Based on observation, interview and record review the facility failed to ensure food items were labeled and dated in the kitchen. 37 of 37 residents residing in the facility were served food prepared in the kitchen. Findings include: During an observation, on 5/21/25 at 9:10 AM, about 20 salad dressing packets were observed in a cooler in the dining room. No expiration dates were observed on the packets. Two open boxes of assorted cheesecake slices, an open box of carrot cake, a plastic container of cupcakes and an open box of cookie dough were observed in the walk-in cooler with no labels or dates. An open bag of shredded cheese had an open date of 4/13/25 with instructions marked on the package to discard on 4/20/25. An open box in the reach in freezer contained an open plastic bag containing hamburger patties with the meat exposed to the air. An open box contained an open plastic bag of hot dogs. The hot dogs were open to air and covered with about 1/2 inch of frost in most places. Neither the hamburgers nor hot dogs were labeled and dated. 9 eggs were observed in a container in the reach-in salad cooler with no label or date. In an interview, on 5/21/25 at 9:12 AM, the Dietary Manager (DM) indicated the dressing packets came from boxes in the dry storage area, but she had no written record of rotation of product to verify each packet coming from the existing boxes in dry storage. She indicated the packets needed to be discarded since the expiration date was unknown. The dietary manager indicated the boxes of cheesecake, carrot cake, cookie dough and container of cupcakes should have been labeled and dated. She indicated the expired cheese should have been discarded. In an interview, on 5/23/25 at 10:53 AM, the Director of Nursing (DON) indicated all 37 residents residing in the facility were served food prepared in the kitchen. A current policy, dated 9/24, provided by the Administrator on 5/21/25 at 2:20 PM indicated all food should be labeled, dated and discarded appropriately. The policy indicated food should be labeled and dated as soon as the original packaging is broken. Any food manufactured in house and served in individual portions will be labeled with a name and expiration date. 3.1-21(i)(2)

Based on observation, interview, and record review; the facility failed to separate oral medications from external medications for 1 of 1 cart reviewed affecting 1 resident. (100 hall, Resident 28). On 07/24/24, at 09:45 AM, during an observation and interview with RN 2; Resident 28's oral medications were obsered stored in locked medication cart (100 Hall) alongside his external medication Triad hydrophilic wound dressing paste and Bengay. RN 2 denied any problem mixing orals with externals. RN 2 explained all the medications were for Resident 28. RN 2 explained one of the creams was Bengay and the other was a topical for a wound. RN 2 offered to move external medications to the treatment cart. In an interview on 7/25/24 at 7:51AM, the DON (Director of Nursing) indicated RN 2 was from the hospital and was not up to date on nursing home requirements. The DON further indicated after speaking with RN 2 she had just completed the dressing change and put the cream there due to being called away. The medication cart and treatment cart were within 10 feet of each other. Resident 28's record review began on 7/29/24 at 9:36AM. Diagnoses included parplegia, pain, and heart disease. A medication administration audit report dated July 2024, indicated Resident 28's dressing change was completed on 7/24/24 at 6AM and at 1:41PM by RN 2. The 100 Hall cart was observed 7/24/24 at 09:45AM, approximately 3 hours later. Resident 28's physician orders included Triad hydrophilic external paste, apply to buttocks/thighs topically every day and evening shift for excoriation apply to areas around wound vac; dated 5/24/24. Additionally, an order for Bengay lidocaine external cream 4%, apply to joints topically every 12 hours as needed for pain, ok for unsupervised self-administration was dated 4/10/24. A current facility policy, titled Storing Medications, dated 2/1/94 was provided by DON on 7/29/24 at 11:10AM. The policy indicated .all drugs intended for internal use should be stored together in a medication cart. No other policies were provided at time of exit. 3.1- 25(j)