**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, policy review, and staff interview, the facility failed to maintain appropriate food holding temperatures at or above 135 degrees Fahrenheit. The facility identified a census of 35 residents. Findings include: Resident #9 Minimum Data Set (MDS) assessment dated [DATE] showed a Brief Interview for Mental Status (BIMS) score of 15 indicating intact cognition. During the initial pool interview 7/29/24 at 1:07 PM Resident #9 reported she dines in her room and many times the food is cold. Observation on 7/30/24 at 10:40 AM revealed the pre-meal temperatures as follows: a. Potatoes - 184 degrees b. Ground barbecue pork 211 degrees. Staff A, [NAME] placed the food items in the steam table with each steam table well noted at setting 3. On 7/30/24 at 11:40 AM Staff A plated the last room tray for the first hallway and set up a test tray. As soon as the last room tray had been delivered the Surveyor and the Dietary Manager performed a temperature check of the food on the test tray. The testing revealed the loaded potato temperature at 124.7 degrees. Post food temperatures completed at 11:52 AM at the conclusion of the meal service revealed the potato at 126 degrees and the ground barbecue pork at 130 degrees on the steam table. During an interview on 7/30/24 at 11:57 AM Staff A reported the potatoes and ground barbecue pork did not temp correctly at 135 degrees. He verbalized food is to be held above 135 degrees on the steam table. Staff A confirmed all the steam table wells were set on setting #3. During an interview on 7/30/24 at 12:35 PM the Dietary Manager reported the staff are to take food temperatures prior to the meal to ensure correct serving temperatures. She expects food to be maintained at 135 degrees. If the food is not held at 135 degrees, she expects staff to reheat the food above 165 degrees before serving. The Serving Line Food Temperature Record Policy revised 4/20/23 provided by the facility documented the temperature of all hot and cold food items will be taken prior to every meal and at the end of service on days that require test trays. The Policy Procedure directed potatoes and hot entrees would be held at 135 degrees or above. If not hot enough, food will be reheated in the oven or the microwave to be at proper temperature.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on clinical record review, facility document review, former staff interviews and staff interviews, the facility failed to respect each resident's dignity and privacy by taking pictures of staff with the resident for 1 of 6 residents reviewed (Resident #1). The facility reported a census of 35 residents. Findings Include: The Minimum Data Set (MDS) dated [DATE] documented Resident #1 had a Brief Interview for Mental Status (BIMS) of 0, indicating severe cognitive impairment. The MDS identified the resident needed extensive assistance for bed mobility, transfers, dressing, eating, toilet use and personal hygiene. A Progress Note written on 10/18/23 at 6:56 PM, documented Resident #1's Power of Attorney (POA) was made aware a picture of Resident #1 was taken by a staff member and requested a copy. A Progress Note written on 10/22/23 at 11:44 AM, documented the POA was provided with written documentation of the investigation and a copy of the picture. Facility documents titled Orientation Information directed staff to have personal phones on vibrate and not use in patient care areas. During an interview on 11/20/23 at 12:54 PM, Staff A, former Certified Nursing Assistant (CNA) admitted he took a picture of Resident #1. He stated the picture was taken on 10/7/22 at 7:02 PM. He explained he took the picture to show to management but didn't show it to management until 10/14/23. When asked about the delay he explained the picture was saved in his phone and it moved down in his pictures list and he forgot it was there. During an interview on 11/20/23 at 1:23 PM, Staff B, CNA, stated Staff A had entered the room while she was cleaning up after caring for Resident #1. She stated she knew Staff A had been taking pictures and sending Snap Streaks (Social media platform where users send pictures back and forth daily for several consecutive days) that evening but she was unaware he had taken a picture of the resident. During an interview on 11/21/23 at 11:37 AM, the Administrator stated she expected CNA's to not be taking pictures of residents in their room.