the one currently used by the facility. The policy indicated . XIV. The care plan should reflect the current status of the wound and appropriate goals 3.1-35(a)

Based on observation, interview and record review, the facility failed to ensure proper infection control practices were implemented related to fanning dry skin after cleansed with alcohol for 1 of 1 Accucheck (blood glucose level) observed and not wearing gloves for 1 of 1 insulin injections observed. (RN 4) Finding includes: During an observation of an Accucheck, on 9/11/2023 at 11:08 A.M., RN 4 put on gloves and cleansed Resident 49's right middle finger with an alcohol wipe. After cleaning the area, RN 4 used an open hand to fan the area she had just cleansed and then used a lancet to poke the skin that had been fanned dried. During an observation of an insulin injection, on 9/11/2023 at 11:12 A.M., RN 4 cleaned the left lower quadrant of Resident 49's abdomen and administered insulin without wearing gloves. During an interview, on 9/11/23 at 11:17 A.M., RN 4 indicated that she shouldn't have fanned the skin dry after cleaning and that she should have been wearing gloves while giving an injection. A policy titled Specific Medication Administration Procedures, dated 7/31/2017 and updated on 11/1/2017, was provided by the Director of Nursing, on 9/11/2023 at 12:45 P.M., and indicated the policy was the one currently used by the facility. The policy indicated .To administer medications via subcutaneous, intradermal and intramuscular routines in a safe, accurate, and effective manner .Equipment .E. Examination gloves .Gather supplies .gloves, alcohol wipes .Put on gloves .Inject medication .Remove & discard gloves. Clean hands by washing or using sanitizer . A 4/2019 policy titled, Blood Glucose Monitoring, and identified as the policy currently used by the facility was provide by the Director of Nursing, on 9/11/2023 at 12:45 P.M. The policy indicated, .7. Clean the intended site with an alcohol pad and allow to dry completely . 3.1-18(a)

Based on observation, record review and interview, the facility failed to provide appropriate catheter care and failed to ensure the catheter drainage tubing tip was covered when not in use for 1 of 1 residents reviewed for catheter use. (Resident 25) Finding includes: During a random observation on 6/20/2022 at 3:07 P.M., Resident 25's catheter drainage tubing was dragging the floor. During an observation, on 6/20/2022 at 12:35 P.M., Resident 25 was being pushed in the wheelchair back to his room with the catheter drainage tubing dragging the floor. A clinical record review was completed on 6/22/2022 at 1:21 P.M. Resident 25's diagnoses included, but were not limited to: Alzheimer's disease, dementia, prostatic hyperplasia and reflux uropathy, history of prostate neoplasm and urinary tract infection. A Significant Change MDS (Minimum Data Set) assessment, dated 6/20/2022 indicated Resident 25 was severely cognitive impaired, required extensive assist of 2 staff for bed mobility, transfer and toilet use, and used a Foley catheter. A Nurses' Note, dated 6/10/2022, indicated an aide informed a nurse that Resident 25's Foley was split in half. Physician was notified and stated to send to ER. A Nurses' Note, dated 6/10/2022, indicated Resident 25 was admitted to hospital with the diagnoses of: UTI (urinary tract infection) and CKD (chronic kidney disease). Catheter was removed/replaced in ER without difficulty. On 6/24/2022 at 9:50 A.M., CNA (Certified Nursing Assistant) 3 was observed to provide catheter care to Resident 25. CNA 3 washed her hands and applied gloves. She then informed the resident what she was going to do. She removed the covers from the residents chest and peri area down to below the knees. She unfastened the brief on both sides, then washed from the tip of the penis down the Foley catheter and away from the opening. She dried the area and without removing her gloves, she then reapplied the brief, moved the covers onto the residents body, then used the bed control to put the bed in a lower position. She then took the supplies in the bathroom with the same gloves still on. During an interview, on 6/24/2022 at 10:00 A.M., CNA 3 indicated she should have removed her gloves and washed her hands after providing catheter care. On 6/24/2022 at 10:01 A.M., the catheter drainage bag was in a plastic bag hanging off the hand rail with the tip of the drainage tubing sticking out of the bag with the tip not covered. During an interview, on 6/24/2022 at 10:02 A.M., the Director of Nursing indicated the tubing tip should have been covered. On 6/24/2022 at 9:45 A.M., Unit Manager 6 provided the policy titled, Urinary Leg Drainage Bags, dated 9/1/2012, and indicated the policy was the one currently used by the facility. The policy indicated .General Guidelines: 1. Every attempt should be made to maintain a closed urinary drainage system. 2. The regular Foley drainage bag may be reconnected only if it appears that the integrity of the system has been maintained. Steps in the procedure: .7. Place the cover over the connection tip of the Foley drainage bag On 6/24/2022 at 11:05 A.M., Unit Manager 6 provided the policy titled,Catheter Care, dated March 2021,and indicated the policy was the one currently used by the facility. The policy indicated .It is the policy of this facility to ensure that residents with indwelling catheters receive appropriate catheter care and maintain their dignity and privacy when indwelling catheters are in use . Guidelines: . 5). Assist resident to a lying position or the most comfortable position. 6). Drape resident to expose only the perineal area. 7). Perform hand hygiene. 8). [NAME] gloves. Both: 1).Bag and gather supplies used, discarding disposable items in the trash can. 2). Assist the resident to a comfortable appropriate position. 3). Ensure call light is within reach. 4). Return room back to original order. 5). Perform hand hygiene. 3.1-41(a)(2)

Based on observation, record review and interview, the facility failed to ensure food was prepared and served in a sanitary manner in both the main kitchen and the healthcare kitchen. This deficient practice potentially affected 61 of 61 residents. Findings include: 1. During a sanitation tour of the main kitchen, located in the Assisted Living side of the facility, conducted on 6/20/2022 between 9:45 A.M. - 10:05 A.M., the following was noted: The regular oven and the convection oven had a build up of burnt food debris in the bottom and the convection oven doors had a heavy buildup of a brown greasy residue. The large, rolling plastic flour and sugar bins had splatters of a dried yellow substance and a gritty residue on the outsides and lids. The inside bottom of a reach in refrigerator had a dried light brown substance and a heavy accumulation of food crumbs. There was also a dried red residue noted on the outer lip of the bottom. The bottom of the warming/holding cabinet was very dirty with food debris/crumbs. During an interview with the Food Service Supervisor, during the sanitation tour, he indicated the stoves were to be cleaned every other week and the flour and sugar bins were to have been cleaned the past weekend. He also indicated some of the food served in both the assisted living and healthcare dining rooms were prepared in the main kitchen. 2. During an observation of the healthcare kitchen, conducted on 6/22/2022 at 9:52 A.M., the following was noted: The air vent above the reach in refrigerator had a heavy accumulation of dark colored dust. Three of 5 food scoops, put away as clean, had dried food substances on them 3. During observation of the lunch meal service, in the healthcare kitchen, conducted on 6/22/2022 from 11:10 A.M. - 11:40 A.M., the following was noted: The cook donned a pair of disposable gloves, after washing his hands. He then, with his gloved hands, sorted through a stack of food order paper tickets, touched handles of serving scoops, ladles and tongs, the bottoms of clean plates, plastic plate covers the counter attached to the steam table and then placed a few slices of roast beef onto the attached counter. With his contaminated, gloved hands, the cook them placed his gloved hand directly on top of the meat to position it, while he utilized a knife to chop the meat into bite size pieces. The cook then, after scooping the meat onto a plate for service, removed his gloves and washed his hands. After donning a clean pair of disposable gloves, the cook continued to touch various items in the kitchen with his gloved hands, such as paper tickets, plates, handles of scoops, ladles and tongs, the counter attached to the steam table, a steam table pan lid and then was observed to grab a loaf of bread. After opening the bread plastic bag, the cook reached into the bag and removed two slices of bread with his contaminated gloved hands and proceeded to touch the bread while he prepared a peanut butter and jelly sandwich for a resident. During an interview with the Assistant Food Service Supervisor, Employee 7, just after the noon meal observation, on 6/22/2022 at 11:45 A.M., she indicated she would review food handling with the cook. Review of the facilities current policy and procedure, titled, Dietary Services provided by the Director of Nursing on 6/24/2022 at 9:25 A.M. included the following: .1. Proper Food Handling C. Foods are prepared and served with clean tongs, scoops, spatulas or other suitable implements to avoid manual contact of prepared foods Review of the facilities current policy and procedure, titled, Dining Services Policy and Procedure Manual, provided by the Director of nursing on 6/24/2022 at 9:15 A.M., included the following .Follow the standards below to maintain clean equipment and work areas 7. Ovens a. All racks and drip trays are debris and grease free with no visible buildup of grease. b. Interior of oven is free of debris and grease, no carbonized grease. c. Doors, hinges an handles are free of grease and debris. d. Glass is clean .12. Hot Boxes/Warming Cabinets .b. Interior and exterior are smooth to the touch and free of grease build up .Refrigerators/Freezers .c. Walls, ceiling, and floors should be free of ice, stains, spots food, drippings and debris .k. Upright refrigerators and freezers clean and free of dirt and food build up inside and out 3.1-21(i)(3)