Based on observation, policy review and staff interview the facility failed to utilize proper food handling to prevent potential cross contamination of food, ensure food maintained appropriate temperature to prevent food borne illness and proper hand hygiene/hand washing for 1 out of 1 meal observed. The facility reported of census 65 residents. Findings include: During continuous observation of puree process and meal service on 8/21/24 at 11:45 AM to 12:40 PM Staff D, Homemaker-Cook presented wearing black nitrile gloves upon surveyor arrival to the household kitchen. Staff D, Homemaker-Cook placed ½ half cup of potato salad in Cuisinart/blender. Staff D, Homemaker-Cook used a rubber spatula to scrap the potato salad into a small bowl. The bowl was covered with aluminon foil and placed in the refrigerator. Staff D, Homemaker-Cook brought the Cuisinart/blender container and placed the mixing container and lid in the sink. The blade was set on the counter to the right of the sink. Staff D, Homemaker-Cook used her gloved left hand to turn on the faucet and rinse the lid, rubber spatula, blade and Cuisinart/blender mixing container. Staff D, Homemaker placed the Cuisinart/blender mixing container on the base, installed the blade and set the lid and rubber spatula off to the side on the counter. Staff D, Homemaker-Cook using tongs placed 1 pork tenderloin patty into Cuisinart/blender. Staff D, Homemaker-Cook warmed chicken broth up in the microwave and added it to the pork tenderloin patty to puree. Staff D, Homemaker-Cook scrapped the pureed pork tenderloin using the rubber spatula into a bowl, covered with aluminon foil and set on top of the two steamwell food warmer. Staff D, Homemaker-Cook disassembled Cuisinart/blender mixing container and rinsed it under the faucet using gloved hands and rubber spatula. Staff D, Homemaker-Cook reassembled Cuisinart/blender mixing container and blade setting the lid off to the side. Staff D, Homemaker-Cook dried gloved hands with paper towels, pulled open trash container drawer with her left gloved hand and disposed of used paper towels. Staff D, Homemaker-Cook grabbed a bun with her left gloved hand from an open package on the counter. The bun was placed in the Cuisinart/blender and pureed with chicken broth. Staff D, Homemaker-Cook used the same spatula to scrape the pureed bun into a bowl. Bowl was covered with aluminon foil and placed on the steam food warmer lid. The Cuisinart/blender mixing container, blade, lid and spatula were placed in the sink. Staff D, Homemaker-Cook, went into the food prep area and grabbed an unwarpped onion, green pepper and red pepper from a black cart into the food prep area refrigerator. Staff D, Homemaker-cook wiped both gloved hands on the sides of her pants and walked back into the kitchen area. The refrigerator was opened with her right gloved hand and lemonade, iced tea and raspberry juice pitchers were placed on the counter. Staff D, Homemaker-Cook opened the ice bin and used a scoop to place ice cubes in stainless steel bowl. Staff D, Homemaker-Cook, with gloved hands used ice scoop to place ice in 13 8-ounce glasses and filled with beverages. Staff D, Homemaker-Cook placed filled glasses on a tray and passed drinks to residents touching the rim of the glasses with her gloved left hand. Staff D, Homemaker-Cook grabbed a paper towel and dried off the used beverage tray and placed pre-dished bowls of salad on the tray. Salads were passed to residents in the dining area. Staff D, Homemaker-Cook removed gloves and washed hands, turning the faucet off with her wet hands. Staff D, Homemaker-Cook donned gloves placed pureed meal on plate and brought to resident sitting at the table. She rinsed the Cuisinart/blender that was sitting in the sink under the faucet with her gloved hands touching the inside surface of the Cuisinart/blender mixing container. She placed the Cuisinart/blender mixing container on the base, dried her gloved hands with paper towels and pulled opened the drawer with her left gloved hand where the trash container was located to dispose of the used paper towels. Staff D, Homemaker-Cook placed used tongs to place two pork loins in the Cuisinart/blender to prepare mechanical soft meal for two residents. She used her left hand to grab a bun from the open package on the counter, used both gloved hands to tear open the bun and then used a spatula to portion out approximately ¼ cup of mechanical soft pork loin on the bun. Staff D, Homemaker-Cook served ten residents pork tenderloin sandwich using her left gloved hand to take the bun out of the packaging. While holding the bun in her left gloved hand, she used her right gloved hand to tear the bun in half opening it up. The bun was placed on a plate. Tongs were used to place a pork tenderloin on the bun. Staff D, Homemaker-Cook used her left gloved hand was to place the top of bun on the pork tenderloin. Observed 4 times Staff D, Homemaker-Cook use her right gloved fingers to grab 2 pickles slices and placed them on the plate beside the sandwich. Staff D, Homemaker-Cook opened drawers to obtain condiment dishes and open refrigerator for condiments with gloved hands. Staff D, Homemaker-Cook removed peanut butter cookies from a parchment lined cookie sheet with the same gloved hands placing one cookie on a plate serving the13 residents in the dining area. Staff D, Homemaker-Cook failed to utilize hand washing. Observed Staff D, Homemaker-Cook removed her gloves two times and washed her hands. Staff D, Homemaker-Cook, turned on faucet, wet hands, applied soap and washed her hands. Staff D, Homemaker-Cook used her left hand to shut the faucet off and then reached for a paper towel to dry her hands. Staff D, Homemaker-Cook failed to use a dry paper towel to shut the faucet off. The faucet is a contaminated surface failing to prevent cross contamination of food. Observed Staff D, Homemaker-Cook recorded temperatures of pureed meat and mechanical ground meat prior to serving. One resident was served pureed pork loin with a temperature of 114 degrees Fahrenheit. Two residents were served the mechanical soft pork loin with a temperature of 123 degrees Fahrenheit. Staff D, Homemaker-Cook failed to reheat the pureed and mechanical soft meat to appropriate temperature to prevent food borne illness. A record review revealed two residents with pureed diets and five with mechanical soft diets. The temperature logs for the month of August 2024 revealed no columns for temperature recordings for the puree or mechanical ground diets. During an interview on 8/21/24 at 12:46 with Staff D, Homemaker-Cook, reported she had not received training on food handling. She stated her process for cleaning the Cuisinart/blender in between preparing mechanical soft or puree food items, is to rinse it under the faucet and replace it on the base of the unit for continued use. She stated that she normally does not use the Cuisinart/blender for mechanical soft diets. For the mechanical soft diet, she reported her normal practice is to use a knife and fork to cut items in small pieces. She reported that she received training on proper food temperature from her supervisor and instructed to bring food to the appropriate food temperature prior to serving. She acknowledged she should have reheated the mechanical soft and puree meat. She stated she has had training on hand washing technique. During an interview on 8/21/24 at 12:54 with Staff E, Director of Food and Beverage, revealed she did observe Staff D, Homemaker-Cook rinse the Cuisinart/blender mixing container, lid, blade and rubber spatula for continued use. She reported the expectation is to run the items through the dish machine between uses. Staff E, Director of Food and Beverage reported earlier today she reminded Staff D, Homemaker-Cook to bring pureed items to proper temperature before serving. The temperature of pureed and mechanical soft items are taken after the process has been completed and brought up to appropriate temperature prior to serving to the resident. The Food Safety Policy dated 07/2024 revealed cross contamination occurs when harmful substances are transferred from one source (i.e. hands, food contact surfaces, unsanitary cleaning cloths, raw foods) to the food. The policy failed to mention touching contaminated surfaces with gloves and contact with ready to eat food. The Hand Washing and Hand Hygiene policy dated 08/24 revealed hand hygiene to be completed before touching medication and food given to a resident. The undated Hand Hygiene Competency directed staff to use a clean, dry paper towel to turn off the faucet. Do not contaminate your hands by touching the surface of the sink or faucet. The Puree Policy dated 08/24 failed to address bringing hot puree food items to appropriate food temperatures to prevent food borne illness.

Based on observation, staff interview, and policy review the facility failed to handle soiled linens with the appropriate Personal Protective Equipment (PPE). The facility reported a census of 65 residents. Findings include: In an observation on 8/20/24 at 9:16 AM Staff A, Certified Nursing Assistant (CNA) put on gloves and failed to put on a gown when she took personal items from a resident's hamper and placed it in the washing machine. She then started the machine and removed her gloves. In an interview on 8/20/24 at 8:55 AM Staff B, CNA noted separate washing machines were used for personal items and household laundry. She explained staff wore gloves to put dirty laundry in the machine and again when switching over laundry to the dryers. Clean laundry is placed in a separate bin and then in a separate room. There are isolation settings for the washer machine and those items are washed separately. In an interview on 8/21/24 at 9:05 AM Staff C, Assistant Director of Nursing explained residents have laundry hampers in their rooms. She expected staff to wear gloves to put soiled laundry into the washer. For general soiled laundry gloves are all that is worn. For soiled laundry from a contact isolation room staff are to wear a gown as well. There are no other precautions. The facility document titled Updated Laundry Process, dated 3/22/24 failed to indicate PPE required when handling soiled laundry.